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Appendix A
ACADEMIC HEALTH CENTERS:
ALL S , ALL DIFFERENT,
THE AME
OR ...
Report Prepared for
The Committee on the Roles of Academic Health Centers
in the 21st Century
Presented by:
Gerard Anderson, Ph.D.
The Johns Hopkins University Bloomberg School of Public Health
July 30, 2002
161
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162 ACADEMIC HEALTH CENTERS
OBJECTIVES
This analysis examines the variation in roles across academic health
centers (AHCs) for calendar year 2000. Roles examined are research, edu-
cation, patient care, and care for the poor and uninsured. The rates of
change in these roles between 1990 and 2000 are compared. The objectives
of the analysis are to:
· Determine whether there are natural groupings of AHCs.
· Compare the activities among (1) AHC hospitals, (2) large teaching
hospitals, and (3) small teaching hospitals.
DEFINITIONS
For purposes of this analysis, the following definitions are used:
Academic health center (AHC)
-- Consists of a medical school and only one primary teaching hos-
pital.
-- The primary teaching hospital is determined based on data show-
ing where most of the residents are trained. Data on other affili-
ated teaching hospitals are not included in the definition of an
AHC. Some expert judgment was also involved in choosing the
primary teaching hospital. A primary teaching hospital could not
be established for osteopathic medical schools.
-- Data from nursing, public health, and other related health profes-
sions schools, if they exist, are included in the definition of the
AHC.
Hospital classification
-- Large teaching hospital--not the primary affiliate of a medical
school and has more than 0.25 residents per bed.
-- Small teaching hospital--not the primary affiliate of a medical
school, and has an Accreditation Council for Graduate Medical
Education (ACGME) approved residency program and 0.25 or
fewer residents per bed.
-- Private hospital--includes both nonprofit and for-profit hospi-
tals.
-- Freestanding AHC--not a component of a larger university; pri-
mary activity is as an academic medical center.
-- University-based AHC--combine the American Association of
Medical Colleges (AAMC) definitions of related/proximate and
related/distant institutions. Proximate medical schools are located
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APPENDIX A 163
in the same city as the parent university; distant medical schools
are not located in the same city as the parent university.
National Institutes of Health (NIH) funds--include direct and indirect payments.
Graduate Medical Education (GME) payments--include only direct gradu-
ate medical education payments from Medicare Cost Reports worksheet
E3, Part IV.
Small metropolitan statistical area (MSA)--an area with fewer than 1 mil-
lion inhabitants.
AHC top 50 ranking
-- AHCs were ranked based on the level of:
Total NIH funding
Total Medicare disproportionate share (DSH) funding
Total direct Medicare GME funding
-- AHCs were then classified based on whether they were in the top
50 in none, one, two, or all three above categories (for example,
top 50 in both NIH and GME funding).
Dispersion--defined as the ratio of the value of the academic medical center
at the 75th percentile to the value of the academic medical center at the
25th percentile.
-- Low dispersion--ratio of the 75th percentile to the 25th percen-
tile is less than 2.0.
-- Medium dispersion--ratio of the 75th percentile to the 25th per-
centile is 2.0 to 2.9
-- High dispersion--ratio of the 75th percentile to the 25th percen-
tile is 3.0 or greater.
Margins
The Medicare Payment Advisory Commission (MedPAC) calculated
three types of margins for this analysis that are included in Tables A-1 and
A-2: Medicare hospital inpatient margins excluding direct GME payments
and costs, overall Medicare margins including direct GME payments and
costs, and total hospital margins. These calculations use 1999 data and are
based on a slightly different sample of hospitals.
The margins are calculated as revenues minus costs divided by rev-
enues. The Medicare margins are based on Medicare-allowed costs. The
overall Medicare margin includes the largest Medicare services: acute inpa-
tient, outpatient, rehabilitation, and psychiatric units; skilled nursing facil-
ity; and home health agency. It also reflects Medicare payments for direct
GME and bad debts. The total margin reflects the relationship of all hospi-
tal revenues to all costs (including Medicare-nonallowed costs).
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164 ACADEMIC HEALTH CENTERS
METHODS
Roles
As noted, this analysis examines four activities of academic health
centers, which are measured using available indicators: research, education,
patient care, and indigent care. Analysis of the data is presented by role.
