Leaders of Maryland's renowned teaching hospitals are feeling vulnerable as the push for a health care overhaul focuses attention on the tremendous differences in hospital costs around the country.
Urban academic medical centers such as top-ranked Johns Hopkins Hospital and the University of Maryland, with its world-class trauma center, are more expensive to run than community hospitals and rural teaching hospitals. The difference can mean patient bills that are higher by thousands of dollars.
Administrators at these urban medical centers fear the national focus on cost-cutting will hurt their ability to train doctors, research diseases and treat complex problems. Community hospitals don't perform these expensive tasks, but medical centers say such work is essential to their mission.
And, the urban centers argue, they're more pricey than rural teaching hospitals because they treat poorer and sicker patients in an area with higher costs.
"To do what we do takes a certain infrastructure, making teaching hospitals more expensive," said Jeffrey A. Rivest, president and chief executive officer of the University of Maryland Medical Center, which trains half the doctors in the state. "If there are specific reductions through Medicare and Medicaid revenue cuts, this will hinder the nation's ability to be a leader in innovation and creators of advancement in care and more cost-effective care."
The U.S government has long paid urban teaching hospitals higher rates through Medicare. But now legislative proposals would slow the growth of Medicare payment rates overall and would study geographic disparities in spending - findings that could limit the amount of money going to pricier hospitals nationwide.
Maryland hospitals are not specific targets - in fact, the state has been hailed by some analysts for efforts to keep hospital costs down. But influential and hotly debated research from Dartmouth College on the cost of care at the end of chronically ill patients' lives ranks the state sixth-highest in the nation. Lawmakers and the White House have seized on this research, which shows big differences in regional health care spending, as evidence of waste.
Hopkins and the University of Maryland are the state's costliest hospitals, according to Dartmouth data from 2001 to 2005. Medicare reimbursed the University of Maryland, the highest spender, $95,000 per patient in the last two years of life. The national average was about $53,000.
