Progression of Emergency Medicine Resident Productivity

Brennan, Daniel F.; Silvestri, Salvatore; Sun, Joanne Y.; Papa, Linda

doi:10.1197/j.aem.2007.05.013

Cited by 29 publications

(19 citation statements)

References 7 publications

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“…Previous studies have demonstrated a significant increase in productivity from first year to second year that may be associated with the rapid growth of the first-year residents as they become familiar with their new role as resident physicians and are able to see greater numbers of patients. 8 Furthermore, first-year residents in our department did not all rotate through the ED during both the control period and the study period.…”

Section: Methods Of Measurementmentioning

confidence: 99%

RVU Ready? Preparing Emergency Medicine Resident Physicians in Documentation for an Incentive‐based Work Environment

Carter

Dawson

Brewer

et al. 2009

Academic Emergency Medicine

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Objectives: The emergency medicine (EM) job market is increasingly focused on incentive-based reimbursement, which is largely based on relative value units (RVUs) and is directly related to documentation of patient care. Previous studies have shown a need to improve resident education in documentation. The authors created a focused educational intervention on billing and documentation practices to meet this identified need. The hypothesis of this study was that this educational intervention would result in an increase in RVUs generated by EM resident physicians and the average amount billed per patient. Methods:The authors used a quasi-experimental study design. An educational intervention included a 1-hour lecture on documentation and billing, biweekly newsletters, and case-specific feedback from the billing department for EM resident physicians. RVUs and charges generated per patient were recorded for all second-and third-year resident physicians for a 3-month period prior to the educational intervention and for a 3-month period following the intervention. Pre-and postintervention data were compared using Student's t-test and repeated-measures analysis of variance, as appropriate.Results: The evaluation and management (E ⁄ M) chart levels billed during each phase of the study were significantly different (p < 0.0001). The total number of RVUs generated per hour increased from 3.17 in the first phase to 3.71 in the second phase (p = 0.0001). During the initial 3-month phase, the average amount billed per patient seen by a second-or third-year resident was $282.82, which increased to $301.94 in the second phase (p = 0.0004). Conclusions:The educational intervention positively affected resident documentation resulting in greater RVUs ⁄ hour and greater billing performance in the study emergency department (ED). ACADEMIC EMERGENCY MEDICINE 2009; 16:423-428 ª 2009 by the Society for Academic Emergency MedicineKeywords: relative value scale, documentation, coding, education, emergency medicine S ince its creation by the Health Care Financing Administration (HCFA, now the Centers for Medicare and Medicaid Services [CMS]) in 1992, the relative value unit (RVU) has become an important measurement tool for the work performed by physicians. Each emergency physician (EP) should have a thorough understanding of this unit to appreciate its use in making comparisons between physicians in regards to work output, billing for physician services, and determining and justifying staffing needs. However, the RVU has most recently gained attention for its relation to physician reimbursement. A Schumacher Group survey of emergency department (ED) administrators found that many EPs are not well prepared for incentive-based salaries.1 To be compensated well in this setting, resident physicians must understand RVUs and proper documentation.Relative value units were developed by HCFA to construct a fee schedule for reimbursement of physician services. The total RVU has three components: the work RVUs for physician time and effort...

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Section: Methods Of Measurementmentioning

confidence: 99%

RVU Ready? Preparing Emergency Medicine Resident Physicians in Documentation for an Incentive‐based Work Environment

Carter

Dawson

Brewer

et al. 2009

Academic Emergency Medicine

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“…Clinical metrics derived from chart review or patient care information systems can be useful in assessing an individual's performance as measured by patients per hour, relative value units (RVUs), or other clinical care measures (e.g., patient acuity, resource utilization), 6,98 When linked to systematic and ongoing feedback, assessment of clinical metrics can lead to long-term clinical practice change. 6 While there is evidence that certain measures such as RVUs/hour correlate with individual cognitive assessments of multitasking ability, 99 they potentially suffer from a lack of specificity given the resident's inherent inability to practice independently because of his or her supervised role.…”

Section: Metricsmentioning

confidence: 99%

Assessing Patient Care: Summary of the Breakout Group on Assessment of Observable Learner Performance

