Skip to main content

Technology Optimizes Transfers from Lower to Higher Acuity Care

Analysis  |  By Scott Mace  
   June 15, 2022

A statewide program launched in Arizona during the pandemic allowed hospitals to manage their capacity and track bed use, ensuring that transfers were handled expediently and no hospital 'ran out of space.'

The pandemic may have highlighted the shortcomings of the nation's healthcare system in shifting resources and patients to optimize care, but it also spurred the development of new technology and strategies to solve those problems. Health systems are now embracing new platforms that reduce silos and improve both care coordination and management.

HealthLeaders recently sat down to talk to Darin Vercillo, MD, a practicing board-certified hospitalist at Davis Hospital and Medical Center (owned by Steward Health Care) in Layton, Utah, and the medical director of the hospitalist division of the Physician Group of Utah. He's also co-founder and chief medical officer of ABOUT Healthcare, a digital health company that partnered with the state of Arizona during the pandemic to improve surge capacity and bed management throughout the state.

In this interview, Vercillo describes how that partnership worked, and how better technology and coordination strategy can shave days off a typical patient's hospital stay. This interview has been edited for clarity and brevity.

HealthLeaders: Does this technology bring a certain kind of order to certain kinds of chaos?

Darin Vercillo: Absolutely. There are disconnects, so many different silos, that areas of the organization operate in. If you have a patient that's needing to be transferred in, there's the silo of who controls the beds, the silo of who controls the transport, the silo of who controls the communication between providers, and even tremendous silos between physicians. If the hospitalist, the cardiologist, and the endocrinologist all have to participate in the care of the patient, who owns the admission, and who's going to say yes?

Darin Vercillo, MD, medical director of the hospitalist group for the Physician Group of Utah. Photo courtesy Physician Group of Utah.

It can be not only very chaotic, but it can be fraught with too many phone calls, clicks, information systems, and delays in patient care, of minutes to hours, in a very highly acute care transfer. Or it can even be a delay of days, like in the case of my own father, just over the Christmas holiday, where he spent 17 days waiting for a transfer from one hospital that doesn't do cardiac ablations to another hospital that did, because of the pandemic [and] beds being filled. And because it was a disjointed process, nobody looked at other nearby facilities. Once those were looked at, it was a mere 36 hours before they got everything done.

So it can be a real issue, not only for patient care, but for the cost of expensive hospitals as well, with lengths of stay.

HL: How do transfers typically work?

Vercillo: Typically, transfers [are conducted through] a clinically-oriented call center. There are varying technologies -- the EHR, bed management systems, transport systems, care management. In many cases, more than 50% of the patients that are being transferred aren't even in those systems yet, because they're coming from outside organizations. So you're talking about a patient that doesn't yet exist in your EHR.

[Technology platforms should reside] is at the nexus of all of these. First of all, [they] integrate with Epic, Cerner, Allscripts, or Meditech EHRs. [they're] exchanging information bidirectionally with them. Also with capacity management, nursing staffing, physician on call and credentialing, transportation, all these systems that are necessary to coordinate to get those transfers done, [they] connect to all of them. And then the process that surrounds that is a transfer coordinator is receiving the call from the referring physician who's saying, 'Help, I have a patient that I need to transfer to you,' getting the appropriate information quickly from that physician connecting in another physician who's going to speak with that referring doctor on the accepting side, so they can make an agreement to transfer responsibility of care.

HL: How has this process changed since the pandemic?

Vercillo: One thing has been the recognition that load balancing, and systemwide visibility, is not just a question of what's going on inside a hospital or even inside a network of hospitals. We were approached by the Department of Health in the state of Arizona because they wanted to do this same thing on a statewide basis, and coordinate COVID transfers across all of these hospital systems, from remote locations on a Native American reservation that was up on the border, into an area where there was capacity for some of their more acute cases.

During the pandemic, we set up a statewide transfer center, utilizing our technology, receiving information from the state HIE and multiple hospital systems to create statewide visibility of every bed that was available to send and receive a patient at all of the varying levels. They coordinated all COVID transfers through this one hub. They never ran out of space. Secondly, they got a tremendous amount of data that they never would have had. They were able to detect focus areas of increased need and outbreaks. They were also able to look very closely at other resources such as ventilators and ECMO machines, even nursing staffing shortages, and use that data to recruit 500 additional nurses into the state under a governor's order to make sure that they could meet all of those needs.

HL: In addition to all of the staffing challenges you mentioned, there are also great pressures on systems to control their costs. How do you justify the cost of this platform?

Vercillo: Transfers are big business. The majority of patients that are being transferred from one facility to another are moving up the level of acuity. Something has been diagnosed, and now needs a surgical or therapeutic procedure that's not offered at that hospital where they currently are. When you talk about these patients, they are going to literally run up tens of thousands, if not hundreds of thousands, of dollars in charges.

We have done a study that showed nationally that every transferred patient contributes $10,800 to the bottom line of that particular hospital, so every patient you receive is about $11,000 in profit. Now, obviously not to reduce a patient's care down to a profit line, but they're businesses and they need to be aware of this. When they're looking in competitive markets, of how do we attract the patients that our particular hospital is focused on - neurosurgery, orthopedic surgery, or trauma surgery, or cardiac or what have you - and that patient is sitting in an ER in a small community hospital that cannot meet the needs of that patient, that hospital has options as to where they're going to go to.

If you're the owner of the hospital system, and you want to make sure that you're the frictionless path of least resistance for providers to refer their patients, in those situations a transfer center will absolutely be the answer to that. We have seen an average of 29% growth in those transfers in just the first year. And on average, the costs associated with setting this up are paid for in the first six months of a multiyear contract. So it generates tremendous revenue and profitability.

On the other side, on the flip side of this, when you're talking about observed vs. expected lengths of stay, when you're talking about clearing patients through in a timely manner and getting them discharged at the right time of day, so you can staff your hospital with nursing staff, open a bed back up, bring the patient out of the PACU or up from the ER, appropriately, this idea of having electronic and seamless connections to your post-acute care partners is absolutely essential. For a care coordinator to contact five different skilled nursing facilities instantaneously with a click of a button, being able to message back and forth and then electronically order the ride and get the patient there, get them taken care of and arranged in their hospital for discharge, then everything happens seamlessly.

And they free that bed up by two o'clock, which they always want to do, so they can manage their staffing and their census levels at the appropriate times. If not, if care coordinators are having to stand in front of fax machines and stuff page after page after page in there, and then make phone calls and follow up. Oftentimes, you see patients getting waited on until four or five or six o'clock in the evening. And at that point they can't transfer them, so they roll over to the next day. And now you've got a possibly avoidable day on your books for that patient, which you may or may not even get reimbursed for from the insurer.

We also see many organizations that use their transfer centers and their access orchestration strategies to build new service lines. It's a venture that more than pays for itself, and is frequently referenced by many organizations as their secret sauce, as well as one of the more important areas where they focused resources for their long-term issues.

“We have done a study that showed nationally across the country that every transferred patient contributes $10,800 to the bottom line of that particular hospital.”

Scott Mace is a contributing writer for HealthLeaders.


During the height of the pandemic, many hospitals across the country struggled to track bed use and transfers so that they always had room available for new patients.

In Arizona, a statewide project used a new technology platform to manage transfers and bed use, ensuring that patients were housed in the right place and that hospitals weren't running out of available beds.

These types of platforms will become more commonplace as health systems look to technology to close gaps in care and better manage their operations.

Get the latest on healthcare leadership in your inbox.