Teaching Hospitals

People are more likely to die from their illnesses when admitted to osteopathic, public or for-profit hospitals, but private hospitals affiliated with medical schools offer the best chance of getting well, a study concludes. The research, based on federal statistics, also concludes that hospitals are most likely to save patients' lives when they have the best-trained doctors and nurses, a lot of sophisticated equipment, large payrolls and high occupancy rates. "All of our findings have the same possible explanation: They reflect differences in quality," said Dr. Arthur J. Hartz, principal author of the research at the Medical College of Wisconsin.

Bleeding financially, the nation's teaching hospitals fear they are about to be slashed further by, of all people, a heart surgeon - Sen. Bill Frist, R-Tenn. Frist says, and credibly, that it isn't so and that he actually means to save the hospitals from the perils of modern medical economics. Congress needs to secure U.S. graduate medical education. But aid to the hospitals is a sideshow in Congress' epic Medicare political wars, so chances are nothing will happen this year and the bleeding will go on. Many of the nation's 1,250 academic medical centers - which train the nation's future doctors, conduct research and take care of some of the poorest and sickest people in America - are already in deep trouble.

The 17 teaching hospitals in the Philadelphia area have become a powerful economic contributor to the region's health, and a strong generator of jobs, many of which go to minority applicants, according to a new report on the economic impact of health care on several metropolitan areas. Philadelphia hospitals contributed more than $1.4 billion to the economy of the eight-county metropolitan area and attracted another $299 million in research grants, said the report, released last week by the Commonwealth Fund's Task Force on Academic Health Centers.

Woodrow A. Myers Jr., who oversees health care for all Ford Motor Co. employees, ventured into the heart of a prominent Philadelphia teaching hospital yesterday and issued this challenge to academic medicine: Prove that you're as good as you think you are. It isn't enough that teaching hospitals say research sets them apart and justifies their high-cost medical care, Myers said. "We want very much to believe you," he told more than 100 people at the seventh annual Raymond C. Grandon lecture at Thomas Jefferson University Hospital.

Hit hard by federal cutbacks, increased competition and shifts in the way medical care is provided, Philadelphia's six university hospitals are being forced to re-examine their traditional roles as educators and health-care providers. After years of strong growth and healthy profits, three of the six academic medical centers here reported operating losses last year. One broke even. And the profit margins of the two centers that did make money dropped sharply. The downturn in business, which many predict will accelerate as federal officials seek additional cutbacks in health-care funding, is prompting administrators to make unprecedented changes in the way they do business and to search for new ways to generate revenues.

The 17 teaching hospitals in the Philadelphia area have become a powerful economic contributor to the region's health, and a strong generator of jobs, many of which go to minority applicants, according to a new report on the economic impact of health care on several metropolitan areas. Philadelphia hospitals contributed more than $1.4 billion to the economy of the eight-county metropolitan area and attracted another $299 million in research grants, said the report, released last week by the Commonwealth Fund's Task Force on Academic Health Centers.

Abortion opponents in Pennsylvania are not content with having fostered laws that are discriminatory in the way they limit poor women's right to a legal abortion. They now seem intent on even more intrusive and objectionable ways of infringing on rights that the U.S. Supreme Court says still belong to all women. So it's good to see that abortion-rights activists, after a decade of only practicing damage control, are planning to confront the battle head- on. In their counter-attack, the abortion-rights forces are talking about stripping away legal provisions that eliminated most Medicaid-funded abortions, one of the most egregious and unfair restrictions.

Doctors who practice at university teaching hospitals in big cities can expect to see sharp declines in their incomes when Medicare begins phasing in a new fee schedule in January, a study by University of Pennsylvania doctors predicts. And because academic medical centers depend on physician income to help pay for the training of new doctors, they will face increased pressure to find new sources of income, according to a report appearing in today's issue of the Journal of the American Medical Association (JAMA)

Leaders of Pennsylvania's academic medical centers - places that train doctors, take care of patients, and do research - have been touring the state, and Washington, for weeks now, trying to head off deep cuts in their special Medicare funding. Last week, they found out who was listening. House Republicans released a proposal that outlined much less painful cuts in funding than lawmakers were suggesting earlier this year. In fact, if a new trust fund for medical education survives the debate and if it has as much money in it as its sponsors say - two very big ifs - teaching hospitals could come out about even.

Thomas Jefferson University and its teaching physicians have agreed to pay the government $12 million for overbilling Medicare, becoming the second medical center in Philadelphia to settle with federal prosecutors in the last year in an expanding probe of expenses at teaching hospitals. The settlement, announced by the U.S. Attorney's Office yesterday, was based on an examination of 100 patient cases from 1994. Auditors found $1.2 million in improper billings: either charges by faculty doctors for services actually performed by medical residents, or charges that were not documented by medical records.