Only statistically significant results are discussed. Statistically significant
results that are obvious, such as hospitals with more beds also having a
higher average daily census, are not discussed.
Data Sources
The following data sources are used in this analysis:
· Medicare Hospital Cost Reports for FY 1990 and 1999
· American Hospital Association Annual Surveys for 1990 and
2000
· NIH data on trends in awards to medical schools 1990 and 2000
· American Association of Health Service Library Surveys, 1990
and 2000
· American Association of Colleges of Nursing Annual Survey,
1994 and 2001, special runs performed for this project
· AAMC, special runs performed for this project.
· MedPAC, special runs performed for this project
DATA ANALYSIS
These analyses are based on 120 AHC hospitals and 119 medical
schools. Cost data for FY 1990 and 1999 are based on 117 hospitals.
· Statistics provided for all variables as of the calendar year 2000:
-- Mean
-- 25th percentile
-- Median
-- 75th percentile
-- Total rate of change between 1990 and 2000
· Characteristics of Academic health center hospitals:
-- Size
Fewer than 500 beds
Greater than or equal to 500 beds
-- Ownership
Government
Private (nonprofit or for-profit)
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APPENDIX A 165
-- MSA
Fewer than 1 million inhabitants
More than 1 million inhabitants
-- Location
Northeast
South
Midwest
West
· Characteristics of Medical Schools
-- Date founded
Before 1960
During or after 1960
-- Type
Free standing
University based
· Top 50 ranking by funding category
-- NIH, GME, and DSH
-- NIH and GME only
-- NIH and DSH only
-- GME and DSH only
-- NIH only
-- GME only
-- DSH only
-- Not top 50 in any category
· Differences among groups calculated using analysis of variance
(ANOVA). Statistically significant differences (p <.05) are shown in bold in
the tables.
RESULTS
The empirical results are reported as follows:
· Table A-1--Dispersion Across the AHCs by Activity, 2000
· Table A-2--Comparison of the AHCs by Characteristic, 2000
· Table A-3--Comparison by Top 50 in Funding Criteria, 2000
· Table A-4--Rate of Change in Activity by Statistical Dispersion
Category, 19902000
· Table A-5--Rate of Change in Activity by AHC Characteristic,
19902000
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166 ACADEMIC HEALTH CENTERS
· Table A-6--Rate of Change in Activity by Top 50 Funding Crite-
ria, 19902000
· Table A-7--Comparison of Hospitals by Teaching Program Size,
2000
· Table A-8--Rate of Change in Activity by Teaching Program
Size, 19902000
· Table A-9--Provision of Specialized Services by Teaching Status
· Table A-10--Comparison of Market Share by Teaching Program
Size
SUMMARY OF RESULTS BY ROLE
Research
· The greatest disparity among AHCs occurs in level of research
funding.
· Certain categories of AHCs received more research funding than
others.
· NIH funding increased 126 percent at the mean AHC between 1990
and 2000.
· While there were differences in the rate of increase in research fund-
ing across AHCs between 1990 and 2000, there were few statistically sig-
nificant differences by type of AHC.
Education
· In general, educational variables showed moderate to low dispersion
and generally did not vary systematically by type of AHC.
· The number of residents increased by 35 percent and the number of
nursing students increased by 9 percent between 1990 and 2000.
· GME payments per resident actually declined from 1990 to 2000 by
3 percent.
· There was little systematic change between 1990 and 2000 in the
level of commitment to education by category of AHC.
Patient Care
· Patient care services showing moderate dispersion across AHCs were
total emergency room visits, total outpatient visits, Medicare inpatient days,
Medicaid inpatient days, and percent Medicaid inpatient days. All the other
patient care services had low dispersion. The committee noted the low
dispersion in percent Medicare days.
· Among AHCs, the greatest dispersion among patient care services
was seen between AHCs with large and small hospitals and between hospi-
tals located in the Northeast and those located elsewhere.
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APPENDIX A 167
· Between 1990 and 2000, the most rapid increase occurred in outpa-
tient and emergency room visits.
