In these top hospitals, socioeconomically vulnerable patients will find care | Second opinion

Many of America’s best hospitals are located in and serve communities of relative privilege. People who are not financially well-off, not well-insured, and not white have historically been underserved by the U.S. health care system and are less likely to receive care at these top medical centers. While about 38 percent of all U.S. hospitals are located in neighborhoods that are socially disadvantaged by one measure, those hospitals are less than a quarter more likely to pass the high-profile quality assessment than hospitals located in more advantaged neighborhoods.

Hospitals, sometimes called safety nets, that treat a substantial portion of poor, uninsured or otherwise vulnerable patients “struggle to achieve the same quality metrics” compared to other medical centers, says Dr. Clyde Yancy, chief of cardiology and professor at Northwestern. Feinberg University School of Medicine. “Safety net hospitals are plagued by very challenging patient populations, often due to the maldistribution of social determinants of health,” he says. The challenges these facilities face are “largely dependent on policy, resources and available investment capital. They typically don’t have as much investment capital and don’t make the same margins for the care they provide.”

The problem is twofold: patients with higher social needs may face barriers to accessing health services from certain providers and institutions due to factors such as insurance acceptance, geographic proximity, or lack of transportation. At the same time, hospitals that care for a greater proportion of more vulnerable patients are often under-equipped and face challenges such as lower reimbursement from some insurance companies, which reduces their revenue potential, limiting their ability to provide services to their communities. These hospitals may also be disadvantaged on performance measures that don’t properly account for each patient’s risk factors, experts say.

“A hospital can do everything it can to help patients, but it won’t reverse decades of inadequate care over the course of a patient’s life,” says Dr. Karen Joynt Maddox, a cardiologist, researcher and professor at Washington University School of Medicine in St. Louis many purchasing programs that reward hospitals with payments for the quality of care they provide do not take social risk into account when evaluating patient outcomes and potentially “penalize hospitals doing the hardest work” in caring for patients with greater social needs.

Yet some hospitals stand out by excelling in quality measures while caring for a range of patients from vulnerable communities. On Parkland Healthand the best hospital in dallas, for example, four out of every 10 patients are on Medicaid, the government insurance program for the poorest Americans. On Grady Memorial Hospital in Atlanta, six out of every 10 patients insured by another government Medicare program are black, exceeding the 28 percent proportion of Atlanta residents covered by Medicare who are black. In Tulsa, Oklahoma, more than a quarter of patients on both St. Francis Hospital and Hillcrest Medical Center they are on Medicaid. Both hospitals serve a large proportion of patients from disadvantaged communities, as well as a significant number of Native American patients. More than a quarter of patients treated for NYC Health and Hospitals-Elmhurst are on Medicaid, and two-thirds of her Medicare patients are non-white.

“Racial and ethnic minorities, as well as low-income patients, are typically segregated in a low percentage of hospitals,” says Dr. Sidra Bonner, a surgeon who has studied hospital-level segregation of Medicare patients. According to surgical research, he adds, “most racial and ethnic minorities are served in 20 percent of hospitals.”

AND recent studies in the American Journal of Surgery found that patients treated at top hospitals had fewer complications and a better chance of survival than similar patients treated elsewhere. In addition, the study authors wrote that “patients living in extreme (persistent poverty) experienced the greatest reductions in the likelihood of mortality and morbidity when they received care at a first-class hospital.” Author Chanza Shaikh and colleagues from The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center concluded: “Improving access to high-quality hospitals for socially disadvantaged patients can help reduce disparities in surgical care.”

Despite treating patients who face social and economic adversity, Parkland, Grady, Hillcrest, Saint Francis and Elmhurst have managed to achieve great results and have previously been recognized as US News Best Regional Hospitals.

We set out to identify multiple hospitals that treat a disproportionate share of patients from three different historically underserved communities: people living in more socioeconomically disadvantaged neighborhoods, Medicaid recipients, and racial and ethnic minorities. We found dozens of such hospitals in 26 states that also provide high quality overall care, ranking them among the best in their region.

The list of institutions below is by no means a definitive list of hospitals involved in providing access to socio-economically vulnerable populations. No doubt there are others that we can identify and recognize in the future. However, these 53 hospitals provide certain vulnerable populations with substantial access to high-quality care—an essential contribution to health equity. That’s why today we recognize them as the best regional hospitals for equitable access by US News & World Report.

