Why this Sacramento-area hospital ranked No. 2 on national list of engaged hospitals
When researchers at a nonpartisan think-tank looked nationally for hospitals excelling at engagement with their communities, one capital region hospital stood out.
Marshall Medical Center in Placerville ranked No. 2 in the nation out of roughly 3,000 evaluated on the Lown Institute Hospitals Index, released for the first time on Tuesday. Marshall shares top 10 status with a number of much-larger medical institutions that have hundreds of physicians and thousands of employees.
“Hospitals are members of their communities, and when we think about them and when we try to understand what their performance is like, we wanted to be able to think about ways we might measure their participation or engagement ... in the community,” said Dr. Vikas Saini, Lown’s president and a cardiologist. “With the (coronavirus) pandemic, I think more than ever the idea that hospitals need to be real partners with their communities has become much clearer to a lot of people.”
The team at Lown (rhymes with down) decided to break new ground in trying to measure factors such as pay equity between hospitals’ lowest-wage worker and their chief executive officers, and the extent to which people admitted hospitals reflect the demographics of their areas they serve, Saini said.
However, he pointed out that, like other hospital rankings, the Lown index places a heavy emphasis on patient outcomes. No one wants to go to a hospital that fails in that measure, Saini said.
Marshall’s rank mean that it scores well in providing quality care while also making strides at offering charity care, paying workers in a way that benefits their community’s economic vibrancy, and serving patients in numbers that reflect the race, education level and income of people living around the hospitals.
To get this information, Lown’s team used information from the U.S. Centers for Medicaid & Medicare Services, nonprofit hospitals’ tax filings, securities documents that publicly traded companies filed with the federal government and many other records.
Because a number of metrics used to evaluate hospitals were brand new, Saini said, Lown had to find documentation, make calls on what it would include and develop ways to measure each attribute. In the case of charity care, for instance, Lown researchers decided not to count training or research dollars spent by companies, even though, the IRS allows them to deduct it.
“We found that a lot of the ‘renowned’ hospitals in the country sometimes struggled when it comes to equity in the community,” Saini said, “and we also found that a lot of hospitals that really do provide care and serve lower-income people or people of color or people of less educational background ... they struggle with overcoming the uphill climb on mortality because many of them are serving people and communities whose life expectancies are way low, before they walk into the hospital.”
Marshall Medical Center and other hospitals such as Memorial Hermann Texas Medical Center in Houston and Providence Portland Medical Center in Oregon didn’t have perfect scores in every category, but the managed well across multiple metrics.
The coronavirus pandemic has revealed inequities in diagnostic testing in communities of color, lingering gaps in access to care for people in those communities and an outsized dependence on elective procedures at many hospitals.
“There are some very fine hospitals that feel forced to focus on profitable elective procedures to stay in business,” Saini said. “This can lead to business decisions that make them look good on outcomes like mortality, but at the expense of equity. The data show that gaps between a hospital’s clinical results and its performance in the community are sometimes very wide, which can contribute to disparities in care and put certain communities at risk.”
The new Lown index isn’t meant as a tool to help consumers decide where to go to get hip surgery, heart surgery or other procedures, Saini said. Rather, he said, he hopes people use the data to help determine what kind of care they want for their neighbors or what the business model for hospitals should be.
“All of America is looking at health care differently with the pandemic, and I think all of us are asking ourselves: What kind of health care do we need? What kind of health care do we want?” Saini said. “We think hospitals that do well in this ranking potentially are examples for all of us to follow because, at the end of the day, one thing COVID tells us all is that, if that if there is a threat to health somewhere, it can be a threat to health anywhere.”
So, what stands out about Marshall’s performance on the Lown Hospitals Index?
When it comes to pay equity, it ranks in the middle of the pack, landing 1,501st out of 3,337 hospitals in the nation and 96th out of 247 California hospitals.
On inclusivity, it’s among the bottom third of hospitals nationally at 2,152nd but in the middle among state hospitals at 146th.
Marshall scores four out of five stars on income inclusivity, meaning that it does a very good job on reflecting the various income levels of people in its service area. It gets three stars for how well it serves people of lower educational levels and one star for how well it serves people of color living in its service area.
The 2010 census showed that the racial makeup of El Dorado County was roughly 87 percent white, 1 percent African American, 1 percent Native American, 3.5 percent Asian and 0.2 percent Pacific Islander. Roughly 12 percent of residents identified as Hispanic or Latino.
Where Marshall excelled was in serving a huge proportion of the Medicaid population in El Dorado County, getting five stars in this metric. It received three stars for the proportion of hospital funds it spends on charity care.
According to Lown’s report, Marshall also largely did a great job of ensuring that it did not provide 13 low-value medical services such as pulmonary artery catheterizations or electroencephalogram, or EEG’s, for headaches or fainting.
The El Dorado County hospital came in at 644th in the nation for its clinical outcomes, 474th for patient safety and 1,352nd for patient satisfaction.
Want to see how other local hospitals did? The index at lownhospitalsindex.org is searchable by state, by individual metrics, hospital type, hospital system or individual hospital.
Other California hospitals in the top 100 were Oroville Hospital (45th), Desert Valley Hospital in Victorville (78th) and Community Memorial Hospital San Buenaventura in Ventura (89th).
While this list makes it look as though small-to-midsize hospitals fared better than large ones, Saina pointed out that 15 large teaching hospitals around the nation also ranked in the top 100. He said he hopes this information will prompt gradual, well-thought out change rather than finger-pointing.
“We think our contribution is to open a conversation, add some new dimensions and really hope that more and more people will think about it this way,” Saini said.