Takayesu

Kulstad

Wallenstein

et al. 2012

Academic Emergency Medicine

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There is an established expectation that physicians in training demonstrate competence in all aspects of clinical care prior to entering professional practice. Multiple methods have been used to assess competence in patient care, including direct observation, simulation-based assessments, objective structured clinical examinations (OSCEs), global faculty evaluations, 360-degree evaluations, portfolios, self-reflection, clinical performance metrics, and procedure logs. A thorough assessment of competence in patient care requires a mixture of methods, taking into account each method's costs, benefits, and current level of evidence. At the 2012 Academic Emergency Medicine (AEM) consensus conference on educational research, one breakout group reviewed and discussed the evidence supporting various methods of assessing patient care and defined a research agenda for the continued development of specific assessment methods based on current best practices. In this article, the authors review each method's supporting reliability and validity evidence and make specific recommendations for future educational research.ACADEMIC EMERGENCY MEDICINE 2012; 19:1379-1389 by the Society for Academic Emergency Medicine I n 2001, the Accreditation Council for Graduate Medical Education (ACGME) introduced a timeline for the implementation of training and assessment in six core competencies that form the foundation of clinical competence. Introduced in 1996, the Canadian CanMEDS manager competency correlates to the AC-GME patient care competency, broadly defined as "the active engagement in decision-making in the operation of the healthcare system."1 The patient care competency for emergency medicine (EM) has been defined by a previous Academic Emergency Medicine (AEM) consensus conference, 2 now further elaborated on by the milestones in training, 3 as being able to efficiently gather and synthesize medical and diagnostic information, prioritize tasks, and implement management plans on multiple patients, as well as performing essential invasive procedures competently.There is an explicit expectation that physicians in training demonstrate competence in various aspects of clinical care prior to graduation and professional practice. 4 While this accountability falls squarely on the shoulders of residency training programs, it is mirrored by commensurate expectations of maintenance of competency during ongoing professional practice.The goals of the 2012 AEM consensus conference patient care working group were to describe the current state of evidence for assessment of competence in patient care and define a research agenda for the further development of specific assessment methods based on current best practices. METHODSA search was conducted using MEDLINE 1996-present using the key word search terms "assessment," "patient care," "competency," "competence," "assess*," "emergency," and "education" and limited to humans and English language [boolean search: ((assessment and patient care AND (competency or competence)) OR (assess* a...

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“…Prior research has indicated that higher training level is associated with greater resident PPH; however the effect on attending PPH has not been studied. 1,2,7,8 It may be that in a one-onone teaching model, despite senior residents seeing more patients than junior residents, the attending physician does not see proportionately more patients. The implications for an academic training center are unclear, as clinical productivity of attending physicians is only one of many parameters affecting attending reimbursement.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3][4][5][6][7][8] Four studies examined the difference in patients per hour for residents at varying post graduate training levels, and found a somewhat higher rate for each additional year of training. 1,2,7,8 Other studies examined the effect of learners on overall department throughput, and while one study found that residents slowed throughput, another found that residents had no impact, while medical students did not affect throughput in two studies. [3][4][5][6] No study to date has specifically examined the impact of learners on EM attending physician productivity, with regards to patients per hour (PPH).…”

Section: Impact Of Learners On Em Attending Physician Productivitymentioning

confidence: 99%

116 Impact of Learners on Emergency Medicine Attending Physician Productivity

Bhat

Maloy

Dubin

2012

Annals of Emergency Medicine

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District of Columbia * † physician coverage. Those that do not alter EM attending physician coverage based on presence or absence of learners (medical students or resident physicians) may have varying Introduction: Several prior studies have examined the impact of learners (medical students or residents) on overall emergency department (ED) flow as well as the impact of resident training level on the number of patients seen by residents per hour. No study to date has specifically examined the impact of learners on emergency medicine (EM) attending physician productivity, with regards to patients per hour (PPH). We sought to evaluate whether learners increase, decrease, or have no effect on the productivity of EM attending physicians in a teaching program with one student or resident per attending.

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Progression of Emergency Medicine Resident Productivity

Cited by 29 publications

References 7 publications

RVU Ready? Preparing Emergency Medicine Resident Physicians in Documentation for an Incentive‐based Work Environment

RVU Ready? Preparing Emergency Medicine Resident Physicians in Documentation for an Incentive‐based Work Environment

Assessing Patient Care: Summary of the Breakout Group on Assessment of Observable Learner Performance

116 Impact of Learners on Emergency Medicine Attending Physician Productivity

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