title: Prospective payments in a regional trauma center: the case for recognition of the transfer patient in diagnostic related groups.
abstract: BACKGROUND
  Transfer patients (TP) differ from patients transported directly from the field (DP) by virtue of their complexity and delays to definitive care, factors that might impact on costs and resource utilization and aggravate the adverse selection that already threatens TC reimbursement.
  
  
  METHODS
  This is a retrospective cohort study where patients admitted to a Level I trauma center were classified as a TP or DP. Crude and adjusted total costs, complications, length of stay, and proportion of DRG outliers were compared across the two cohorts.
  
  
  RESULTS
  Among 8,665 patients, 40% were transferred. TP were more likely to be DRG outliers (15% versus 10%, p < 0.001). Costs in 65% of the DRGs were higher in the TP. Rates of complications and length of stay were significantly greater in the TP.
  
  
  CONCLUSIONS
  There are systematic differences in resource consumption between transferred patients and patients transported directly from the field. These differences render conventional DRG-based mechanisms of reimbursement inadequate, suggesting a need for recognition of the transfer patient as a distinct entity by payers.
authors.affiliation: Division of Trauma/General Surgery, Harborview Medical Center, Department of Surgery, University of Washington, Seattle, Washington 98104, USA.
authors.forename: Jason A
authors.initials: JA
authors.lastname: London
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Rosengart
authors.forename: Gregory J
authors.initials: GJ
authors.lastname: Jurkovich
authors.forename: Avery B
authors.initials: AB
authors.lastname: Nathens
mesh_terms: D000328:Adult; D015897:Comorbidity; D003953:Diagnosis-Related Groups / Q000191:economics*; D004180:Direct Service Costs / Q000706:statistics & numerical data; D017598:Efficiency, Organizational / Q000191:economics; D005260:Female; D006301:Health Services Needs and Demand; D006302:Health Services Research; D017721:Hospital Costs / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008484:Medicaid / Q000191:economics; D006278:Medicare / Q000191:economics; D008875:Middle Aged; D009936:Organizational Innovation; D018579:Patient Selection; D010360:Patient Transfer / Q000191:economics*; D011445:Prospective Payment System / Q000191:economics*; D012042:Registries; D012189:Retrospective Studies; D014193:Trauma Centers / Q000191:economics*; D014600:Utilization Review; D014861:Washington / Q000453:epidemiology; D014947:Wounds and Injuries / Q000191:economics* / Q000453:epidemiology / Q000209:etiology