Financial and Clinical Impact of Transfer Patients at Major Teaching Hospitals

Abstract

Purpose The authors examined the “hub-and-spoke” health care system in the United States 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 2015 for transfer cases and nontransfer 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 nontransfer cases was a 2.18 day longer ALOS and a $1,716 lower 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 with nontransfer 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 multipart mission.

Inter-hospital cardiorespiratory telemonitoring of newborns and infants: a wellworking example of a hub and spoke network

“…Telemedicine potentially allows achieving equity and improving the quality of health care through easier accessibility and a cost reduction in any field of medicine [18][19][20][21][22][23]. The analysis of cost reduction is not a goal of this study, so more detailed data on telemedicine network cost analysis should be performed.…”

Incidence and Outcomes of Laryngeal Complications Following Adult Cardiac Surgery: A National Analysis

“…Postoperative laryngeal complications (LCs) resulting in poor voice and swallow function are an increasingly recognized sequelae of several surgical procedures [1][2][3]. Generally attributable to laryngeal injury, dysphagia after cardiac surgery is estimated to occur between 2 and 16% of patients, with risk factors including congestive heart failure, diabetes mellitus, and advanced age [4][5][6][7]. Postoperative LCs result from either direct injury to the laryngeal structures, recurrent laryngeal or vagus nerves from endotracheal intubation, transesophageal echocardiography (TEE), and/or direct impact of surgical dissection [3,[8][9][10].…”