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Subtitle of Presentation
Teaching Hospital CharacteristicsAssociation of American Medical Colleges
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Series 1: AAMC-Member Teaching Hospitals Overview• AAMC-Member Teaching Hospitals by Category• AAMC-Member Teaching Hospitals by Ownership Category• AAMC Membership Geography• Comparison of Hospitals by Bed Size
Series 2: AAMC-Member Teaching Hospitals and GME• The Role of AAMC-Member Teaching Hospitals in Graduate Medical Education• Residents Educated at AAMC-Member Teaching and Other Teaching Hospitals• Per Resident Amount• Medicare Coverage of DGME costs
Series 3: AAMC-Member Teaching Hospital Clinical Services• Overview of AAMC-Member Hospital Services• Poison Control Centers at AMCs• Outpatient Visits, by Bed Size and Teaching Status• Comparison of Length of Stay, Case Complexity and Occupancy Rates Among AAMC-Member
Teaching, Other Teaching, and Non-Teaching Hospitals• AAMC-Member Teaching Hospitals Treat Higher Rates of Transfers• Mortality is Lower at Teaching Hospitals
Series 4: AAMC-Member Teaching Hospital Financial Information• Proportion of Charity Care Costs Provided at AAMC-Member Teaching and Other Hospitals• Median Amount of Charity and Uncompensated Care Provided at AAMC-Member Teaching and
Other Hospitals• Net Patient Revenue Payer Mix at AAMC-Member Teaching and Other Hospitals• Aggregate Patient Care Margins at AAMC-Member and Non-Member Teaching Hospitals• Impact of IPPS Medicare Revenue Cuts
Series 5: AAMC-Member Veteran’s Affairs (VA) and Children’s Hospitals• Distribution of Residents at VA Hospitals• Distribution of Residents at Children’s Teaching Hospitals
Table of Contents
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Table 1-1: AAMC-Member Teaching Hospitals by Category, 2019
AAMC-Member Teaching Hospital Category
Number of Members Percentage
Integrated 115 40.8%
Independent 109 38.7%
Specialty 6 2.1%
Children’s 17 6.0%
Veteran’s Affairs 34 12.1%
Other Federal (NIH) 1 0.4%
Total Hospitals 282 100.0%
Note: Counts exclude corresponding members. Integrated and independent institutions are all short-term, general, nonfederal COTH
members.
Source: AAMC membership data, December 2018
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Table 1-2: Integrated and Independent AAMC-Member Teaching Hospitals by Ownership Category, 2019
Category Number of Members Percent
Church 16 7.1%
For-profit 6 2.7%
Municipal/county/city 24 10.7%
Other not-for-profit 154 68.8%
State government 24 10.7%
Total 224 100.0%
Note: Data reflect short-term, general, nonfederal, integrated and independent COTH members. Short-term, general,
nonfederal designation obtained from the FY2017 American Hospital Association file. Excludes all corresponding
members as well as specialty, children’s, VA, and other federal hospitals.
Source: AAMC membership data, December 2018
Ownership categories obtained from the FY2017 American Hospital Association data.
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Chart 1-3: AAMC Membership Geography, 2019
Note: Includes independent, integrated, children’s, specialty, VA, and other federal hospitals. Counts exclude
corresponding members. Integrated and independent institutions are all short-term, general, nonfederal
AAMC-member teaching hospitals.
Source: AAMC membership data, December 2018
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Count ofCOTHMembers
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Table 1-4: Comparison of Hospitals by Bed Size, FY2017
Bed Size AAMC-Member Integrated and Independent Hospitals
All Hospitals
No. of Hospitals Percent of All AAMC No. of Hospitals Percent of All Hospitals
Fewer than 200 beds 5 2.2% 3,114 71.3%
200-299 beds 17 7.6% 497 11.4%
300-399 beds 22 9.8% 304 7.0%
400-499 beds 34 15.2% 170 3.9%
500+ beds 146 65.2% 282 6.5%
All 224 100.0% 4,367 100.0%
Note: Data reflect short-term, general, nonfederal hospitals. AAMC-member hospitals reflect integrated and
independent AAMC members, excluding corresponding members, as well as specialty, children’s, VA,
and other federal hospitals.
Source: AAMC analysis of FY2017 American Hospital Association data
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20%80%
AAMC Teaching
Other Teaching
74%
26%AAMC Teaching
Other Teaching
Chart 2-1: The Role of AAMC-Member Teaching Hospitals in Graduate Medical Education, FY2017
AAMC-Member Teaching Hospitals as a
Percent of All Teaching Hospitals
Residents Educated at AAMC-Member and
Other Teaching Hospitals
Note: Data reflect short-term, general, non-federal hospitals. Data for AAMC-member teaching hospitals reflect
integrated and independent AAMC members.
