title: Regionalization of surgical services in central Florida: the next step in acute care surgery.
abstract: BACKGROUND
  There is a national loss of access to surgeons for emergencies. Contributing factors include reduced numbers of practicing general surgeons, superspecialization, reimbursement issues, emphasis on work and life balance, and medical liability. Regionalizing acute care surgery (ACS), as exists for trauma care, represents a potential solution. The purpose of this study is to assess the financial and resources impact of transferring all nontrauma ACS cases from a community hospital (CH) to a trauma center (TC).
  
  
  METHODS
  We performed a case mix and financial analysis of patient records with ACS for a rural CH located near an urban Level I TC. ACS patients were analyzed for diagnosis, insurance status, procedures, and length of stay. We estimated physician reimbursement based on evaluation and management codes and procedural CPT codes. Hospital revenues were based on regional diagnosis-related group rates. All third-party remuneration was set at published Medicare rates; self-pay was set at nil.
  
  
  RESULTS
  Nine hundred ninety patients were treated in the CH emergency department with 188 potential surgical diseases. ACS was necessary in 62 cases; 25.4% were uninsured. Extrapolated to 12 months, 248 patients would generate new TC physician revenue of >$155,000 and hospital profits of >$1.5 million. CH savings for call pay and other variable costs are >$100,000. TC operating room volume would only increase by 1%.
  
  
  CONCLUSIONS
  Regionalization of ACS to TCs is a viable option from a business perspective. Access to care is preserved during an approaching crisis in emergency general surgical coverage. The referring hospital is relieved of an unfavorable payer mix and surgeon call problems. The TC receives a new revenue stream with limited impact on resources by absorbing these patients under its fixed costs, saving the CH variable costs.
authors.affiliation: University of Central Florida College of Medicine, Orlando, Florida, USA. Ernest.Block@health-first.org
authors.forename: Ernest F J
authors.initials: EF
authors.lastname: Block
authors.forename: Beth
authors.initials: B
authors.lastname: Rudloff
authors.forename: Charles
authors.initials: C
authors.lastname: Noon
authors.forename: Bruce
authors.initials: B
authors.lastname: Behn
mesh_terms: D003365:Costs and Cost Analysis; D003422:Critical Care / Q000191:economics / Q000458:organization & administration*; D003953:Diagnosis-Related Groups; D005251:Fees, Medical; D005375:Financial Audit; D005431:Florida; D006764:Hospitals, Community / Q000191:economics / Q000458:organization & administration*; D006801:Humans; D007348:Insurance, Health; D007902:Length of Stay; D017057:Medically Uninsured; D014193:Trauma Centers / Q000191:economics / Q000458:organization & administration*; D014194:Traumatology / Q000191:economics / Q000458:organization & administration*