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Appendix A ACADEMIC HEALTH CENTERS: ALL S , ALL DIFFERENT, THE AME OR ... Report Prepared for The Committee on the Roles of Academic Health Centers in the 21st Century Presented by: Gerard Anderson, Ph.D. The Johns Hopkins University Bloomberg School of Public Health July 30, 2002 161
162 ACADEMIC HEALTH CENTERS OBJECTIVES This analysis examines the variation in roles across academic health centers (AHCs) for calendar year 2000. Roles examined are research, edu- cation, patient care, and care for the poor and uninsured. The rates of change in these roles between 1990 and 2000 are compared. The objectives of the analysis are to: · Determine whether there are natural groupings of AHCs. · Compare the activities among (1) AHC hospitals, (2) large teaching hospitals, and (3) small teaching hospitals. DEFINITIONS For purposes of this analysis, the following definitions are used: Academic health center (AHC) -- Consists of a medical school and only one primary teaching hos- pital. -- The primary teaching hospital is determined based on data show- ing where most of the residents are trained. Data on other affili- ated teaching hospitals are not included in the definition of an AHC. Some expert judgment was also involved in choosing the primary teaching hospital. A primary teaching hospital could not be established for osteopathic medical schools. -- Data from nursing, public health, and other related health profes- sions schools, if they exist, are included in the definition of the AHC. Hospital classification -- Large teaching hospital--not the primary affiliate of a medical school and has more than 0.25 residents per bed. -- Small teaching hospital--not the primary affiliate of a medical school, and has an Accreditation Council for Graduate Medical Education (ACGME) approved residency program and 0.25 or fewer residents per bed. -- Private hospital--includes both nonprofit and for-profit hospi- tals. -- Freestanding AHC--not a component of a larger university; pri- mary activity is as an academic medical center. -- University-based AHC--combine the American Association of Medical Colleges (AAMC) definitions of related/proximate and related/distant institutions. Proximate medical schools are located
APPENDIX A 163 in the same city as the parent university; distant medical schools are not located in the same city as the parent university. National Institutes of Health (NIH) funds--include direct and indirect payments. Graduate Medical Education (GME) payments--include only direct gradu- ate medical education payments from Medicare Cost Reports worksheet E3, Part IV. Small metropolitan statistical area (MSA)--an area with fewer than 1 mil- lion inhabitants. AHC top 50 ranking -- AHCs were ranked based on the level of: Total NIH funding Total Medicare disproportionate share (DSH) funding Total direct Medicare GME funding -- AHCs were then classified based on whether they were in the top 50 in none, one, two, or all three above categories (for example, top 50 in both NIH and GME funding). Dispersion--defined as the ratio of the value of the academic medical center at the 75th percentile to the value of the academic medical center at the 25th percentile. -- Low dispersion--ratio of the 75th percentile to the 25th percen- tile is less than 2.0. -- Medium dispersion--ratio of the 75th percentile to the 25th per- centile is 2.0 to 2.9 -- High dispersion--ratio of the 75th percentile to the 25th percen- tile is 3.0 or greater. Margins The Medicare Payment Advisory Commission (MedPAC) calculated three types of margins for this analysis that are included in Tables A-1 and A-2: Medicare hospital inpatient margins excluding direct GME payments and costs, overall Medicare margins including direct GME payments and costs, and total hospital margins. These calculations use 1999 data and are based on a slightly different sample of hospitals. The margins are calculated as revenues minus costs divided by rev- enues. The Medicare margins are based on Medicare-allowed costs. The overall Medicare margin includes the largest Medicare services: acute inpa- tient, outpatient, rehabilitation, and psychiatric units; skilled nursing facil- ity; and home health agency. It also reflects Medicare payments for direct GME and bad debts. The total margin reflects the relationship of all hospi- tal revenues to all costs (including Medicare-nonallowed costs).
164 ACADEMIC HEALTH CENTERS METHODS Roles As noted, this analysis examines four activities of academic health centers, which are measured using available indicators: research, education, patient care, and indigent care. Analysis of the data is presented by role. Only statistically significant results are discussed. Statistically significant results that are obvious, such as hospitals with more beds also having a higher average daily census, are not discussed. Data Sources The following data sources are used in this analysis: · Medicare Hospital Cost Reports for FY 1990 and 1999 · American Hospital Association Annual Surveys for 1990 and 2000 · NIH data on trends in awards to medical schools 1990 and 2000 · American Association of Health Service Library Surveys, 1990 and 2000 · American Association of Colleges of Nursing Annual Survey, 1994 and 2001, special runs performed for this project · AAMC, special runs performed for this project. · MedPAC, special runs performed for this project DATA ANALYSIS These analyses are based on 120 AHC hospitals and 119 medical schools. Cost data for FY 1990 and 1999 are based on 117 hospitals. · Statistics provided for all variables as of the calendar year 2000: -- Mean -- 25th percentile -- Median -- 75th percentile -- Total rate of change between 1990 and 2000 · Characteristics of Academic health center hospitals: -- Size Fewer than 500 beds Greater than or equal to 500 beds -- Ownership Government Private (nonprofit or for-profit)
APPENDIX A 165 -- MSA Fewer than 1 million inhabitants More than 1 million inhabitants -- Location Northeast South Midwest West · Characteristics of Medical Schools -- Date founded Before 1960 During or after 1960 -- Type Free standing University based · Top 50 ranking by funding category -- NIH, GME, and DSH -- NIH and GME only -- NIH and DSH only -- GME and DSH only -- NIH only -- GME only -- DSH only -- Not top 50 in any category · Differences among groups calculated using analysis of variance (ANOVA). Statistically significant differences (p <.05) are shown in bold in the tables. RESULTS The empirical results are reported as follows: · Table A-1--Dispersion Across the AHCs by Activity, 2000 · Table A-2--Comparison of the AHCs by Characteristic, 2000 · Table A-3--Comparison by Top 50 in Funding Criteria, 2000 · Table A-4--Rate of Change in Activity by Statistical Dispersion Category, 19902000 · Table A-5--Rate of Change in Activity by AHC Characteristic, 19902000
166 ACADEMIC HEALTH CENTERS · Table A-6--Rate of Change in Activity by Top 50 Funding Crite- ria, 19902000 · Table A-7--Comparison of Hospitals by Teaching Program Size, 2000 · Table A-8--Rate of Change in Activity by Teaching Program Size, 19902000 · Table A-9--Provision of Specialized Services by Teaching Status · Table A-10--Comparison of Market Share by Teaching Program Size SUMMARY OF RESULTS BY ROLE Research · The greatest disparity among AHCs occurs in level of research funding. · Certain categories of AHCs received more research funding than others. · NIH funding increased 126 percent at the mean AHC between 1990 and 2000. · While there were differences in the rate of increase in research fund- ing across AHCs between 1990 and 2000, there were few statistically sig- nificant differences by type of AHC. Education · In general, educational variables showed moderate to low dispersion and generally did not vary systematically by type of AHC. · The number of residents increased by 35 percent and the number of nursing students increased by 9 percent between 1990 and 2000. · GME payments per resident actually declined from 1990 to 2000 by 3 percent. · There was little systematic change between 1990 and 2000 in the level of commitment to education by category of AHC. Patient Care · Patient care services showing moderate dispersion across AHCs were total emergency room visits, total outpatient visits, Medicare inpatient days, Medicaid inpatient days, and percent Medicaid inpatient days. All the other patient care services had low dispersion. The committee noted the low dispersion in percent Medicare days. · Among AHCs, the greatest dispersion among patient care services was seen between AHCs with large and small hospitals and between hospi- tals located in the Northeast and those located elsewhere.
