Medicare reimbursement policy and teaching physicians' behavior in hospital clinics: the changes of 1996

To determine the frequency of attending physicians' contacts with residents' patients in hospital-based outpatient clinics and changes in these practices after June 1996.

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.

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.

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.