This Viewpoint examines US News & World Report’s approach to evaluating and publicly reporting hospital performance in various aspects of health equity as well as describes several novel equity measures published as part of its “Best Hospitals” rankings program.

To the Editor In a recent Viewpoint, 1 authors from US News & World Report described several health equity measures to be used to evaluate hospitals' performance on 3 dimensions: access, outcome, and social determinants of health. While we applaud the effort to promote health equity and ensure hospital accountability, in this Letter, we highlight some potential limitations of the effectiveness of these measures for evaluating hospitals' health equity performance.The proposed access measure captured how closely the racial composition of Medicare patients undergoing typically elective procedures in a hospital matched Medicare beneficiaries residing in the surrounding community. However, some hospitals that provide specialized care (eg, organ transplants) attract Medicare patients from a broader geographic base. In addition, patients from racial and ethnic minoritized groups may bypass a closer, higher-quality hospital to go to a more distant lower-quality hospital not because of hospital acceptance metrics but because of insurance networks-and hospitals are only one part of the decisions regarding networks. 2 To investigate outcomes disparities, hospital-level differences in the risk of 30-day unplanned readmission were examined between Black and White patients following common surgical procedures. Whether hospital readmission rate is a valid measure of quality is under debate because a given patient's probability of readmission appears heavily influenced by social determinants of health, which hospitals do not directly control. 3 Hospitals may be incentivized to take actions that reduce the racial and ethnic differences in readmission risk without improving health equity, for example, by selectively admitting healthier Black patients and avoiding admissions of individuals with unstable housing or limited social support.In addition, the proposed measure for social determinants of health was the alignment between the proportion of a hospital's cost spent on uninsured charity care and the proportion of uninsured individuals in its communities. However, hospitals provide charity care to both uninsured and underinsured patients, 4 so this measure might reduce incentives for hospitals to assist underinsured patients. Also, nonprofit and for-profit hospitals receive different taxpayer subsidies and thus have different obligations for charity care provision. 4 Organizations adjust behaviors in response to performance measures. We are concerned that the proposed hospital health equity measures outlined in the Viewpoint 1 might induce hospitals to act in ways that do not necessarily improve health equity. More understanding and refinement of these measures are needed to rigorously evaluate hospital performance and motivate hospitals to effectively enhance health equity.