Going From an Academic Medical Center to a Community Hospital: Patient Experiences with TransfersGoing from an academic medical center to a community hospital: Patient experiences with transfers

Academic medical centers (AMCs) often operate at or near full capacity, which leads to delays in care while smaller community hospitals may have excess capacity. To address this issue and to match patient needs to care acuity, patients may be transferred from an AMC emergency department for direct admission to a community hospital. We aimed to explore the experiences and perspectives of patients who were transferred. We randomly selected patients transferred between February 2019 and February 2020. We conducted structured thirty-minute interviews containing fixed response and open-ended questions focusing on the transfer rationale and experience, care quality, and patient financial outcomes. We used descriptive statistics to summarize questions with fixed responses and thematic analysis for open-ended questions. We interviewed a total of 40 patients. While most (88%) understood the rationale for transfer, many (60%) did not feel they had agency in the decision despite the voluntary nature of the program. Patients generally had a positive experience with the transfer (65%) and valued the expedited admission. However, some highlighted issues with transfer-related billing and the mismatch between the expectations of presenting to an academic hospital and the reality of being admitted to a community one. We conclude that patients are amenable to transfers for an expedited admission and understand the rationale for such transfers. However, participants should receive a clear explanation of benefits to them, guidance that the program is voluntary, and protection from financial risk Experience Framework This article is associated with the Patient, Family & Community Engagement lens of The Beryl Institute Experience Framework (https://www.theberylinstitute.org/ExperienceFramework). Access other PXJ articles related to this lens. Access other resources related to this lens

A Survey of Innovative Reimbursement Models in Spine Care

Purpose: The United States spends $90 billion annually on medical expenses for low back pain. One approach to promoting high-quality, cost-effective care is through bundled payments and other reimbursement models wherein physicians are held accountable for costs and utilization. The aim of the study was to describe innovative reimbursement models in spine care and gather perspectives on the future of spine care reimbursement. Methods: Through literature review and discussions with leaders in the field, we identified organizations that were engaged in bundled payment initiatives for spine care and surgery. These included healthcare systems, physician groups, organizations helping to set up bundles, and a large employer. We conducted interviews to understand the background and specific features of each initiative, generalizable success factors and challenges, and perspectives on the future of spine reimbursement. Results: We interviewed 24 stakeholders across 18 organizations that collectively perform approximately 12,000 inpatient spine surgeries annually. Fee-for-service reimbursement accounts for a majority of revenue, but several organizations expect 30% to 45% of their spine volume to be covered under bundled payments within 3 years and cite new patient volume, increased surgical yield, and financial benefits from efficiency improvements as reasons for adopting bundled payments. Current initiatives are heterogeneous, but share similar success factors and challenges. Institutions are more hesitant to adopt risk-based payment models for chronic back care, citing difficulty modeling risk, patient heterogeneity, and difficulty aligning incentives. Conclusions: Payment models outside of the traditional fee-for-service paradigm are emerging in spine care. Providers that preemptively adopt bundled payments can increase patient volumes from payers seeking cost-effective care. Going forward, organizations should begin considering reimbursement models that focus on noninterventional spine care. Finally, developments in spine reimbursement may apply to other procedure-based specialties, including orthopedics and cardiology.Scholarly Projec