J. C. Pradarelli1, C. P. Scally1, H. Nathan1, J. R. Thumma1, J. B. Dimick1 1University Of Michigan,Ann Arbor, MI, USA
Introduction:
Several emerging payment policies penalize hospitals for higher costs. Teaching hospitals may be at a disadvantage given the perception that they deliver care less efficiently.
Methods:
We studied Medicare patients who underwent abdominal aortic aneurysm (AAA) repair (n=74,767), colectomy (n=288,378), or pulmonary resection (n=94,629) from 2009 to 2012. Patients’ hospitals were categorized into quintiles of teaching intensity (very major, major, minor, very minor, and non-teaching hospitals) based on the resident-to-bed ratio. Risk-adjusted 30-day Medicare payments were price-standardized to account for social subsidies and regional variation in costs. Risk-adjusted perioperative outcomes were also assessed.
Results:
Comparing risk-adjusted Medicare payments per episode of surgery, very major teaching hospitals were $13,947 more expensive than non-teaching hospitals for AAA repair ($45,632 vs. $31,685; p<0.001), $19,315 more expensive for colectomy ($52,199 vs. $32,884; p<0.001), and $9,788 more expensive for pulmonary resection ($39,513 vs. $29,725; p<0.001). However, after accounting for social subsidies and regional variation in Medicare payments, very major teaching hospitals were paid only $1,811 more than were non-teaching hospitals for AAA repair ($30,030 vs. $28,219; p=0.35), $4,701 more for colectomy ($35,182 vs. $30,480; p<0.001), and $1,424 less for pulmonary resection ($25,373 vs. $26,796; p=1.00). Very major teaching hospitals generally had higher risk-adjusted rates of serious complications and readmissions, but lower risk-adjusted rates of failure to rescue and 30-day mortality than did non-teaching hospitals.
Conclusion:
After price-standardization to account for intended differences in payments, risk-adjusted Medicare payments for an episode of surgical care were similar at teaching hospitals and non-teaching hospitals for three inpatient operations.