Wide spectrum of patients see better outcomes at academic medical centers, study finds
Medicare patients who received treatment at an academic medical center (AMC) had lower 30-day mortality rates compared to those at nonteaching hospitals, according to a recent Health Affairs study. This was the case not just for the sickest, but also among less sick patients.
After adjusting for patient and hospital characteristics, the study found high-severity patients had 7% lower odds of 30-day mortality, medium-severity patients had 13% lower odds and low-severity patients had 17% lower odds compared to similar patients at nonteaching facilities. For surgical procedures, high-severity patients had 17% lower odds of mortality, medium-severity patients had 10% lower odds and low-severity patients saw no difference.
“Taken together, these findings suggest that efforts to limit care at academic medical centers have the potential to lead to worse outcomes, as mortality rates for even low-severity patients seem to be lower at the centers,” the study authors wrote.
AMCs are often seen as a better alternative for patients with complex conditions.
However, some payers exclude those facilities from narrow networks because they have higher costs. The study, funded by the Association of American Medical Colleges, looked at 11.8 million hospitalizations between 2012 and 2014 in nearly 4,500 hospitals, most of which were nonteaching facilities.
Academic centers are thought of as places to care for the sickest patients because of their breadth of expertise, technology and innovative programs. But, because of the high spending, they haven't been seen as the best option for those needing less intense care. The Health Affairs report, however, shows that AMCs can improve outcomes for patients who are not the sickest.
The authors acknowledged being somewhat surprised about the association between status and mortality being as strong or stronger among low- and medium-severity patients compared to high-severity patients with common medical conditions. They said the result could be because healthier patients get the benefit of the AMC's abilities if there are complications, or that AMCs have lower rates of diagnostic errors for some conditions, which improves outcomes.
Given the higher costs of AMCs, the study authors said figuring out which patient groups would benefit from receiving care at a teaching facility is “an important step toward a higher-value care system.” They suggested that stratifying by risk will likely not be worthwhile. “To the extent that policymakers or clinical leaders want to steer patients away from teaching hospitals, they will need a different approach to identify which patients don’t benefit from that care,” they wrote.
AMCs face a challenging world of higher expenses, payers nudging patients to lower-cost facilities, lower Medicare and Medicaid reimbursements and reduced government funding for research. That’s pushing some to look at M&As and partnerships with nonacademic providers to survive. A 2017 JAMA report suggested that AMCs that merge with nonacademic providers may put their research missions at risk.