University of California Irvine, Department of Emergency Medicine, Orange, California.
West J Emerg Med. 2013 May;14(3):227-32. doi: 10.5811/westjem.2011.10.6906.
Higher-level-of-care (HLOC) transfers to tertiary care hospitals are common. While this has been shown profitable for hospitals, the impact on physicians has not been described. Community medical center call panels continue to erode, in part due to the perception that patients needing transfer are underinsured. Surveys show that the problematic specialties to maintain call panels in community hospitals are neurosurgery, otolaryngology, plastic surgery, orthopedics and ophthalmology. This places greater stress on tertiary care hospitals' physicians. The objective of this study is to describe the financial consequences to physicians who care for HLOC transfers across specialties and compare these with all patients from each specialty and specialty-specific national reimbursement benchmarks.
Financial data were obtained for all HLOC transfers to a single tertiary care center from January 2007 through March 2008. Work relative value unit (RVU) and reimbursement were taken from a centralized professional fee billing office. National benchmarks for reimbursement per RVU were calculated from the 2006 Medical Group Management Association (MGMA) Compensation and Production Survey.
In this period 570 patients were transferred, 319 (55.9%) through the emergency department (ED). Reimbursement per RVU varied from a high of $74.93 for neurosurgery to $25.91 for family medicine. Reimbursement to emergency medicine (EM) for HLOC patients was 16% above the average reimbursement per RVU for all ED patients ($50.5 vs. $43.7). Similarly, neurosurgery reimbursement per RVU was 22% above the reimbursement per RVU for all patients ($74.93 vs. $61.27). The remainder of specialties was reimbursed less ($25.91 vs $69.60) per RVU for HLOC patients than for all of their patients at this center. All specialties at this site were reimbursed less for each HLOC patient than national average reimbursement for all patients in each specialty.
Average professional fee reimbursement for HLOC patients was higher for EM and neurosurgery than for all other patients in these specialties at this site, but lower for the rest of the specialties. Compared to the national benchmarks, this site had an overall lower reimbursement per RVU for all specialties, reflecting a poorer patient mix. At this site HLOC transfers patients are financially advantageous for EM and neurosurgery.
将患者转移到更高层次的医疗机构（HLOC）是很常见的。虽然这对医院来说是有利可图的，但对医生的影响尚未得到描述。社区医疗中心的呼叫小组继续减少，部分原因是人们认为需要转院的患者保险不足。调查显示，在社区医院中难以维持呼叫小组的问题专业包括神经外科、耳鼻喉科、整形外科、骨科和眼科。这给三级保健医院的医生带来了更大的压力。本研究的目的是描述跨专业照顾 HLOC 转移的医生的经济后果，并将这些后果与每个专业的所有患者以及特定专业的国家报销基准进行比较。
从 2007 年 1 月至 2008 年 3 月，获取了一家三级保健中心所有 HLOC 转移患者的财务数据。工作相对价值单位（RVU）和报销从集中的专业费用计费办公室获得。每个 RVU 的国家报销基准是根据 2006 年医疗集团管理协会（MGMA）薪酬和生产调查计算的。
在此期间，有 570 名患者被转移，其中 319 名（55.9%）通过急诊部（ED）转移。每个 RVU 的报销金额从神经外科的 74.93 美元到家庭医学的 25.91 美元不等。HLOC 患者的急诊医学（EM）报销比所有 ED 患者的平均 RVU 报销高出 16%（50.5 美元对 43.7 美元）。同样，神经外科每个 RVU 的报销比所有患者的 RVU 报销高出 22%（74.93 美元对 61.27 美元）。该中心的其他专业的报销金额则较低（HLOC 患者为每个 RVU 25.91 美元，而所有患者为每个 RVU 69.60 美元）。与全国平均水平相比，该中心每个 HLOC 患者的报销都低于各专业的全国平均水平，这反映出患者的混合情况较差。所有专业的平均专业费用报销对于 HLOC 患者来说，EM 和神经外科比该中心的其他专业的所有患者都要高，但对于其他专业来说则要低。与国家基准相比，该站点的所有专业的每个 RVU 报销金额都较低，反映出患者的混合情况较差。在该站点，对于 EM 和神经外科来说，HLOC 转移患者在经济上是有利可图的。
