Sharkfan

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My program is giving us a new rule: we must be in-house between 8AM-4PM on weekdays no matter what. Even if you have nothing to do. Even if you are rotating somewhere else, where a supervisor might be done with you on their schedule, not yours. When asked for an explanation, we were told that it is Medicare fraud to not work enough hours since Medicare is paying our salaries.

Is this true? Can they do this? The crazy thing is that the latest any of us (chiefs, mainly) get to the hospital is 7AM, most of us are there by 5-6AM, and we are very rarely done by 4PM. But those days happen, and it would be nice to take advantage of the opportunity. There are enough weeks of us working our balls off over 12hrs a day to make up for the times when we can cut out early.

Help! Any information would be appreciated. I feel like I'm being taken for a ride. :confused:
 

bluealiendoctor

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My program is giving us a new rule: we must be in-house between 8AM-4PM on weekdays no matter what. Even if you have nothing to do. Even if you are rotating somewhere else, where a supervisor might be done with you on their schedule, not yours. When asked for an explanation, we were told that it is Medicare fraud to not work enough hours since Medicare is paying our salaries.

Is this true? Can they do this? The crazy thing is that the latest any of us (chiefs, mainly) get to the hospital is 7AM, most of us are there by 5-6AM, and we are very rarely done by 4PM. But those days happen, and it would be nice to take advantage of the opportunity. There are enough weeks of us working our balls off over 12hrs a day to make up for the times when we can cut out early.

Help! Any information would be appreciated. I feel like I'm being taken for a ride. :confused:
Hmm. Doesn't make sense to me. If it's based on "work enough hours since Medicare pays salary" then how you work the hours shouldn't matter?
 

lowbudget

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Ugh. I have PTSD from this subject, but the answer is yes.

Medicare pays money to your program, but only when the residents are on hospital property. When you are rotating elsewhere, it doesn't count. After hours doesn't count. And for some reason I don't understand, it's within those hours you mentioned. Your program administrators have to account hour-by-hour where you are at all times during those hours and submit it for money.

Or, something like that. Yea, I was pretty pissed when GME called me to put this information together for them...
 

randomedstudent

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My program is giving us a new rule: we must be in-house between 8AM-4PM on weekdays no matter what. Even if you have nothing to do. Even if you are rotating somewhere else, where a supervisor might be done with you on their schedule, not yours. When asked for an explanation, we were told that it is Medicare fraud to not work enough hours since Medicare is paying our salaries.

Is this true? Can they do this? The crazy thing is that the latest any of us (chiefs, mainly) get to the hospital is 7AM, most of us are there by 5-6AM, and we are very rarely done by 4PM. But those days happen, and it would be nice to take advantage of the opportunity. There are enough weeks of us working our balls off over 12hrs a day to make up for the times when we can cut out early.

Help! Any information would be appreciated. I feel like I'm being taken for a ride. :confused:
This sounds like complete BS. I can assure you we have no such rule at our program or any program at my institution. I'm sure Medicare does track this and if they felt like residents weren't working enough or whatever that would probably result in the program losing 1 or more positions for the next year. This has in fact happened to several programs at my institution when residents weren't logging all their hours or weren't always logging in at the VA (which is very closely monitored, we are told that when on a VA rotation you must log in to some computer every day to prove you were there). Anyway, I have never heard of the rule describe, I think this should be further investigated with your program.
 

randomedstudent

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Or alternately you could skip all the arguing with your program, leave at 2 pm on your rare lucky day and just log that you were there until 4. Problem solved. Most residents I know lie about hours all the time. I usually log mine so late that I don't even remember and just make stuff up anyway.
 

MOHS_01

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Our PD did this... and they had little trolls out looking for us. Clinic over at 3? Sit in the library until 4. Monitored our parking even......
 

lowbudget

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I'm trying to remember. Medicare dollars follow residents around. So if you work at 2 hospitals, one hospital should get paid for teaching and the other hospital should also get paid. And they use hours to determine the % on how the split it.

But what if you're working with the volunteer community/private attendings? Those attendings don't get paid for teaching you. So Medicare wants to make sure that your main teaching hospital is not cashing in on the use of volunteer community attendings. I *think* that's what this is about. But don't quote me.

Sounds like your program is strapped for cash. They're sending a report to Medicare, and then on the back end requiring the residents to comply. Stupid. That's the tail wagging the dog. If they wanted to do it right, they should either forfeit the cash or redesign the curriculum and rotations so that you're more in-house to capture those dollars from Medicare. Sucks. Total BS.
 
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aProgDirector

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You've asked two questions.

The first is easy to answer: "Can they make you do this?". The answer is "Of course they can". They could mandate that you walk on all fours at all times, and there really isn't much you can do about it. As long as they implement the rules consistantly for everyone, there isn't much you can do.

The second is harder to answer: "Is this really a Medicare rule or just BS?"

Medicare payments to teaching hospitals is really convoluted and complex. I certainly don't understand it fully. Honestly, I don't think the financial people at my program understand it either and it doesn't help that the rules keep changing. Still:

1. Medicare pays hospitals for training residents

2. This payment is split into DME (which pays for direct expenses -- salary, benefits, etc) and IME (which pays for "indirect" expenses -- defined sometimes as "residents order too many tests" or "our patients are sicker than most" or "our patients have less insurance than most").

3. "Medicare" doesn't really exist. Instead, private companies serve as "Medicare Intermediaries". Hospitals submit "cost reports" to these intermediaries who then review them, decide what to allow, and then pay the hospital and bill the US Govt. And presumably, take a cut for themselves.

4. Each Medicare Intermediary can basically interpret the rules themselves. Seems crazy, but they are divided geographically and can set different rules for what is acceptable and what is not.

5. IME funding depends on the proportion of medicare patients cared for by the hospital, and also is only claimable if the resident is actually doing clinical work that day.

6. Some intermediaries are, apparently, starting to look at units less than days, perhaps half days. If you are not on site, taking care of patients (which is pretty loosely defined, but would not include bench research for example) then the intermediary can deny payment for you for that period.

7. Presumably intermdiarys are under pressure to cut costs. Or, perhaps they think that if they cut costs well, they will get a bigger slice of the pie. Plus, it sounds like the whole system is going to be redefined shortly, with the end result being less contracts for intermediaries (i.e. less companies, each with a bigger piece of pie). So, part of this push may be some intermediaries trying to cut costs even more, so they can compete for these contracts.

Anyway, this doesn't surprise me. It's probably legit. I doubt your program wants to keep you until 4PM every day.