Cost Implications of ACGME’s 2011 Changes to Resident Duty Hours and the Training Environment
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In July 2011, the Accreditation Council for Graduate Medical Education (ACGME) will implemented stricter duty-hour limits and related changes to the training environment. This may affect preventable adverse event (PAE) rates.
To estimate direct costs under various implementation approaches, and examine net costs to teaching hospitals and cost-effectiveness to society across a range of hypothetical changes in PAEs.
A decision-analytical model represented direct costs and PAE rates, mortality, and costs.
Published literature and publicly available data.
Patients admitted to hospitals with ACGME-accredited programs.
All teaching hospitals, major teaching hospitals, society.
ACGME’s 2011 Common Program Requirements.
Direct annual costs (all accredited hospitals), net cost (major teaching hospitals), cost per death averted (society).
RESULTS OF BASE-ANALYSIS
Nationwide, duty-hour changes would cost $177 million annually if interns maintain current productivity, vs. up to $982 million if they transfer work to a mixture of substitutes; training-environment changes will cost $204 million. If PAEs decline by 7.2–25.8%, net costs to major teaching hospitals will be zero. If PAEs fall by 3%, the cost to society per death averted would be –$523,000 (95%-confidence interval: –$1.82 million to $685,000) to $2.44 million ($271,000 to $6.91 million). If PAEs rise, the policy will be cost-increasing for teaching hospitals and society.
RESULTS OF SENSITIVITY ANALYSIS
The total direct annual cost nationwide would be up to $1.34 billion using nurse practitioners/physician assistants, $1.64 billion using attending physicians, $820 million hiring additional residents, vs. 1.42 billion using mixed substitutes.
The effect on PAEs is unknown. Data were limited for some model parameters.
Implementation decisions greatly affect the cost. Unless PAEs decline substantially, teaching hospitals will lose money. If PAEs decline modestly, the requirements might be cost-saving or cost-effective to society.
KEY WORDSACGME residents duty hours costs training
An earlier version of this analysis was commissioned by the Accreditation Council for Graduate Medical Education (ACGME). ACGME representatives provided information related to selected model parameters, as specified in the paper. The authors were wholly responsible for conducting the analysis and preparing the manuscript; ACGME played no other roles in these activities. The authors performed a similar analysis for the Institute of Medicine in 2008. The authors have no other conflicts of interest. Teryl Nuckols, MD, MSHS is currently supported by a Mentored Clinical Scientist Career Development Award (K08) from the Agency for Healthcare Research and Quality (grant number HS17954).
The authors thank Jan Wilson, who provided research support, and Jodi Friedman, MD, who provided helpful feedback on the analysis.
- 1.Institute of Medicine. Resident duty hours: enhancing sleep, supervision, and safety. 2008; http://www.iom.edu/Reports/2008/Resident-Duty-Hours-Enhancing-Sleep-Supervision-and-Safety.aspx. Accessed May 27, 2011.
- 2.Nasca T. Letter to the Graduate Medical Education Community. 2009; http://www.acgme.org/acWebsite/home/nascalettercommunity2_2009.pdf Accessed May 27, 2011.
- 3.Accreditation Council for Graduate Medical Education. Common Program Requirements. 2010; http://www.acgme.org/acwebsite/home/Common_Program_Requirements_07012011.pdf. Accessed May 27, 2011.
- 4.Accreditation Council for Graduate Medical Education. Resident Duty Hours in the Learning and Working Environment: Comparison of 2003 and 2011 Standards. 2010; http://www.acgme.org/acwebsite/dutyhours/dh-ComparisonTable2003v2011.pdf. Accessed May 27, 2011.
- 7.Nuckols T, Escarce J. ACGME Common Program Requirements: Potential Cost Implications of Changes to Resident Duty Hours and Related Changes to the Training Environment Announced on September 28, 2010. 2010; http://www.acgme.org/acwebsite/dutyhours/dh-FinalReportCostAnalysis2011CPRs.pdf.
- 8.Fletcher K, Reed D, Arora V. Systematic Review of the Literature: Resident Duty Hours and Related Topics. 2009; http://acgme-2010standards.org/pdf/Resident_Duty_Hours_and_Related_Topics.pdf. Accessed May 27, 2011.
- 9.Caruso J, Veloski J, Grasberger M, et al. Systematic Review of the Literature on the Impact of Variation in Residents' Duty Hour Schedules on Patient Safety: 2009. 2009; http://acgme-2010standards.org/research-testimony.html. Accessed May 27, 2011.
- 16.Nasca T, Nylen J. Personal communication with Dr. Nuckols: Accreditation Council for Graduate Medical Education; 2010.Google Scholar
- 26.National Organization for Research at the University of Chicago (NORC). GRADUATE MEDICAL EDUCATION: What Are We Paying For? Report to the Assistant Secretary for Planning and Evaluation. 2006; http://aspe.hhs.gov/health/reports/06/GradMedicalEdu/index.html. Accessed May 27, 2011.
- 28.Bureau of Labor Statistics. National compensation survey: occupational earnings in the United States. 2008; http://www.bls.gov/ncs/ncswage2006.htm. Accessed May 27, 2011.
- 29.Bureau of Labor Statistics - Department of Labor. Employer cost for employee compensation: annual data for 2008. http://www.bls.gov/news.release/archives/ecec_03122009.pdf. Accessed May 27, 2011.
- 30.American Association of Medical Colleges. AAMC Data Book: Medical Schools and Teaching Hospitals by the Numbers. Washington DC: AAMC Section for Medical School and Faculty Studies; 2010.Google Scholar
- 39.U.S. Department of Labor - Occupational Safety and Health Administration. Statement by US Department of Labor's OSHA Assistant Secretary Dr. David Michaels on long work hours, fatigue and worker safety. 2010; http://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=NEWS_RELEASES&p_id=18285. Accessed May 27, 2011.
- 40.Public Citizen. Petition to Reduce Medical Resident Work Hours. 2010; http://www.citizen.org/hrg1917. Accessed May 27, 2011.
- 41.Supreme Court of the United States. Mayo Foundation for Medical Education and Research et al versus United States2010.Google Scholar
- 42.Council on Graduate Medical Education (COGME). Physician workforce policy guidelines for the United States, 2000–2020: sixteenth report. 2005; http://stanford.biocareers.com/articles/physician-workforce-policy-guidelines-united-states-2000-2020. Accessed June 3, 2011.
- 43.Medicare Payment Advisory Commission. Report to the Congress: Aligning Incentives in Medicare. 2010; http://www.ncrponline.org/PDFs/2010/MEDPAC_Congress_June2010.pdf. Accessed May 27, 2011.
- 48.Viscusi WK, Aldy JE. The Value of a Statistical Life: A Critical Review of Market Estimates Throughout the World. J Risk Uncertain. 2003;27(1):5-76(72).Google Scholar