A new article just came out in JAMA this morning. The authors look at the thirty day cost of care for Medicare beneficiaries dependent on whether or not they go to academic medical centers or community hospitals.
In this cross-sectional study of more than 1.2 million hospitalizations, major teaching hospitals had higher initial hospitalization costs than nonteaching hospitals, but the total costs of care at 30 days were lower at major teaching hospitals largely because of lower costs for post–acute care services and readmissions.
By contrast, readmission and post-acute care spending was lower at major teaching hospitals (driven by lower utilization as well as lower spending per episode). (4/7) pic.twitter.com/fXBlbkPVr4
— Laura Burke (@LauraBurke20) June 7, 2019
This is a big finding if it is generalizable to younger populations. Right now, quite a few insurers attempt to control costs by narrowing their networks. Narrowing networks can produce savings in one of two ways. One is the insurer leverages competetive hospital markets to get a price concession. In North Carolina, BCBS North Carolina put their ACA networks out for bid between Duke, UNC and Wake-Med. Those three systems are all high end, comprehensive systems. UNC won the ACA contract to be BCBS-NC’s sole tertiary care hospital system in the Research Triangle. UNC, from what I heard, put in a significantly lower bid than Duke. This lower bid helped BCBS-NC cut their ACA rates substantially in 2019.
The other way premiums can be cut is to screen out sick people from any product offered by a given insurer. Mark Shepard has an excellent paper that showed an incredible amount of adverse selection due to the presence of a single high end hospital in Massachusetts. Other research shows significant adverse selection by the presence of a sole specialty hospital. Excluding a high cost hospital lowers premiums for the people who don’t want access to that high cost hospital but it makes people who want/need access to a high cost and highly specialized care portfolio worse off.
This paper suggests that we need to re-evaluate how we think about attributing costs and benefits of academic medical centers. They may be expensive up front but over a reasonable short time frame, they could be quite cost effective at the value they provide.
TenguPhule
Speaking of high costs…..
US homeopaths claim ‘therapies’ prevent measles and ‘cure’ autism
The snake oil folks are going to injure and kill a lot of children with stupid and ignorant parents.
FlyingToaster (Tablet)
Our HMO plan steers us clear of the Partners and specialty hospitals here in Boston. (Mass General, Brigham & Women’s, Dana Farber, Childrens, etc.) We are fine with it because all of our doctors are at/with Mt. Auburn (part of Harvard Med School). We want to be at a teaching hospital, but we don’t have to be at one in the expensive parts of town.
And if we need specialty care, we can still end up referred over there, and it’s covered (with pre-approval).
taumatugo
No matter the healthcare pie is sliced, the middle man will not let go of its share. It is gouging taken to the umpteen degree. A great deal of complexity is how the profit before care miscreant take advantage of the bumper sticker mentality consumers.
Steve in the ATL
@TenguPhule: homeopathy? What a scam.
CBD oil is the all-purpose miracle cure!
john fremont
Just think , 20 years ago people were telling us we needed colloidal silver! We know so much more now! What a time to be alive!
Raven
@Steve in the ATL: I dropped a bill on it an it ain’t done diddly shit.
Raven
@john fremont: And DMSO!
Raven
@Steve in the ATL: Then again I used to spend a lot more than that!
Raven
@Steve in the ATL: Hey, did you know Jeff Walls from Guadalcanal Diary? He passed away and there is a memorial gig for him tonight.
Ohio Mom
@Steve in the ATL: Yes, I just got an email telling me that today! And yesterday, and the day before that…which reminds me, time to empty the email Trash file.
@TenguPhule: Not only could there never be a cure for autism (for many reasons I don’t have time to go into), there could never even be A treatment for autism because there are multiple autisms with different etiologies, presentations, prognoses, etc.
What autism really needs is a very strong social service safety net, so people with autism can have whatever supports they need to live their best lives. But you knew that.
schrodingers_cat
@TenguPhule: Oh noes not the homeopaths!