50 Hospitals Get Dubious Ranking on Racial Inclusion

A Lown Institute report released Tuesday named the 50 most — and 50 least — racially inclusive hospitals in the U.S.

The report, which ranks acute care facilities based on whether the racial makeup of their patients matches that of the people living in the surrounding zip codes, revealed the structural racism present in healthcare, especially in urban hospitals.

One example of such racial inequity is right in New York City, said Vikas Saini, MD, president of the Lown Institute. Metropolitan Hospital Center in East Harlem, which topped the list of most racially inclusive hospitals, is just 1.5 miles from Lenox Hill Hospital in Manhattan’s Upper East Side. Despite this proximity, three-fourths of Metropolitan’s patients are people of color, while the proportion is only one-third at Lenox Hill.

“If you arrived from another planet and saw two airports a mile apart, one for Black people and another for whites, you’d think this is some kind of weird apartheid,” Saini told MedPage Today.

“We don’t do that for airports, but somehow that’s where we’ve ended up with hospitals, and everyone knows it. If you want an illustration of what structural racism is, this is it,” he said. “The results are outlandish.”

The report is one in a series the institute has been releasing in an attempt to produce quantitative measurements of each hospital’s inclusivity or inequity. The institute wants to encourage healthcare leaders and stakeholders to examine the factors that contribute to what Saini called “this type of obvious segregation.”

In addition to Metropolitan Hospital Center, other list toppers included Boston Medical Center and St. Charles Madras in Oregon.

At the bottom of the list — those that do not represent the surrounding communities — were Englewood Hospital and Medical Center in New Jersey; Gateway Regional Medical Center in Granite City, Illinois; and Mariners Hospital in Tavernier, Florida.

Hospitals that treat patients whose racial makeup matches the populations in surrounding census tracts received a neutral score, Saini said.

Five of the hospitals at the bottom of the list were contacted by MedPage Today for comment; only officials at Englewood Hospital and Medical Center responded by publication deadline, stating that they disagreed with the report’s ranking.

“Without seeing the actual data used by the Lown Institute, 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,” they said in a statement.

“Englewood Hospital, our acute care facility, is in a unique location just minutes from the George Washington Bridge. We question how the survey determined the radius of our community. We also question the use of traditional Medicare claims, as this narrow lens is not a true reflection of the patients and communities we serve on an inpatient and outpatient basis over six counties in northern New Jersey and New York.”

The institute used Medicare fee-for-service claims data from 2018 for each hospital, and compared these data with the zip codes in the surrounding area. Specialty, pediatric, and psychiatric hospitals were excluded, as were hospitals with fewer than 50 Medicare admissions in 2018.

The report also ranked major cities on their number of most and least racially inclusive hospitals. For example, Atlanta, Los Angeles, and Philadelphia have 22, 22, and 19 of the least inclusive hospitals, respectively.

Hospitals in major cities are a big part of the problem, as are many so-called “elite” hospitals, which performed poorly, according to the report.

The pandemic has made some of these disparities more obvious. “If you want to see structural racism, just look at big city hospitals during COVID,” Saini said in a news release. “Hospitals with a history of serving communities of color needed refrigerator trucks to hold bodies of deceased patients, while wealthier hospitals nearby had empty beds.”

Saini also noted that the data revealed economic disparities. For example, he said, for the most inclusive hospital, patients came from zip codes where families had on average $27,000 lower annual incomes compared with those in surrounding zip codes. Another hospital had its patients coming from zip codes where the average annual incomes were $29,000 higher compared with people in surrounding zip codes.

“In other words, some hospitals are selecting higher, wealthier, whiter patients, while other hospitals are overserving poorer, less well educated” people of color, he added.

Asked if disproportionate share hospital payments, a federal subsidy for certain hospitals with higher percentages of underinsured or uninsured patients, might influence lower-income patients to go to those designated acute care centers, Saini said it’s possible.

Lower-income patients would likely be less able to afford supplemental Medicare coverage, and be less able to pay their 20% Medicare Part B co-pays or Part A deductibles that accompany each hospital stay.

“It could be that poor people go to hospitals that aren’t going to sue them, where they aren’t going to end up in collection. That could well be an explanation for what we’re showing,” Saini noted, adding that there’s likely more to it.

He said one possible explanation is that hospital admission patterns are “probably a reflection of legacy behaviors before the patients enrolled in Medicare.”

But decisions made by hospital executives are partly to blame. “Hospitals make decisions about where to place a clinic, about which primary care practices to buy. There are decisions made about what kinds of services to offer, and they’re often driven by [the desire to increase] the bottom line,” he said.

The Lown Institute has a history of releasing reports that in many cases shame certain providers. With its “Shkreli Awards,” they called out greedy corporations, uncaring hospitals, and other bad actors in healthcare.

Earlier this month, the institute named 50 hospitals likely to perform an unnecessary procedure.

They will release a complete ranking examining racial inclusivity among 3,200 hospitals in late June, including metrics of income and education.