Source: AAMC analysis of FY2017 American Hospital Association data
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Table 2-2: Residents Educated at AAMC-Member and Other Teaching Hospitals, FY2017
Bed Size AAMC-Member Teaching Hospitals All Other Teaching Hospitals
No. of Hospitals
Percent of All AAMC
Median No. of Residents
No. of Hospitals
Percent of All Other Teaching Hospitals
Median No. of Residents
Fewer than 200 3 1.6% 79 182 31.5% 11
200-299 14 7.4% 68 141 24.4% 20
300-399 18 9.5% 77 111 19.2% 30
400-499 26 13.7% 242 78 13.5% 47
500+ 129 67.9% 407 66 11.4% 68
All 190 100.0% 274 578 100.0% 24
Note: Data reflect short-term, general, nonfederal hospitals. Teaching hospitals are defined as having intern and resident to
bed ratio greater than zero (FY2019 IPPS final rule impact file) and reported number of FTE residents in the FY2017
AHA annual survey. The counts of hospitals reflect such a definition.
Source: AAMC analysis of FY2017 American Hospital Association data
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Table 2-3: Per Resident Amount, FY2016
DGME Cost per Trainee Average Cost
Average Cost per trainee $169,280
Average Per Resident Amount (PRA)* $111,526
Average Medicare DGME payment per Resident (based on Medicare’s share of the PRA) $44,205
Total Cost of Training in US Teaching Hospitals $18.5 billion
Total Medicare DGME Payment $3.8 billion
Medicare underpayment (based on Medicare share of DGME costs) $3.8 billion
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There are approximately 109,539 trainees, including 105,808 residents in ACGME and
AOA accredited programs. Of trainees in those programs, Medicare only reimburses
85,774 at or below the cap established in 1997.
*The amount Medicare uses which represents the maximum payment from Medicare per resident assuming 100% of care is borne by Medicare
Source: July 2018 Healthcare Cost Report Information System data
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Medicare Covered Only 20% of All DGME Costs for US Teaching Hospitals in FY 2016
Source: AAMC Analysis of the Medicare Cost Reports. FY 2016/FY 2015.
Note: This analysis was restricted to hospitals that were included in the FY2019 IPPS impact file released by CMS. Previous years’ data were
used for hospitals missing FY 2016 data. About 99% of hospitals reported FY 2016 data, and 1% reported FY 2015. The total training costs
include intern and resident salary, fringe, and other costs.
*DGME Costs Not Paid for by
Medicare = $3.83B in Medicare
Costs above the Cap that Medicare
does not pay and $10.91B in non-
Medicare DGME costs.
Total Teaching Hospital DGME Costs FY 2016
$18.54 Billion
$14.75 Billionin DGME Costs Not Paid
for by Medicare*
$3.79 Billion in Medicare DGME
Payments
© 2019 AAMC. May not be reproduced without permission.
98%of comprehensive cancer centers
69% of burn unit beds
68%of level-one trauma centers
63%of pediatric ICUbeds
Overview of AAMC-Member Hospital Services
Source: AAMC analysis of FY2017 American Hospital Association data, American College of Surgeons Level 1 Trauma Center designations,
2018, and the National Cancer Institute’s Office of Cancer Centers, 2018.
Note: Data reflect short-term, general, nonfederal hospitals.
of all U.S. hospitals are AAMC-member teaching hospitals
5%
However, they provide:
of hospital charity care
of Medicaid hospitalizations
25% 32%
AAMC-member teaching hospitals operate:
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Chart 3-2: Poison Control Centers at AMCs, 2015
Notes: Includes US poison control centers only. AMC affiliation is defined as academic school and/or teaching hospital
affiliation.
Source: AAMC analysis of the American Association of Poison Control Centers, November 2015.
Total Number of Poison Control Centers
Academic Medical Center Affiliated
Centers
AAMC-Member Teaching Hospitals
as Percent of All Centers
57 48 84%
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Table 3-3: Outpatient Visits, by Bed Size and Teaching Status, FY2017
Bed Size Median Outpatient Visits
AAMC-Member Teaching Hospitals
Other Teaching Hospitals
Nonteaching Hospitals
Fewer than 200 beds 317,568 125,128 49,079
200-299 beds 355,435 195,015 145,374
300-399 beds 240,218 215,785 202,771
400-499 beds 488,443 333,727 277,912
500+ beds 670,907 427,914 313,894
All 552,556 203,287 58,533
Note: Data reflect short-term, general, nonfederal hospitals. Data for AAMC-member teaching hospitals reflect
integrated and independent AAMC members.
