The threat to remove DME funds from Medicare altogether, Dr. Cooney explained, is exacerbating the tension between hospital administrators and residency program directors. The prudent and responsible thing may be to reduce your exposure by cutting out the residency program. Take the situation in Dayton, Ohio, where the community hospitals that contract with Wright State University's Department of Medicine to train its internal medicine residents are each reacting to the news from Washington differently. Wright State's chair of medicine. Still others are asking about whether they should be getting out the training business altogether.
Residents are still a less expensive source of care than any alternative.
These conversations are occurring this year. For some educators, however, the bigger concern is not that programs will close, but that they will instead have to make so many cutbacks that resident education will suffer. Dr. Wallenstein wondered, for instance, whether programs will have enough money for book allowances, funds for housestaff to attend conferences and do research, and money for enough nurses and ancillary support staff so residents don't have to spend all their time doing scut work like transporting patients to X-ray and putting in IVs. In fact, several recent articles in the New England Journal of Medicine concluded that the quality of care provided to patients in several large teaching hospitals was superior to that provided in hospitals without residents. To date, its proposal would leave IME as part of Medicare, with the insurance program continuing to pay for differences in costs between teaching and non-teaching hospitals.