We believe a socially responsible health system is possible, but the first step is 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 continuously building more into 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, hospitals, 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 2023, we’ve made the following changes:
One hundred sixty-two more hospitals are included in this year’s rankings compared to last year, for a total of 3,926 hospitals in the full LIHI dataset. There are 3637 hospitals ranked on social responsibility.
Medicare Advantage claims are now included in clinical outcomes, overuse, and inclusivity metrics, increasing the volume of claims and making these metrics more reliable. This change also allows for systems with few fee-for-service claims like Kaiser Permanente to be included in the Index.
“Colonoscopy Screening” is now included as a new avoiding overuse metric, which measures how often a hospital performs inappropriate colonoscopies for asymptomatic patients. We have removed hysterectomy as an overuse metric this year as we work on refining the criteria for this service.
We’ve adjusted our risk adjustment algorithm, readmissions definition, and mortality cohort for better accuracy in the clinical outcomes metric.
For each detail (eg. racial inclusivity, financial assistance), hospitals receive between 1-5 stars and a ranking. 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) 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 (30% weight), value (30%), and outcomes (40%).
How does COVID-19 impact the Lown Index rankings?
The 2023 rankings incorporate data from 2019-2021, 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 small hospitals did not have enough patient stays to reliably calculate their clinical outcomes or cost-efficiency scores (289 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 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 with more than 45% of their cases in orthopedics, cardiac care, or surgeries. We excluded specialty hospitals 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 2023
Hospitals with patient volume below 50 annual patient stays or hospitals that did not perform any surgeries from 2019 to 2021.