Academic health centers: Exploring a financial paradox

Health Affairs

Volumn 18, Issue 2, 1999, Pages 156-167

  Anderson, Gerard F ^a   Greenberg, George ^b   Lisk, Craig K ^c  

^a JOHNS HOPKINS UNIVERSITY   (United States)

^b Department of Health Service ^*

^c Medicare Payment Advisory Commission   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

ARTICLE; ECONOMICS; FINANCIAL MANAGEMENT; HEALTH INSURANCE; HUMAN; MEDICAID; MEDICAL EDUCATION; MEDICARE; UNITED STATES; UNIVERSITY HOSPITAL;

ACADEMIC MEDICAL CENTERS; EDUCATION, MEDICAL; HUMANS; INSURANCE, HEALTH; MEDICAID; MEDICARE; RESEARCH SUPPORT; UNITED STATES;

EID: 0033089296     PISSN: 02782715     EISSN: None     Source Type: Journal    
DOI: 10.1377/hlthaff.18.2.156     Document Type: Article

References (66)

1. J. Kassirer, "Academic Medical Centers under Siege " New England Journal of Medicine 331, no. 20 (1994): 1370-1371; D. Blake, "Whither Academic Values during the Transition from Academic Medical Centers to Integrated Health Delivery Systems?" Academic Medicine 71, no. 8 (1996): 818-819; and J.K. Iglehart, "Rapid Changes for Academic Health Centers," New England Journal of Medicine 331, no. 20 (1994): 1391-1395.
2. J. Kassirer, "Academic Medical Centers under Siege " New England Journal of Medicine 331, no. 20 (1994): 1370-1371; D. Blake, "Whither Academic Values during the Transition from Academic Medical Centers to Integrated Health Delivery Systems?" Academic Medicine 71, no. 8 (1996): 818-819; and J.K. Iglehart, "Rapid Changes for Academic Health Centers," New England Journal of Medicine 331, no. 20 (1994): 1391-1395.
3. J. Kassirer, "Academic Medical Centers under Siege " New England Journal of Medicine 331, no. 20 (1994): 1370-1371; D. Blake, "Whither Academic Values during the Transition from Academic Medical Centers to Integrated Health Delivery Systems?" Academic Medicine 71, no. 8 (1996): 818-819; and J.K. Iglehart, "Rapid Changes for Academic Health Centers," New England Journal of Medicine 331, no. 20 (1994): 1391-1395.
4. Commonwealth Fund Task Force on Academic Health Centers, Leveling the Playing Field: Financing the Missions of Academic Health Centers (Boston: Massachusetts General Hospital, May 1997). Space precludes a thorough literature review; contact Gerard Anderson at Johns Hopkins University, Center for Hospital Finance and Management, 624 N. Broadway, Baltimore, Maryland 21205.
5. G. Anderson et al., Providing Hospital Services: The Changing Financial Environment (Baltimore: Johns Hopkins University Press, 1989) ; J. Reuter, The Financing of Academic Health Centers: A Chart Book (Washington: Institute for Health Care Research and Policy, 1997); and Iglehart, "Rapid Changes."
6. G. Anderson et al., Providing Hospital Services: The Changing Financial Environment (Baltimore: Johns Hopkins University Press, 1989) ; J. Reuter, The Financing of Academic Health Centers: A Chart Book (Washington: Institute for Health Care Research and Policy, 1997); and Iglehart, "Rapid Changes."
7. G. Anderson et al., Providing Hospital Services: The Changing Financial Environment (Baltimore: Johns Hopkins University Press, 1989) ; J. Reuter, The Financing of Academic Health Centers: A Chart Book (Washington: Institute for Health Care Research and Policy, 1997); and Iglehart, "Rapid Changes."
8. "Report by the Task Force for the Initiative on the Future of Academic Health Centers: Review of Department Policies and Recommendations" (Washington: U.S. Department of Health and Human Services, 7 October 1997).
9. Whenever possible, we use the term hospitals affiliated with AHCs to distinguish the approximately 118 teaching hospitals listed by the AAMC as either integrated or associated with medical schools. The Medicare Payment Advisory Commission (MedPAC) and Health Care Financing Administration (HCFA) define major teaching hospitals as teaching hospitals with a ratio of residents to hospital beds of 0.25 or more. There are approximately 250 major teaching hospitals by this definition. The Council of Teaching Hospitals (COTH) has approximately 400 members. Some studies of teaching hospitals use COTH membership as the universe for analysis. Finally, there are approximately 1,200 hospitals with at least one resident, comprising the broadest possible universe of teaching hospitals.
10. Although these entities are critically important, they have not received much public policy attention and are not perceived to be financially precarious.
11. Commonwealth Fund Task Force, Leveling the Playing Field.
12. J.K. Iglehart, "Health Care Reform and Graduate Medical Education," New England Journal of Medicine 330, no. 16 (1994): 1167-1171.
