Family practice graduate medical education and hospitalsʼ patient care costs in New Jersey

Tallia, Alfred F.; Swee, David E.; Winter, Robin O; Lichtig, Leo K.; Knabe, F M; Knauf, Robert

doi:10.1097/00001888-199409000-00021

Cited by 4 publications

(5 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“… 5,6 The type of residency program may also be important: one study in New Jersey found that hospitals with family practice residencies had lower inpatient costs compared with nonteaching hospitals or with hospitals sponsoring other types of training programs. 7 …”

Section: Discussionmentioning

confidence: 99%

“…5,6 The type of residency program may also be important; one study in New Jersey found that hospitals with family practice residencies had lower inpatient costs compared with nonteaching hospitals or with hospitals sponsoring other types of training programs. 7 These interinstitutional comparisons have attributed increased use of resources at teaching hospitals in part to the inexperience of residents. However, one study specifically refuted this explanation by finding similar resource utilization among teaching patients admitted early and late in the academic year.…”

Section: Discussionmentioning

confidence: 99%

“…Without resolving this methodologic problem, most previous studies have found resident care more costly. 5–11 Likewise, current government‐funded subsidies of teaching hospitals reflect the generally held belief that postgraduate medical education is a net financial burden to its sponsors. 12 …”

mentioning

confidence: 99%

See 2 more Smart Citations

Association of resident coverage with cost, length of stay, and profitability at a community hospital

et al. 2001

View full text Add to dashboard Cite

OBJECTIVE: The effect of care by medical residents on hospital length of stay (LOS), indirect costs, and reimbursement was last examined across a range of illnesses in 1981; the issue has never been examined at a community hospital. We studied resource utilization and reimbursement at a community hospital in relation to the involvement of medical residents.DESIGN: This nonrandomized observational study compared patients discharged from a general medicine teaching unit with those discharged from nonteaching general medical/ surgical units. SETTING:A 620-bed community teaching hospital with a general medicine teaching unit (resident care) and several general medicine nonteaching units (no resident care).PATIENTS: All medical discharges between July 1998 and February 1999, excluding those from designated subspecialty and critical care units. MEASUREMENTS AND MAIN RESULTS:Endpoints included mean LOS in excess of expected LOS, mean cost in excess of expected cost, mean payments, and mean profitability (payments minus total costs). Observed values were obtained from the hospital's database and expected values from a proprietary risk adjustment program. No significant difference in LOS between 917 teaching-unit patients and 697 nonteaching patients was demonstrated. Costs averaged $3,178 (95% confidence interval [CI] $489) less than expected among teaching-unit patients and $4,153 (95% CI $422) less than expected among nonteaching-unit patients. Payments were significantly higher per patient on the teaching unit than on the nonteaching units, and as a result, mean profitability was higher: $848 (95% CI $307) per hospitalization for teachingunit patients and $451 (95% CI $327) for patients on the nonteaching units. Teaching-unit patients of attendings who rarely admitted to the teaching unit (nonteaching attendings) generated an average profit of $1,299 (95% CI $613), while nonteaching patients of nonteaching attendings generated an average profit of $208 (95% CI $437). CONCLUSIONS:Resident care at our community teaching hospital was associated with significantly higher costs but also with higher payments and greater profitability.KEY WORDS: health care finance; residents; length of stay; indirect costs.J GEN INTERN MED 2001;16:1±8.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Association of resident coverage with cost, length of stay, and profitability at a community hospital

et al. 2001

View full text Add to dashboard Cite

show abstract

“…The effect of resident care on costs of hospitalization has been well studied, although infrequently with consideration of reimbursements generated by that care 1–3 . We recently reported that patients on an internal medicine inpatient teaching service generated payments to the sponsoring community hospital that were higher, on average and for most diagnosis‐related groups (DRGs), than payments for nonteaching patients.…”

mentioning

confidence: 99%

Actual and potential effects of medical resident coverage on reimbursement for inpatient visits by attending physicians

et al. 2002

View full text Add to dashboard Cite

CONTEXT: The impact of residents on hospital finance has been studied; there are no data describing the economic effect of residents on attending physicians. OBJECTIVE:In a community teaching hospital, we compared allowable inpatient visit codes and payments (based on documentation in the daily progress notes) between a general medicine teaching unit and nonteaching general medicine units. DESIGN:Retrospective chart review, matched cohort study.SETTING: Six hundred fifty±bed community teaching hospital. PATIENTS:Patients were discharged July 1998 through February 1999 from Saint Barnabas Medical Center. We randomly selected 200 patients in quartets. Each quartet consisted of a pair of patients cared for by residents and a pair cared for only by an attending physician. In each pair, 1 of the patients was under the care of an attending physician who usually admitted to the teaching service, and 1 was under the care of a usually nonteaching attending. Within each quartet, patients were matched for diagnosis-related group, length of stay, and discharge date. MAIN OUTCOME MEASURES:We assigned the highest daily visit code justifiable by resident and attending chart documentation, determining relative value units (RVUs) and reimbursements allowed by each patient's insurance company.RESULTS: Although more seriously ill, teaching-unit patients generated a mean 1.75 RVUs daily, compared with 1.84 among patients discharged from nonteaching units (P = .3). Median reimbursement, daily and per hospitalization, was similar on teaching and nonteaching units. Nonteaching attendings documented higher mean daily RVUs than teaching attendings (1.83 vs 1.76, P = .2). Median allowable reimbursements were $267 per case ($53 daily) among teaching attendings compared with $294 per case ($58 daily) among nonteaching attendings (Z = 1.54, P = .1). When only the resident note was considered, mean daily RVUs increased 39% and median allowable dollars per day 27% (Z = 4.21, P < .001). CONCLUSIONS:Nonteaching attendings appear to document their visits more carefully from a billing perspective than do teaching attendings. Properly counter-documented, resident notes could substantially increase payments to attending physicians.KEY WORDS: health care finance; residents; coding. J GEN INTERN MED 2002;17:428±434. T he effect of resident care on costs of hospitalization has been well studied, although infrequently with consideration of reimbursements generated by that care. 1±3 We recently reported that patients on an internal medicine inpatient teaching service generated payments to the sponsoring community hospital that were higher, on average and for most diagnosis-related groups (DRGs), than payments for nonteaching patients. At least part of this difference was attributable to extensive documentation by residents in the medical record. 4 In this study, we extend our work on resident care from its association with hospital reimbursement to its effect on physician payments for hospital care. We were interested in determining whether residen...

show abstract

“…These adjustments are difficult to make, 6 7 but when attempts are made the difference between teaching and non-teaching hospitals is diminished. 8 9…”

mentioning

confidence: 99%

Doctors in training: wasteful and inefficient?

Rosborough

1998

BMJ

View full text Add to dashboard Cite

Family practice graduate medical education and hospitalsʼ patient care costs in New Jersey

Cited by 4 publications

References 0 publications

Association of resident coverage with cost, length of stay, and profitability at a community hospital

Association of resident coverage with cost, length of stay, and profitability at a community hospital

Actual and potential effects of medical resident coverage on reimbursement for inpatient visits by attending physicians

Doctors in training: wasteful and inefficient?

Contact Info

Product

Resources

About