Home News Briefs Resident work hour rules, Medicare pay

Resident work hour rules, Medicare pay

September 2004

Published in the September 2004 issue of Today’s Hospitalist

ACGME details violations of work hour rules

While most residency programs appear to be following year-old rules that limit how many hours young physicians can work during their training, internal medicine was one of several specialties that received an above average number of citations for violating work hour rules.

According to a report from the Accreditation Council for Graduate Medical Education (ACGME), 99 programs out of a total of 2,019 received citations for violating the new work hour rules. The ACGME is in charge of enforcing the new rules, which took effect July 1, 2003.

Internal medicine programs received 10 of those citations. Only family medicine programs, which were cited 26 times, received more citations. Internal medicine subspecialty programs received a total of nine citations.

In most of those instances “51 “programs violated the 80-hour weekly limit.
In 27 instances, programs did not give residents one day out of seven off. In an additional 27 cases, they did not comply with the rules limiting residents to 24 hours “plus six” of continuous duty.

The good news was that when ACGME officials interviewed more than 10,000 residents during site visits, they found that a mere 3.3 percent of residents reported working more than 80 hours a week during the previous four weeks. The ACGME found only a few programs where most residents regularly worked more than 80-hour weeks.

The ACGME received a total of 53 complaints from residents about violations of the rules. While 11 of those complaints were dismissed as unfounded, ACGME officials addressed the others.

Internal medicine training programs also led in complaints. A total of 15 complaints, or nearly one-third of the total, addressed internal medicine residencies. Family practice residencies, by comparison, logged only three complaints.

Medicare pay for inpatient care will increase Oct. 1

Beginning Oct. 1, Medicare will pay hospitals an extra $5 billion for inpatient care, raise reimbursements for rural hospitals, and link pay to performance data.

The Centers for Medicare and Medicaid Services (CMS) announced the increase earlier this summer. While acute care hospitals were scheduled to receive $100 billion for inpatient care, that amount was increased to $105 billion as part of the Medicare Prescription Drug Improvements and Modernization Act of 2003. That legislation was signed into law in late 2003.

It is only the third time in the last 20 years that Medicare has given hospitals a full increase adjusted for inflation for the care of inpatients.

There is a catch, however: Only hospitals that submit reports on quality of care to Medicare will receive the full increase of 3.3 percent. Facilities that don’t submit performance data will receive an increase of 2.9 percent.

This is the first time that Medicare has linked increases in hospital payments to performance data. The CMS says that nearly all hospitals will be eligible for the full increase, and analysts are predicting that most facilities will submit data on quality of care to get the full update.

The CMS also announced that starting Oct. 1, rural hospitals will receive a 6.2 percent increase in Medicare reimbursements. By comparison, urban hospitals will receive an average increase of 5.7 percent.

Medicare will also relax formulas regulating outlier payments that had been tightened after Tenet Healthcare facilities were accused of gaming the system of outlier payments. The CMS will lower the threshold at which outlier payments can be made from $31,000 to $25,800.