APPENDIX A 167 · Between 1990 and 2000, the most rapid increase occurred in outpa- tient and emergency room visits. · On most patient care variables, there were no systematic differences in the rate of change between 1990 and 2000 by category of AHC. Disproportionate Share · There was high dispersion in DSH payments per Medicare discharge. · Higher DSH payments per Medicare discharge were received by AHCs located in larger MSAs and by public AHCs. · Mean DSH payments per Medicare discharge increased 91 percent between 1990 and 2000. There were no systematic differences by category of AHC. Market Share · Hospitals were classified into four groups--AHC hospitals, large teaching, small teaching, and nonteaching hospitals. AHC hospitals gener- ally provide more education, patient care, and DSH share than the other types of hospitals. · AHC hospitals generally provide more education, patient care, and disproportionate share than the other types of hospitals. · The level of commitment to education did not change among AHC hospitals, large teaching hospitals, and small teaching hospitals between 1990 and 2000. · While AHCs are only 3 percent of all hospitals, they provide a much larger proportion of training and patient care. However, they are not the majority (> 50 percent) producer of any services. They provide 48 percent of residency training. · The market share of AHCs increased between 1990 and 2000. Notes on Table A-1 Dispersion Across the AHCs by Activity Research · The greatest dispersion across the AHCs for all variables occurs with respect to the level of NIH funding. In 2000, the AHC at the 25th percentile received $11.6 million in NIH funding, compared with $90.7 million for the AHC at the 75th percentile. In other words, the AHC at the 75th percentile received 7.8 times more NIH funding than the AHC at the 25th percentile. Using this measure of dispersion, this is the indicator with the largest variation of all variables analyzed. · Among all indicators studied, the second-greatest amount of disper- sion occurs with respect to NIH funding per full-time equivalent (FTE)
168 ACADEMIC HEALTH CENTERS faculty member. At the 25th percentile, the average faculty member receives $27,244 in NIH funding, compared with $86,769 at the 75th percentile. Education · Across AHCs, there is moderate dispersion in the total number of residents and total clinical faculty. · Across academic health centers, there is relatively low variance in biological Medical College Admissions Test (MCAT) scores, percentage family practice residents, percentage internal medicine residents, percentage pediatrics residents, percentage primary care residents, number of residents per bed, GME payments per resident, number of nursing school graduates, and library recurring expenditures. Patient Care Services · None of the patient care services showed high dispersion across the AHC hospitals. · Moderate dispersion was demonstrated in: -- Total emergency room visits -- Total outpatient visits -- Total Medicare inpatient days -- Total Medicaid inpatient days -- Percent Medicaid inpatient days · Low dispersion was demonstrated in -- Average daily census -- Total hospital inpatient beds -- Occupancy rate -- Total inpatient days -- Percent Medicare inpatient days -- Medicare case mix index -- Total FTE personnel -- FTE nurses per 1,000 inpatient days -- Total FTE personnel per 1,000 inpatient days -- Length of stay (overall, Medicare, Medicaid) · There was high dispersion in disproportionate share payments per Medicare discharge. Notes on Table A-2 Comparison of the AHC by Characteristic AHC Characteristics · AHCs in larger MSAs, AHC hospitals with more than 500 beds, and
APPENDIX A 169 AHCs with medical schools founded before 1960 all received more total NIH funding than their counterparts in 2000. Research · There was no difference in the level of total NIH funding between freestanding and university-based AHCs or between public and private institutions. · NIH funding per FTE faculty member was greater in larger MSAs, AHCs with larger hospitals, medical schools founded prior to 1960, and AHCs located in the West. · No difference in the level of NIH funding per FTE faculty member was detected between public and private institutions or between freestand- ing and university-based AHCs. Education · AHCs in large MSAs and medical schools founded prior to 1960 had higher resident-to-bed ratios and more recurring library expenditures. · AHCs located in the West had the highest ratios of residents to beds. · AHCs located in the Northeast received the highest level of GME funding per resident. Patient Care · AHC hospitals located in small MSAs had a higher percentage of Medicare patients and lower Medicare overall and inpatient margins. · Public AHC hospitals had a smaller percentage of Medicare patients and a larger percentage of Medicaid patients than private hospitals. · Smaller AHC hospitals had more FTEs per 1,000 inpatient days, shorter overall and Medicare lengths of stay, and a lower Medicare case mix. · AHC hospitals whose medical school was founded before 1960 had more nurses per 1,000 inpatient days. · AHC hospitals located in the Northeast had the longest lengths of stay (overall, and Medicare), fewest FTE nurses per 1,000 inpatient day, fewest FTE personnel per 1,000 inpatient days, lowest percent of Medicaid days, highest occupancy rate, and highest Medicare overall and Medicare inpatient margins. DSH Funds · AHC hospitals located in larger MSAs received higher DSH pay- ments per Medicare discharge. · Public AHC hospitals received higher DSH payments per Medicare beneficiary. · AHC hospitals located in the West received more DSH payments per Medicare discharge.
