This research study addresses two questions: 1) how have academic medical centers performed during the 1990s and 2) what environmental pressures affected performance? The study examined 220 urban, academic medical centers during the period 1990-97 A comparison group of 1400 non-teaching and small-teaching hospitals was used. The AHA Annual Survey of Hospitals and the Medicare Hospital Cost Reports were the primary data sources. A comprehensive set of performance measures was developed to answer the first question. These included: profitability, cost, output volume, case mix, and efficiency. Univariate and multivariate analysis was performed. The latter incorporated a panel design and used fixed and random-effect regression analysis. Preliminary results indicate changes in performance were not smooth and did not occur for most variables until 1993. It appears that academic medical centers (ACMs) have been very responsive to changes operating environment changes. Results suggest that ACM responses included reducing length of stay, downsizing, shifting care to outpatient settings, and increasing cost efficiency. Fiscal pressures were manifested by a 41% decrease in the operating margin ratio, resulting in a mean operating margin that was negative. However, most of this decline occurred during one year. Despite the poor performance in the operating margin, the mean total margin ratio of ACMs increased by 35% during the study period ending with a mean value of 0.038 in 1997. Regression analysis suggests that many of the changes were significantly associated (p < 0.05) with managed care penetration and competitive pressures. The paper concludes with policy implications.
Learning Objectives: 1. Present findings of changes in performance of academic medical centers 2. Examine correlates of performance of academic meidical centers 3. Discuss policy implications of correlates of academic medical center performance
Keywords: Cost Issues, Managed Care
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.