13. Anderson et al., Providing Hospital services;
14. J. Pettingill and J. Vertrees, "Reliability and Validity in Hospital Case-Mix Measurement," Health Care Financing Review 4, no. 2 (1982): 101-128;
15. K. Thorpe, "The Use of Regression Analysis to Determine Hospital Payment: The Case of Medicare's Indirect Teaching Adjustment," Inquiry 25, no. 2 (1988): 219-231;
16. and G. Anderson and J. Lave, "Financing Graduate Medical Education: Using Multiple Regression to Set Payment Rates," Inquiry 23, no. 2 (1986): 191-199.
17. Reuter, The Financing of Academic Health Centers.
18. Ibid.
19. Health Care Spending and the Medicare Program: A Data Book (Washington: Medicare Payment Advisory Commission, July 1998).
20. Ibid.
21. S. Guterman, "The Balanced Budget Act of 1997: Will Hospitals Take a Hit on Their PPS Margins?" Health Affairs (January/February 1998): 159-166; and Federal Register (29 August 1997): 4126-4127.
22. S. Guterman, "The Balanced Budget Act of 1997: Will Hospitals Take a Hit on Their PPS Margins?" Health Affairs (January/February 1998): 159-166; and Federal Register (29 August 1997): 4126-4127.
23. Federal Register (29 August 1997).
24. Guterman, "The Balanced Budget Act of 1997."
25. Reuter, The Financing of Academic Health Centers.
26. D. Plumb and T. Henderson, Medicaid Funding of Graduate Medical Education: A Survey of the States (Washington: George Washington University Press, 1995).
27. G. Anderson and M. Hall, "The Adequacy of Hospital Reimbursement under Medicaid's Boren Amendment," Journal of Legal Medicine 13, no. 2 (1992): 205-236.
28. Ibid.
29. R. Cunningham, "States Exploring New Roles as Catalysts in GME Restructuring," Medicine and Health 51, no. 36 (1997): S1-S4.
30. L. Ku and T. Coughlin, "Medicaid Disproportionate Share and Other Special Financing Programs," Health Care Financing Review (Spring 1995): 27-40.
31. D. Blumenthal and G.S. Meyer, "Academic Health Centers in a Changing Health Care Environment," Health Affairs (Summer 1996): 200-215.
32. J.M. Mann et al., "A Profile of Uncompensated Hospital Care, 1983-1995," Health Affairs (July/August 1997): 223-232; and P.J. Cunningham and H.T. Tu, "A Changing Picture of Uncompensated Care," Health Affairs (July/August 1997): 167-175.
33. J.M. Mann et al., "A Profile of Uncompensated Hospital Care, 1983-1995," Health Affairs (July/August 1997): 223-232; and P.J. Cunningham and H.T. Tu, "A Changing Picture of Uncompensated Care," Health Affairs (July/August 1997): 167-175.
34. Reuter, The Financing of Academic Health Centers.
35. Kassirer, "Academic Medical Centers under Siege;" Blake, "Whither Academic Values?" and Anderson et al.. Providing Hospital Services.
36. Kassirer, "Academic Medical Centers under Siege;" Blake, "Whither Academic Values?" and Anderson et al.. Providing Hospital Services.
37. Kassirer, "Academic Medical Centers under Siege;" Blake, "Whither Academic Values?" and Anderson et al.. Providing Hospital Services.
38. Anderson et al., Providing Hospital Services; and Reuter, The Financing of Academic Health Centers. 28. Ibid.; Pettingill and Vertrees, "Reliability and Validity;" Thorpe, "Use of Regression Analysis;" Anderson and Lave, "Financing Graduate Medical Education;" and J. Reuter and D. Gaskin, "Academic Health Centers in Competitive Markets; Health Affairs (July/August 1997): 242-252.
39. Anderson et al., Providing Hospital Services; and Reuter, The Financing of Academic Health Centers. 28. Ibid.; Pettingill and Vertrees, "Reliability and Validity;" Thorpe, "Use of Regression Analysis;" Anderson and Lave, "Financing Graduate Medical Education;" and J. Reuter and D. Gaskin, "Academic Health Centers in Competitive Markets; Health Affairs (July/August 1997): 242-252.
40. Anderson et al., Providing Hospital Services; and Reuter, The Financing of Academic Health Centers. 28. Ibid.; Pettingill and Vertrees, "Reliability and Validity;" Thorpe, "Use of Regression Analysis;" Anderson and Lave, "Financing Graduate Medical Education;" and J. Reuter and D. Gaskin, "Academic Health Centers in Competitive Markets; Health Affairs (July/August 1997): 242-252.
41. Anderson et al., Providing Hospital Services; and Reuter, The Financing of Academic Health Centers. 28. Ibid.; Pettingill and Vertrees, "Reliability and Validity;" Thorpe, "Use of Regression Analysis;" Anderson and Lave, "Financing Graduate Medical Education;" and J. Reuter and D. Gaskin, "Academic Health Centers in Competitive Markets; Health Affairs (July/August 1997): 242-252.