170 ACADEMIC HEALTH CENTERS Notes on Table A-3 Comparison by Top 50 in Funding Criteria · AHCs with the highest resident-to-bed ratios were in the top 50 in GME only while AHCs that were in the top 50 in DSH only had the lowest ratios. · AHCs that are in the top 50 on GME only received the highest GME payments per resident while AHCs in the top 50 in NIH only received the lowest. · AHCs that are in the top 50 in both NIH and GME had the most nursing graduates, while those that were not in the top 50 on any category had the least. · AHC hospitals that were in the top 50 for DSH only had the highest percentage of Medicaid days, while those that are in the top 50 in NIH and GME had the lowest. · AHC hospitals with the highest occupancy rates were in the top 50 for GME only, while hospitals with the lowest occupancy rates were not in the top 50 in any category. Notes on Table A-4 Rate of Change in Activity by Statistical Dispersion Category (1990-2000) Research · The mean increase in NIH funding for all AHCs between 1990 and 2000 was 126 percent. The increase in the level of funding varied consider- ably. The AHC at the 25th percentile had an NIH funding increase of 60 percent while the AHC at the 75th percentile had an NIH funding increase of 161 percent. Education · At AHC hospitals, the total number of residents increased an aver- age of 33 percent between 1990 and 2000. The number of residents in- creased 1 percent in the AHC hospital at the 25th percentile and 44 percent in the AHC hospital at the 75th percentile · The resident-per-bed ratio increased by 35 percent between 1990 and 2000. The ratio in the AHC hospital at the 25th percentile increased 12 percent while that in the AHC hospital of the 75th percentile increased 50 percent. · The mean of the distribution of percentage changes across all institu- tions that graduated nurses in both 1990 and 2000 was 9 percent. At the
APPENDIX A 171 25th percentile, the decline was 17 percent, while at the 75th percentile the increase was 12 percent. Patient Care · Between 1990 and 2000, the greatest increase occurred in outpatient visits, followed by emergency room visits and total FTE personnel per 1,000 inpatient days. Patient Care--DSH · The mean AHC hospital received 91 percent more in DSH payments per Medicare discharge in 2000 than in 1990. The 25th percentile AHC hospital received 31 percent more, while the 75th percentile AHC hospital received 123 percent more. Notes on Table A-5 Rate of Change in Activity by AHC Characteristic (1990-2000) · On most educational variables, the rate of increase between 1990 and 2000 did not vary systematically by category of AHC. The one excep- tion was total residents, which increased more rapidly at private hospitals. · There were few statistically significant differences in the rate of in- crease from 1990 to 2000 by category of AHC hospital for patient care variables. The one major exception was private hospitals, which had greater increases in the number of outpatient visits and total FTE personnel and showed a more rapid decline in overall length of stay. It is also noted that private hospitals had a statistically significant increase in hospital beds as compared with public hospitals, which experienced a decline in that time period. · AHC hospitals in the Midwest showed the greatest decline in overall length of stay (LOS) while those in the Northeast showed the greatest overall decline in Medicare LOS. · AHCs whose medical schools were founded before 1960 saw their NIH funds increase more rapidly than AHCs whose medical schools were founded during or after 1960. · There were no statistically significant differences in rate of increase in NIH funding by: -- Level of funding in 1990 -- MSA size -- Number of hospital beds -- University based vs. freestanding -- Ownership (public vs. private) -- Region
172 ACADEMIC HEALTH CENTERS Notes on Table A-6 Rate of Change in Activity by Top 50 Funding Criteria · AHC hospitals in the top 50 in NIH and GME funding showed the greatest decline in percent Medicaid inpatient days. · There were no statistically significant differences in rates of increase in any of the other research, patient care, or education variables by funding category. Notes on Table A-7 Comparison of Hospitals by Teaching Program Size Research No data available. Education Compared with the other teaching hospitals, AHC hospitals had: · More total residents · Higher-resident-to bed ratios · Lower Medicare GME payments per resident Patient Care Compared with other teaching hospitals, AHC hospitals were much larger. They had: · Higher daily censuses · More emergency room visits · More outpatient visits · More hospital beds · Higher occupancy rates · More Medicare days · More Medicaid days · More total inpatient days · Higher proportion of Medicaid days · Higher Medicare case mix · Longer overall, Medicare, and Medicaid lengths of stay · Lower percentage of Medicare days. · Given their higher intensity of care, it is somewhat surprising that there were no statistically significant differences in number of FTE nurses per 1,000 inpatient days.
APPENDIX A 173 Patient Care--DSH Funds Compared with other teaching hospitals, AHC hospitals received higher DSH payments Notes on Table A-8 Rate of Change in Activity by Teaching Program Size (1990-2000) · The only statistically significant difference in the rate of change between 1990 and 2000 on any of the education variables among the three groups was in residents per bed. AHCs had the smallest rate of change among the three groups of teaching hospitals. · Between 1990 and 2000, AHC hospitals had: -- Smallest reduction in hospital beds -- Smallest reduction in average daily census -- Smallest reduction in percent of Medicare inpatient days -- Greatest overall decline in percent of Medicaid days -- Largest increase in Medicare case mix index -- Smallest reduction in overall length of stay · There were no statistically significant differences in the rate of change between 1990 and 2000 in DSH payments. Notes on Table A-9 Provision of Specialized Services by Teaching Status · AHC hospitals represented 3 percent of all hospitals in 2000. · In no category did they provide a majority of services. However, they: -- Trained 48 percent of all residents -- Provided 20 percent of Medicaid inpatient days -- Provided 16 percent of Medicaid hospital discharges -- Provided 13 percent of all inpatient days -- Provided 11 percent of all hospital discharges -- Represented 10 percent of all hospital beds -- Provided 9 percent of all Medicare days -- Provided 8 percent of all Medicare discharges · The percent of specialty services available at AHC hospitals shown in the table measures the availability of services, not the use of services. The services for which more than 20 percent are available at AHC hospitals are burn unit, transplant services, pediatric unit, and positron emission tomog- raphy (PET) scanner.
174 ACADEMIC HEALTH CENTERS Notes on Table A-10 Comparison of Market Share by Teaching Program Size · In 1990, AHCs represented 2 percent of hospitals, 7 percent of hospital beds, and 8 percent of total discharges. By 1999, AHCs repre- sented 3 percent of all hospitals, 10 percent of all hospital beds, and 11 percent of total discharges. The AHC share of Medicare and Medicaid discharges increased similarly. In general, AHCs and major teaching hospitals increased their market share between 1990 and 1999, while small teaching and nonteaching hospi- tals lost market share.
