Measuring teaching intensity with the resident-to-average daily census ratio.

This article analyzes a change in the measure of teaching intensity when calculating Medicare's indirect medical education (IME) adjustment: It looks at the potential for replacing, in the denominator of the ratio, beds with the average daily census (ADC). Among the findings are: (1) Hospitals with small teaching programs would benefit from this switch more than hospitals with larger programs because of their generally lower occupancy rates, (2) The adjustment formula currently used for the capital prospective payment system (PPS) would alleviate this effect relative to the adjustment formula used for the operating PPS, (3) Although ADC appears to vary more on average, the weighted average rates of change in the resident-to-ADC ratios for a matched group of teaching hospitals are equal to the rates of change for the resident-to-bed ratios.