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 2025, we’ve made the following changes:

• The rankings consist of 2,738 Acute Care Hospitals and 896 Critical Access Hospitals. We identified the hospital type designation based on CMS Care Compare as of February 2025.
• 46 fewer hospitals are included in the LIHI rankings compared to last year; a total of 3,634 hospitals in the full dataset. One of the main reasons fewer hospitals are included this year is hospital closures.
• For pay equity, we used the average of 3 years of salary data as part of the imputation process instead of our usual 1 year. This allowed us to better adjust for yearly salary volatility and stabilize those estimates.

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 (e.g. racial inclusivity, financial assistance), hospitals receive between 1-5 stars and a ranking. The star ratings of 1-5 are based on hospitals’ relative performance. Raw scores are divided into 5 regions based on either quantiles from a standard normal distribution or equal split of the range of values. In this way, many hospitals may receive the same star rating if they perform similarly on a metric. 

The respective detail scores are weighted and combined 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. 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%).

What's new on the hospital profile page?

We implemented two method changes this year: (1) We removed the COVID-19 burden data and (2) replaced it with hospital’s financial assistance information, if the hospital was included in our database of hospital financial assistance and debt collection policies.

Since 2023, we have been collecting data on a sample of 2,500 hospitals and publishing it in our Lown Institute Financial Assistance and Collections Policy Database. We collected information on hospital financial assistance and billing practices by reviewing financial assistance and collection policies available publicly on hospital websites and reaching out to hospitals via email to ask for confirmation of the data. Data that is visible on a hospital’s ranking page was collected between June 2024 and April 2025. Note, these results do not have any impact on a hospital or system’s Social Responsibility Grade. 

The full Policy Database is available on our website, but we selected three data points from this to display on a hospital’s individual ranking webpage: 

1. Whether the average family in the hospital county can apply for free care. We define free care as 100% coverage of the patient costs of hospital care (excluding any fees or co-pays mentioned in the policy). 
2. Whether the average family in the hospital county can apply for discounted care. We used the maximum income threshold, if described, where patients were eligible for discounted care.
3. The minimum bill size families must have, if they don’t otherwise qualify for discounted care. 

Why did my hospital not receive a composite grade?

Some hospitals did not have enough patient stays to reliably calculate their cost-efficiency scores (93 hospitals) or did not have data available for two or more equity metrics (17 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 no longer in CMS Care Compare as of February 2025 or we learned had closed as of April 2025.
• 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.