Teaching hospitals have been getting the short end of the stick of late.
Managed-care companies want to direct patients to lower-cost community hospitals. The growth of outpatient services has left teaching hospitals with only the sickest patients to treat. The government continually wants to trim Medicare's financial responsibility for graduate medical education. And teaching hospitals have become a favorite target of federal fraud investigators, who are looking into how their faculty practice plans bill Medicare for their services (See story below).
But new research indicates teaching hospitals might be a much better value for the dollar than often believed, if the standard of measurement is how many patients die and how long they stay in the hospital.
Researchers at Case Western Reserve University School of Medicine compared mortality and length of stay at 30 major teaching, minor teaching and nonteaching hospitals in northeast Ohio.
In an article published in the Aug. 13 Journal of the American Medical Association, they found that patients treated in major teaching hospitals have 19% lower adjusted odds of dying than in a nonteaching hospital. They further discovered that risk-adjusted length of stay was 9% lower in teaching hospitals.
The research covered 89,851 patient discharges from 1991 through 1993 for six conditions: myocardial infarction, congestive heart failure, obstructive airway disease, gastrointestinal hemorrhage, pneumonia and stroke.
The study found that mortality and length of stay at minor teaching hospitals resembled figures at community hospitals.
These results should give pause to any managed-care plan or other payer directing patients away from expensive academic medical centers, the authors said.
"If generalizable to other regions, the results provide evidence that hospital performance, as assessed by two commonly used indicators, may be higher in major teaching hospitals. These results*.*.*.*underscore the potential adverse effects on patient outcomes of purchasing decisions that shift hospital utilization patterns away from major teaching hospitals and to other hospitals," they wrote.
The Association of American Medical Colleges, the lobby for 125 medical schools, endorsed the study's observation that "cost of care should not be the only, or even primary, benchmark used to make delivery of care decisions."
In an accompanying JAMA editorial, a professor at Harvard Medical School argues that "quality at the level of each individual patient" might not be the best measure of value for major teaching hospitals. Their role as scientific laboratories and training grounds for clinicians justifies their existence independently, the editorial said.
The American Association of Health Plans, the HMO industry's lobbying arm, said managed-care plans already demonstrate their commitment to teaching hospitals by sending more of their patients there than fee-for-service insurers do.
Capitated plans send 27% of patients to teaching hospitals, while fee-for-service plans send 22%, according to an AAHP-commissioned study, What's more, HMOs pay teaching hospitals about 12% more than they pay nonteaching hospitals.