Source: AAMC analysis of FY2017 American Hospital Association data
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Table 3-4: Comparison of Length of Stay, Case Complexity and Occupancy Rates Among AAMC-Member Teaching, Other Teaching, and Non-Teaching Hospitals
Median Length of
Stay (days)*
Aggregate Case Mix**
Median Occupancy Rate
AAMC-Member Teaching Hospitals 5.7 2.05 76%
Other Teaching Hospitals 4.7 1.75 64%
Nonteaching Hospitals 4.4 1.63 46%
*Length of stay is not adjusted to reflect complexity of patient population (i.e., case mix)
**Based on 2016 Medicare claims data
Note: Data reflect short-term, general, nonfederal hospitals. Data for AAMC-member teaching hospitals reflect integrated and
independent AAMC members.
Source: AAMC analysis of FY2017 American Hospital Association data
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Table 3-5: AAMC-Member Teaching Hospitals Treat Higher Rates of Transfers, 2016
Percent of Medicare Inpatient Cases that
are Transfers
Aggregate Case Mix for Transfers
AAMC-Member Teaching Hospitals 12.7% 2.58
Other Teaching Hospitals 6.3% 2.14
Nonteaching Hospitals 2.8% 2.01
Note: Data reflect short-term, general, nonfederal hospitals. Data for AAMC-member teaching hospitals reflect integrated and
independent AAMC members.
Source: Medicare claims data, 2016.
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Table 3-6: Mortality is Lower at Teaching Hospitals
3.3%
8.3%
13.8%
3.6%
9.2%
15.0%
3.6%
9.5%
15.5%
0%
2%
4%
6%
8%
10%
12%
14%
16%
7 Day Mortality 30 Day Mortality 90 Day Mortality
Major Teaching Minor Teaching Non Teaching
p<0.001 for all results
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Burke, Laura G., Austin B. Frakt, Dhruv Khullar, E. John Orav, and Ashish K. Jha. "Association Between
Teaching Status and Mortality in US Hospitals." JAMA 317, no. 20 (2017): 2105-2113.
Model includes state fixed effects and adjusted for correlation of patients at the hospital level. Patient
characteristic adjustments include principal discharge Diagnosis Related Group Weight, age, sex, Medicaid
eligibility, and Hierarchical Condition Category. Hospital characteristic adjustments include profit status,
rural/urban location, and volume of hospitalizations.
© 2019 AAMC. May not be reproduced without permission.
Chart 4-1: Proportion of Charity Care Costs Provided at
AAMC-Member Teaching, Other Teaching, and Non-
Teaching Hospitals, FY2017
Note: Data reflect short-term, general, nonfederal hospitals. Data for AAMC-member teaching hospitals reflect integrated and
independent AAMC members. Charity care is defined as the revenue forgone as a result of care provided without the
expectation of payment. As these labels are rounded percentages, the totals for each bar may not add up to 100%.
Source: AAMC analysis of FY2017 American Hospital Association data
5%
32%19%
35%
75%
32%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
AS A % OF ALL HOSPITALS AS A % OF ALL CHARITY CARE
AAMC Other Teaching Non-Teaching
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Table 4-2: Median Amount of Charity and Uncompensated Care Costs Provided at AAMC-Member,
Other Teaching, and Nonteaching Hospitals, FY2017
Number of Hospitals
Median Amount (Millions of $)
Charity Care Costs
Uncompensated Care Costs
AAMC-member teaching hospitals 224 $15.3 $26.8
Other teaching hospitals 851 $4.2 $8.4
Nonteaching hospitals 3,292 $0.6 $2.0
Note: Data reflect short-term, general, nonfederal hospitals. Data for AAMC-member teaching hospitals reflect integrated and
independent AAMC members. Charity care is defined as care provided without the expectation of payment. Excludes
hospital’s bad debt and is measured in terms of costs, not charges.
Source: AAMC analysis of a special tabulation using FY2017 American Hospital Association (AHA) data and AAMC membership data as
of December 2018.
