Frequently Asked Questions

What is the Lown Hospitals Index?

We believe a socially responsible health system is possible, but to get there, we have to measure what matters. The Lown Hospitals Index produces data-driven metrics of equity, value, and outcomes, giving hospitals the information they need to improve, and empowering communities to hold them accountable. As the first ranking for hospital social responsibility, we strive to measure everything that matters to patients and communities—and we’re improving the Index each year.

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

Hospitals are essential care providers and lifelines for complex and emergency care in their communities. However, hospitals do more than just provide medical services. 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, including novel metrics like racial inclusivity and pay equity to create a holistic evaluation of hospital social responsibility.

Who is the Lown Index for?

The Lown Hospitals Index is a valuable resource for policymakers, researchers, hospital leaders, clinicians, journalists, community leaders, and all citizens that believe socially responsible hospitals are important. The rankings have been used to showcase hospital performance, identify key areas of improvement, and enact health system change in communities or institutions.

What's new on the Lown Index this year?

For 2024, we’ve made the following changes:

• Separate ranking for Critical Access Hospitals: Acute Care Hospitals and Critical Access Hospitals are both vital for healthy communities, but there are also many differences between the two types of institutions. This year we are offering separate rankings for each type of hospital. For more information on how these separate rankings are reflected in the methods, please see our methodology page. 
• Reweighting for equity: We updated the weights of our three major categories as follows: Equity (40%), outcomes (30%), value (30%). Previously outcomes had been weighted at 40% and equity at 30%. The updated weighting ensures that equity measures have adequate importance within the composite.  
• New unplanned admissions metric: We have added a new metric to our clinical outcomes component, “7-day unplanned admissions,” which measures how often patients experience an unplanned hospital visit a week after outpatient surgery. Having to go to the hospital unexpectedly after an outpatient surgery can be disruptive, dangerous, and costly for patients, so avoiding complications that can lead to these admissions is an important outcome. Only acute care hospitals with adequate outpatient procedure volume are ranked on this metric. 
• Inclusivity grade change: This year, we adjusted the grade cut-offs for our inclusivity measure. Hospitals will receive an “A” grade if their patient population at least matches the demographics of their surrounding community. Previously, hospitals had to have much higher proportions of patients from communities of color, or communities with lower income or education, to achieve an “A” grade. 

Read our methodology paper for the full list of changes.

How can I share my hospital's performance?

Visit our hospital resources page for examples of how other hospitals have shared their recognition, learn about our badge licensing program, and request no-cost press release templates.

Is Lown Hospitals Index data available to purchase?

Yes. Hospital and system level data is available for purchase and can be customized to your specifications. Complete a Data Access Application or contact index@lowninstitute.org for more information. Additionally, our rankings, grades, and hospital characteristics data are available for download for free on the Rankings page. 

How are the stars and grades calculated?

For each detail (eg. racial inclusivity, financial assistance), hospitals receive between 1-5 stars and a ranking. The star ratings of 1-5 are based on hospitals’ raw scores rather than relative scores compared to other hospitals. That means 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: A (highest) to D (lowest) based on their relative performance compared to other hospitals. 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 equity (40% weight), value (30%), and outcomes (30%).

How does COVID-19 impact the Lown Index rankings?

The 2024 rankings incorporate data from 2019-2022, time periods that overlap with the  COVID-19 pandemic. COVID-19 hit different regions and populations differently. To account for this uneven impact 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.

Why did my hospital not receive a composite grade?

Some hospitals did not have enough patient stays to reliably calculate their cost-efficiency scores (102 hospitals) or did not have data available for two or more equity metrics (14 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 U.S. states and Washington, DC
• Hospitals that are not included in Medicare fee-for-service or Medicare Advantage claims data (such as children’s hospitals)
• Federally-run hospitals (such as Veterans Health Administration or Indian Health Service hospitals)
• Specialty hospitals (such as orthopedic hospitals). We defined specialty hospitals as those with more than 45% admissions for orthopedic, more than 45% for cardiac, more than 80% surgical procedures, more than 80% elective surgeries (among hospitals with > 45% surgical procedures).  
• Hospitals that were closed as of February 2024
• Hospitals with patient volume below 50 annual patient stays were also eliminated as well as hospitals that did not perform any surgery.

See the methodology paper for more details.