Jonathan M. Schwartz, MD, MBA
Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=L14-0156.
Schwartz JM. Insurance Status and the Transfer of Hospitalized Patients. Ann Intern Med. 2014;160:810. doi: 10.7326/L14-5011-7
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Published: Ann Intern Med. 2014;160(11):810.
We read Hanmer and colleagues' article (1) with great interest. A patient's status as “insured” is probably the principal element in his or her likelihood to undergo interhospital transfer directly from the emergency department or after admission.
Specifically, patients insured and enrolled in a managed care product, accountable care organization, or otherwise who are subject to the constraints of a specifically designated network of care and who present and are admitted to an out-of-network facility on an emergency or unplanned basis will be of great interest to their designated provider network for financial reasons. Patients and their provider networks will have a financial incentive to “repatriate” patients back to an in-network facility. Uninsured patients are not subject to utilization management, prior authorization rules, network enforcement, case management, or other resources typically found in managed care environments with an incentive to enforce in-network utilization and inpatient admission.
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