· On most patient care variables, there were no systematic differences
in the rate of change between 1990 and 2000 by category of AHC.
Disproportionate Share
· There was high dispersion in DSH payments per Medicare discharge.
· Higher DSH payments per Medicare discharge were received by
AHCs located in larger MSAs and by public AHCs.
· Mean DSH payments per Medicare discharge increased 91 percent
between 1990 and 2000. There were no systematic differences by category
of AHC.
Market Share
· Hospitals were classified into four groups--AHC hospitals, large
teaching, small teaching, and nonteaching hospitals. AHC hospitals gener-
ally provide more education, patient care, and DSH share than the other
types of hospitals.
· AHC hospitals generally provide more education, patient care, and
disproportionate share than the other types of hospitals.
· The level of commitment to education did not change among AHC
hospitals, large teaching hospitals, and small teaching hospitals between
1990 and 2000.
· While AHCs are only 3 percent of all hospitals, they provide a much
larger proportion of training and patient care. However, they are not the
majority (> 50 percent) producer of any services. They provide 48 percent
of residency training.
· The market share of AHCs increased between 1990 and 2000.
Notes on Table A-1
Dispersion Across the AHCs by Activity
Research
· The greatest dispersion across the AHCs for all variables occurs with
respect to the level of NIH funding. In 2000, the AHC at the 25th percentile
received $11.6 million in NIH funding, compared with $90.7 million for
the AHC at the 75th percentile. In other words, the AHC at the 75th
percentile received 7.8 times more NIH funding than the AHC at the 25th
percentile. Using this measure of dispersion, this is the indicator with the
largest variation of all variables analyzed.
· Among all indicators studied, the second-greatest amount of disper-
sion occurs with respect to NIH funding per full-time equivalent (FTE)
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168 ACADEMIC HEALTH CENTERS
faculty member. At the 25th percentile, the average faculty member receives
$27,244 in NIH funding, compared with $86,769 at the 75th percentile.
Education
· Across AHCs, there is moderate dispersion in the total number of
residents and total clinical faculty.
· Across academic health centers, there is relatively low variance in
biological Medical College Admissions Test (MCAT) scores, percentage
family practice residents, percentage internal medicine residents, percentage
pediatrics residents, percentage primary care residents, number of residents
per bed, GME payments per resident, number of nursing school graduates,
and library recurring expenditures.
Patient Care Services
· None of the patient care services showed high dispersion across the
AHC hospitals.
· Moderate dispersion was demonstrated in:
-- Total emergency room visits
-- Total outpatient visits
-- Total Medicare inpatient days
-- Total Medicaid inpatient days
-- Percent Medicaid inpatient days
· Low dispersion was demonstrated in
-- Average daily census
-- Total hospital inpatient beds
-- Occupancy rate
-- Total inpatient days
-- Percent Medicare inpatient days
-- Medicare case mix index
-- Total FTE personnel
-- FTE nurses per 1,000 inpatient days
-- Total FTE personnel per 1,000 inpatient days
-- Length of stay (overall, Medicare, Medicaid)
· There was high dispersion in disproportionate share payments per
Medicare discharge.
Notes on Table A-2
Comparison of the AHC by Characteristic
AHC Characteristics
· AHCs in larger MSAs, AHC hospitals with more than 500 beds, and
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APPENDIX A 169
AHCs with medical schools founded before 1960 all received more total
NIH funding than their counterparts in 2000.
Research
· There was no difference in the level of total NIH funding between
freestanding and university-based AHCs or between public and private
institutions.
· NIH funding per FTE faculty member was greater in larger MSAs,
AHCs with larger hospitals, medical schools founded prior to 1960, and
AHCs located in the West.
· No difference in the level of NIH funding per FTE faculty member
was detected between public and private institutions or between freestand-
ing and university-based AHCs.
Education
· AHCs in large MSAs and medical schools founded prior to 1960 had
higher resident-to-bed ratios and more recurring library expenditures.
· AHCs located in the West had the highest ratios of residents to beds.
· AHCs located in the Northeast received the highest level of GME
funding per resident.
Patient Care
· AHC hospitals located in small MSAs had a higher percentage of
Medicare patients and lower Medicare overall and inpatient margins.
