Funding the future: 3 key takeaways from a study comparing teaching and nonteaching hospitals

Graduate medical education (GME) is a hot topic in modern healthcare. It’s vital for successfully teaching the next generation of physicians, yet attempts have repeatedly been made to limit the amount of funding it receives from Medicare. In a recent study published by Academic Radiology, researchers took a closer look at this ongoing struggle, noting that teaching hospitals are already facing an uphill battle and need all the funding they can get.

“Sustained GME funding is increasingly vital to support the mission of teaching hospitals in promoting biomedical research, educating the physicians of tomorrow, and providing uninsured and other underserved populations with critical safety net clinical services,” wrote Andrew B. Rosenkrantz, MD, department of radiology at NYU Langone Medical Center in New York City, and colleagues.

Rosenkrantz et al. noted that information on the differences between teaching and nonteaching hospitals is needed to truly discuss the policies behind GME funding, so they examined American Hospital Association (AHA) survey data from the years 2007 and 2012. Hospitals were then split into three categories—members of the Council of Teaching Hospitals (COTH), non-COTH teaching hospitals, and nonteaching hospitals—and the authors compared them based on available imaging services and numerous other characteristics.

This list represents some of the most fascinating statistics included in the team’s findings:

1. Imaging modalities are more available at hospitals with higher teaching intensities

For each of the 15 modalities evaluated—CT, multi-slice spiral CT, 64-slice spiral CT, electron-beam CT, ultrasound, MRI, PET, PET/CT, SPECT, mammography, full-field digital mammography, diagnostic radioisotope facility, intra-operative MRI, image-guided radiation therapy, and virtual colonoscopy—availability was higher at COTH member hospitals than at nonteaching hospitals.

For CT and ultrasound, the difference between COTH member hospitals and nonteaching hospitals was less than 10 percent; for the other modalities, it ranged anywhere from 10 and 11 percent (mammography in 2007 and 2012, respectively) all the way to 53 percent (SPECT in 2007 and 2012, 64-slice spiral CT in 2012) and 64 percent (image-guided radiation therapy in 2012).

“Although we have demonstrated associations between intensity of teaching services and availability of imaging services, the exact cause of this association remains unknown,” the authors wrote. “We believe it likely that the observed greater complexity of services rendered at teaching hospitals, as indicated by their overall higher [case mix index], provides a partial explanation for the greater availability of imaging services at such hospitals. Hospitals treating more complex patients intuitively require greater resources to provide such care, and imaging is but one of those groups of resources. Indeed, patient complexity was higher in the presence of nearly all imaging modalities with the exception of what may be considered among the three most basic modalities assessed (CT, US, and mammography).”

2. In some modalities, the gap between COTH member hospitals and nonteaching hospitals is increasing

From 2007 to 2012, the difference in frequency of availability increased for PET/CT (43 percent in 2007, 57 percent in 2012) and virtual colonoscopy (34 percent in 2007, 48 percent in 2012).

However, there was no significant change in the other modalities.

3. Number of beds and number of FTE physicians are increasing in teaching hospitals

The researchers also studied the number of setup and staffed facility beds and the number of full-time equivalent physicians and dentists (FTE physicians), noting increases in both categories from 2007 to 2012.

These numbers further indicate that teaching hospitals would be impacted negatively by decreases in funding. More beds and more FTE physicians, but less funding is a difficult situation for any facility tasked with educating trainees and providing care.

Overall, Rosenkrantz and colleagues concluded that their research shows why less GME funding from Medicare could be a recipe for disaster for teaching hospitals.

“Our findings reflect the greater advanced imaging resources necessary to support the complexity of care rendered at teaching hospitals,” the authors wrote. “This differential must be considered when exploring adjustments to teaching hospitals' funding levels.”

The authors did note that their study had limitations. The data was based on survey responses, for instance, which are prone to response bias. In addition, they did not look at the impact on modality availability on a hospital’s operating margins.