Frequently Asked Questions

What is the Lown Hospitals Index?

The Lown Institute Hospitals Index is the first ranking of hospital social responsibility based on three categories of metrics: Outcomes, Value, and Equity.

A lot of hospital rankings exist already. Why do we need another one?

While patient outcomes are of course important, we believe that they are just part of the story when it comes to hospital social responsibility. Hospitals make decisions every day that impact the health and well-being of their community, such as how they invest in community health initiatives, who they welcome into the hospital, and how much they pay their workers. The Lown Institute Hospitals Index is the first ranking to take these factors into account, in a holistic measure of social responsibility.

Who is the Lown Index for?

The Lown Index shows how well hospitals serve communities, as well as individual patients. Policymakers, hospital administrators, clinicians, journalists, and community health advocates have found these rankings useful for .enacting health system change in their communities or institutions. 

How are the stars and grades calculated?

For each detail (eg. racial inclusivity, charity care), hospitals receive between 1-5 stars and a ranking. The stars reflect the actual result of hospital performance on a metric, not just their performance relative to other hospitals; many hospitals may get 5 stars on a metric if they all have similar (and good) results. 

The respective detail scores are weighted to create grades and rankings for each component (eg. inclusivity, community benefit). Each hospital gets a grade rating: A (highest) to D (lowest). Hospitals within the top range of scores (approximately the top 25%) get an A, the next 40% get a B, the next 20% get a C, and the last 15% get a D. These component grades are then weighted to create grades for each category (equity, value, and outcomes).

Finally, an overall Social Responsibility grade is assigned based on the weighted grades from value (30% weight), equity (30%) and outcomes (40%).

How does COVID-19 impact the Lown Index rankings?

The 2022 rankings are the first edition of the Lown Index to incorporate data from 2020, the first year of the Covid-19 pandemic. Our clinical outcomes, patient experience, patient safety, overuse, inclusivity, and cost efficiency metrics all use data from 2020. 

The pandemic hit different regions and populations differently. To account for this uneven impact of Covid-19 on clinical outcomes and cost efficiency, we removed all hospitalizations with suspected or confirmed Covid-19 for these metrics.

To better understand how hospitals were impacted during the first year of the pandemic, we created a metric of Covid-19 burden, which can be found on each hospital’s profile page and the Lown Institute’s public Tableau dashboard. We measured:

  • COVID Burden: The number of weeks in which hospitals had 10% or more Covid-19 patients, from March 2020-March 2021
  • Maximum COVID Beds: The highest proportion of hospitalized Covid-19 patients over a 3-week period, from March 2020-March 2021

Covid-19 burden was not incorporated into the Lown Index rankings, but can be used to put in the rankings in context. For example, some hospitals achieved “A” grades across outcomes, equity, and value while facing incredibly high Covid-19 burdens compared to their peers. We’ve recognized these hospitals that rank high on social responsibility despite having large proportions of Covid-19 patients in the first year of the pandemic -- see our Honor Roll page for more. 

Why did my hospital not receive a composite grade?

Some small hospitals did not have enough patient stays to reliably calculate their outcomes or cost-efficiency scores (158 hospitals). These hospitals were not given a composite score, but were still graded on the components for which data were available.

Why is my hospital missing from the Index?

The following types of hospitals are excluded from the Index:

  • Hospitals outside the 50 US states and Washington, DC
  • Hospitals that are not included in Medicare fee-for-service data (such as children’s hospitals and Kaiser Permanente hospitals)
  • Federally-run hospitals (such as VA Hospitals)
  • Specialty hospitals (such as orthopedic hospitals). We defined specialty hospitals with more than 45% of their cases in orthopedics, cardiac care, or surgeries. 
  • Hospitals that were closed as of October 2021, based on Hospital Compare, a website run by CMS.
  • Hospitals with patient volume below 50 annual patient stays or hospitals that did not perform any surgeries from 2018 to 2020. 

See the methodology paper for more details.

Understand the Rankings

The Lown Index rolls up scores from 42 detailed metrics, 8 components, and 3 categories to create an overall composite score.

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