· Public AHC hospitals had a smaller percentage of Medicare patients
and a larger percentage of Medicaid patients than private hospitals.
· Smaller AHC hospitals had more FTEs per 1,000 inpatient days,
shorter overall and Medicare lengths of stay, and a lower Medicare case
mix.
· AHC hospitals whose medical school was founded before 1960 had
more nurses per 1,000 inpatient days.
· AHC hospitals located in the Northeast had the longest lengths of
stay (overall, and Medicare), fewest FTE nurses per 1,000 inpatient day,
fewest FTE personnel per 1,000 inpatient days, lowest percent of Medicaid
days, highest occupancy rate, and highest Medicare overall and Medicare
inpatient margins.
DSH Funds
· AHC hospitals located in larger MSAs received higher DSH pay-
ments per Medicare discharge.
· Public AHC hospitals received higher DSH payments per Medicare
beneficiary.
· AHC hospitals located in the West received more DSH payments per
Medicare discharge.
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170 ACADEMIC HEALTH CENTERS
Notes on Table A-3
Comparison by Top 50 in Funding Criteria
· AHCs with the highest resident-to-bed ratios were in the top 50 in
GME only while AHCs that were in the top 50 in DSH only had the lowest
ratios.
· AHCs that are in the top 50 on GME only received the highest GME
payments per resident while AHCs in the top 50 in NIH only received the
lowest.
· AHCs that are in the top 50 in both NIH and GME had the most
nursing graduates, while those that were not in the top 50 on any category
had the least.
· AHC hospitals that were in the top 50 for DSH only had the highest
percentage of Medicaid days, while those that are in the top 50 in NIH and
GME had the lowest.
· AHC hospitals with the highest occupancy rates were in the top 50
for GME only, while hospitals with the lowest occupancy rates were not in
the top 50 in any category.
Notes on Table A-4
Rate of Change in Activity by Statistical Dispersion Category
(1990-2000)
Research
· The mean increase in NIH funding for all AHCs between 1990 and
2000 was 126 percent. The increase in the level of funding varied consider-
ably. The AHC at the 25th percentile had an NIH funding increase of 60
percent while the AHC at the 75th percentile had an NIH funding increase
of 161 percent.
Education
· At AHC hospitals, the total number of residents increased an aver-
age of 33 percent between 1990 and 2000. The number of residents in-
creased 1 percent in the AHC hospital at the 25th percentile and 44 percent
in the AHC hospital at the 75th percentile
· The resident-per-bed ratio increased by 35 percent between 1990
and 2000. The ratio in the AHC hospital at the 25th percentile increased 12
percent while that in the AHC hospital of the 75th percentile increased 50
percent.
· The mean of the distribution of percentage changes across all institu-
tions that graduated nurses in both 1990 and 2000 was 9 percent. At the
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APPENDIX A 171
25th percentile, the decline was 17 percent, while at the 75th percentile the
increase was 12 percent.
Patient Care
· Between 1990 and 2000, the greatest increase occurred in outpatient
visits, followed by emergency room visits and total FTE personnel per
1,000 inpatient days.
Patient Care--DSH
· The mean AHC hospital received 91 percent more in DSH payments
per Medicare discharge in 2000 than in 1990. The 25th percentile AHC
hospital received 31 percent more, while the 75th percentile AHC hospital
received 123 percent more.
Notes on Table A-5
Rate of Change in Activity by AHC Characteristic (1990-2000)
· On most educational variables, the rate of increase between 1990
and 2000 did not vary systematically by category of AHC. The one excep-
tion was total residents, which increased more rapidly at private hospitals.
· There were few statistically significant differences in the rate of in-
crease from 1990 to 2000 by category of AHC hospital for patient care
variables. The one major exception was private hospitals, which had greater
increases in the number of outpatient visits and total FTE personnel and
showed a more rapid decline in overall length of stay. It is also noted that
private hospitals had a statistically significant increase in hospital beds as
compared with public hospitals, which experienced a decline in that time
period.
· AHC hospitals in the Midwest showed the greatest decline in overall
length of stay (LOS) while those in the Northeast showed the greatest
overall decline in Medicare LOS.
