A new report ranking urban hospitals based on racial inclusivity finds ‘de facto segregation’

A new report ranking urban hospitals based on their racial inclusivity is ruffling some feathers.

On Tuesday, the Lown Institute released the first standalone report that examined the racial makeup of patient populations at over 3,200 U.S. hospitals and compared them to the racial demographics of people living in the areas those same hospitals serve.

Using 2018 Medicare claims and five-year data from the Census Bureau’s American Community Survey, also from 2018, the institute examined the patients who came to a hospital for care and the zip codes they lived in, said Dr. Vikas Saini, president of the Lown Institute, in a phone interview.

Report authors used that information to define the radius within which most of a hospital’s patient population lives. Then they examined the racial demographics of all the people who lived within that radius — that is, all the people the hospital could serve — and compared it to the racial demographics of its actual patient population, which is all the people the hospital does serve.

This methodology ranked Gateway Regional Medical Center in Granite City, Illinois hospital second to last on the list but a hospital spokeswoman pushed back charging that the “community area” defined for their hospital is flawed.

The Lown Institute defines community area as the distance from which about 90% of the hospital’s Medicare patients travel. 

“For Gateway, the Lown community area includes several zip codes in the neighboring state of Missouri, including at least one that is densely populated and more than 90% non-Caucasian,” said Beth Ann Gailey, director of public relations and marketing, in an email. “These residents would need to pass four hospitals and cross the Mississippi River on their way to Gateway…it would probably be unrealistic that Gateway would serve the entire population for such distant cities, especially for the 65 years-plus patient population.”

Gateway is not alone in its dissatisfaction with the Lown Institute’s methodology.

Englewood Health in New Jersey, ranked the least racially inclusive hospital in America, also questions how the survey determined the radius of its community area and why it uses traditional Medicare claims, which is a “narrow lens,” said an Englewood Health spokesperson who declined to be identified publicly, in an email.

“…we can only speculate as to why our ranking was low, but we do not agree that it accurately reflects the work we do to reach underserved and diverse audiences,” the spokesperson said.

The Lown Institute, which has been around since 1973, albeit in a different incarnation, provided a reason for why it uses Medicare data.

Though there is commercially available data, it is very expensive to acquire and does not identify the hospitals, so it is not useful for Lown Institute’s purposes, said Aaron Toleos, vice president of communications, in an email.

And, more importantly, Medicare represents the largest claims database that is publicly accessible, Toleos added.

While no other similar report from other nonprofit thinktanks are available to make comparisons on methodology with the report Lown put out, the analysis of this dataset does seem to portray several troubling trends. This includes the stark difference in the racial makeup of patient populations served by hospitals in the same area.

In New York City, NYC Health + Hospitals/Metropolitan, which topped the list as the most racially inclusive hospital in the country, is a 10-minute drive from Lenox Hill Hospital, which ranks 3,163rd on the list. The former’s patient mix is 77% people of color, while the latter serves only 33%.

Overall, in the top 50 most inclusive hospitals, people of color made up 61% of patients on average, compared to 17% in the bottom 50 hospitals.

“This seems to be how the system works — [there is] a pattern of de facto segregation,” Saini, of the Lown Institute, said.

In large urban areas, safety-net hospitals, which provide care regardless of a patient’s insurance status or ability to pay, almost exclusively cater to low-income people of color while other hospitals in the area take care of a whiter, richer population, Saini said.

While there are several factors, including residential segregation and insurance status, driving this trend, it is a pretty clear example of structural racism, he added.

“The example I’ve been using is can anyone imagine having a Black airport and a white airport a mile apart? Does that even make any sense? And yet in some ways, that’s what we have with hospitals,” he said.

The striking segregation that exists in urban hospital markets is only one key finding of the analysis. The other is that prestige does not equate to racial inclusivity.

Among the 20 U.S. News & World Report Honor Roll hospitals, 11 ranked in the bottom third for racial inclusivity, and only five hospitals ranked in the top third.

For example, Rochester, Minnesota-based Mayo Clinic, the No. 1 hospital in the country per U.S. News & World Report’s rankings, was No. 2,516 on Lown Institute’s racial inclusivity rankings. Cleveland Clinic, No. 2 on U.S. News’ Honor Roll, did not break the top 50 for racial inclusivity either, ranking No. 159.

“We created this [racial inclusivity] ranking because we felt the hospital ranking systems that are out there and prominent don’t do enough justice to some really important aspects of healthcare that matter to many millions of people and that would benefit from greater public visibility,” Saini said. “It’s [also] part of a broader mission to encourage accountability of our healthcare system.”

In addition to racial inclusivity, the Lown Institute is examining income and educational inclusivity in different hospital markets. They plan to release those rankings, as part of its overall Hospital Index, by the end of June.

Photo: Irina Devaeva, Getty Images