Financial Implications for Physicians Accepting Higher Level of Care Transfers

Mark I. Langdorf, MD, MHPE; Sharon Lee, MD; Michael D. Menchine, MD, MPH


Western J Emerg Med. 2013;14(3):227-232. 

In This Article


We acknowledge several limitations and recommend further study. Billing data were unavailable at our center for some of the specialties we were most interested in, including orthopedics, head and neck surgery, and plastic surgery. These are specialties often cited by EPs as the most problematic for obtaining consultation, admission, or follow-up care.

Also, the number of HLOC patients for some specialties was low, and comparison to national data and to all of our tertiary care patients for that specialty is inexact (eg. plastic surgery and family medicine).

We used 2006 MGMA national benchmark data for 2007–2008 patients, as this was the latest available at the time of data analysis.

We believe this is a consecutive patient sample, but acknowledge that some transfers may have occurred that were not discovered in our screening process. Conversely, some revenue could have been lost due to inaccurate billing practices in our centralized university billing center.

Finally our data would not be generalizable to other tertiary care centers with varied HLOC transfer patient proportions by specialty, differing payer mixes, billing efficiencies, and direct admission practices.