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{
    "pk": 19348,
    "title": "Financial Implications For Physicians Accepting Higher Level Of Care Transfers",
    "subtitle": null,
    "abstract": "Introduction\n: 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.\nMethods\n: 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.\nResults\n: 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.\nConclusion\n: 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. [West J Emerg Med. 2013;14(3):227–232.]",
    "language": "en",
    "license": {
        "name": "Creative Commons Attribution-NonCommercial  4.0",
        "short_name": "CC BY-NC 4.0",
        "text": "Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNonCommercial — You may not use the material for commercial purposes.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.",
        "url": "https://creativecommons.org/licenses/by-nc/4.0"
    },
    "keywords": [
        {
            "word": "Higher Level of Care"
        },
        {
            "word": "transfer"
        },
        {
            "word": "EMTALA"
        },
        {
            "word": "on-call"
        },
        {
            "word": "Reimbursement"
        },
        {
            "word": "Emergency Medicine"
        }
    ],
    "section": "Healthcare Utilization",
    "is_remote": true,
    "remote_url": "https://escholarship.org/uc/item/93k6g905",
    "frozenauthors": [
        {
            "first_name": "Mark",
            "middle_name": "I",
            "last_name": "Langdorf",
            "name_suffix": "",
            "institution": "University of California Irvine, Department of Emergency Medicine, Orange, California",
            "department": "None"
        },
        {
            "first_name": "Sharon",
            "middle_name": "",
            "last_name": "Lee",
            "name_suffix": "",
            "institution": "University of California Irvine, Department of Emergency Medicine, Orange, California",
            "department": "None"
        },
        {
            "first_name": "Michael",
            "middle_name": "",
            "last_name": "Menchine",
            "name_suffix": "",
            "institution": "University of Southern California, Department of Emergency Medicine, \nLos Angeles California",
            "department": "None"
        }
    ],
    "date_submitted": "2011-10-04T17:15:22-04:00",
    "date_accepted": "2011-10-04T17:15:22-04:00",
    "date_published": "2013-02-15T14:27:38-05:00",
    "render_galley": null,
    "galleys": [
        {
            "label": "",
            "type": "pdf",
            "path": "https://journalpub.escholarship.org/westjem/article/19348/galley/9570/download/"
        }
    ]
}