Medicare's first public effort to pinpoint hospitals with high complication rates has identified many prestigious teaching hospitals in Pennsylvania and around the nation, raising concerns at these places but also bolstering objections that the government's measures are skewed. Temple University Hospital, Hahnemann University Hospital, Thomas Jefferson University Hospitals, and the Hospital of the University of Pennsylvania were among those places having far more serious complications than the average hospital, according to the Medicare program.

THE MIRROR image of "Build it and they will come" ( "Eliminate It and We Won't Need It" ) seems to be the idea behind many health-care proposals suggested as part of D.C. deficit-reduction negotiations. Proposed Medicare cuts will hurt patients, doctors, and hospitals in the region and the state especially hard. Pennsylvania is one of the oldest states in the union, and we have the third-highest percentage of residents who are covered by Medicare. The needs of older adults, who typically require about double the health-care services used by younger people, won't go away just because Medicare funding has been slashed.

Young doctors are about to be prescribed more sleep. Beginning Friday, new rules will reduce the number of consecutive hours that first-year resident physicians can work - from 30 to 16. The mandate is billed as a means of enhancing patient safety and residents' quality of life by reducing physician fatigue and errors. But it will also boost hospital costs and further reduce the long hours that some doctors believe are critical to learning. Doctors in Philadelphia, an epicenter of teaching hospitals and medical schools, helped usher in this sea change.

TRENTON - Rutgers University will not be getting into the marijuana growing business. New Jersey's largest university has declined a request from Gov. Chris Christie to become the lone grower of the state's medical marijuana crop. The school's dean of environmental and biological sciences department tells The Star-Ledger of Newark that marijuana's status as an illegal drug would jeopardize federal funding to the school. The Legislature approved a plan allowing patients with certain chronic illnesses to access marijuana.

New Jersey's hospitals barely broke even last year, according to the New Jersey Hospital Association. In its annual report on its members' finances, the association said the average operating margin - the equivalent of profits on operations - was only 0.2 percent. Total margin, which includes return on investments, was even worse: minus 14.1 percent. The report was based on audited financial statements from 48 acute-care hospitals and systems - 95 percent of the total - and six rehabilitation hospitals.

Metro Philadelphia's mix of corporate employers makes for a mellow regional economy, slow-growing but also recession-resistant. An Inquirer survey of more than 200 major employers shows the region's biggest job engines are the hospital system affiliated with Thomas Jefferson University, and the combination of the University of Pennsylvania and its hospital network. Other big employers include drugmakers and medical-device manufacturers such as Merck & Co. Inc., GlaxoSmithKline P.L.C.

Metro Philadelphia's mix of corporate employers makes for a mellow regional economy, slow-growing but also recession-resistant. An Inquirer survey of more than 200 major employers shows the region's biggest job engines are the hospital system affiliated with Thomas Jefferson University, and the combination of the University of Pennsylvania and its hospital network. Other big employers include drugmakers and medical-device manufacturers such as Merck & Co. Inc. , GlaxoSmithKline P.L.C.

On the morning of her Caesarean section, Tyriesha Tucker met the woman who would deliver her baby - obstetrician Hyun-Joo Lee - for the first time. That was fine with Tucker, a tiny woman who was 41 weeks pregnant with her second child. She didn't care whether she had a long relationship with the doctor who would cut into her womb that day. What mattered, she said, was that her doctor knew what she was doing. By early afternoon, Lee, whose job was to care for all the women in labor on Albert Einstein Medical Center's busy maternity floor that day and night, was furiously scrubbing her hands and arms for Tucker's surgery.

The Jenkintown man who gained worldwide admiration by donating a kidney to a stranger is continuing his giving ways. He is donating $30 million to Ohio State University. The donation by Zell Kravinsky, a real-estate investor, will tie the $30 million given to the university's law school in 2001 by the late Michael Moritz, a lawyer. Kravinsky's gift will go to the university's school of public health. In donating his kidney, Kravinsky specified that it go to a "low-income African-American.

It's hard to imagine doctors giving unauthorized, invasive examinations to patients who are in their office for an outpatient procedure. That would be a huge abuse of trust. Yet, some are willing to do just that on anesthetized gynecological surgery patients. A 1995 survey of Philadelphia medical students, published this month in the American Journal of Obstetrics and Gynecology, found that a quarter thought it unimportant to get consent before examining an anesthetized gynecological surgery patient.