Report lauds community hospitals

A Harvard University researcher found that community hospitals did just as good a job treating most common illnesses as academic medical centers, but provided that care far more cheaply.

Nancy Kane, a professor at the Harvard School of Public Health, studied how patients fared for 41 basic illnesses and conditions in community hospitals versus teaching hospitals in Massachusetts, Virginia, Illinois, Florida, New York, and California. She found that patients were slightly less likely to suffer post-surgical pneumonia and post-surgical lung complications in teaching hospitals, but slightly more likely to suffer wound infection, post-surgical urinary tract infection, and death. For example, 0.34 percent of patients in the hospitals studied died soon after their treatment, but they were 27 percent more likely to die if they were cared for in a teaching hospital.

She found no difference in mechanical complications for patients with an implantable device, such as a pacemaker, or for patients with a range of other serious problems.

Kane conducted the research for the Pioneer Institute in Boston, a think tank that promotes small government and free-market principles. She adjusted the results to account for the fact that teaching hospitals by their nature treat sicker patients with more complicated illnesses who are more likely to die.

But Kane's study surely will spark disagreement over the methodology. Like Kane, researchers and companies that rank hospitals look at data extracted from hospital bills, rather than reviewing patient charts and medical records, so they can't fully account for differences in how sick patients are.

Even so, insurers and employers are likely to use the study as evidence for promoting new health plans that charge consumers more to use expensive teaching hospitals for basic care. Many insurers are making similar hospital rankings public, hoping to motivate members to choose the best-performing and least expensive hospitals.

"The academic medical centers are wonderful places, but the data are beginning to emerge that things are not quite as simple as they seemed," said Dolores Mitchell, executive director of the Group Insurance Commission, which manages benefits for state employees in Massachusetts. "Are people going to the right hospital for the right reasons? We're trying to lay out some choices for people."

As of July, state employees who enroll in Tufts Health Plan pay a $200 insurance copayment per admission at 15 hospitals -- most of them community hospitals -- Tufts identified as a better value for adult care. Employees pay double that if they choose treatment at other hospitals across the state that the plan considers either more expensive, lower in quality, or both.

Kane's study did not say how many patients experienced particular complications at community hospitals versus teaching hospitals. Rather, she reported the percentage differences between academic medical centers and community hospitals.

For example, patients who suffered wound infections were 15 percent more likely to have contracted the complication at teaching hospitals. But since the numbers of patients who suffer wound infections are small anyway -- 0.21 percent, or about 2 out of 1,000 patients -- the differences between the two types of hospitals also are tiny.

Looking at costs, she calculated that hospitals affiliated with medical schools that train students and new doctors charged 19 percent more for treating patients with common conditions than community hospitals.

Dr. Peter Slavin, president of Massachusetts General Hospital, said consumers should be cautious about the results. Teaching hospitals, he said, are more expensive not because they're inefficient, but because they must subsidize other parts of their mission, including research, medical education, and complex care for very ill patients.

"If care shifted dramatically, we would be able to provide less of these other things," Slavin said. For community hospitals, however, "such a shift would mean a financial windfall," Kane's report stated.

Slavin also pointed out that other quality studies have put teaching hospitals on top. For example, recent hospital ratings released by the Leapfrog Group, a coalition of more than 160 large healthcare purchasers, showed Massachusetts teaching hospitals much further along at adopting computerized drug-ordering and other patient safety measures.

But many community hospital executives said just as many studies are emerging that put their care on par with their bigger, more prestigious competitors.

"We're very very pleased, but this confirms what we'd already thought," said Dale Lodge, president of Winchester Hospital. Still, Lodge said, swaying the public is another matter.

"Those brands in town are very, very strong," he said. "I hope this helps give people a comfort level with community hospitals. We've got a problem in this state with costs going through the roof."

Liz Kowalczyk can be reached at kowalczyk@globe.com.