ACADEMIC MEDICAL CENTERS in Massachusetts are often ranked among the best in the nation, but data gathered by the Lown Institute of Needham suggests they lag behind their peers nationally in several key categories.
According to an analysis of the data, the 10 academic medical centers in Massachusetts generally performed poorly compared to 200 other peer institutions around the country when it comes to patient outcomes and patient safety, but fared well in avoiding the overuse of certain “low-value” medical procedures.
The Lown data for these clinical metrics are derived from the most recent Medicare claims available and covered the period 2019 to 2022. Claims data from other populations, such as Medicaid and private health insurance, would likely yield different results.
The Lown Institute is a nonprofit organization that believes hospitals often prioritize profits over healing and sometimes even put patients in harm’s way with the care they provide. The organization faces strong pushback from many sectors of the health care industry, with many hospital systems criticizing its methodology.
Academic medical centers are commonly known as teaching hospitals – institutions affiliated with medical schools that provide patient care and, at the same time, educate and train medical students and residents.
Lown’s patient outcome metrics assess how well hospitals achieve two critical clinical goals — keeping their patients alive (mortality) and preventing them from having to be readmitted to the hospital.
Of the 10 academic medical centers in the state, Lahey Hospital & Medical Center performed the best on patient outcomes with a middle-of-the-road rank of 90 out of 210 of its national peers. This is followed by Mount Auburn Hospital (99), Tufts Medical Center (116), Massachusetts General Hospital (117), and Beth Israel Deaconess Medical Center (122). Further behind were Boston Medical Center (146), Brigham and Women’s Hospital (148), UMass Medical Center (162), Cambridge Health Alliance (169), and Baystate Medical Center (191).
A number of Massachusetts academic medical centers did not rank well on Lown’s patient safety metric, which measures how well hospitals avoid six preventable medical errors, including pressure ulcers (bed sores), accidental punctures, and IV line infections.
The poorest performing medical centers in Massachusetts on patient safety were Mass General at 131 and Baystate Medical at 152 out of their 210 national peers. The highest-performing Massachusetts medical centers for this metric were Boston Medical Center (30) and Mount Auburn (35).
According to the Lehman Center for Patient Safety, tens of thousands of people are harmed every year in Massachusetts as a result of medical errors that are preventable.
Low-value medical procedures, according to Lown, are those that offer little to no clinical benefit to patients and, in many cases, are more likely to harm them than help them under various circumstances.
A number of the Massachusetts academic medical centers were leaders in avoiding the overuse of such procedures. Topping the list was Beth Israel with a rank of 5 among its 210 national peers, followed by Cambridge Health (8), Lahey (9), and UMass Memorial (15). Brigham and Women’s and Mass General ranked 44 and 78, respectively.
Lown determines what constitutes low-value procedures based on an in-depth review of the medical literature as it pertains to the inappropriate use of 12 specific procedures, including coronary artery stenting, colonoscopy screening, and spinal fusion/laminectomy.
This year hysterectomy, which involves the surgical removal of the uterus, was abruptly dropped by Lown from its list of low-value procedures after the institute was heavily criticized for its inclusion.
The American Hospital Association, for example, said that Lown’s methodology appears to count all hysterectomies performed for non-cancer diagnoses as unnecessary, even though the American College of Obstetricians and Gynecologists said there are several non-cancerous conditions for which hysterectomies are appropriate.
Vikas Saini, the president of the Lown Institute, said Lown dropped hysterectomies after listening to the feedback. “It’s pretty clear that there is a lot of overuse of hysterectomy,” he said. “But when we started looking at the algorithms that we had adopted, we realized that it needs improvement. So we kind have taken it back to the shop for improvement.”
By some estimates, overuse care represents up to 30 percent of all medical spending in the United States, amounting to an estimated $780 billion annually.
Each of the 10 Massachusetts academic medical centers was provided with the Lown data for their respective institutions accompanied by requests for interviews. Cambridge Health Alliance declined the request, while Baystate Medical Center and UMass Memorial Medical Center did not respond.
The remainder of the medical centers issued prepared statements.
Boston Medical Center and Tufts Medical Center cited their commitment to the health of their patients and pointed out areas in which they performed well in the Lown datasets.
Beth Israel Lahey Health, the parent of Lahey Health, Beth Israel Deaconess, and Mount Auburn, called attention to its commitment to patient safety. “Our hospitals are deeply committed to providing exceptional care to our patients and ensuring safety is at the foundation of everything we do,” the institution said in its prepared statement.
Mass General Brigham, the umbrella organization of Massachusetts General Hospital and Brigham and Women’s Hospital, took Lown to task for its methodology.
“We engage in robust benchmarking and analysis to ensure we are addressing the health challenges and inequities of our communities and relentlessly improving the care we deliver,” the hospital system said in a prepared statement. “The Lown Institute’s measurements represent a narrow and incomplete perspective on care delivery by excluding complex conditions and devaluing certain treatments that are critical to the health of our patients.”
The American Hospital Association is a long-standing critic of Lown’s work. “Hospitals and health systems across the country [are] working diligently to ensure that their communities and patients achieve their full potential for health,” said Aaron Wesolowsky, the association’s vice president for policy research, analytics and strategy. “Lown’s self-appointed ranking of those efforts is not always representative of these efforts.”
Saini, the president of the Lown Institute, pushes back.
“Our actions have brought increased scrutiny on a sector we all know needs to improve,” he said. “We’ve been rigorous in our work, basing it on the best scientific evidence available.”