Delivering high-quality care is not enough for hospitals to excel at serving and supporting their communities, according to a new nationwide study of hospitals. 

The new ranking of U.S. hospitals considers civic leadership and value of care as well as quality of care. It shows that some hospitals with good patient outcomes aren’t always the best at addressing inequities that affect the health of their communities. Likewise, safety net hospitals often do well in serving their communities and advancing equality, but don’t perform as well in delivering quality care. 

The Lown Institute, a Massachusetts-based think tank, assessed nearly 3,300 hospitals on 42 performance indicators to measure outcomes in three categories: 

•Civic leadership, which assesses a commitment to equity, inclusion and community health. 
•Value of care, which measures use of unnecessary services. 
•Quality of care, which evaluates patient outcomes, safety and satisfaction.

“At a time when communities are relying on them like never before, hospitals must rethink what it means to be great,” said Dr. Vikas Saini, president of the Lown Institute. “COVID-19 highlights how hospitals are essential community partners for anyone in need. To be great, however, a hospital cannot only provide care that’s high in quality. It must also deliver value and advance equality. Our index is designed to help them do just that.”

The institute was founded by Dr. Bernard Lown, who launched the Lown Cardiovascular Research Foundation in 1973 to promote cardiovascular health around the world through research, education and global outreach. The organization was renamed the Lown Institute in 2012 to reflect a shift from primarily cardiovascular research toward a broader focus on health care issues such as medical overuse and underuse, health equity, and cost of care. Lown has received numerous humanitarian awards, including the Nobel Peace Prize. 

Eighty-one Iowa hospitals were included in the rankings. Some of the state’s smallest hospitals were excluded, as well as children’s hospitals and some other hospitals that were considered specialty hospitals. 

Broadlawns Medical Center, Polk County’s safety net hospital, scored as the top hospital in the state on civic leadership and value of care measures, but near the bottom for quality of care, placing it overall at 80th among 81 hospitals with an overall D-minus grade. 

Iowa Lutheran Hospital and MercyOne-Des Moines received grades of C-plus and C, respectively, placing them at No. 32 and No. 40. Iowa Methodist Medical Center was not ranked because its large number of orthopedic procedures placed it among specialty hospitals that will be ranked in a separate study. 

By considering civic leadership factors, the index claims to be the first hospital ranking to measure inclusivity, or the degree to which a hospital is caring for patients of color and of lower income or education. The institute also said it’s the first index to measure the ratio of executive compensation to that of employees without advanced degrees. 

Based on the index measures, Iowa’s top 10 hospitals that best balance civic leadership, value of care and quality of care are: 

1.Mercy Medical Center-Cedar Rapids – Cedar Rapids.
2.Trinity Regional Medical Center – Fort Dodge.
3.University of Iowa Hospitals & Clinics – Iowa City.
4.St. Luke’s Regional Medical Center – Sioux City.
5.Unitypoint Health-Marshalltown – Marshalltown.
6.Pella Regional Health Center – Pella.
7.Mercy Medical Center-North Iowa – Mason City.
8.Mercy Medical Center-Dubuque – Dubuque.
9.Trinity Muscatine – Muscatine.
10.Grinnell Regional Medical Center – Grinnell.

“No other hospital ranking provides a 360-degree view of hospital performance,” said Shannon Brownlee, senior vice president at the Lown Institute. “Many of the best-known hospitals score highly on patient outcomes but poorly on civic leadership and value of care. Our data show that it’s possible to do well in all three categories, because some hospitals are doing it. That means all the people in their communities are being served effectively and fairly.”

In determining hospitals’ scores, patient outcomes accounted for 50% of the total scores, Saini said in a telephone interview. 

“We put half the weight on patient outcomes because, bottom line, that’s very important,” he said. Those factors include measures such as mortality rates, numbers of readmissions, specific safety measures and patient satisfaction scores. 

Civic leadership factors accounted for 30% of a hospital’s total score, and value of care accounted for 20% of the total. 

“When we did our analysis, we found one of the things going on is that there are many trade-offs,” Saini said. One of the biggest trade-offs is that it’s difficult to achieve both service to high-need communities and high quality of care. 

“Our results really show this tension and this difficulty, but we have found there are some hospitals that are able to do it across the three dimensions,” he said. “These are the hospitals that we need to spotlight, to learn how they’re able to do it.” 

Saini said the Lown Index really wasn’t intended to be used as a tool for individuals to decide which particular hospital they should use. “It doesn’t help an individual, except when you have your ‘citizen hat’ on, looking at what you want for not only yourself but for people across town.” 

The top hospitals in each category for Iowa were: 

– Civic leadership: Broadlawns Medical Center in Des Moines, Mercy Hospital of Franciscan Sisters-Oelwein, and Gundersen Palmer Lutheran Hospital and Clinics in West Union. 

– Value of care: Broadlawns Medical Center, Myrtue Medical Center in Harlan, and CHI Health Missouri Valley.  

– Quality of care: Mercy Medical Center-Cedar Rapids, Mercy Medical Center-Dubuque and Trinity Regional Medical Center. 

To determine hospitals’ value of care, the Lown Institute assessed hospitals based on estimates of their rates of overuse, including hysterectomy for benign disease, head imaging for simple headaches, and 11 other procedures and tests. The research found that for-profit hospitals and those in certain states, particularly in the South, were more likely to overuse low-value services measured. 

To determine hospitals’ quality of care, the Lown Institute used an algorithm called the Risk Stratification Index (RSI) that has been validated on multiple national, state-based and hospital-based datasets using billions of insurance claims. RSI has been shown to predict outcomes such as mortality with greater discriminatory accuracy compared with other publicly available risk adjustment tools.

David Lind, president of Heartland Health Research Institute in Clive, reviewed the Lown Institute results for Iowa and said it could be a helpful tool for patients when planning for elective procedures, along with other widely used hospital comparisons including those conducted by  U.S. News & World Report, Leapfrog and the CMS Hospital Compare. 

Lind cautioned that different rankings can vary widely in their results, which can make it confusing to know which rating tool is most reliable. 

“Short of having ONE authoritative hospital comparison tool to use, I have come to the conclusion that using multiple sources may be the best strategy for value-conscious healthcare ‘consumers,’” he said in an email. “Additionally, hospitals and their administrators become equally confused when assessing how they compare against competing hospitals, primarily because the metrics used are frequently altered by rating organizations to ‘improve’ their rating methodologies.” 

Patient safety is one indicator that is poorly used by all rating organizations, Lind said.  

“Most rating organizations use the CMS Hospital Compare website for many of the established patient safety indicators,” he wrote. “Unfortunately, medical errors can be (and often are) grossly under-reported to CMS and other organizations, which gives the public a false sense of security that care is safer than it really is.” 

The Lown Index results are available at LownHospitalsIndex.org, where people can compare hospitals based on location, hospital type and metric.