APPENDIX A TABLES 175
176 Percentile 7.8 2.5 3.2 1.1 2.1 1.4 1.3 1.3 1.3 1.7 1.6 1.9 1.8 25th 7 22 10 38 919 $11 410 0.74 219 $86,769 $76,713 $3,581,601 $90,728,000 Percentile 9 20 35 564 $10 278 0.59 159 Percentile/ $56,223 $59,794 $2,714,715 75th Median $42,219,000 7 17 29 364 $10 198 0.44 115 $27,244 $47,077 $1,986,795 75th Percentile $11,649,000 2000 755 9 23 39 717 $10 308 0.59 169 $63,403 $65,200 Activity, $2,861,640 Ratio 25th Mean $62,689,524 by AHCs the 2000 Across Faculty basic Centers, faculty Residents Science MCAT Residents Expenses full-time Residents Dispersion Health Bed per clinical Residents Medicine Care Resident Clinical Science Practice per A-1 and Graduates per Recurring Residents--Hospital Funding Funding $ Academic Family Internal Pediatric Primary TABLE All Variable NIH Full-Time NIH science Biological Total % % % % Residents GME Nursing Library
177 1.9 2.0 2.3 1.8 1.2 2.3 2.9 1.9 1.6 2.0 1.2 1.8 1.3 1.2 1.2 1.2 1.4 1.8 3.3 2.0 3.0 516 656 7.5 6.2 7.1 7.0 4.5 77% 37% 26% 1.88 29.3 26.1 16.5 4,619 67,586 51,509 34,516 $2,066 544,123 163,025 396 489 6.7 5.7 6.3 5.9 1.3 69% 30% 19% 1.78 25.4 19.0 10.6 3,266 50,979 35,576 21,898 $1,324 374,944 130,290 275 370 5.6 5.2 5.9 5.0 5.1 64% 23% 13% 1.63 24.3 14.6 2.3 2,561 $697 34,332 22,634 11,934 84,546 236,563 428 532 6.8 5.8 6.5 6.3 3.2 69% 30% 20% 1.77 25.4 20.6 11.3 3,774 57,690 40,331 27,970 $1,454 419,145 135,726 costs. costs. and Hospital and dischg. Total Hospital Days -- IP Days payments (LOS) payments Days Total Index IP (Margin)* Medicare GME Visits -- Stay Hospital (Hospital) (Hospital) (Margin)** GME Census Beds Mix 1,000 of -- 1,000 (Margin) per Rate Days Days Days per direct direct Daily Visits Inpatient IP Case Personnel per LOS LOS Inpatient Days IP IP Length Medicare ER Outpatient Hospital IP FTE Hospital Total Nurses Payment MCR MCD Includes Excludes Average Total Total Total Occupancy Medicare Medicaid Total % % Medicare FTE FTE Total Overall Medicare Medicaid Medicare Overall Total DSH * **
178 ACADEMIC RESEARCH CENTERS TABLE A-2-1 Comparison of the AHCs by Characteristic, 2000 All Academic Medical Centers, 2000 (bold values differ by p <.05) Variable All < 1 mil. 1 mil. NIH Funding $62,689,524 $40,435,000 $77,216,782 Full-Time Clinical Science Faculty 717 478 879 NIH Funding per full-time basic $63,403 $52,644 $70,525 science and clinical faculty Biological Science MCAT 10.2 9.9 10.5 Total Residents--Hospital 483 361 564 % of Family Practice Residents 7 9 6 % Internal Medicine Residents 23 20 24 % Pediatric Residents 9 9 10 % Primary Care Residents 39 38 40 Residents per Bed 0.59 0.51 0.64 GME $ per resident $65,200 $63,248 $66,510 Total Clinical Faculty 674 473 807 Nursing Graduates 169 160 177 Library Recurring Expense $2,861,640 $2,472,726 $3,146,843 Average daily census 428 367 469 Total ER visits 57,690 52,591 61,090 Total outpatient visits 419,145 399,889 431,982 Total Hospital Beds 532 482 566 Occupancy Rate 69% 69% 69% Medicare IP Days--Total Hospital 40,331 40,678 40,098 Medicaid IP Days--Total Hospital 27,970 23,597 30,906 Total IP Days--Hospital 135,726 121,570 145,231 % MCR IP Days (Hospital) 30% 34% 27% % MCD IP Days (Hospital) 20% 19% 22% Medicare Casemix Index 1.77 1.78 1.76 FTE total personnel 3,774 3,195 4,160 FTE Nurses per 1,000 IP Days 6.8 6.9 6.7 Total FTE per 1,000 IP Days 25.4 24.5 25.9 Overall Length of Stay (LOS) 5.8 5.7 5.9 Medicare LOS 6.5 6.3 6.7 Medicaid LOS 6.3 6.0 6.6 Medicare Inpatient (Margins) 20.6 17.2 22.7 Overall Medicare (Margins) 11.3 9.6 12.3 Total Hospital (Margins) 3.2 4.9 2.2 Medicare Inpatient (% Margins at Loss) 2 4 0 Overall Medicare (% Margins at Loss) 15 13 16 Total Hospital (% Margins at Loss) 36 29 42 DSH Payment per Medicare dischg. $1,454 $1,156 $1,655
APPENDIX A 179 1 AMC 2+ AMCs in MSA in MSA Private Public <500 beds 500+ beds $54,008,947 $77,485,961 $68,806,056 $51,475,881 $35,676,712 $88,373,836 592 939 786 586 497 920 $62,315 $65,301 $61,757 $66,494 $50,404 $75,549 10 10.4 10.1 10.4 267 382 447 745 386 570 8 7 9 6 21 23 21 23 9 10 10 9 38 40 40 38 0.54 0.66 0.56 0.64 0.61 0.56 $60,123 $74,265 $65,889 $63,921 $63,768 $66,759 692 745 560 776 167 172 164 176 159 177 $2,743,769 $3,075,081 $2,796,980 $2,969,405 $2,399,390 $3,257,853 402 473 446 396 270 576 55,955 60,688 54,976 62,732 45,191 69,383 414,047 427,950 405,256 444,937 331,629 501,014 505 580 565 472 358 722 68% 71% 69% 69% 68% 70% 37,602 45,204 47,811 26,466 27,869 53,905 25,214 32,890 25,527 32,498 17,387 39,497 125,565 153,870 143,713 120,920 89,783 185,771 31% 29% 33% 24% 31% 29% 19% 22% 17% 26% 20% 21% 1.79 1.73 1.79 1.72 1.73 1.81 3,489 4,265 3,983 3,386 2,610 4,862 7.0 6.5 6.6 7.2 7.0 6.6 25.0 26.1 24.9 26.2 26.8 24.1 5.8 5.8 5.7 6.0 5.6 6.0 6.4 6.8 6.5 6.6 6.3 6.8 6.1 6.8 6.5 6.1 5.9 6.9 19.8 22.9 20.1 20.8 11.4 10.8 11.3 11.3 3.6 2.2 1.5 4 3 0 2 2 11 24 13 16 33 42 43 30 $1,348 $1,645 $1,188 $1,948 $1,408 $1,505
