Residents rules cost hospitals millions

Published Aug 19, 2003

Home Health Columnist / Guide

10 Articles; 18,327 Posts

Specializes in Vents, Telemetry, Home Care, Home infusion.

some academic medical centers say new rules limiting work hours for doctors-in-training will cost teaching hospitals millions of dollars a year to hire additional health professionals to make up for lost labor.

chicago tribune, july 10, 2003

by bruce japsen

tribune staff reporter

http://www.chicagotribune.com/business/chi-0307100288jul10,1,4748197.story?coll=chi-business-hed

new rules limiting work hours for doctors-in-training will cost teaching hospitals millions of dollars a year to hire additional health professionals to make up for lost labor, academic medical centers say.

the new standards, which became effective july 1, limit residents to about 80 hours a week, down from as many as 130-- more than five 24-hour days. the new rules also affect resident duty hours, mandating that residents rest between daily duties and being on call.

while hospitals agree such changes are overdue for bleary-eyed residents, the new rules will add millions in costs for academic medical centers already reeling from reductions in government reimbursement for services from government health insurance programs.

"this is an expense for all the right reasons, but it still adds to the financial challenges facing all hospitals, particularly teaching hospitals," said rick wade, senior vice president of the chicago-based american hospital association. "for the average teaching hospital, there is no question the figure will be in the millions."

although it is up to each of the nation's 7,800 residency programs to decide how they will comply with the new rules, the accreditation council for graduate medical education in chicago says sponsoring hospitals have already added staff.

for small hospitals with fewer than a dozen residents, it can mean as little as hiring an additional nurse or physician's assistant. but for large medical centers like northwestern memorial hospital and university of chicago hospitals, costs are expected to hit especially hard.

with flat or falling revenue from government health insurers, inner-city hospitals like these are already struggling to care for an increasing number of uninsured patients who cannot pay their bills, juggling expenses for new medical technology and absorbing higher malpractice insurance premiums.

for northwestern memorial hospital in chicago, the new residency requirements are projected to cost more than $5 million a year in extra staff and additional specialized physicians known as "hospitalists," who do not admit patients but take care of them while they are in the hospital.

a hospitalist's salary averages $100,000 to $150,000 a year, according to industry figures. by comparison, residents make about $40,000, although those figures vary widely depending on specialty.

northwestern memorial, which trains 340 residents at any given time during the year, is in the process of adding residency slots by either lengthening the time required for some residency programs or adding more residency slots to others, a hospital spokeswoman said.

university of chicago hospitals officials expect that the changes will cost an additional $3 million each year for specialized staffers to make up for lost time from the facilities' 650 residents and fellows.

other costs will include nearly $100,000 for a new software program to help with scheduling changes.

"the biggest single cost is to add physician extenders like nurse practitioners, and operating nurses that are surgical assistants," said michael koetting, vice president for planning at university of chicago hospitals.

meanwhile, university of chicago hospitals is getting no relief from insurers. about 60 percent of the facilities' revenue comes from the medicare health insurance program for the elderly and the medicaid program for the poor, and those programs are not increasing payments.

"it's another challenge," koetting said. "our medicaid and medicare rates are going to go up zero. on the other hand, residents have a tough schedule, and these are overdue changes."

in the long run, taxpayers and consumers could recoup the increased costs for hospitals if they result in improved quality in the nation's health-care system, some observers say. after all, a key reason for imposing the limits on hours is to prevent young doctors from making mistakes because they are exhausted.

the change in residency hours comes in the wake of reports showing medical errors are rising at the same time patients are paying more for care.

such reports cite problems ranging from medical errors and unnecessary treatments to misused drugs and bureaucratic waste.

an estimated 103,000 patients died from hospital-acquired infections and an estimated 75,000 deaths were preventable in 2000, according to a tribune investigative series last year.

low-quality health care in the united states costs nearly $400 billion a year, or about 30 percent of the $1.3 trillion spent annually, according to a study last year by the chicago-based midwest business group on health.

"if you have people who are getting more alert and more competent and more rested, you do things in a more efficient manner," said larry boress, vice president of the midwest business group on health.

---------------------------

if a hospitalist's salary averages $100,000 to $150,000 a year , how can a the biggest single cost is to add physician extenders like nurse practitioners, and operating nurses that are surgical assistants when we average about $50,000???