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WOutsourcing Transfer Centers

Many large academic centers have been running their own transfer centers for years. What’s new is that transfer centers are now being adopted for the next tier of referral hospitals: smaller academic centers and large community hospitals.

Also new is the growth of for-profit companies that hospitals can outsource their transfer center operations to. One is the Omaha, Neb. -based company DirectCall Patient Management Center, which started in 2002 and grew out of a medical helicopter company. DirectCall now operates transfer centers for 180 hospitals in nearly every state.

Another is Verihealth Inc., which is based in Petaluma, Calif. The company provides transfer center services to about 20 hospitals in California.

Why are these companies proliferating? Because in an era when inpatient margins and volumes are supposed to go down, grabbing more market share in transfers makes good business sense.

“This is all about creating the path of least resistance,” explains Kerin M. Zuger, MBA, DirectCall’s vice president. “With health care reform, it is going to get extremely competitive, and hospitals are going to have to streamline ways to get patients into their institutions.”

According to Ms. Zuger, every institution the company works with “has seen at minimum a 20% increase in referral volume.” Most larger hospitals have sub-specialists respond to transfer requests, she says, while more midsized referral hospitals use a hospitalist model. Both models work as long as staff can handle the typical volume of calls.

For hospitals, outsourcing may look good because transfer centers are expensive to start, staff and operate.

“Setting up a transfer center is going to cost about $1.2 million to do right,” says hospital medicine consultant Martin B. Buser, MPH, of Hospitalist Management Resources LLC. “Outsourcing drops the price in half.”

Transfer centers offer one number to call and the ability to put the right people on the phone at the same time. And hiring a middle person tends to make transfers more cordial. That’s the rationale, Mr. Buser says, behind transfer centers recording every transation.

“You sell it as medical-legal” and protection against dumping, he points out, “but the real reason is that surgeons are not going to explode and chew out the referring doc once they know they are being taped.” Outsourcing companies also help hospitals market their new 800 numbers, with outreach to referring hospitals, and they track transfer data.

What transfer centers don’t do is find beds for transferred patients. But they do shine a very strong light on bed management problems by reporting transfers that don’t take place because beds weren’t available.

That in turn leads executives to put pressure on everyone below them to fix longstanding bed management problems. Some hospitalists and specialists are being incentivized to respond to transfer-center calls within 10 minutes. New hospital policies are also stopping staff from playing what Mr. Buser calls “hide-a-bed” games, particularly when staff are about to go off-shift, that end up turning potential transfers away due to lack of capacity.

Mr. Buser says he worked with one CEO who was so gung-ho on accepting transfers that “every manager’s bonus is now based on ED throughout.”

March 14, 2007
Press release