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© 2019 AAMC. May not be reproduced without permission.© 2019 AAMC. May not be reproduced without permission.

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Teaching Hospital CharacteristicsAssociation of American Medical Colleges

© 2019 AAMC. May not be reproduced without permission.

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


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

Return to Table of Contents


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.


Ownership categories obtained from the FY2017 American Hospital Association data.



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.



Count ofCOTHMembers


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



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.




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.




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


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


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


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:


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%



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.




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.




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


independent AAMC members.

Source: Medicare claims data, 2016.



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


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.


Chart 4-1: Proportion of Charity Care Costs Provided at

AAMC-Member Teaching, Other Teaching, and Non-

Teaching Hospitals, FY2017


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%.


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



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


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.



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.



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.



Chart 4-5: Impact of IPPS Medicare Revenue Cuts to AAMC-Member Teaching Hospitals, FY2010 – FY2019


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


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.



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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