180 ACADEMIC RESEARCH CENTERS TABLE A-2-2 Comparison of the AHCs by Characteristic, 2000 All Academic Medical Centers, 2000 (bold values differ by p <.05) Post-1960 Pre-1960 NIH Funding $24,807,009 $79,311,940 Full-Time Clinical Science Faculty 417 847 NIH Funding per full-time basic $43,955 $71,604 science and clinical faculty Biological Science MCAT 9.9 10.4 Total Residents--Hospital 375 529 % of Family Practice Residents 9 7 % Internal Medicine Residents 24 22 % Pediatric Residents 9 10 % Primary Care Residents 42 39 Residents per Bed 0.48 0.63 GME $ per resident $62,776 $65,687 Total Clinical Faculty 421 782 Nursing Graduates 154 175 Library Recurring Expense $2,413,861 $3,034,781 Average daily census 366 457 Total ER visits 60,333 56,368 Total outpatient visits 371,179 442,435 Total Hospital Beds 472 562 Occupancy Rate 68% 70% Medicare IP Days--Total Hospital 38,108 41,705 Medicaid IP Days--Total Hospital 21,364 30,531 Total IP Days--Hospital 117,013 144,461 % MCR IP Days (Hospital) 32% 29% % MCD IP Days (Hospital) 18% 21% Medicare Casemix Index 1.75 1.78 FTE total personnel 3,189 4,039 FTE Nurses per 1,000 IP Days 6.4 7.0 Total FTE per 1,000 IP Days 24.5 25.7 Overall Length of Stay (LOS) 5.6 5.9 Medicare LOS 6.3 6.6 Medicaid LOS 5.8 6.6 Medicare Inpatient (Margins) 20.8 20.2 Overall Medicare (Margins) 10.8 12.9 Total Hospital (Margins) 3.9 1 Medicare Inpatient (% Margins at Loss) 0 6 Overall Medicare (% Margins at Loss) 15 11 Total Hospital (% Margins at Loss) 43 30 DSH Payment per Medicare dischg. $1,323 $1,471
APPENDIX A 181 University- Freestanding Based Northeast South Midwest West $48,119,458 $66,981,588 $72,009,621 $53,113,674 $52,777,910 $88,502,882 621 743 1,002 579 599 799 $55,531 $65,413 $62,720 $56,978 $56,521 $94,812 10.1 10.3 10.5 10 10.1 10.6 514 474 604 416 441 528 8 7 4 8 8 9 22 23 27 19 21 24 9 9 9 10 10 10 39 39 40 37 39 43 0.58 0.58 0.66 0.53 0.54 0.70 $60,017 $66,059 $76,985 $63,534 $62,679 $55,195 611 690 797 657 580 678 168 169 150 172 179 168 $2,910,297 $2,848,585 $3,014,322 $2,844,958 $2,501,413 $3,262,530 422 432 556 407 380 353 52,715 58,859 61,182 59,008 48,455 65,242 392,005 428,558 474,213 362,008 399,546 505,465 527 537 578 560 498 456 67% 69% 76% 66% 67% 69% 35,911 41,848 53,355 37,868 42,882 21,080 26,270 28,155 28,135 33,420 19,840 29,066 128,791 138,107 162,502 136,095 122,904 115,667 28% 31% 33% 28% 35% 19% 22% 19% 16% 24% 17% 24% 1.78 1.77 1.84 1.77 1.74 1.70 3,467 3,865 4,445 3,476 3,622 3,658 6.6 6.9 5.9 6.8 7.1 7.9 24.3 25.6 23.4 24.2 26.6 29.5 6.2 5.7 6.5 5.9 5.4 5.3 6.8 6.4 7.3 6.5 6.2 5.9 6.7 6.3 6.4 7.0 5.6 5.9 20.8 19.7 25.4 19.1 15.9 21.4 12 15.3 15.3 10.4 6.3 11.3 0.9 2.1 0.9 2.1 7.2 2.9 2 0 0 3 0 7 11 24 4 12 26 27 33 52 29 43 34 20 $1,741 $1,344 $1,338 $1,670 $954 $2,019
182 ACADEMIC RESEARCH CENTERS TABLE A-3 Comparison by Top 50 in Funding Criteria, 2000 All Academic Health Centers, 2000 (bold values differ by p <.05) Top 50, Top 50, Top 50, Variable NIH, GME, DSH NIH and GME NIH and DSH NIH Funding $132,518,250 $120,947,333 $112,967,333 Full-Time Clinical Science Faculty 1,130 1,416 841 NIH Funding per full-time basic $99,137 $85,417 $118,950 science and clinical faculty Biological MCAT 11 10.6 10.6 Total Residents--Hospital 773 564 515 % of Family Practice Residents 5 5 5 % Internal Medicine Residents 24 22 16 % Pediatrics Residents 10 7 11 % Primary Care Residents 39 34 32 Residents per Bed 0.68 0.73 0.55 GME $ per resident $69,338 $80,838 $50,576 Total Clinical Faculty 1058 954 767 Nursing Graduates 175 223 189 Library Recurring Expense $3,635,405 $3,550,124 $3,094,337 Average daily census 678 562 462 Total ER visits 80,126 71,880 54,633 Total outpatient visits 624,288 626,292 451,506 Total Hospital Beds 829 639 584 Occupancy Rate 74% 76% 71% Medicare IP Days--Total Hospital 66,570 47,243 47,246 Medicaid IP Days--Total Hospital 54,998 23,570 26,408 Total IP Days--Hospital 223,239 176,139 150,935 % MCR IP Days (Hospital) 30% 28% 30% % MCD IP Days (Hospital) 25% 13% 19% Medicare Casemix Index 1.76 1.81 1.88 FTE total personnel 6,286 5,355 3,736 FTE Nurses per 1,000 IP Days 7.3 7.4 6.1 Total FTE per 1,000 IP Days 27.0 27.2 22.8 Overall Length of Stay (LOS) 6.0 5.6 5.8 Medicare LOS 6.8 6.7 6.4 Medicaid LOS 7.6 5.5 6.6 DSH Payment per Medicare dischg. $1,535 $1,369 $1,361
