16687 The economic value of dermatology resident consultations: A retrospective multi-institutional evaluation of hospital-based consultation

Abstract

Medicare funding for graduate medical education has been threatened, despite the important role residents play in academic medical centers. We sought to characterize the total amount and type of consultation work performed by dermatology residents, and compare that with the amount of Medicare funding hospitals receive for training residents. Hospital-based consults provided by Harvard dermatology residents at Brigham and Women’s Hospital and Massachusetts General Hospital from March 1 to May 31, 2018 were reviewed. Procedures were coded according to the Current Procedural Terminology and converted into work relative value units (wRVUs), which were multiplied by the 2018 rate of $35.999. This value was then multiplied by 4 to generate annual estimates. The annual amount was divided by the number of residents on call, and compared with the Medicare Graduate Medical Education funding of $117,000/resident/year. There were 754 encounters on 389 patients from March 1 to May 31, 2018. The total wRVU during the 3-month period was 1094.9 which represented $40,014.29. For the whole year, the extrapolated wRVU was 4379.6 and corresponding value was $160,057.16. The most common payers were private insurance (48.5%), Medicare (33.2%), and Medicaid (13.9%). The overall financial value generated per resident was $80,028.58, which represented 68.4% of the Medicare stipend. This study suggests that hospital consult services led by residents may substantially offset costs associated with resident training. Future prospective studies may provide additional insight into total economic value generated by dermatology residents on call and underscore the importance of continuing to fund robust graduate medical education programs.