RESUMO
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.
Assuntos
Hospitais de Ensino/economia , Medicaid/economia , Transferência de Pacientes/economia , Adolescente , Criança , Grupos Diagnósticos Relacionados , Avaliação do Impacto na Saúde , Custos Hospitalares/tendências , Humanos , Tempo de Internação , Medicaid/estatística & dados numéricos , Transferência de Pacientes/estatística & dados numéricos , Inquéritos e Questionários , Estados Unidos/epidemiologiaRESUMO
At HFMA's recent Thought Leadership Retreat, the issue of behavioral health emerged as an issue of significant importance to health systems, clinicians, and health plans alike.
Assuntos
Serviços de Saúde Mental , Atenção Primária à Saúde , Serviços de Saúde Mental/economia , Serviços de Saúde Mental/normas , Serviços de Saúde Mental/estatística & dados numéricos , Satisfação do Paciente , Atenção Primária à Saúde/economia , Melhoria de Qualidade , Estados UnidosRESUMO
Conversations on improving the value of health care often focus on clinical performance improvement efforts. Yet during Phase 2 of HFMA's Value Project research, CFOs time and again identified the revenue cycle as the place where their hospital's performance improvement efforts have begun.
Assuntos
Economia Hospitalar , Aquisição Baseada em Valor , Codificação Clínica , Acessibilidade aos Serviços de Saúde , Satisfação do Paciente , Melhoria de Qualidade , Estados UnidosRESUMO
Three core programs have heped reduce reedrmissions in Illinois hospitals: Projct BOOST (better Outcomem by Optimizing Safe Transitions), whih focuses on redesigning hospital discharge processes and improving transitions of care. HP3: Hospitalist Program Peak Performance which provides ducational resources, motivation, and a process improvement structure for hospitalist programs. Communications and Palliative Care, which teaches physicians and dclinicians how to work with paients to define their goal of care and identify options to improve their quality of life.
