The Future of Publicly-Funded University Hospitals (Dahn Shaulis and Glen McGhee)

There are more than 200 active university medical centers (UMCs) and 1,700 teaching hospitals in the United States. These institutions, tied to America's major universities, employ large numbers of medical professionals, administrators, and laborers. While UMCs have grown in size, dominating areas in major cities, finding facilities that are financially well, well staffed, and adequately resourced has become more difficult to find. 

Also known as academic medical centers or AMCs, UMCs feel the financial strain of a number of social issues: a growing elderly population, drug overdoses, mental health problems, gunshot wounds, victims of car crashes, children with severe illnesses, and numerous medical problems related to poverty.  Some UMCs are trying to grow out of their financial problems by expanding their networks and buying up other facilities that may provide more profitability.  

Private equity is also taking over hundreds of hospitals and clinics across the US, finding value where they can, however they can. Private for-profit hospitals, for example, will steer their most vulnerable patients to UMCs. And they will cut out programs they cannot profit from. Publicly funded university hospitals often cannot turn people away or dump patients if they cannot pay their medical bills--or if they are not covered by premium insurance.  

While nurses and other medical laborers may be overworked and short-staffed, CEO pay is often $1M-$3M a year at larger institutions. And many medical centers, both public and private, are run with administrators focused more on cost containment rather than patient care and preventive care. 

 

Simply adding money to these institutions without transparency, accountability, and reform not only makes the situation no better, it means less money for other areas of need, such as public health, K-12 education, safe and affordable housing, clean air and water, public transportation, and infrastructure.

Critical Condition   

While the covid epidemic was horrifying for hospitals, the underlying conditions for many UMC's are a slow-motion disaster. University medical centers are facing financial challenges due to several key factors:

1. Rising costs outpacing revenue growth: Operating expenses, particularly for staff, facilities, and technology investments, are increasing faster than patient care revenue. 

2. Reduced government funding: State support for academic health centers has been shrinking since the early 1990s. Federal and state funding for medical research and education has also stagnated or declined.

3. Lower reimbursement rates: UMCs are facing low reimbursement rates from Medicaid, Medicare, and commercial insurance. Cost-control measures introduced by the Affordable Care Act have also impacted revenues.

4. Legacy pension costs: Some UMCs are burdened with high fringe benefit costs inherited from state systems.

5. Increased competition: Many UMCs are too small to compete effectively in the current healthcare market against monopolies like HCA and Keiser. Their lack of scale gives them little leverage in negotiations for services and supplies.

6. Balancing multiple missions: UMCs must juggle patient care, research, and education. This can lead to inefficiencies, as physician time spent on research and teaching is less profitable than pure clinical care.

7. Infrastructure investments: UMCs need to make large investments in infrastructure and technology to maintain top-tier diagnostic and research capabilities

The main problem seems to be that the traditional financial model for academic medical centers is no longer sustainable in the current healthcare environment. Their operating costs are rising faster than their revenue sources can keep up, and they are struggling to maintain financial viability while fulfilling their multiple missions of patient care, research, and education.

Saving Lives is Unprofitable 

 

Burn Units: Treating burn victims requires specialized staff and facilities, leading to high costs, while insurance reimbursements may not fully cover them.

Neonatal Intensive Care Units (NICUs): While essential, NICU care for premature or critically ill newborns is expensive due to the high level of support needed.

Trauma Centers: Trauma care often involves a high volume of resources and unpredictable patient conditions, making it difficult to predict or control costs.

Mental Health Services: Mental healthcare reimbursement rates tend to be lower compared to other specialties, making these programs less profitable.

The Bigger (Unhealthy) Picture 

This strain at UMCs is under-girded by a dysfunctional and expensive healthcare system serving a population that is violent and unequal, and increasingly sedentary, unhealthy, disabled, elderly, and under psychological strain.

 

Around 40% of US hospitals are operating at a loss according to Kaufman Hall. And about half of all rural hospitals are running in the red. Obstetrics and delivery services are big money losers in these hospitals. Hundreds of these units, and their hospitals, are at risk of closing, leaving folks with longer travel times to get medical care. 

