By Sharon Begley
STAT, July 7, 2020
You won’t find the usual suspects like Massachusetts General Hospital or the Mayo Clinic at the top of a new ranking of U.S. hospitals. That’s because the rating system relies not just on traditional quality measures, but also on a hospital’s community-minded policies and avoidance of unnecessary care.
The rankings show that those hospitals with good clinical outcomes tend to score poorly in addressing inequities that affect the health of their communities. And even when hospitals perform many low-value procedures — those that research has shown to be of limited or no benefit — their patients generally have a low risk of dying both in the hospital and after being discharged, as well as a low risk of having to be readmitted.
No previous hospital rankings use “civic leadership,” which includes community-minded policies such as charity care, financial aid, and paying all staffers a living wage, or “value of care,” meaning whether a hospital avoids 13 procedures of questionable or clearly absent clinical benefit. The Lown Institute, a nonprofit think tank in Brookline, Mass., incorporated both measures into its rankings of 3,282 hospitals because “it is time for hospitals to rethink what it means to be great,” said Lown’s president, physician Vikas Saini.
Civic leadership matters because the health of the people in a hospital’s community “reflect things outside the four walls of a hospital,” he said. “If one patient is going back to a community without a lot of resources, where health equity is low, and another is going back to a wealthier community, their [long-term] health will be very different even if the quality of care in the hospital was identical. Hospitals have an obligation to improve the health of the outside community.”
A number of hospitals renowned for their quality of care got A+ or A for patient outcomes but a D for civic leadership, including Massachusetts General Hospital, the Cleveland Clinic, the Mayo Clinic, and the University of Washington in Seattle. Teaching hospitals such as these do pretty well on supporting their communities, but pay equity — multimillion-dollar salaries for top executives — sinks them in Lown’s calculation of civic leadership. Not a single hospital in the top 100 for patient outcomes was in the top 100 for civic leadership, and vice versa.
Many hospitals perform high numbers of low-quality procedures, which tend to be lucrative (and waste an estimated $100 billion per year in health care spending). “The right thing to do financially isn’t necessarily the right thing to do for patients,” said Leah Binder, president and CEO of the Leapfrog Group, a nonprofit backed by large employers that aims to identify and promote high-quality, high-value health care and whose hospital ratings emphasize patient safety.
She called Lown’s decision to downgrade a hospital for performing many low-quality procedures “a breakthrough” in hospital ratings. “We know inappropriate care is an extremely significant problem for the health care system,” Binder said. “It’s also a terrible tragedy for individual patients to go through an unnecessary procedure.”
Few patients are likely to reject a hospital based on how much it pays its CEO relative to its custodians. But Binder called civic leadership an important metric. “If there is anything you want out of a hospital, it’s ethics,” she said. Charity care, community support, and pay equity “are informative about a hospital’s culture.”
The American Hospital Association, however, said in a statement that the report offers consumers no “accurate and useful information,” instead offering “a hodgepodge of composite score, ranking, star ratings, and letter grades that will, at best, confuse consumers and likely mislead them.”
Lown Institute – Hospitals Index:
By Don McCanne, M.D.
Some hospitals are great at pleasing the principal players in the medical-industrial complex. To no surprise, many of these hospitals score high on current arbitrary measures of hospital performance, not to mention that they also have impressive financial statements. But Vikas Saini and his colleagues at the Lown Institute have studied extensively problems with the health care delivery system, and they identify another crucial factor that contributes to high performance of hospitals, and that is “civic leadership.”
Civic leadership includes community-minded policies such as charity care, financial aid, and paying all staffers a living wage, or “value of care,” meaning whether a hospital avoids 13 procedures of questionable or clearly absent clinical benefit. As Leah Binder of the Leapfrog Group stated, “If there is anything you want out of a hospital, it’s ethics.”
When you look at the features of single payer Medicare for All, you see that its infrastructure represents the epitome of ethics or civic leadership that stands in contrast to the mere business foundation of the medical-industrial complex. Single payer is universal, equitable, affordable for everyone, allocated efficiently, and always there when needed – ethical features that are simply not innate in a system controlled exclusively by the medical-industrial complex.
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