By Dick Hall-Sizemore
In a new national ranking of hospitals, two Virginia hospitals are included in the Top 20 Hospitals in the country. Furthermore, the Commonwealth’s two major teaching hospitals are in the list of the 50 best teaching hospitals. Finally, one Virginia hospital was one of the 100 best safety net hospitals.
The two Virginia hospitals in the top 20 (which included teaching hospitals) probably would come as a surprise to most readers. They are Norton Community Hospital in Wise County (ranked 11) and Sentara Halifax Regional Hospital in South Boston (ranked 14). In the teaching hospital category, UVa Medical Center was ranked 18 and Medical College of Virginia Hospitals was ranked 39. The Virginia hospital recognized as being among the top safety net hospitals in the country was the Lonesome Pine Hospital in Big Stone Gap (ranked 29).
The ranking has been produced by the Washington Monthly. This more-than-50-year-old journal specializes in government and public affairs and is published bi-monthly (despite its name) in Washington, D.C.
The Washington Monthly chose to rank hospitals in a decidedly different manner than the more well-known ranking by U.S. News. The Monthly’s editor explains the different approaches this way:
“[The U.S. News] elevate[s] … prestigious institutions that primarily cater to the elite at the expense of those that serve the rest of us. Their hospital rankings focus almost exclusively on expensive specialized treatments and surgeries, like organ transplants. Meanwhile, they ignore the bulk of what most hospitals do, which is treating patients for more routine ailments, like broken bones and pneumonia. And they rely heavily on a survey of medical specialists, effectively boosting the ratings of hospitals with high national brand-name recognition, while downgrading or ignoring others that score better on measures of cost and value.”
In contrast to this approach to rankings, the Monthly compiled a large database to use in establishing its rankings. Working with a nonprofit healthcare think tank, the Lown Institute, they evaluated 3,362 hospitals in the country in an effort that took two years to complete. They used data in the following major categories and subcategories to compile their rankings:
I. Quality of Care (50 percent)
- Clinical outcomes
- Patient safety
- Patient satisfaction
II. Civic leadership (30 percent)
- Community benefit—includes charity care, subsidized health services (free clinics, etc.), contributions to community organizations
- Inclusivity—degree to which a hospital’s patient population reflects the demographics of its catchment area
- Pay equity—how much it pays its senior executives compared to its frontline workers.
III. Value of care (Avoidance of overuse of medical procedures (20 percent)
More details, along with a lengthy explanation of the study’s methodology, can be found here and here.
The resulting rankings produced by this approach differ markedly from those in U.S. News rankings. For example, one will not find the Mayo Clinic or Massachusetts General in the Monthly’s lists. It is not that the Monthly editors feel those hospitals do not provide excellent medical care. In fact, they note, “The Mayo Clinic is world-renowned, and for good reason.” However, the Mayo Clinic may score very high in “quality of care”, but it “does abysmally on civic leadership and value of care … The Mayo Clinic is a great place to get a major surgery—as long as you aren’t poor, have excellent insurance, and actually need the surgery.”
The Monthly editors summarize its rankings this way: “Our top institutions are not at the cutting edge of advanced medical research, and they may not be at the forefront of experimental surgical techniques. … They are doing a great job, simultaneously, of treating a diverse patient population representative of their communities, healing those patients, and not overtreating them.”
The top-ranked hospital in the Monthly’s listing was the JPS Health Network. (No, I had never heard of it, either.) It is a large, public, safety net hospital with more than 500 beds and 40 outpatient clinics in Ft. Worth, Texas. It was ranked best overall, as well as the best major teaching hospital and best safety net hospital. In fact, the three top-ranked teaching hospitals were all in Texas, as were five of the 20 overall best.
I should provide some background on the Washington Monthly for those unfamiliar with it, so as to establish its credibility. The publication was founded by Charles Peters in 1969. Peters is a West Virginia lawyer and former state lawmaker who got involved in John F. Kennedy’s 1960 presidential campaign. He then joined Kennedy’s administration as a top assistant to Sargent Shriver in setting up the Peace Corps.
The animating spirit of the Monthly is sort of a practical progressivism. One label that it had was neoliberalism. That term has come to mean different things to different people Here is how Peters described his approach in 1982:
“We are liberals who took [a look at liberalism] and decided to retain our goals but to abandon some of our prejudices. We still believe in liberty and justice and a fair chance for all, in mercy for the afflicted and help for the down and out. But we no longer automatically favor unions and big government or oppose the military and big business. Indeed, in our search for solutions that work, we have come to distrust all automatic responses, liberal or conservative.”
The magazine has consistently upheld and encouraged the principles of entrepreneurship and community service. It has said that there is an important role for government—to protect society from the excesses and occasional rapacious behavior of private business and to help the weak and vulnerable. Its emphasis is on programs and approaches that work, rather than on those that primarily suit a specific agenda. In fact, there are no sacred cows for the Monthly. The writers are not content to just criticize, however; they offer solutions, as well.
The Monthly has been a training ground for many nationally known journalists and authors, such as James Fallows, David Ignatius, Jon Meacham, and Gregg Easterbrook.
Although now retired from the Monthly, Peters is still active. In his latest book, published in 2017, he took the Democratic Party to task for having lost its way. As one reviewer explained, “Democrats, Washington and too much of the country, he argues, have drifted from the sense of shared purpose that lifted America out of the Depression, created the will to win World War II and fostered the rise of a more egalitarian, if still inequitable, society.” Peters argues that the party’s traditional voters “can be won back if Democrats are again seen as the party of the common man rather than the liberal professional class.”
In each issue of the Monthly, there is likely to be something to appeal to a variety of political outlooks. For example, Jim Sherlock would probably feel a kinship with the article in the current issue that takes aim at large hospitals that use their nonprofit status to amass monopolistic power.
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