A brief description of the criteria appears after this list.

Providence Alaska Medical Center Berth AND
University of Alabama at Birmingham Hospital Birmingham AL
UAMS Medical Center A small rock AR
TMC Healthcare-Tucson Tucson THE
Banner-University Medical Center Phoenix Phoenix THE
Banner-University Medical Center Tucson Tucson THE
Mercy San Juan Medical Center Carmichael ca
Loma Linda University Medical Center Loma Linda ca
Providence St. Mary Medical Center Apple Valley ca
Sharp Chula Vista Medical Center Chula Vista ca
Kaiser Permanente Fontana and Ontario Medical Centers Fountain ca
Adventist Health-White Memorial Angels ca
Kaiser Permanente South Sacramento Medical Center Sacramento ca
UCHealth Memorial Hospital Colorado Springs WHAT
Hospital and Medical Center St. Francis Hartford CT
Yale-New Haven Hospital New heaven CT
UF Health Jacksonville Jacksonville FL
Grady Memorial Hospital Atlanta GA
Advocate Trinity Hospital Chicago IL
Carle Foundation Hospital Urban IL
Ochsner Lafayette General Medical Center Lafayette THE
UMass Memorial Medical Center Worcester MA
Johns Hopkins Bayview Medical Center Baltimore MD
Hospital of the Assumption of St. Agnes Baltimore MD
MedStar Southern Maryland Hospital Center Clinton MD
Corewell Health Hospital in Dearborn Dearborn ME
Henry Ford Hospital Detroit ME
St. John’s Assumption Hospital Detroit ME
Christian Hospital St. Louis MO
Barnes-Jewish Hospital St. Louis MO
Mercy Hospital Springfield Springfield MO
Moses H. Cone Memorial Hospital Greensboro NC
Cape Fear Valley Medical Center Fayetteville NC
UNC Hospital Chapel Hill NC
ECU Health Medical Center Greenville NC
Altru Health System-Grand Forks Grand Forks N.D
Sanford Medical Center Bismarck Bismarck N.D
Cooper University Health Care-Camden Camden NJ
Jefferson Health-Stratford, Cherry Hill and Washington Township Stratford NJ
NYC Health and Hospitals-Elmhurst Elmhurst NY
Hillcrest Medical Center Tulsa OK
Hospital of St. Francis-Tulsa Tulsa OK
Asante Rogue Regional Health Center Medford OR
Salem Hospital Salem OR
UPMC Presbyterian Shadyside Pittsburgh BYE
Geisinger Wyoming Valley Medical Center Wilkes Barre BYE
McLeod Regional Medical Center Florence SC
Grand Strand Regional Health Center Myrtle Beach SC
Lexington Medical Center Western Colombia SC
Memphis Methodist Hospital Memphis TN
Parkland Health-Dallas dallas TX
JPS Health Network – Fort Worth strength value TX
Inova Fairfax Hospital Falls Church VA

The hospitals recognized here previously met the criteria for inclusion in 2023-2024 The best regional hospitals. They also met at least two of the following three criteria:

  • At least 40% of Medicare inpatient visits involved patients living in more socioeconomically disadvantaged neighborhoods. Socio-economic deprivation of neighborhoods was assessed using area deprivation index data obtained from Neighborhood Atlas. Both national percentiles, which compare neighborhoods to others in the country, and state deciles, which compare neighborhoods only to others within the same state, were considered. A neighborhood with national ADI values ​​above 70 (on a scale where 100 indicates the greatest deprivation) or state ADI values ​​above 7 (on a scale of 1 to 10) was classified as more socio-economically deprived for this analysis. A hospital could meet this criterion if at least 40% of its Medicare patients lived in disadvantaged neighborhoods, according to the state or national ADI.
  • A substantial Medicaid population. A hospital met this requirement if at least 20% of its patients were insured by Medicaid or if it achieved the highest category (“Higher than other hospitals”) for the US News Health Equity measure “Representation of Low-Income Patients.”
  • A patient population that reflects the racial and ethnic diversity of the surrounding community. A hospital met this requirement if at least 20% of its Medicare inpatients receiving elective care were racial or ethnic minorities, or if it treated a non-trivial Medicare population from one or more of the five racial/ethnic minorities and achieved the highest category (“” Comparable to or higher than the community”) for the corresponding measure of race/ethnicity that US News publishes as part of its Health Equity measures.