Dudas Robert A, Monroe David, McColligan Borger Melissa
Department of Pediatrics, Johns Hopkins Bayview Medical Center, Baltimore, MD 21224, USA.
Pediatr Emerg Care. 2011 Nov;27(11):1099-103. doi: 10.1097/PEC.0b013e31823606f5.
Community hospital pediatric inpatient programs are being threatened by current financial and demographic trends. We describe a model of care and report on the financial implications associated with combining emergency department (ED) and inpatient care of pediatric patients. We determine whether this type of model could generate sufficient revenue to support physician salaries for continuous in-house coverage in community hospitals.
Financial productivity and selected performance indicators were obtained from a retrospective review of registration and billing records. Data were obtained from 2 community-based pediatric hospitalist programs, which are part of a single health system and included care delivered in the ED and inpatient settings during a 1-year period from July 1, 2008, to July 1, 2009.
Together, the combined programs were able to generate 6079 total relative value units and collections of $244,828 annually per full-time equivalent (FTE). Salary, benefits, and practice expenses totaled $235,674 per FTE. Thus, combined daily revenues exceeded expenses and provided 104% of physician salary, benefits, and practice expenses. However, 1 program generated a net profit of $329,715 ($40,706 per FTE), whereas the other recorded a loss of $207,969 ($39,994 per FTE). Emergency department throughput times and left-without-being-seen rates at both programs were comparable to national benchmarks.
Incorporating ED care into a pediatric hospitalist program can be an effective strategy to maintain the financial viability of pediatric services at community hospitals with low inpatient volumes that seek to provide 24-hour pediatric staffing.
社区医院儿科住院项目正受到当前财务和人口趋势的威胁。我们描述了一种护理模式，并报告了将儿科患者的急诊科（ED）护理与住院护理相结合所带来的财务影响。我们确定这种模式是否能够产生足够的收入来支持社区医院持续内部覆盖所需的医生薪酬。
通过对登记和计费记录进行回顾性审查来获取财务生产力和选定的绩效指标。数据来自两个基于社区的儿科住院医师项目，它们是同一医疗系统的一部分，包括2008年7月1日至2009年7月1日这1年期间在急诊科和住院环境中提供的护理。
两个项目合在一起，每年每个全时当量（FTE）能够产生总计6079个相对价值单位，收款244,828美元。每个FTE的工资、福利和业务费用总计235,674美元。因此，合并后的每日收入超过支出，为医生工资、福利和业务费用提供了104%的资金。然而，一个项目产生了329,715美元的净利润（每个FTE为40,706美元），而另一个项目则记录了207,969美元的亏损（每个FTE为39,994美元）。两个项目的急诊科周转时间和未就诊离开率均与全国基准相当。
将急诊科护理纳入儿科住院医师项目可以是一种有效的策略，以维持那些住院量较低但希望提供24小时儿科人员配备的社区医院儿科服务的财务可行性。
