title: Cost implications of ACGME's 2011 changes to resident duty hours and the training environment.
abstract: BACKGROUND
  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.
  
  
  OBJECTIVE
  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.
  
  
  METHODS
  A decision-analytical model represented direct costs and PAE rates, mortality, and costs.
  
  
  METHODS
  Published literature and publicly available data.
  
  
  METHODS
  Patients admitted to hospitals with ACGME-accredited programs.
  
  
  METHODS
  One year.
  
  
  CONCLUSIONS
  All teaching hospitals, major teaching hospitals, society.
  
  
  METHODS
  ACGME's 2011 Common Program Requirements.
  
  
  METHODS
  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
  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.
  
  
  CONCLUSIONS
  The effect on PAEs is unknown. Data were limited for some model parameters.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at the University of California, 911 Broxton Avenue, Los Angeles, CA 90095, USA. tnuckols@mednet.ucla.edu
authors.forename: Teryl K
authors.initials: TK
authors.lastname: Nuckols
authors.forename: José J
authors.initials: JJ
authors.lastname: Escarce
mesh_terms: D000068:Accreditation / Q000191:economics* / Q000639:trends; D003365:Costs and Cost Analysis / Q000191:economics; D004503:Education, Medical, Graduate / Q000191:economics* / Q000639:trends; D006784:Hospitals, Teaching / Q000191:economics* / Q000639:trends; D006801:Humans; D007396:Internship and Residency / Q000191:economics* / Q000639:trends; D010561:Personnel Staffing and Scheduling / Q000191:economics* / Q000639:trends; D014481:United States; D014940:Work Schedule Tolerance