Changing Payer Mix and Transfer Rate

Changing Payer Mix and Transfer Rate

Citizens in a suburb of Philadelphia rely on one community hospital, Hospital A, for emergency department and inpatient hospital services. Recently, Hospital A’s payer mix has changed from one third commercial, one third Medicaid, and one third Medicare, to nearly two thirds Medicaid and one third Medicare. Average length of stay for inpatient visits has dropped 50 percent in the last three months.
Emergency department providers have reported being overwhelmed. In the last month, providers have transferred three times as many emergency department patients to other area hospitals when compared to the usual transfer rate. Some of those hospitals are more than 30 minutes away. At the same time, the wait time for primary care visits in the community is approaching three months.
Pretend that you are a compliance officer for Hospital A. You have received a call from a local reporter who wants to do a story on the changing payer mix and transfer rate. Your CEO has directed you to speak with the reporter and answer her questions.
How would you address the information set forth above? What additional information do you need before you speak to the reporter? What issues do you see that might arise regarding community values?

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