For the rankings, the Lown Institute excluded non-acute care hospitals, federal hospitals, hospitals outside the 50 states and Washington, D.C., hospitals run by Medicare Advantage programs, and specialty hospitals with more than 45% admissions for orthopedic, cardiac, or surgical procedures.
Hospitals that were closed as of October 2020 and those with volumes below 50 annual patient stays were also excluded, as were hospitals that didn't perform any surgeries between 2016 and 2018.
Eligible hospitals were given an overall letter grade based their performance across three categories, as well as separate grades for their performance in each individual category. The categories were:
The Lown Institute assessed performance across these categories and subcomponents by pulling from sources such as CMS' Healthcare Cost Report Information System, the U.S. Bureau of Labor Statistics, IRS 990 forms, the U.S. Census Bureau's American Community Survey, Medicare Provider Analysis and Review administrative claims data, and more.
In total, the Lown Institute ranked 3,709 hospitals. The top 20 were:
* Denotes an Advisory Board member
According to Vikas Saini, president of the Lown Institute, "It's not enough for hospitals to say they’re committed to social responsibility. They need to put their commitment into action. Doing well on the Lown Index is one way they can demonstrate progress."
But following the release of the rankings, the American Hospital Association (AHA) said the Lown Institute's index draws "sweeping and arbitrary conclusions" and uses "old and incomplete data."
Specifically, AHA took issue with the rankings' inclusivity metric as it looks only at Medicare data, which AHA said is not representative of the communities cared for by hospitals.
"Hospitals treat the patients who come through their doors regardless of their ability to pay, and those who do enter the hospital may or may not match with the demographics of the Medicare population," AHA said. "Yet Lown penalizes hospitals whose patient mix does not match the local Medicare population."
AHA also took issue with the rankings' use of mortality as the only clinical outcome to measure cost efficiency.
"These and other shortcomings may explain why researchers themselves acknowledge the index won't help patients actually choose between hospitals," AHA said. (America's Most Socially Responsible Hospitals rankings, accessed 9/23; America's Most Socially Responsible Hospitals methodology, accessed 9/23; Toleos, Lown Institute release, 9/21; Paavola, Becker's Hospital Review, 9/22)
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