· AHCs whose medical schools were founded before 1960 saw their
NIH funds increase more rapidly than AHCs whose medical schools were
founded during or after 1960.
· There were no statistically significant differences in rate of increase
in NIH funding by:
-- Level of funding in 1990
-- MSA size
-- Number of hospital beds
-- University based vs. freestanding
-- Ownership (public vs. private)
-- Region
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APPENDIX A 187
1 AHC 2+ AHCs in <500 500+
in MSA MSA Private Public beds beds
137% 108% 126% 127% 131% 122%
35% 28% 43% 20% 34% 37%
34% 37% 39% 29% 43% 28%
1% 6% 7% 2% 1% 7%
81% 80% 66% 93% 66% 94%
6% 17% 3% 20% 15% 4%
2% 10% 0% 6% 7% 2%
49% 63% 66% 33% 38% 69%
135% 128% 171% 61% 107% 157%
2% 4% 5% 6% 4% 8%
9% 7% 9% 7% 7% 9%
7% 6% 8% 2% 6% 5%
10% 12% 2% 22% 14% 3%
9% 13% 6% 14% 13% 4%
0% 1% 1% 1% 0% 1%
3% 2% 2% 3% 3% 2%
22% 18% 19% 23% 20% 20%
30% 21% 31% 18% 24% 29%
33% 33% 33% 34% 32% 34%
32% 39% 36% 32% 38% 32%
16% 18% 20% 11% 17% 16%
32% 30% 32% 29% 32% 30%
5% 2% 5% 1% 6% 1%
85% 102% 95% 82% 83% 98%
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188 ACADEMIC RESEARCH CENTERS
TABLE A-5-2 Rate of Change in Activity by AHC Characteristic, 1990-2000
All Academic Health Centers
Percent Change 1990-2000
(bold values differ by p <.05)
Post-1960 Pre-1960 Freestanding
% Chg. - NIH Funding 97% 139% 127%
% Chg. - Total Residents--Hospital 40% 30% 21%
% Chg. - Residents per Bed 40% 33% 26%
% Chg. - GME $ per resident 1% 4% 10%
% Chg. - Library Recurring Expense 94% 72% 84%
% Chg. - Nursing Graduates 2% 14% 46%
% Chg. - Average daily census 4% 5% 3%
% Chg. - Total ER visits 52% 55% 59%
% Chg. - Total outpatient visits 125% 138% 142%
% Chg. - Total Hospital Beds 1% 0% 1%
% Chg. - Occupancy Rate 8% 8% 9%
% Chg. - Medicare IP Days--Total Hospital 8% 9% 13%
% Chg. - Medicaid IP Days--Total Hospital 20% 6% 9%
% Chg. - Total IP Days--Hospital 8% 11% 13%
% Chg. - % MCR IP Days (Hospital) 0% 0% 1%
% Chg. - % MCD IP Days (Hospital) 4% 2% 1%
% Chg. - Casemix Index 21% 20% 24%
% Chg. - FTE total personnel 31% 24% 20%
% Chg. - FTE Nurses per 1000 IP Days 26% 35% 25%
% Chg. - Total FTE per 1000 IP Days 33% 36% 28%
% Chg. - Overall LOS 15% 18% 13%
% Chg. - Medicare LOS 31% 31% 31%
% Chg. - Medicaid LOS 4% 4% 4%
% Chg. - Disp Shr Payment per MCR dischg. 105% 85% 105%
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APPENDIX A 189
University-
Based Northeast South Midwest West
126% 92% 137% 143% 128%
36% 42% 25% 42% 19%
38% 45% 32% 39% 19%
1% 7% 3% 1% 1%
73% 83% 80% 91% 73%
2% 56% 2% 9% 3%
2% 4% 7% 6% 4%
53% 75% 51% 44% 46%
132% 183% 87% 162% 110%
1% 0% 3% 3% 3%
8% 6% 9% 8% 10%
7% 13% 3% 9% 0%
