A recent study made possible with support from The Commonwealth Fund and published in Health Affairs shows that major teaching hospitals, or academic health centers (AHCs), make a unique contribution to their communities by delivering highly specialized care, including complex surgical procedures.
“Trends in Specialized Surgical Procedures at Teaching Hospitals and Nonteaching Hospitals,” authored by Rebecca Levin, Ernest Moy, and Paul F. Griner, finds that complex procedures such as bone marrow and liver transplants, reconstructive surgeries, and brain biopsies, are increasingly concentrated in major teaching hospitals. This is trend that is likely to continue, the authors add.
The study finds that from 1989 to 1995, of all surgeries performed, the volume of those very often complex procedures primarily performed in AHCs rose dramatically, from 3.9 percent to 8.1 percent. Thus, increasingly, AHCs are absorbing these complex procedures.
While specialized surgeries account for a relatively modest portion of the care provided by AHCs, the elevated risks and high costs associated with such procedures have important implications for the perceived efficiency of these institutions.
Results also show that patients requiring highly specialized surgeries have more complex conditions, need longer hospital stays, and incur higher total charges than patients undergoing less specialized surgeries. Although these factors effectively raise costs for teaching hospitals, they may not be reflected in current Medicaid or Medicare payments.
Understanding the role of major teaching hospitals in performing highly specialized surgical procedures could shed light on AHCs' higher costs and their efficiency relative to nonteaching hospitals. Without appropriate adjustments made for the cost and severity of cases, the authors conclude, some teaching hospitals may be at greater financial risk than their nonteaching competitors.
Facts and Figures
- From 1989 to 1995, of all surgeries performed, the volume of those very often complex procedures primarily performed in AHCs rose dramatically, from 3.9 percent to 8.1 percent.
- Highly specialized procedures in major teaching hospitals rose from nearly 14,000 in 1989 to 22,470 in 1995, while the number remained essentially flat in other teaching and nonteaching hospitals.
- Recipients of highly specialized and specialized surgeries were younger than were recipients of less specialized surgeries. They were also more likely to be male and nonwhite, and more likely to reside in the poorest or wealthiest neighborhoods.