title: Routine diversion of patients with STEMI to high-volume PCI centres: modelling the financial impact on referral hospitals.
abstract: To quantify possible revenue losses from proposed ST-elevation myocardial infarction (STEMI) patient diversion policies for small hospitals that lack high-volume percutaneous coronary intervention (PCI) capability status (ie, 'STEMI referral hospitals').
  
  
  
  Negative financial impacts on STEMI referral hospitals have been discussed as an important barrier to implementing regional STEMI bypass/transfer protocols. However, there is little empirical data available that directly quantifies this potential financial impact.
  
  
  
  Using detailed financial charges from Florida hospital discharge data, we examined the potential negative financial impact on 112 STEMI referral hospitals from losing all inpatient STEMI revenue. The main outcome was projected revenue loss (PRL), defined as total annual patient with STEMI charges as a proportion of total annual charges for all patients. We hypothesised that for most community hospitals (>90%), STEMI revenue represented only a small fraction of total revenue (<1%). We further examined the financial impact of the 'worst case' scenario of loss of all acute coronary syndrome (ACS) (ie, chest pain) patients.
  
  
  
  PRLs were $0.33 for every $100 of patient revenue statewide for STEMI and $1.73 for ACS. At the individual hospital level, the 90th centile PRL was $0.74 for STEMI and $2.77 for ACS. PRLs for STEMI were not greater in rural areas compared with major metropolitan areas. Hospital revenue centres that would be most impacted by loss of patients with STEMI were cardiology procedures and intensive care units.
  
  
  
  Loss of patient with STEMI revenues would result in only a small financial impact on STEMI referral hospitals in Florida under proposed STEMI diversion/rapid transfer protocols. However, spillover loss of patients with ACS would increase revenue loss for many hospitals.
authors.affiliation: Department of Internal Medicine , University of South Florida , Tampa, Florida , USA.
authors.forename: Elizabeth Barnett
authors.initials: EB
authors.lastname: Pathak
authors.affiliation: Department of Health Policy and Management , University of South Florida , Tampa, Florida , USA.
authors.forename: Meg M
authors.initials: MM
authors.lastname: Comins
authors.affiliation: Department of Anthropology , University of South Florida , Tampa, Florida , USA.
authors.forename: Colin J
authors.initials: CJ
authors.lastname: Forsyth
authors.affiliation: Department of Medicine , University of Florida College of Medicine , Jacksonville, Florida , USA.
authors.forename: Joel A
authors.initials: JA
authors.lastname: Strom
keywords: QUALITY OF CARE AND OUTCOMES