Surgery News - November 2008 - (Page 7)

NOVEMBER 2008 • SURGERY NEWS NEWS tients rather than performing both emergency general surgery and trauma surgery appeals to many surgeons. Higher emergency surgery volume at a trauma center could also potentially translate into better outcomes for patients. “One of the difficulties [in initiating this kind of partnership] is that hospitals have traditionally competed for patients, but not on the basis of quality of care or efficiencies,” said Dr. Block, president of the Eastern Association for the Surgery of Trauma. He did the study as a part of the Physician Executive MBA program at the University of Tennessee, Knoxville. If all nontrauma acute care surgery cas- 7 Reducing Readiness Costs Acute Care • from page 1 to remove the least desirable or the most difficult or the most challenging or the least paying of patients from one center to another center. As long as there exist inequalities of financing and inequalities in the workload of caring for a patient, there will be greater risks involved in the care of some patients,” he added. But Dr. Block suggested that a community hospital might be willing to give up the business of emergency general surgery because focusing on elective surgery pa- In Florida, a community hospital’s readiness costs total several million dollars per year, which is multiplied across other local hospitals that have the same costs. “The concept behind this should work and should be encouraged and should be helpful, if in fact it eases the burden of access to care and workforce issues. It has the potential, though, for making it worse, and that has to be balanced,” said Dr. Gregory J. Jurkovich, an ACS Fellow and chief of the trauma service at Harborview Medical Center, Seattle, in an interview. “At present the regionalization of moving of patients has been on an ad hoc, sort of select basis. The new concept here is the intent to regionalize care for everybody that falls within some domain of injuries or illnesses or diseases,” he said. Dr. Block and his colleagues identified 62 patients who required acute care surgery, out of a total of 990 patients who were treated at a rural community hospital emergency department during a 3month period. An extrapolation of their data to a 12-month period and 248 patients showed that more than $155,000 in revenue would be generated for physicians at the trauma center, while the hospital would profit by more than $1.5 million. The operating room volume at the trauma center would rise by only 1%. The community hospital would save more than $100,000 in call pay and other variable costs, according to Dr. Block, who presented the study at the annual meeting of the American Association for the Surgery of Trauma in Maui, Hawaii. The cases most often involved pancreasbiliary surgery (41%), while other operations included appendectomy (26%), drainage of soft tissue infection (15%), bowel resection or repair (8%), and anorectal surgery (5%). Other procedures accounted for the remaining 5%. “The perception of emergency call is that it’s a poor payer mix, and it is, compared to a private practice. But it obviously varies from institution to institution. In Florida, the percentage of uninsured [acute care surgery patients] varies between 25% and 70%,” he said. In the study, 25% of the acute care surgery patients had no insurance. The investigators’ financial analysis assumed that all of the patients without insurance did not pay for their care, while third-party payments used Medicare rates. The amount of money reimbursed to physicians was estimated on the basis of evaluation and management codes and CPT codes. Hospital revenue was estimated from regional diagnosis–related group rates. Future studies should calculate how much cost is added by transporting the patients (not only fuel and time but also accidents), Dr. Jurkovich noted. One of the “legitimate concerns about this is that at some level it could deplete the practice of generalists—both generalist surgeons and generalist practitioners who exist in the community hospital— to the point where they no longer have enough to do. That could mean the death of the sending hospital,” he cautioned. “The other concern is that is there a tendency to use regionalization as a way es are transferred to a trauma center, patients also are likely to get better care because they can be seen immediately by an emergency surgery team. At a community hospital they may have to wait until a surgeon finishes with other duties, he said. It is not clear how many patients could be handled by implementing a fully regionalized system of transferring nontrauma acute care surgery patients from community hospitals to trauma centers, but it helps that most surgical emergencies are short-stay patients, Dr. Block said. In the current study, the trauma center averaged about two cases for every 3 days, with a mean length of stay of 3 days. ■

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Surgery News - November 2008

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