Medicare Reimbursement Policy and Teaching Physiciansʼ Behavior in Hospital Clinics

PURPOSE: To determine the frequency of attending physicians' contacts with residents' patients in hospital-based outpatient clinics and changes in these practices after June 1996. METHOD: Using data from the National Hospital Ambulatory Medical Care Surveys, 1993 to 1997, the author determined the numbers and characteristics of residents' patients in hospital-based outpatient clinics and the proportions of these patients also seen by a staff physician before and after the date new explicit national guidelines for Medicare Part B reimbursement (IL-372) took effect (July 1, 1996). Logistic regression models were used to identify patients' and clinics' attributes associated with a higher chance of a resident's patient's also being seen by a staff physician and changes after June 30, 1996. RESULTS: From 1993 to 1997, residents saw about 15,000,000 hospital-based clinic outpatients each year. Overall, 45% of residents' patients also saw a staff physician. The odds that a resident's patient would also see a staff physician varied substantially among patients seen in different regions of the country, types of clinics, and patients' sociodemographic characteristics. Overall, after July 1, 1996, the odds that a resident's patient would also see a staff physician increased significantly (odds ratio 1.64, 95% CI = 1.11 to 2.41), but the proportion of Medicare-insured patients who also saw a staff physician did not increase significantly. CONCLUSION: The proportion of residents' patients also seen by a staff physician increased after June 1996. The lack of a similar significant increase for patients 65 and over with Medicare suggests that the more explicit and stricter interpretation of Medicare regulations did not primarily affect Medicare-insured patients but rather changed the process of care for all clinic patients.