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Chart 4-3: Net Patient Revenue Payer Mix at AAMC-Member, Other Teaching, and
Nonteaching Hospitals, FY2017
18% 17% 14%
31%38%
39%
48%40% 41%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
AAMC HOSPITALS OTHER TEACHING HOSPITALS NONTEACHING HOSPITALS
Pa
ye
r P
erc
en
t o
f N
et
Pa
tie
nt
Reve
nu
e
Medicaid Medicare 3rd Party Self-Pay Other
Note: Data reflect short-term, general, nonfederal hospitals. Data for AAMC-member teaching hospitals reflect integrated
and independent AAMC members. Gross patient payer mix is defined as net patient revenue from each source
divided by total net patient revenue.
Source: AAMC analysis of a special tabulation using FY2017 American Hospital Association (AHA) data and AAMC
membership data as of December 2018.
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Chart 4-4: Aggregate Margins at AAMC-Member and Non-Member Teaching Hospitals, FY2016
-12.1%
-3.5%
5.4%6.5%
-9.8%
2.0%
5.9% 6.9%
-30%
-25%
-20%
-15%
-10%
-5%
0%
5%
10%
MEDICARE OVERALL MARGINS
ALL PAYER PATIENT CARE MARGINS
ALL PAYER OPERATING MARGINS
ALL PAYER TOTAL MARGINS
Ag
gre
ga
te M
arg
in
AAMC-Member Hospitals Non-AAMC-Member Hospitals
Note: Data reflect short-term, general Medicare hospitals subject to IPPS. Data for AAMC-member teaching hospitals reflect
integrated and independent AAMC members. Aggregate values by hospital category.
General formula for all margin types: (Revenues - Expenses) / Revenues. Each margin type below uses different types of
revenues and expenses, described below. Patient Care Margin: both revenues and expenses are defined as those
associated with service to patients. Operating Margin: revenues include all sources other than “Contributions,
Donations, Bequests” and “Investment Income” and expenses include all hospital expenses. Total Margin: revenues
include all sources of revenue and expenses include all hospital expenses.
Source: Centers for Medicare and Medicaid Services, HCRIS Database, June 30, 2018 update.
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Chart 4-5: Impact of IPPS Medicare Revenue Cuts to AAMC-Member Teaching Hospitals, FY2010 – FY2019
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Notes:
Includes IPPS payment cuts only, and does not take into account payment cuts to OPPS, IPF, IRF, or other payment systems.
Percent cuts for all cuts except sequestration are derived from the FY2010 to FY2019 Medicare IPPS Final Rules.
All payment cuts are computed as the difference between what a hospital would be paid without the relevant cut and actual payments. For FY2010
to FY2016, total IPPS payments are as reported on CMS’s HCRIS databases. For FY2017-FY2019, total IPPS payments are estimated using the
Medicare IPPS Final Rules.
Quality pay-for-performance reductions are estimated from adjustment factors for HVBP, HRRP, and HACRP published in the FY2013 to FY2019
Medicare IPPS Final Rules.
AAMC membership is as of September 2018.
1 Source: Appendix B of the Medicare Provisions in the Patient Protection and Affordable Care Act (PPACA): Summary
and Timeline. Congressional Research Service. Accessed at: http://www.ncsl.org/documents/health/ACAMCProv.pdf
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Table 5-1: Distribution of Residents Among VA AAMC-Member and Other Teaching VA Hospitals, FY2017
VA AAMC-Member Teaching Hospitals
All Other Teaching VA Hospitals
Number of Hospitals 31 73
Percent of All VA Teaching Hospitals 29.8% 70.2%
Total Number of Resident FTEs 983 1,216
Percent of Resident FTEs* 44.7% 55.3%
Note: VA hospitals are institutions that are owned, staffed, and operated by the VA for the primary function of providing inpatient services.
This chart reflects data submitted by 104 VA teaching hospitals to AHA in their annual survey.
*Resident FTEs reflect the total medical and dental full time equivalent (FTE) residents.
Source: AAMC analysis of FY2017 American Hospitals Association data.
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Table 5-2: Distribution of Residents at Children’s Teaching Hospitals, FY2017
AAMC-Member Children’s Teaching
Hospitals
Other Children’s Teaching Hospitals
Number of Hospitals 17 38
Percent of Residents Educated at Children’s
Teaching Hospitals80.1% 19.9%
Median Number of Residents and Fellows 134 33
Note: These numbers reflect acute, general, nonfederal Children’s Teaching hospitals. These data exclude Nonteaching
Children’s hospitals. Not all hospitals that responded to the AHA survey responded to this question, so the
number of hospital counts may be lower.
Source: AAMC analysis of FY2017 American Hospital Association (AHA) data
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