APPENDIX A 183 Top 50, GME and DSH Top 50, NIH Top 50, GME Top 50, DSH None $23,770,455 $113,201,583 $25,971,667 $17,040,333 $17,734,657 590 926 453 356 382 $39,171 $103,314 $53,477 $32,731 $36,754 10.1 10.6 10.1 9.7 9.8 351 591 386 322 353 6 10 4 11 9 23 22 19 21 23 9 10 8 9 10 38 31 41 42 0.59 0.70 0.75 0.43 0.48 $81,584 $47,154 $91,343 $58,327 $58,790 905 832 445 362 378 178 190 185 162 129 $3,159,827 $3,718,533 $2,442,508 $2,249,832 $1,933,196 423 369 305 381 293 60,910 46,276 42,728 57,950 48,715 385,021 443,800 316,424 339,509 298,022 574 429 369 542 372 69% 66% 77% 68% 64% 47,647 27,931 26,354 36,490 27,946 32,032 15,004 20,865 41,660 14,639 144,267 101,960 103,805 131,504 87,575 33% 28% 26% 29% 32% 23% 15% 22% 31% 18% 1.68 1.83 1.70 1.76 1.74 3,919 3,576 2,767 2,985 2,458 6.7 7.5 6.9 6.6 6.5 26.2 27.7 25.6 22.2 25.2 5.9 5.7 5.7 5.7 5.8 6.7 6.0 6.8 6.3 6.5 6.2 6.6 5.1 6.8 5.9 $1,697 $1,141 $1,843 $1,938 $1,257
184 ACADEMIC RESEARCH CENTERS TABLE A-4 Rate of Change in Activity by Statistical Dispersion Category, 1990- 2000 All Academic Health Centers Percent Change 1990-2000 25th 75th Variable Mean Percentile Median Percentile % Chg. - NIH Funding 126% 60% 107% 161% % Chg. - Total Residents--Hospital 33% 1% 22% 44% % Chg. - Residents per Bed 35% 12% 26% 50% % Chg. - GME $ per resident 3% 24% 8% 9% % Chg. - Linrary Recurring Expense 81% 48% 71% 98% % Chg. - Nursing Graduates* 9% 17% 9% 12% % Chg. - Average daily census 2% 25% 10% 10% % Chg. - Total ER visits 54% 3% 30% 74% % Chg. - Total outpatient visits 133% 19% 81% 172% % Chg. - Total Hospital Beds 0% 15% 3% 10% % Chg. - Occupancy Rate 8% 12% 7% 1% % Chg. - Medicare IP Days--Total Hospital 7% 28% 13% 3% % Chg. - Medicaid IP Days--Total Hospital 10% 39% 19% 3% % Chg. - Total IP Days--Hospital 10% 25% 13% 1% % Chg. - % MCR IP Days (Hospital) 0% 3% 0% 3% % Chg. - % MCD IP Days (Hospital) 2% 6% 1% 3% % Chg. - Medicare Casemix Index 20% 12% 20% 29% % Chg. - FTE total personnel 26% 4% 22% 39% % Chg. - FTE Nurses per 1,000 IP Days 33% 11% 29% 51% % Chg. - Total FTE per 1,000 IP Days 35% 13% 33% 50% % Chg. - Overall Length of Stay (LOS) 17% 27% 20% 9% % Chg. - Medicare LOS 31% 37% 32% 26% % Chg. - Medicaid LOS 4% 27% 13% 10% % Chg. - DSH Payment per Medicare dischg. 91% 31% 65% 123% * Calculated by dividing the sum of all percentage changes by the number of instititions (98) with nursing graduate data in both 1990 and 2000.
APPENDIX A 185 TABLE A-5 IS ON THE NEXT PAGE
186 ACADEMIC RESEARCH CENTERS TABLE A-5-1 Rate of Change in Activity by AHC Characteristic, 1990-2000 All Academic Health Centers Percent Change 1990-2000 (bold values differ by p <.05) All (Mean) < 1 mil. 1 mil. % Chg. - NIH Funding 126% 142% 116% % Chg. - Total Residents--Hospital 33% 39% 33% % Chg. - Residents per Bed 35% 36% 35% % Chg. - GME $ per resident 3% 4% 9% % Chg. - Library Recurring Expense 81% 88% 75% % Chg. - Nursing Graduates 9% 2% 19% % Chg. - Average daily census 2% 5% 7% % Chg. - Total ER visits 54% 59% 51% % Chg. - Total outpatient visits 133% 132% 133% % Chg. - Total Hospital Beds 0% 3% 0% % Chg. - Occupancy Rate 8% 7% 9% % Chg. - Medicare IP Days--Total Hospital 7% 3% 11% % Chg. - Medicaid IP Days--Total Hospital 10% 3% 12% % Chg. - Total IP Days--Hospital 10% 5% 12% % Chg. - % MCR IP Days (Hospital) 0% 1% 1% % Chg. - % MCD IP Days (Hospital) 2% 1% 3% % Chg. - Casemix Index 20% 20% 20% % Chg. - FTE total personnel 26% 31% 23% % Chg. - FTE Nurses per 1000 IP Days 33% 30% 35% % Chg. - Total FTE per 1000 IP Days 35% 31% 37% % Chg. - Overall LOS 17% 16% 17% % Chg. - Medicare LOS 31% 32% 30% % Chg. - Medicaid LOS 4% 0% 6% % Chg. - Disp Shr Payment per MCR dischg. 91% 87% 92%
APPENDIX A 187 1 AHC 2+ AHCs in <500 500+ in MSA MSA Private Public beds beds 137% 108% 126% 127% 131% 122% 35% 28% 43% 20% 34% 37% 34% 37% 39% 29% 43% 28% 1% 6% 7% 2% 1% 7% 81% 80% 66% 93% 66% 94% 6% 17% 3% 20% 15% 4% 2% 10% 0% 6% 7% 2% 49% 63% 66% 33% 38% 69% 135% 128% 171% 61% 107% 157% 2% 4% 5% 6% 4% 8% 9% 7% 9% 7% 7% 9% 7% 6% 8% 2% 6% 5% 10% 12% 2% 22% 14% 3% 9% 13% 6% 14% 13% 4% 0% 1% 1% 1% 0% 1% 3% 2% 2% 3% 3% 2% 22% 18% 19% 23% 20% 20% 30% 21% 31% 18% 24% 29% 33% 33% 33% 34% 32% 34% 32% 39% 36% 32% 38% 32% 16% 18% 20% 11% 17% 16% 32% 30% 32% 29% 32% 30% 5% 2% 5% 1% 6% 1% 85% 102% 95% 82% 83% 98%
