Association of Resident Coverage with Cost, Length of Stay, and Profitability at a Community Hospital


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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 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–cost adjustment program. No significant difference in LOS between 917 teaching-unit patients and 697 nonteaching patients was demonstrated. Costs averaged $3,178 (95% confidencence 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 teaching-unit 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.