Judging which are the best hospitals in the United States really depends on how you define “best.”

A new national health care ranking goes beyond just looking at patient outcomes like popular lists compiled by magazines such as US News & World Reports or Newsweek do.

The Lown Institute, a nonpartisan health care think tank, added civic leadership and value of care to its scoring system to judge how well a hospital fulfills its social mission to provide care for a community.

The addition of those factors knocked Mayo Clinic out of its usual spot on top of such lists to place at 965th out of 3,282 U.S. hospitals.

Instead of famous names such as Mayo Clinic or Johns Hopkins, the Lown Institute Hospital Index is led by hospitals that aren’t international brands. JPS Health Network in Fort Worth, Texas, Marshall Medical Center in Placerville, Calif., and UPMC McKeesport in McKeesport, Pa., filled Lown’s first three positions.

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Mayo Clinic in Rochester did score its usual A+ for patient outcomes, which added helped its ranking. However, it earned a D- in civic leadership and a D in value of care.

Mayo Clinic’s usual competitors, Johns Hopkins and Cleveland Clinic, were ranked at 461st and 1,009th, respectively.

Within Minnesota, the Rochester hospital ranked 24th out of 72 hospitals. However, Mayo Clinic Health System hospitals in Albert Lea and Mankato took the second and third spots, respectively. Fairview Lakes Medical Center in Wyoming, Minn., was ranked number one.

Patients considering hospitals typically are looking for the best care they can afford. Why factor in issues such as pay equity, inclusion and value in a hospital ranking?

“There are plenty of lists for people to look at to decide where to get your knee replaced,” said Lown Senior Vice President Shannon Brownlee. “We wanted a list that policymakers and community leaders could look at and could really start to re-think how we judge hospital performance and what we expect from hospitals.”

Erin Sexton, Mayo Clinic’s enterprise community relations director, released a statement defending the hospital and questioning the methodology of Lown's ranking.

"Mayo Clinic is proud of the strong partnerships we have formed in the communities we serve. ... Mayo Clinic provides millions of dollars every year in philanthropic support to nonprofits in the Rochester community,” she wrote. “Unfortunately, much of this important work and key partnerships appear not to be reflected in the recent evaluation by the Lown Institute.”

Sexton added, “Although we may question the accuracy of the report’s assessment, we also recognize these are opportunities to review our performance and will use the feedback to ensure that we are continuing to meet the expectations of our patients, our communities and our staff.”

Brownlee and others at Lown created a system that uses 42 metrics and seven sub-components to score hospitals. The system considers how a hospital CEO’s pay compares to its lowest paid workers, community benefits like charity care and the use of 13 medical services considered to have “low value” for patients.

Research, training not counted

The Lown Index does not include points for medical research, education and financial shortfalls related to Medicaid. Research and education are two areas that Mayo Clinic often cites as primary contributions to health care and society.

“The vast amount of research is paid for by the federal government and the pharmaceutical industry. And the cost of teaching clinicians, particularly physicians … the vast majority of that cost is paid by the federal government,” said Brownlee.

Mayo Clinic’s Sexton countered that research and education are integral parts of Mayo's mission of serving humanity.

“The recent role that research has played in helping to advance COVID-19 testing and response are critical examples of how Mayo Clinic serves our community and nation. The Lown Institute’s methodology appears to exclude these research and workforce activities specifically,” she wrote.

The American Hospital Association too issued a statement strongly criticizing the Lown Index.

“America’s hospitals and health systems support providing consumers with accurate and useful information to enable them to be more informed purchasers of health care. Unfortunately, the Lown Institute’s new report will not supply consumers with any such information,” according to the statement by the association’s Nancy Foster.

The statement agreed with Mayo Clinic that research and education should be included.

“... Its view of community benefit is too narrow. The report undervalues the vital contribution hospitals make to medical research and professional training. This has been especially important as the country faces a pandemic that has cost too many lives. The report also fails to recognize that hospitals further subsidize care for low-income and underserved individuals due to chronic underpayments from Medicaid and similar programs,” wrote Foster.

Dr. Roy Poses, the president of the Foundation for Integrity and Responsibility in Medicine, described the various hospital rankings as being like the well-known fable about the blind men describing an elephant by feeling individual parts. Hospitals are very complex organizations that can be judged on a variety of issues.

He said an interesting element of the Lown ranking is that it did not take a hospital’s reputation into account.

“It’s based purely on numbers… It’s worthy of some thought and debate… It may push the debate in a positive direction,” said Poses.

That’s what Brownlee and her colleagues at the Lown Institute hope.

“We aren’t in the business of dinging hospitals. We wanted to start a national conversation,” she said.

Lown hopes to make the ranking an annual event. Brownlee says they are open to adjusting the methodology.

“We would welcome a conversation with the Mayo Clinic to talk about our logic and talk about where we got our data,” said Brownlee. “We think every hospital should have the kind of patient outcomes that Mayo Clinic has. We also believe every hospital can truly be great in terms in how they make a community healthier.”