188 ACADEMIC RESEARCH CENTERS TABLE A-5-2 Rate of Change in Activity by AHC Characteristic, 1990-2000 All Academic Health Centers Percent Change 1990-2000 (bold values differ by p <.05) Post-1960 Pre-1960 Freestanding % Chg. - NIH Funding 97% 139% 127% % Chg. - Total Residents--Hospital 40% 30% 21% % Chg. - Residents per Bed 40% 33% 26% % Chg. - GME $ per resident 1% 4% 10% % Chg. - Library Recurring Expense 94% 72% 84% % Chg. - Nursing Graduates 2% 14% 46% % Chg. - Average daily census 4% 5% 3% % Chg. - Total ER visits 52% 55% 59% % Chg. - Total outpatient visits 125% 138% 142% % Chg. - Total Hospital Beds 1% 0% 1% % Chg. - Occupancy Rate 8% 8% 9% % Chg. - Medicare IP Days--Total Hospital 8% 9% 13% % Chg. - Medicaid IP Days--Total Hospital 20% 6% 9% % Chg. - Total IP Days--Hospital 8% 11% 13% % Chg. - % MCR IP Days (Hospital) 0% 0% 1% % Chg. - % MCD IP Days (Hospital) 4% 2% 1% % Chg. - Casemix Index 21% 20% 24% % Chg. - FTE total personnel 31% 24% 20% % Chg. - FTE Nurses per 1000 IP Days 26% 35% 25% % Chg. - Total FTE per 1000 IP Days 33% 36% 28% % Chg. - Overall LOS 15% 18% 13% % Chg. - Medicare LOS 31% 31% 31% % Chg. - Medicaid LOS 4% 4% 4% % Chg. - Disp Shr Payment per MCR dischg. 105% 85% 105%
APPENDIX A 189 University- Based Northeast South Midwest West 126% 92% 137% 143% 128% 36% 42% 25% 42% 19% 38% 45% 32% 39% 19% 1% 7% 3% 1% 1% 73% 83% 80% 91% 73% 2% 56% 2% 9% 3% 2% 4% 7% 6% 4% 53% 75% 51% 44% 46% 132% 183% 87% 162% 110% 1% 0% 3% 3% 3% 8% 6% 9% 8% 10% 7% 13% 3% 9% 0% 11% 17% 8% 5% 36% 9% 8% 14% 6% 10% 0% 2% 2% 2% 1% 3% 4% 0% 0% 10% 19% 28% 35% 18% 30% 27% 35% 28% 31% 42% 31% 36% 34% 33% 43% 27% 18% 17% 13% 24% 14% 31% 37% 27% 32% 29% 6% 19% 12% 13% 0% 87% 119% 104% 73% 47%
190 ACADEMIC RESEARCH CENTERS TABLE A-6 Rate of Change in Activity by Top 50 Funding Criteria, 1990-2000 All Academic Health Centers, 2000 Percent Change 1990-2000 (bold values differ by p <.05) Top 50, Top 50, Top 50, Variable NIH, GME, DSH NIH and GME NIH and DSH % Chg. - NIH Funding 120% 159% 123% % Chg. - Total Residents--Hospital 40% 37% 5% % Chg. - Residents per Bed 36% 39% 24% % Chg. - GME $ per resident 5% 4% 18% % Chg. - Library Recurring Expense 82% 73% 78% % Chg. - Nursing Graduates 16% 4% 0% % Chg. - Average daily census 6% 1% 19% % Chg. - Total ER visits 41% 90% 39% % Chg. - Total outpatient visits 126% 200% 30% % Chg. - Total Hospital Beds 4% 1% 12% % Chg. - Occupancy Rate 8% 5% 5% % Chg. - Medicare IP Days--Total Hospital 6% 9% 21% % Chg. - Medicaid IP Days--Total Hospital 11% 38% 22% % Chg. - Total IP Days--Hospital 6% 8% 18% % Chg. - % MCR IP Days (Hospital) 0% 1% 1% % Chg. - % MCD IP Days (Hospital) 1% 9% 2% % Chg. - Medicare Casemix Index 22% 21% 24% % Chg. - FTE total personnel 29% 38% 10% % Chg. - FTE Nurses per 1000 IP Days 35% 39% 16% % Chg. - Total FTE per 1000 IP Days 39% 36% 16% % Chg. - Overall LOS 18% 22% 16% % Chg. - Medicare LOS 32% 28% 29% % Chg. - Medicaid LOS 7% 19% 4% % Chg. - Disp Shr Payment per MCR dischg. 101% 95% 48%
APPENDIX A 191 Top 50, GME and DSH Top 50, NIH Top 50, GME Top 50, DSH None 137% 120% 119% 166% 110% 34% 23% 22% 33% 36% 36% 23% 21% 25% 45% 12% 2% 11% 5% 1% 78% 67% 86% 143% 62% 0% 8% 11% 2% 22% 14% 7% 7% 12% 3% 53% 97% 53% 102% 26% 163% 236% 55% 166% 95% 1% 4% 0% 11% 5% 7% 9% 6% 8% 11% 8% 7% 27% 16% 16% 9% 14% 21% 6% 14% 10% 7% 6% 1% 16% 0% 1% 2% 3% 0% 1% 3% 7% 1% 3% 10% 18% 16% 18% 23% 15% 46% 33% 29% 24% 34% 39% 52% 43% 26% 41% 40% 44% 20% 37% 15% 16% 15% 17% 15% 31% 29% 28% 33% 32% 12% 0% 14% 8% 7% 147% 71% 100% 80% 81%
192 ACADEMIC RESEARCH CENTERS TABLE A-7 Comparison of Hospitals by Teaching Program Size, 2000 All Academic Health Centers, 2000 (bold values differ by p <.05) Large Small Non-teaching, Variable AHC Teaching Teaching 100+ Beds Total Residents--Hospital 308 149 34 N/M Residents per Bed 0.59 0.42 0.09 N/M GME $ per resident $65,200 $78,262 $72,599 N/M Average daily census 428 320 249 122 Total ER visits 57,690 54,408 44,516 25,862 Total outpatient visits 419,145 318,624 240,677 111,828 Total Hospital Beds 532 367 346 195 Occupancy Rate 69% 66% 59% 46% Medicare IP Days--Total Hospital 40,331 33,959 32,294 15,592 Medicaid IP Days--Total Hospital 27,970 15,811 8,628 3,576 Total IP Days--Hospital 135,726 94,204 76,573 31,857 % MCR IP Days (Hospital) 30% 37% 43% 52% % MCD IP Days (Hospital) 20% 17% 11% 12% Medicare Casemix Index 1.77 1.53 1.54 1.30 FTE total personnel 3,774 2,566 1,895 812 FTE Nurses per 1,000 IP Days 6.8 6.8 6.1 5.6 Total FTE per 1,000 IP Days 25.4 28.0 22.3 19.9 Overall Length of Stay (LOS) 5.8 5.3 4.9 4.6 Medicare LOS 6.5 6.5 5.9 5.5 Medicaid LOS 6.3 5.8 5.0 4.2 DSH per Medicare dischg. $1,454 $1,081 $597 $457 Has HIV/AIDS Unit 92% 79% 67% 38% Has Burn Unit 57% 20% 23% 2% Has Geriatric Unit 80% 73% 68% 48% Has Neonatal Unit 83% 63% 57% 17% Has Pediatric Unit 68% 44% 29% 6% Has PET Scanner 48% 14% 17% 7% Has Transplant Services 88% 26% 26% 5% Has Trauma Center 87% 57% 57% 30% Has Angioplasty center 96% 60% 72% 30% Has Open Heart Surgery 95% 55% 67% 27% * Small teaching means ACGME residency program or residents/bed >0. * Nonteaching means any hospital not in the first three groups with 100+ beds in 2000. ** NM means not meaningful, because these hospitals have no residents.
