JACQUELINE KOSECOFF, Ph.D.; ROBERT H. BROOK, M.D. Sc.D.; ARLENE FINK, Ph.D.; CAREN KAMBERG, M.S.P.H.; CAROL PINDAR ROTH, R.N., M.P.H.; GEORGE A. GOLDBERG, M.D.; LAWRENCE S. LINN, Ph.D.; VIRGINIA A. CLARK, Ph.D.; JOSEPH P. NEWHOUSE, Ph.D.; THOMAS L. DELBANCO, M.D.
KOSECOFF J, BROOK RH, FINK A, KAMBERG C, ROTH CP, GOLDBERG GA, et al. Providing Primary General Medical Care in University Hospitals: Efficiency and Cost. Ann Intern Med. 1987;107:399-405. doi: 10.7326/0003-4819-107-2-399
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Published: Ann Intern Med. 1987;107(3):399-405.
Data on efficiency, costs, and profits of 15 internal medicine outpatient group practices in university hospitals were collected for 9 months from interviews, a time-motion study, observations, and reviews of bills. Charges for a follow-up visit were about 25% higher than Medicare's allowable charges, but differed threefold across practices. Physicians spent more than half their allocated patient care or supervision time in other activities and 14% of nursing time was used for direct patient care. Visits to second- and third-year residents cost one half of those to faculty. Faculty supervision of second- and third-year residents was limited; it was, on average, 2 minutes per follow-up visit. Despite these inefficiencies, bad debts, and educational costs, practices appeared to break even financially. We conclude it is financially feasible for university hospitals to provide primary care to disadvantaged populations.
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