A model of determining a fair market value for teaching residents: who profits?
BACKGROUND
Centers for Medicare & Medicaid Services (CMS) Health Resources and Services Administration Children's Hospitals Graduate Medical Education (GME) Payment Program now supports freestanding children's teaching hospitals.


OBJECTIVE
To analyze the fair market value impact of GME payment on resident teaching efforts in our pediatric intensive care unit (PICU).


METHODS
Cost-accounting model, developed from a 1-year retrospective, descriptive, single-institution, longitudinal study, applied to physician teachers, residents, and CMS.


METHODS
Sixteen-bed PICU in a freestanding, university-affiliated children's teaching hospital.


METHODS
Pediatric critical care physicians, second-year residents.


METHODS
Cost of physician opportunity time; CMS investment return; the teaching physicians' investment return; residents' investment return; service balance between CMS and teaching service investment margins; economic balance points; fair market value.


RESULTS
GME payments to our hospital increased 4.8-fold from 577 886 dollars to 2 772 606 dollars during a 1-year period. Critical care physicians' teaching opportunity cost rose from 250 097 dollars to 262 215 dollars to provide 1523 educational hours (6853 relative value units). Residents' net financial value for service provided to the PICU rose from 245 964 dollars to 317 299 dollars. There is an uneven return on investment in resident education for CMS, critical care physicians, and residents. Economic balance points are achievable for the present educational efforts of the CMS, critical care physicians, and residents if the present direct medical education payment increases from 29.38% to 36%.


CONCLUSIONS
The current CMS Health Resources and Services Administration Children's Hospitals GME Payment Program produces uneven investment returns for CMS, critical care physicians, and residents. We propose a cost-accounting model, based on perceived production capability measured in relative value units and available GME funds, that would allow a clinical service to balance and obtain a fair market value for the resident education efforts of CMS, physician teachers, and residents.
Cullen
Edward J
EJ
Department of Anesthesiology and Critical Care Medicine, Nemours Children's Clinic, Alfred I. duPont Hospital for Children, Wilmington, Delaware, USA. ecullen@nemours.org
Lawless
Stephen T
ST
Hertzog
James H
JH
Penfil
Scott
S
Bradford
Kathleen K
KK
Nadkarni
Vinay M
VM
Corddry
David H
DH
Costarino
Andrew T
AT
D000328:Adult; D014487:Centers for Medicare and Medicaid Services, U.S. / Q000191:economics*; D003422:Critical Care / Q000191:economics*; D003691:Delaware; D004503:Education, Medical, Graduate / Q000191:economics*; D018588:Fee-for-Service Plans / Q000191:economics; D005380:Financing, Government / Q000191:economics*; D019981:Health Care Sector; D006742:Hospital Bed Capacity; D006776:Hospitals, Pediatric / Q000191:economics*; D006785:Hospitals, University / Q000191:economics*; D006801:Humans; D015278:Intensive Care Units, Pediatric / Q000191:economics*; D007396:Internship and Residency / Q000191:economics*; D008962:Models, Theoretical; D010372:Pediatrics / Q000191:economics* / Q000193:education; D012456:Salaries and Fringe Benefits; D012984:Software; D014146:Training Support / Q000191:economics*; D014481:United States