11% 17% 8% 5% 36%
9% 8% 14% 6% 10%
0% 2% 2% 2% 1%
3% 4% 0% 0% 10%
19%
28% 35% 18% 30% 27%
35% 28% 31% 42% 31%
36% 34% 33% 43% 27%
18% 17% 13% 24% 14%
31% 37% 27% 32% 29%
6% 19% 12% 13% 0%
87% 119% 104% 73% 47%
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190 ACADEMIC RESEARCH CENTERS
TABLE A-6 Rate of Change in Activity by Top 50 Funding Criteria, 1990-2000
All Academic Health Centers, 2000
Percent Change 1990-2000
(bold values differ by p <.05)
Top 50, Top 50, Top 50,
Variable NIH, GME, DSH NIH and GME NIH and DSH
% Chg. - NIH Funding 120% 159% 123%
% Chg. - Total Residents--Hospital 40% 37% 5%
% Chg. - Residents per Bed 36% 39% 24%
% Chg. - GME $ per resident 5% 4% 18%
% Chg. - Library Recurring Expense 82% 73% 78%
% Chg. - Nursing Graduates 16% 4% 0%
% Chg. - Average daily census 6% 1% 19%
% Chg. - Total ER visits 41% 90% 39%
% Chg. - Total outpatient visits 126% 200% 30%
% Chg. - Total Hospital Beds 4% 1% 12%
% Chg. - Occupancy Rate 8% 5% 5%
% Chg. - Medicare IP Days--Total Hospital 6% 9% 21%
% Chg. - Medicaid IP Days--Total Hospital 11% 38% 22%
% Chg. - Total IP Days--Hospital 6% 8% 18%
% Chg. - % MCR IP Days (Hospital) 0% 1% 1%
% Chg. - % MCD IP Days (Hospital) 1% 9% 2%
% Chg. - Medicare Casemix Index 22% 21% 24%
% Chg. - FTE total personnel 29% 38% 10%
% Chg. - FTE Nurses per 1000 IP Days 35% 39% 16%
% Chg. - Total FTE per 1000 IP Days 39% 36% 16%
% Chg. - Overall LOS 18% 22% 16%
% Chg. - Medicare LOS 32% 28% 29%
% Chg. - Medicaid LOS 7% 19% 4%
% Chg. - Disp Shr Payment per MCR dischg. 101% 95% 48%
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APPENDIX A 191
Top 50,
GME and DSH Top 50, NIH Top 50, GME Top 50, DSH None
137% 120% 119% 166% 110%
34% 23% 22% 33% 36%
36% 23% 21% 25% 45%
12% 2% 11% 5% 1%
78% 67% 86% 143% 62%
0% 8% 11% 2% 22%
14% 7% 7% 12% 3%
53% 97% 53% 102% 26%
163% 236% 55% 166% 95%
1% 4% 0% 11% 5%
7% 9% 6% 8% 11%
8% 7% 27% 16% 16%
9% 14% 21% 6% 14%
10% 7% 6% 1% 16%
0% 1% 2% 3% 0%
1% 3% 7% 1% 3%
10% 18% 16% 18% 23%
15% 46% 33% 29% 24%
34% 39% 52% 43% 26%
41% 40% 44% 20% 37%
15% 16% 15% 17% 15%
31% 29% 28% 33% 32%
12% 0% 14% 8% 7%
147% 71% 100% 80% 81%
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192 ACADEMIC RESEARCH CENTERS
TABLE A-7 Comparison of Hospitals by Teaching Program Size, 2000
All Academic Health Centers, 2000
(bold values differ by p <.05)
Large Small Non-teaching,
Variable AHC Teaching Teaching 100+ Beds
Total Residents--Hospital 308 149 34 N/M
Residents per Bed 0.59 0.42 0.09 N/M
GME $ per resident $65,200 $78,262 $72,599 N/M
Average daily census 428 320 249 122
Total ER visits 57,690 54,408 44,516 25,862
Total outpatient visits 419,145 318,624 240,677 111,828
