Perhaps not evident to many patients, there are two kinds of hospitals–teaching and nonteaching–and an intense debate about which is better. Teaching hospitals, affiliated with medical schools, are the training grounds for the next generation of physicians. They cost more. The debate is over whether their increased cost is accompanied by better patient outcomes, says The New York Times.A new study shows that teaching #hospitals save lives. Click To Tweet
Teaching hospitals cost taxpayers more in part because Medicare pays them more, to compensate them for their educational mission. They also tend to command higher prices in the commercial market because the medical-school affiliation enhances their brand. Their higher prices could even cost patients more, if they are paying out of pocket.
To save money, insurers have started establishing hospital networks, and policy makers are considering ways to steer patients away from teaching hospitals. Those efforts may well save patients and taxpayers money. But how will that affect the quality of care?
One answer is provided in a new study of over 21 million hospital visits paid for by Medicare in 2012 and 2013. Simple fact: Teaching hospitals save lives. For every 83 elderly patients seen by a major teaching hospital, one more is alive 30 days after discharge than if those patients had been admitted to a nonteaching hospital. This is a large mortality effect, the Times concluded.
“It’s about half the size of a breakthrough medical therapy like stenting for heart-attack patients,” said Amitabh Chandra, an economist with the Harvard Kennedy School and a longtime skeptic of the value of teaching hospitals, who wasn’t involved in this study.
“Minor” teaching hospitals–which also have educational missions but are not members of the Council of Teaching Hospitals and Health Systems–also outperformed nonteaching hospitals, but by a smaller margin.
The study, published in the Journal of the American Medical Association, adjusted for other factors that could have skewed the results, like demographics, patients’ diagnoses, hospital size and profit status. Because mortality rates differ geographically, it compared teaching with nonteaching hospitals within the same state.
Even after such adjustments, it found mortality rates are lower at teaching hospitals for 11 of 15 common medical conditions and five of six major surgical conditions. The more medical students per bed a hospital had, the lower its mortality rate.
Some eight years ago, I had just finished a training run for an event here in San Diego and noticed I was a bit more winded than usual. Having been a runner for about 37 years back then, I passed it off as probably pressing too much to amp up the intensity of the workout with the event a few days away.
Ironically, I was having a post-workout beer with a neighbor, who just happened to be a cardiologist, and hearing my account said, “Let’s give a listen.” He found his stethoscope and, relenting, assuring him it was nothing, I let him eavesdrop.
A minute or thereabouts later he said something like, “Steve, I’ll call over to UCSD and have them waiting for you there at the ER.” I recall saying something like, “Sure, Bill, real funny.” But he looked me in the eye and said, “I’m serious Steve, you need to go.”
Realizing he actually wasn’t kidding, I said, “Alright, I guess I’ll go home, shower and pick up some clothes.” To which he replied, “No, you need to go directly there, and now.”
Long story short, I was diagnosed with heart failure (I forget which stage) due to a damaged aortic valve. About two weeks later, I emerged from the cardiology wing of the University of California, San Diego, Medical Center with a new titanium valve, root and stem, and a 9-inch scar on my chest.
Six months later I was back to full strength, running at the same, pathetically slow pace, but feeling better than I had in years. Today, I’m still at it. Well, except even more pathetic, pace-wise
Late-night television is characterized by light entertainment and comedy, says Darrell G. Kirch, MD, President and CEO of the American Association of Medical Colleges. On May 1, 2017, however, Jimmy Kimmel opened his late-night show with an emotional monologue about his newborn son, Billy, who was born with a serious heart condition. Kirch gives the following account.
Full of gratitude for the professionals at Cedars-Sinai Medical Center and Children’s Hospital Los Angeles who saved his son’s life, Kimmel’s monologue was a moving and personal tribute to the value of interprofessional healthcare teams, the special missions of teaching hospitals, and the role of medical research in making medical miracles–such as Billy’s survival–possible.
Each member of the highly skilled healthcare teams who treated Billy brought to the table important perspectives and skill sets that contributed to his survival, Dr. Kirch points out. While it may sometimes seem that doctors get much of the credit, Kimmel highlighted the other vitally important healthcare professionals who play essential roles, especially the nurse who first recognized Billy’s heart murmur and the purple tinge to his skin.
Kimmel also expressed gratitude for the exceptional capabilities of the two teaching hospitals that treated his son: Cedars-Sinai Medical Center and Children’s Hospital Los Angeles. As Kimmel and his family experienced, teaching hospitals not only serve as the training ground for America’s healthcare workforce, they provide the most advanced medical care in the best facilities in the world and serve as hubs of medical innovation.
In addition, teaching hospitals provide critical healthcare services that often cannot be found at other hospitals–96% of the nation’s comprehensive cancer centers are located at teaching hospitals, as are 69% of burn unit beds, 71% of Level I trauma centers, and 60% of pediatric intensive care unit beds.
While only 5% of US hospitals are teaching hospitals, they account for 24% of Medicaid hospitalizations and provide 33% of all hospital charity care in the United States. And highly trained specialists, such as the pediatric cardiologist and the cardiac surgeon who cared for Billy, are available 24–7 in teaching hospitals.
“In our healthcare system, our first responsibility is to provide the best possible care to our patients. But unless we plan for the health care system to stop after this generation of physicians, we have to constantly be training the next generation,” says David Shahian, a professor of surgery at Harvard Medical School and vice president of the Massachusetts General Hospital Center for Quality and Safety.
Shahian points out that teaching hospitals are at the forefront of medical research and are often referral centers for rare and extreme medical cases, according to US News. They also encourage surgical attendings to be up to date on medical discoveries.
“It forces [attending surgeons] to keep up with all the current literature because they are constantly getting questions from the residents,” he says. “The residents bring a vibrant intellectual atmosphere to the institution.”
Shahian adds that people tend to forget residents are qualified medical doctors, and at a teaching institution, certified doctors are constantly available.
“I don’t think people realize that after medical school, the period of residency for a surgeon can be anywhere from five to 10 years,” he says.
Philip Young, a gynecologic surgeon and clinical professor of reproductive medicine at the University of California-San Diego School of Medicine, says patients shouldn’t avoid a hospital simply because it has a teaching program.
“Having been in both situations in my life, I don’t think it makes a bit of difference as far as the care is concerned,” he says. “A good private hospital will provide you the same care as a good teaching hospital, except a teaching hospital has more resources and is better at taking care of oddball things.”
During my two-week stint at a teaching hospital, there were legions of care providers. I mean the ones who preceded and followed my brilliant heart surgeon, Michael Madani, and all those in the OR who put me to sleep, opened my chest, stopped my heart, put me on a pump, assisted in removing and replacing the damaged valve, root and stem and sewed me back together again.Steve's Take: I personally know that teaching #hospitals save lives. Click To Tweet
Before and after the OR theater proceedings were the nurses, the residents, the attendings, even daily and nightly check-ins from Thomas Waltman, the cardio department CEO, the therapy dogs, the whole panoply of caregivers who…saved my life.
Private hospitals here in San Diego are among the world’s best. But the data in this latest study are clear. If teaching hospitals save an additional one life versus a private hospital for every documented percentage of medical conditions treated and/or surgeries performed, and your child or another loved one’s life is at stake, which would you choose?