“We found it really interesting that the lower costs seen at major teaching hospitals was driven primarily by lower costs after discharge from the hospital,” Dr. Laura G. Burke from Harvard T. H. Chan School of Public Health, in Cambridge, Massachusetts, told Reuters Health by email. “It seems that this lower post-discharge spending offset the higher costs of the initial hospital stay.”
Teaching hospitals are generally considered to be more expensive than nonteaching hospitals, leading some insurers and policymakers to advocate shifting care away from these institutions in order to lower healthcare spending. The actual extent to which this might be true is not clear.
Dr. Burke and colleagues investigated whether hospital teaching status was associated with differences in total spending for Medicare beneficiaries within 30 and 90 days of a hospitalization across a broad range of clinical conditions.
The study included 1.2 million hospitalizations at 232 major teaching hospitals, 837 minor teaching hospitals and 1,995 nonteaching hospitals.
The adjusted total standardized costs at 30 days were lowest at major teaching hospitals ($18,275), followed by minor teaching hospitals ($18,706) and then nonteaching hospitals ($18,850), the team reported in JAMA Network Open, online June 7.
Results were similar after adjusting for patient characteristics and when considering medical conditions and surgical procedures separately.
For the index hospitalization, treatment at a major teaching hospital was associated with the highest total spending at 30 days (followed by minor teaching hospitals and nonteaching hospitals), but the opposite was observed for readmission costs (lowest at major teaching hospitals, intermediate at minor teaching hospitals, and highest at nonteaching hospitals).
Postdischarge facility claims were also lowest after treatment at major teaching hospitals, intermediate after treatment at minor teaching hospitals, and highest after treatment at nonteaching hospitals.
The observed 30-day costs were lower at major teaching hospitals than at nonteaching hospitals for 12 of 21 conditions evaluated (with statistically significant associations for three conditions: arrhythmia, congestive heart failure, and acute myocardial infarction), whereas treatment at a major teaching hospital was associated with higher costs for patients hospitalized with stroke.
After adjusting for patient characteristics, there was no association between hospital teaching status and total standardized costs at 90 days. This was also true for medical conditions, but for surgical procedures, treatment at a major teaching hospital was associated with significantly lower total costs at 90 days.
“These findings are consistent with the idea that it is important to examine costs across an entire episode of care, rather than individual components of spending,” Dr. Burke said. “The patterns of care provided at teaching hospitals may actually be more efficient than is widely believed.”
She cautioned, “These results may not be generalizable for the commercially insured where there is wide price variation.”
- Burke LG, Khullar D, Zheng J, et al. Comparison of Costs of Care for Medicare Patients Hospitalized in Teaching and Nonteaching Hospitals. JAMA Netw Open. 2019 Jun 5;2(6):e195229.