Total Hospital Beds 532 367 346 195
Occupancy Rate 69% 66% 59% 46%
Medicare IP Days--Total Hospital 40,331 33,959 32,294 15,592
Medicaid IP Days--Total Hospital 27,970 15,811 8,628 3,576
Total IP Days--Hospital 135,726 94,204 76,573 31,857
% MCR IP Days (Hospital) 30% 37% 43% 52%
% MCD IP Days (Hospital) 20% 17% 11% 12%
Medicare Casemix Index 1.77 1.53 1.54 1.30
FTE total personnel 3,774 2,566 1,895 812
FTE Nurses per 1,000 IP Days 6.8 6.8 6.1 5.6
Total FTE per 1,000 IP Days 25.4 28.0 22.3 19.9
Overall Length of Stay (LOS) 5.8 5.3 4.9 4.6
Medicare LOS 6.5 6.5 5.9 5.5
Medicaid LOS 6.3 5.8 5.0 4.2
DSH per Medicare dischg. $1,454 $1,081 $597 $457
Has HIV/AIDS Unit 92% 79% 67% 38%
Has Burn Unit 57% 20% 23% 2%
Has Geriatric Unit 80% 73% 68% 48%
Has Neonatal Unit 83% 63% 57% 17%
Has Pediatric Unit 68% 44% 29% 6%
Has PET Scanner 48% 14% 17% 7%
Has Transplant Services 88% 26% 26% 5%
Has Trauma Center 87% 57% 57% 30%
Has Angioplasty center 96% 60% 72% 30%
Has Open Heart Surgery 95% 55% 67% 27%
* Small teaching means ACGME residency program or residents/bed >0.
* Nonteaching means any hospital not in the first three groups with 100+ beds in 2000.
** NM means not meaningful, because these hospitals have no residents.
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APPENDIX A 193
TABLE A-8 Rate of Change in Activity by Teaching Program Size, 1990-2000
All Academic Health Centers, 2000
Percent Change, 1990-2000
(bold values differ by p <.05)
Large Small Non-teaching,
Variable AHC Teaching Teaching* 100+ Beds*
% Chg. - Total Residents--Hospital 33% 26% 47% NM**
% Chg. - Residents per Bed 35% 54% 61% NM**
% Chg. - GME $ per resident 3% 6% 11% NM**
% Chg. - Average daily census 2% 18% 6% 15%
% Chg. - Total ER visits 54% 35% 51% 45%
% Chg. - Total outpatient visits 133% 105% 138% 123%
% Chg. - Total Hospital Beds 0% 16% 9% 6%
% Chg. - Occupancy Rate 8% 9% 6% 7%
% Chg. - Medicare IP Days--Total Hospital 7% 30% 9% 13%
% Chg. - Medicaid IP Days--Total Hospital 10% 2% 11% 13%
% Chg. - Total IP Days--Hospital 10% 25% 5% 16%
% Chg. - % MCR IP Days (Hospital) 0% 4% 2% 1%
% Chg. - % MCD IP Days (Hospital) 2% 1% 1% 1%
% Chg. - Medicare Casemix Index 20% 14% 11% 7%
% Chg. - FTE total personnel 26% 12% 30% 32%
% Chg. - FTE Nurses per 1,000 IP Days 33% 61% 45% 46%
% Chg. - Total FTE per 1,000 IP Days 35% 60% 46% 45%
% Chg. - Overall Length of Stay (LOS) 17% 25% 22% 19%
% Chg. - Medicare LOS 31% 35% 31% 27%
% Chg. - Medicaid LOS 4% 9% 10% 12%
% Chg. - DSH per Medicare dischg. 91% 92% 69% 72%
* Small teaching means ACGME residency program or residents/bed >0.
* Nonteaching means any hospital not in the first three groups with 100+ beds in 2000.
