Study: Despite Improvements, Academic Medical Centers Trail Non-Academics on Cost and Quality Metrics
Navigant analysis of
According to the analysis,
In addition, a 22% cost per case disparity exists between high (25th
percentile) and low (75th percentile) performing AMCs, compared to 19.8%
for non-AMCs. Thus, the differential for low performers would amount to
Analysis results also suggest:
- AMCs received more overall value-based program penalties from 2016-2018, with 40% getting seven or more of nine possible penalties versus 23.1% of non-AMCs.
- Although AMC overall weighted performance on CMS readmission, hospital-acquired condition, and value-based program measures increased 10.4% from 2016 to 2018, AMC scores still trail non-AMCs by 1.3 points.
“While AMCs have earned strong reputations for cutting-edge and
specialty care, our previous experience has found most AMC admissions
and procedures could also be performed at non-AMCs,” said study author
and Navigant Director
Facilities struggling with value-based programs could face further financial pressures due to such trends as:
- Quality indicators driving patient-care decisions: With consumers increasingly using value-based program indicators to decide where to seek care, poor performance on such metrics could impact patient volumes – specifically commercially insured patients.
- Growing revenue at-risk through alternative payment models (APMs): Traditionally active APM participants, AMCs performing poorly on quality measures may face penalties and miss bonus opportunities under both public and commercial models.
Partnerships impacted by performance: As accountable care
organizations look to increase influence on patient-care decisions and
payers become more selective in contracting choices – including
through increasingly popular
Medicare Advantageplans – facilities with poorer quality and cost performance may be cast aside by these influential partners that drive patient volumes.
Approaches AMCs can implement to minimize these negative implications and improve quality and cost include:
- Utilize industry-wide benchmarking data comparing performance against peers.
- Engage leadership, physicians, and other staff for buy-in on enhancement strategies.
- Focus on retaining customers by building tight provider network relationships across the care continuum and common standards for access, quality, and cost.
- Leverage evidence-based clinical protocols to address clinical variation.
Navigant’s analysis is based on data from 387 U.S. hospitals (175 AMCs,
212 non-AMCs) with more than