 

In 2022, U.S. healthcare spending reached $4.5 trillion, or $13,493 per person. The cost of healthcare per person in other wealthy countries is less than half as much. Despite this enormous spending, US life expectancy is 3 to 4 years less than other OECD nations. For those with means, though, the US offers some of the best medical care in the world. 

Zooming In

Financial problems and/understaffing and safety issues have been noted at:

University of Vermont Health Network (VM)

Nassau University Medical Center (NY)

CarePoint Health and Hoboken University Medical Center (NJ)
Rutgers Robert Wood Johnson Medical School (NJ)

George Washington University Hospital (DC)

Penn Medicine-University of Pennsylvania (PA)
University of Pittsburgh Medical Center (PA)

University Hospitals-Case Western Reserve (OH)
West Virginia University Medicine (WV)
University of Miami Health System (FL)

University Medical Center-LSU and Tulane (LA)
Detroit Medical Center-Wayne State University (MI)
Marquette University Health Care (WI)
Cook County Health-Rush University (IL)
University of Chicago Medical Center (IL)
Oregon Health & Science University (OR)

University of New Mexico Hospital (NM)
UCLA Health (CA)

University of California, including UC Davis (CA)

We expect to see more headlines about the declining finances at some university hospitals--and the downsizing that will follow. Fierce Healthcare has created a layoff tracker to monitor these events.

Related links:

Baby Boomers Turning 80: The Flip Side of the 2026 Enrollment Cliff

State Universities and the College Meltdown

American Hospital Association (AHA) Report: New AHA Report Finds Financial Challenges Mount for Hospitals & Health Systems Putting Access to Care at Risk (April 2023)

McKinsey & Company: Ensuring the financial sustainability of academic medical centers (July 2023)

 

PESP Private Equity Hospital Tracker 

Ahead of the Learned Herd: Why the Higher Education Inquirer Grows During the Endless College Meltdown (Dahn Shaulis and Glen McGhee)

The Higher Education Inquirer (HEI) continues to grow without financial support and without paying for advertising or SEO help. The reason is that HEI continues to provide useful information for folks who follow US higher education. We do it in the spirit of Upton Sinclair and others pejoratively known as the muckrakers. And we gladly take the label. 

For years, the higher ed herd dismissed warnings of looming financial crises, but HEI accurately foresaw the revenue declines and unsustainable models forcing college closures, and the downside of the online pivot (including online program managers and robocolleges). We also saw a decade of enrollment declines with no end in sight. 

HEI has published a number of articles that provide value to higher ed workers (including adjuncts), future, present, and former students (including the tens of millions of student loan debtors), and other folks affiliated with the higher ed industry (including workers at edtech and financial companies). We called it the College Meltdown. 

 

We have examined a number of groupings in the industry (from community colleges and for-profit schools to elite universities and everything in between) and issues (to include student and worker protests, student loan debt, and violence on campus).  We highlight those who are trying to good, like David Halperin (Republic Report), Gary Stocker (College Viability), Mark Salisbury (TuitionFit), Helena Worthen (Power Despite Precarity), Theresa Sweet and Tarah Gramza (Sweet v Cardona), and Ann Bowers (Debt Collective). 

HEI has also had the good fortune of getting outstanding contributions from Randall Collins, Bryan Alexander, Robert Kelchen, Phil Hill, Gary Roth, Bill Harrington, and others. Bryan Alexander's contributions have been extremely important in highlighting the existential threat of global climate change and the civil strife that accompanies it.

While honest reporting is important to us, we do take sides, just as other outlets do (most others take the side of big business and government). We are for the People, and we hunt for corruption that undermines democracy. We have examined companies (like Guild, Maximus, and EducationDynamics) that few others will bother to examine. We continue to follow subprime for-profit colleges that have morphed into subprime state universities (like Purdue Global and University of Arizona Global) and other bad actors in higher ed (like 2U and the University of Phoenix). 

We value history, the real unvarnished history, not the tales, myths and lies that have been repeated to children for generations and used as indoctrination at all levels of society. And we value those who look honestly at the present and the future, those not trying to sell themselves or their hidden agendas. 

As Howard Zinn proclaimed, you can't be neutral on a moving train. And US higher education, we fear, is a train moving away from America's hopes and dreams of diversity, equity, inclusion, and justice, towards a less utopian, more dangerous, place.