42. Anderson et al., Providing Hospital Services; and Reuter, The Financing of Academic Health Centers. 28. Ibid.; Pettingill and Vertrees, "Reliability and Validity;" Thorpe, "Use of Regression Analysis;" Anderson and Lave, "Financing Graduate Medical Education;" and J. Reuter and D. Gaskin, "Academic Health Centers in Competitive Markets; Health Affairs (July/August 1997): 242-252.
43. Anderson et al., Providing Hospital Services; and Reuter, The Financing of Academic Health Centers. 28. Ibid.; Pettingill and Vertrees, "Reliability and Validity;" Thorpe, "Use of Regression Analysis;" Anderson and Lave, "Financing Graduate Medical Education;" and J. Reuter and D. Gaskin, "Academic Health Centers in Competitive Markets; Health Affairs (July/August 1997): 242-252.
44. Anderson et al., Providing Hospital Services; and Reuter, The Financing of Academic Health Centers. 28. Ibid.; Pettingill and Vertrees, "Reliability and Validity;" Thorpe, "Use of Regression Analysis;" Anderson and Lave, "Financing Graduate Medical Education;" and J. Reuter and D. Gaskin, "Academic Health Centers in Competitive Markets; Health Affairs (July/August 1997): 242-252.
45. Anderson et al., Providing Hospital Services; and Reuter, The Financing of Academic Health Centers. 28. Ibid.; Pettingill and Vertrees, "Reliability and Validity;" Thorpe, "Use of Regression Analysis;" Anderson and Lave, "Financing Graduate Medical Education;" and J. Reuter and D. Gaskin, "Academic Health Centers in Competitive Markets; Health Affairs (July/August 1997): 242-252.
46. M. Gold, "Effects of the Growth of Managed Care on Academic Medical Centers and Graduate Medical Education," Academic Medicine 71, no. 8 (1996): 828-838.
47. MEDSTAT Group study prepared for the American Association of Health Plans, summarized in Policy Brief, 14 April 1997.
48. Commonwealth Fund Task Force, Leveling the Playing Field.
49. MedPAC, Health CareSpending; and W. Cleverley, The Almanac of Hospital Financial and Operating Indicators (Columbus, Ohio: Center for Healthcare Industry Performance Studies, 1996).
50. MedPAC, Health Care Spending; and Reuter and Gaskin, "Academic Health Centers in Competitive Markets."
51. Cleverley, Almanac of Hospital Financial and Operating Indicators; and Reuter and Gaskin, "Academic Health Centers in Competitive Markets."
52. Cleverley, Almanac of Hospital Financial and Operating Indicators; and Reuter and Gaskin, "Academic Health Centers in Competitive Markets."
53. Cleverley, Almanac of Hospital Financial and Operating Indicators.
54. D. Pekne and J. Neel, "Academic Health Centers Work to Balance High-Level Care with Attention to Cost," Standard and Poor's Viewpoint on Health Care (18 September 1996).
55. R. Jones et al., "Review of U.S. Medical School Finances, 1996-1997," Journal of the American Medical Association 280, no. 9 (1998): 813-818; Annual Report to Congress, 1997 (Washington: Physician Payment Review Commission, 1997); and AAMC Data Book: Statistical Information Related" to Medical Education (Washington: Association of American Medical Colleges, 1995).
56. R. Jones et al., "Review of U.S. Medical School Finances, 1996-1997," Journal of the American Medical Association 280, no. 9 (1998): 813-818; Annual Report to Congress, 1997 (Washington: Physician Payment Review Commission, 1997); and AAMC Data Book: Statistical Information Related" to Medical Education (Washington: Association of American Medical Colleges, 1995).
57. R. Jones et al., "Review of U.S. Medical School Finances, 1996-1997," Journal of the American Medical Association 280, no. 9 (1998): 813-818; Annual Report to Congress, 1997 (Washington: Physician Payment Review Commission, 1997); and AAMC Data Book: Statistical Information Related" to Medical Education (Washington: Association of American Medical Colleges, 1995).
58. The Financing of Medical Schools-A Report of the AAMC Task Force on Medical School Financing (Washington: AAMC, 1996), 18.
59. Jones et al, "Review of U.S. Medical School Finances."
60. AAMC Data Book.
61. H. Pardes, "The Future of Medical Schools and Teaching Hospitals in the Era of Managed Care," Academic Medicine 72, no. 2 (1997): 97-102.
62. Iglehart, "Rapid Changes for Academic Health Centers."
63. Pardes, "Future of Medical Schools;" and D. Blumenthal, E.G. Campbell, and J.S. Weissman, "The Social Missions of Academic Health Centers," New England Journal of Medicine 337, no. 21 (1997): 1550-1553.
64. Pardes, "Future of Medical Schools;" and D. Blumenthal, E.G. Campbell, and J.S. Weissman, "The Social Missions of Academic Health Centers," New England Journal of Medicine 337, no. 21 (1997): 1550-1553.
65. Blumenthal et al., "Social Missions of Academic Health Centers."
66. Commonwealth Fund Task Force, Leveling the Playing Field.