Factors contributing to the variability of direct costs for graduate medical education in teaching hospitals.
Costs and Cost Analysis/*statistics & numerical data; Data Collection; Education; Faculty; Graduate/*economics; Hospitals; Medical; Medicare/legislation & jurisprudence; Regression Analysis; Reimbursement Mechanisms; Salaries and Fringe Benefits; Teaching/*economics; Training Support; United States
Medicare's support of graduate medical education includes funds allocated to the direct costs of graduate medical education: housestaff stipends and benefits, faculty costs, and related educational costs such as classroom space. As reimbursed through the mechanism called the direct graduate medical education (DGME) pass-through, these direct costs have been reported to vary widely from one teaching hospital to another, with little explanation for this variation being available. Based on a national survey of 69 teaching hospitals–principally affiliated community teaching hospitals–the author suggests that a major cause for the variation in these costs might be found in their faculty-expenses component. It is further suggested that economies of scale may provide some clue as to the variability of these costs. The author also reports lower DGME costs for the survey sample than for the national sample, and suggests that the fact that community teaching hospital faculties include a significant volunteer component may account for some of these savings.
Boex J R
Academic medicine : journal of the Association of American Medical Colleges
1992
1992-02
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1097/00001888-199202000-00004" target="_blank" rel="noreferrer noopener">10.1097/00001888-199202000-00004</a>
Understanding the costs of ambulatory care training.
*Ambulatory Care; Costs and Cost Analysis; Education; Faculty; Graduate/*economics; Medical; Models; Theoretical; United States
While patient care has been shifting to the ambulatory setting, the education of health care professionals has remained essentially hospital-based. One factor discouraging the movement of training into community-based ambulatory settings is the lack of understanding of what the costs of such training are and how these costs might be offset. The authors describe a model for ambulatory care training that makes it easier to generalize about to quantify its educational costs. Since ambulatory care training does not exist in a vacuum separate from inpatient education, the model is compatible with the way hospital-based education costs are derived. Thus, the model's elements can be integrated with comparable hospital-based training cost elements in a straightforward way to allow a total-costing approach. The model is built around two major sets of variables affecting cost. The first comprises three types of costs–direct, indirect, and infrastructure–and the second consists of factors related to the training site and factors related to the educational activities of the training. The model is constructed to show the various major ways these two sets of variables can influence training costs. With direct Medicare funding for some ambulatory-setting-based education pending, and with other regulatory and market dynamics already in play, it is important that educators, managers, and policymakers understand how costs, the characteristics of the training, and the characteristics of the setting interact. This model should assist them. Without generalizable cost estimates, realistic reimbursement policies and financial incentives cannot be formulated, either in the broad public policy context or in simple direct negotiations between sites and sponsors.
Boex J R; Blacklow R; Boll A; Fishman L; Gamliel S; Garg M; Gilchrist V; Hogan A; Meservey P; Pearson S; Politzer R; Veloski J J
Academic medicine : journal of the Association of American Medical Colleges
1998
1998-09
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1097/00001888-199809000-00011" target="_blank" rel="noreferrer noopener">10.1097/00001888-199809000-00011</a>