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Hospitals considered the nation's "best," like the Mayo Clinic, avoid treating lower-income and minority patients who are dying disproportionately from COVID-19. That's the scandalous #1 takeaway from the Washington Monthly's latest issue. https://washingtonmonthly.com/magazine/july-august-2020/introducing-the-best-hospitals-for-america/
The more hopeful #2 takeaway is that it doesn't have to be this way. We discovered a whole other category of high quality hospitals that don't screw the poor and people of color. We call them the real "Best Hospitals for America."
To find them, we and @lowninstitute assessed thousands of hospitals on 53 metrics to figure out which do the best job of saving lives, saving money, and serving everyone.
The "saving lives" metrics include patient outcome data like in-hospital mortality.
The "saving money" metric assesses how much a hospital overuses low-value tests and procedures. That's crucial because health care costs for most privately insured Americans have been rising at 2X the rate of wages for years, helping to drive historic levels of income inequality.
The "serving everyone" metrics include the degree to which a hospital treats low-income and minority patients in its community and how much it pays its senior executive compared to its frontline workers--in other words, whether it serves its social justice mission.
Because remember, the vast majority of American hospitals are nonprofits. In return for huge tax advantages (not to mention vast amounts of other government subsidies) they're supposed to serve the public interest.
These metrics differ sharply from those used by outlets like U.S. News & World Report, which ranks hospitals on their record of delivering expensive specialized treatments regardless of cost while ignoring whether those hospitals treat less-well-off people in their vicinity.
Given our different approaches, we expected that our lists of top hospitals would look different from U.S. News and other rankings. We had no idea just how different.
Amazingly, not one of the 20 institutions on the U.S. News "honor roll" appears on our top 20 list. https://washingtonmonthly.com/2020-hospital-guide
All the hospitals on U.S. News' list are prestigious teaching hospitals, like the Mayo Clinic, ranked #1. Mayo is world renowned for providing top-notch specialty care, such as organ transplants. People from all over the world fly in for their specialty care.
But not only does the Mayo Clinic fail to make our top 20 honor roll, it doesn’t even rank on our list of top 50 teaching hospitals, coming in instead at number 100—that is, the middle of the pack.
That’s because, though its patient outcomes score is excellent, it does abysmally on serving low-income and minority patients and on avoiding use of low-value tests and procedures
The Mayo Clinic is a great place, in other words, to get a major surgery—as long as you aren’t poor, have excellent insurance, and actually need the surgery.
Our top 20 list, by contrast, contains a mix of well-regarded (if not necessarily world-famous) teaching hospitals, many safety net hospitals, and community hospitals whose names few outside their communities has ever heard of, like Mercy Health–West Hospital in Cincinnati.
With a couple of exceptions, such as Boston Medical Center, our top institutions are not at the cutting edge of advanced medical research or the forefront of experimental surgical techniques, like those on the U.S. News honor roll.
Rather, they are succeeding at something that is arguably more difficult, because so few hospitals manage to pull it off: They are doing a great job, simultaneously, of treating everyone, including poor and minority patients, healing those patients, and not overtreating them.
We think every American ought to have access to institutions like these. And if the hospital sector needs another bailout because of the pandemic—as it almost certainly will—we hope lawmakers, inspired by our rankings, will demand some accountability for all that money.
We’d also like to see Washington mandate that hospitals and insurance companies make public the prices paid for specific procedures—which, amazingly, they don’t. https://washingtonmonthly.com/magazine/july-august-2020/why-hospitals-keep-their-prices-secret/
In addition, like to see government crack down on hospitals that abuse their nonprofit status by acting like predatory for-profit monopolies. https://washingtonmonthly.com/magazine/july-august-2020/elite-hospitals-have-an-epidemic-of-greed/
Most of all, we'd like to see the nation's hospitals compete to be more like the outstanding hospitals on our Best Hospitals for America rankings.
If more had done so before the pandemic, how many Americans might have been in healthier shape to fend off the virus, or survive it if they did get it?
Of course, it’s impossible to say. But it’s not impossible to use this moment to remake our health care system so that next time we don’t have to ask the question.