** NM means not meaningful, because these hospitals have no residents.
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194 ACADEMIC RESEARCH CENTERS
TABLE A-9 Provision of Specialized Serviced by Teaching Status
Provision of Specialized Services
Who Provides What Services
Large Small
Variable AHC Teaching Teaching Nonteaching
Total Hospital Beds 10% 8% 31% 51%
Medicare Inpatient Days--Hospital 9% 9% 34% 48%
Medicaid Inpatient Days--Hospital 20% 17% 30% 34%
Total Inpatient Days--Hospital 13% 11% 35% 41%
Interns and Residents--Hospital 48% 30% 22% 0%
Total Medicare Discharges--Hospital 8% 8% 34% 50%
Total Medicaid Discharges--Hospital 16% 14% 30% 41%
Total Discharges--Hospital 11% 10% 35% 44%
Has HIV AIDS Unit 10% 8% 20% 62%
Has Burn Unit 43% 16% 17% 23%
Has Geriatrics Unit 6% 6% 16% 72%
Has Neonatal Unit 16% 12% 31% 41%
Has Pediatric Unit 23% 16% 29% 32%
Has >1 PET Scanner 22% 7% 23% 48%
Has Single PET Scanner 8% 5% 18% 69%
Has Transplant Services 33% 10% 28% 29%
Has Trauma Center 9% 6% 18% 67%
Has Angioplasty Center 13% 8% 29% 50%
Has Open Heart Surgery 15% 9% 32% 43%
Percent of Hospitals 3% 4% 9% 84%
SOURCES: Hospital Cost Report Information System, 1999; American Hospital Association, 2000.
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APPENDIX A 195
TABLE A-10 IS ON THE NEXT PAGE
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196 ACADEMIC RESEARCH CENTERS
TABLE A-10 Comparison of Market Share by Teaching Program Size
Summary of Market Share for AHC and Other Hospitals
Hospital Cost Report Information System (HCRIS), 1990 and 1999
12-Month Reporting Period; Short Term, Non-Federal Hospitals
Hospital Cost Report Information Large Small
System, 1990 (sums) AHC Teaching Teaching Nonteaching
Total Hospital Beds 63,492 46,357 278,088 480,139
Medicare Inpatient Days--
Total Hospital 5,391,356 4,320,665 29,998,331 43,837,324
Medicaid Inpatient Days--
Total Hospital 4,081,416 2,969,668 8,142,101 8,978,683
Total Inpatient Days--Hospital 18,126,428 13,220,641 67,855,270 88,833,843
Interns and Residents--Hospital 29,233 20,017 22,808 --
Total MCR Discharges--Hospital 557,916 430,066 3,289,418 5,602,497
Total MCD Discharges--Hospital 619,421 475,744 1,376,539 1,804,251
Total Discharges--Hospital 2,577,235 1,939,022 10,611,524 15,464,833
% of Hospitals 2% 2% 17% 79%
% of Totals
Total Hospital Beds 7% 5% 32% 55%
Medicare Inpatient Days--
Total Hospital 6% 5% 36% 52%
Medicaid Inpatient Days--
Total Hospital 17% 12% 34% 37%
Total Inpatient Days--Hospital 10% 7% 36% 47%
Interns and Residents--Hospital 41% 28% 32% 0%
Total MCR Discharges--Hospital 6% 4% 33% 57%
Total MCD Discharges--Hospital 14% 11% 32% 42%
Total Discharges--Hospital 8% 6% 35% 51%
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APPENDIX A 197
TABLE A-10 Continued
Hospital Cost Report Information
System, 1999 (sums)
Total Hospital Beds 63,064 52,395 198,408 321,031
Medicare Inpatient Days--Hospital 4,763,347 4,669,159 18,009,980 24,925,268
Medicaid Inpatient Days--Hospital 3,306,950 2,776,128 4,946,093 5,691,269
Total Inpatient Days-- Hospital 16,050,935 13,689,631 43,257,039 50,686,618
Interns and Residents--Hospital 36,111 22,376 16,270 --
Total MCR Discharges--Hospital 724,861 698,953 2,998,947 4,510,503
Total MCD Discharges--Hospital 554,365 489,894 1,044,790 1,447,558
Total Discharges--Hospital 2,776,901 2,535,508 8,941,337 11,158,306
% of Hospitals 3% 4% 18% 75%
% of Totals
Total Hospital Beds 10% 8% 31% 51%
Medicare Inpatient Days--Hospital 9% 9% 34% 48%
Medicaid Inpatient Days--Hospital 20% 17% 30% 34%
Total Inpatient Days--Hospital 13% 11% 35% 41%
Interns and Residents--Hospital 48% 30% 22% 0%
Total MCR Discharges--Hospital 8% 8% 34% 50%
Total MCD Discharges--Hospital 16% 14% 30% 41%
Total Discharges--Hospital 11% 10% 35% 44%
Representative terms from entire chapter:
inpatient days
