Financial and Clinical Impact of Transfer Patients at Major Teaching Hospitals.
Acad Med. 2019 Jun 25;:
Authors: Baker MC, Koopman CJ, Landman JH, Alsdurf CR, Gundling RL, Haberman M, Horvath KA, Orlowski JM
PURPOSE: The authors examined the "hub-and-spoke" health care system in the U.S. for patients transferred from one hospital ("spoke") to a major teaching hospital ("hub") and assessed the financial and clinical impact of this system on major teaching hospitals.
METHOD: The authors surveyed Council of Teaching Hospitals and Health Systems members to collect detailed financial and clinical data from fiscal year (FY) 2015 for transfer cases and non-transfer cases (cases directly admitted to the teaching hospital). Data included computed margins (the difference between revenue received and direct and indirect facility costs as estimated by the hospitals) as well as case severity, average length of stay (ALOS), time of admission, surgical or medical status, and other situational variables for All Patient Refined Diagnosis Related Groups (APR-DRGs). The authors used an ordinary least squares regression model with fixed effects to analyze the data.
RESULTS: Twenty-six hospitals provided data. The average difference between transfer and non-transfer cases was 2.18 days longer (ALOS) and $1,716 less computed margin, for a case in the same APR-DRG and hospital (P < .001 for both outcomes). Transfer cases had a 19% higher case severity of illness rating and were disproportionately represented among complex APR-DRGs. Transfer patients were 14% more likely to be Medicaid beneficiaries.
CONCLUSIONS: Compared to non-transfer cases, transfer cases at major teaching hospitals were more complex and resulted in greater resource utilization, affecting the financial margins on which teaching hospitals rely to support their multi-part mission.
PMID: 31246622 [PubMed - as supplied by publisher]