Abstract • Medicare currently pays for "indirect costs" of medical education to support the higher costs of care in teaching hospitals. To investigate whether indirect costs are higher earlier in the training year when house officers might be less efficient–the "July phenomenon"–we compared utilization by 1251 patients hospitalized during July and August with 1338 patients hospitalized during April and May from 1982 through 1984 at Brigham and Women's Hospital, Boston, Mass. These included all patients in the 10 most prevalent medical and surgical diagnosis related groups. Using analysis of covariance to correct for age, sex, diagnosis related group, urgency of admission, temporal change, and mortality, we found no differences in length of stay, total charges, or categories of ancillary charges. These results suggest that there is no substantial increase in the cost of care early in the training year; there was no evidence of a "July phenomenon." (Arch Intern Med. 1989;149:765-768) References 1. Cameron JM. The indirect costs of graduate medical education . N Engl J Med . 1985;312:1233.Crossref 2. Frick AP, Martin SG, Shwartz M. Case-mix and cost differences between teaching and non-teaching hospitals . Med Care . 1985;23:283-295.Crossref 3. Jones KR. Predicting hospital charge and stay variation . Med Care . 1985;23:220-235.Crossref 4. Schroeder SA, O'Leary DS. Differences in laboratory use and length of stay between university and community hospitals . J Med Educ . 1977;52:418-420. 5. Martz EW, Ptakowski R. Educational costs to hospitalized patients . J Med Educ . 1978;53:383-386. 6. Garber AM, Fuchs VR, Silverman JF. Case mix, costs, and outcomes . N Engl J Med . 1984;310:1231-1237.Crossref 7. Horn SD, Buckley G, Sharkey PP, Chambers MS, Horn RA, Schramm CJ. Interhospital differences in severity of illness: problems for prospective payment based on diagnosis-related groups (DRGs) . N Engl J Med . 1985;313:20-24.Crossref 8. Epstein AM, Stern R, Hartley RM, Cumella E, Ayanian J. Socioeconomic characteristics and utilization for hospitalized patients: do poor people cost more? Clin Res . 1986;34:363A. 9. Schwartz WB, Newhouse JP, Williams AP. Is the teaching hospital an endangered species? N Engl J Med . 1985;313:157-162.Crossref 10. Detsky AS, McLaughlin JR, Abrams HB, L'Abbe K, Markel FM. Do interns and residents order more tests than attending staff? Med Care . 1986;24:526-534.Crossref 11. Schweiker RS. Report to Congress: Hospital Prospective Payment for Medicare . Washington, DC: US Dept of Health and Human Services; 1982. 12. Kleinbaum DG, Kupper LL. Applied Regression Analysis and Other Multivariable Models . Boston, Mass: Duxbury Press; 1978. 13. Colton T. Statistics in Medicine . Boston, Mass: Little Brown & Co Inc; 1974. 14. Mantel N, Haenszel W. Statistical aspects of the analysis of data from retrospective studies of disease . JNCI . 1958;22:719-748.
Archives of Internal Medicine – American Medical Association
Published: Apr 1, 1989