Monday, July 27, 2020

A meaningful best hospitals list, and a temporary relocation

This July 4th, as Americans held socially distanced celebrations (or not) of the 244th anniversary of our Declaration of Independence, the Washington Post published a story whose headline just about said it all: "Hospital ratings often depend more on nice rooms than on health care." The story reviewed a 2012 study that found that more satisfied patients were more likely than less satisfied patients to be dead 6 months later, and subsequent research that found little correlation between patient-recommended hospitals and quality of care or patient survival.

In a previous blog post, I criticized the Cleveland Clinic, at the time ranked by U.S. News and World Report as the #2 hospital in America, for providing little tangible benefits to its surrounding community in exchange for its non-profit status. (The Cleveland Clinic is hardly alone in taking advantage of its reputation among patients and tax-exempt status to rack up lucrative profits; a Washington Monthly article exposes the University of Pittsburgh Medical Center's performance in this regard.) The title of my post was a question: How about ranking how well hospitals serve their communities?

The Lown Institute, in partnership with the Washington Monthly, has now done just that. For their "Best Hospitals for America" rankings released earlier this month, Lown created a Hospital Index that incorporated not only patient outcomes (mortality, safety, and satisfaction), but also civic leadership (community benefit, representativeness of patients compared to the surrounding community, and institutional salary distribution) and medical overuse. Unsurprisingly, few of the famous academic hospitals that traditionally dominate rankings (and receive the bulk of philanthropic and Medicare graduate education dollars) performed well on these criteria. Instead, top primary care and community-focused institutions such as JPS Health Network in Fort Worth, TX (#1) and Lancaster General Hospital in PA (#13) - where I completed my family medicine residency - led the way in the composite Lown rankings. Lown and the Washington Monthly hope that other hospitals can become more like JPS and LGH:

Hospitals motivated to rise in our rankings ... would compete to bring in patients from all levels of society, not just the well insured. They would find ways to get their staffs to stop performing unnecessary procedures and tests. They would try to reduce the pay differential between hospital workers and chief executives. (Do we really want our hospital workers earning so little that they feel they can’t afford to stay home when they’re sick, especially during a pandemic?) And they would put more of their earnings into improving the conditions that affect the health of their communities.

On a personal note, after 16 years of living and practicing family medicine in DC, I am relocating with my family to Salt Lake City for the next academic year so that my wife can pursue an training opportunity there. Even though I won't be physically in DC (my colleagues have graciously agreed to take on my patients while I'm away), and plan to continue practicing part-time while in Utah, I have decided not to change the tag line of this blog, "Common sense thoughts on health and conservative medicine from a family doctor in Washington, DC." I'm not sure how my new perspective and new colleagues (I will be a visiting professor in the Department of Family & Preventive Medicine at the University of Utah) will influence my blog posts, but I intend to keep writing regularly while I'm there.