APPENDIX A 193 TABLE A-8 Rate of Change in Activity by Teaching Program Size, 1990-2000 All Academic Health Centers, 2000 Percent Change, 1990-2000 (bold values differ by p <.05) Large Small Non-teaching, Variable AHC Teaching Teaching* 100+ Beds* % Chg. - Total Residents--Hospital 33% 26% 47% NM** % Chg. - Residents per Bed 35% 54% 61% NM** % Chg. - GME $ per resident 3% 6% 11% NM** % Chg. - Average daily census 2% 18% 6% 15% % Chg. - Total ER visits 54% 35% 51% 45% % Chg. - Total outpatient visits 133% 105% 138% 123% % Chg. - Total Hospital Beds 0% 16% 9% 6% % Chg. - Occupancy Rate 8% 9% 6% 7% % Chg. - Medicare IP Days--Total Hospital 7% 30% 9% 13% % Chg. - Medicaid IP Days--Total Hospital 10% 2% 11% 13% % Chg. - Total IP Days--Hospital 10% 25% 5% 16% % Chg. - % MCR IP Days (Hospital) 0% 4% 2% 1% % Chg. - % MCD IP Days (Hospital) 2% 1% 1% 1% % Chg. - Medicare Casemix Index 20% 14% 11% 7% % Chg. - FTE total personnel 26% 12% 30% 32% % Chg. - FTE Nurses per 1,000 IP Days 33% 61% 45% 46% % Chg. - Total FTE per 1,000 IP Days 35% 60% 46% 45% % Chg. - Overall Length of Stay (LOS) 17% 25% 22% 19% % Chg. - Medicare LOS 31% 35% 31% 27% % Chg. - Medicaid LOS 4% 9% 10% 12% % Chg. - DSH per Medicare dischg. 91% 92% 69% 72% * Small teaching means ACGME residency program or residents/bed >0. * Nonteaching means any hospital not in the first three groups with 100+ beds in 2000. ** NM means not meaningful, because these hospitals have no residents.
194 ACADEMIC RESEARCH CENTERS TABLE A-9 Provision of Specialized Serviced by Teaching Status Provision of Specialized Services Who Provides What Services Large Small Variable AHC Teaching Teaching Nonteaching Total Hospital Beds 10% 8% 31% 51% Medicare Inpatient Days--Hospital 9% 9% 34% 48% Medicaid Inpatient Days--Hospital 20% 17% 30% 34% Total Inpatient Days--Hospital 13% 11% 35% 41% Interns and Residents--Hospital 48% 30% 22% 0% Total Medicare Discharges--Hospital 8% 8% 34% 50% Total Medicaid Discharges--Hospital 16% 14% 30% 41% Total Discharges--Hospital 11% 10% 35% 44% Has HIV AIDS Unit 10% 8% 20% 62% Has Burn Unit 43% 16% 17% 23% Has Geriatrics Unit 6% 6% 16% 72% Has Neonatal Unit 16% 12% 31% 41% Has Pediatric Unit 23% 16% 29% 32% Has >1 PET Scanner 22% 7% 23% 48% Has Single PET Scanner 8% 5% 18% 69% Has Transplant Services 33% 10% 28% 29% Has Trauma Center 9% 6% 18% 67% Has Angioplasty Center 13% 8% 29% 50% Has Open Heart Surgery 15% 9% 32% 43% Percent of Hospitals 3% 4% 9% 84% SOURCES: Hospital Cost Report Information System, 1999; American Hospital Association, 2000.
APPENDIX A 195 TABLE A-10 IS ON THE NEXT PAGE
196 ACADEMIC RESEARCH CENTERS TABLE A-10 Comparison of Market Share by Teaching Program Size Summary of Market Share for AHC and Other Hospitals Hospital Cost Report Information System (HCRIS), 1990 and 1999 12-Month Reporting Period; Short Term, Non-Federal Hospitals Hospital Cost Report Information Large Small System, 1990 (sums) AHC Teaching Teaching Nonteaching Total Hospital Beds 63,492 46,357 278,088 480,139 Medicare Inpatient Days-- Total Hospital 5,391,356 4,320,665 29,998,331 43,837,324 Medicaid Inpatient Days-- Total Hospital 4,081,416 2,969,668 8,142,101 8,978,683 Total Inpatient Days--Hospital 18,126,428 13,220,641 67,855,270 88,833,843 Interns and Residents--Hospital 29,233 20,017 22,808 -- Total MCR Discharges--Hospital 557,916 430,066 3,289,418 5,602,497 Total MCD Discharges--Hospital 619,421 475,744 1,376,539 1,804,251 Total Discharges--Hospital 2,577,235 1,939,022 10,611,524 15,464,833 % of Hospitals 2% 2% 17% 79% % of Totals Total Hospital Beds 7% 5% 32% 55% Medicare Inpatient Days-- Total Hospital 6% 5% 36% 52% Medicaid Inpatient Days-- Total Hospital 17% 12% 34% 37% Total Inpatient Days--Hospital 10% 7% 36% 47% Interns and Residents--Hospital 41% 28% 32% 0% Total MCR Discharges--Hospital 6% 4% 33% 57% Total MCD Discharges--Hospital 14% 11% 32% 42% Total Discharges--Hospital 8% 6% 35% 51%
APPENDIX A 197 TABLE A-10 Continued Hospital Cost Report Information System, 1999 (sums) Total Hospital Beds 63,064 52,395 198,408 321,031 Medicare Inpatient Days--Hospital 4,763,347 4,669,159 18,009,980 24,925,268 Medicaid Inpatient Days--Hospital 3,306,950 2,776,128 4,946,093 5,691,269 Total Inpatient Days-- Hospital 16,050,935 13,689,631 43,257,039 50,686,618 Interns and Residents--Hospital 36,111 22,376 16,270 -- Total MCR Discharges--Hospital 724,861 698,953 2,998,947 4,510,503 Total MCD Discharges--Hospital 554,365 489,894 1,044,790 1,447,558 Total Discharges--Hospital 2,776,901 2,535,508 8,941,337 11,158,306 % of Hospitals 3% 4% 18% 75% % of Totals Total Hospital Beds 10% 8% 31% 51% Medicare Inpatient Days--Hospital 9% 9% 34% 48% Medicaid Inpatient Days--Hospital 20% 17% 30% 34% Total Inpatient Days--Hospital 13% 11% 35% 41% Interns and Residents--Hospital 48% 30% 22% 0% Total MCR Discharges--Hospital 8% 8% 34% 50% Total MCD Discharges--Hospital 16% 14% 30% 41% Total Discharges--Hospital 11% 10% 35% 44%
