PubMed1986
Patients who reside outside of New York City have long been an important segment of the patient population at New York City hospitals. Each year, as far back as systematic data are available, approximately 10 percent of all patients at New York City hospitals have been non residents. Increasing competition and changing reimbursement policies compel hospitals in New York City to assess their role in caring for these patients and its economic implications. This report provides a comprehensive assessment of the characteristics of nonresident patients and their significance to the city's hospitals. Using data from all New York City hospitals, the report analyzes the demographics, insurance coverage, and case-mix characteristics of nonresident and resident patients. And, using more detailed data from New York University Medical Center and Columbia-Presbyterian Medical Center, it addresses the financial and reimbursement policy questions posed by the care of nonresident patients. The key findings of the report are as follows: A total of 115,307 nonresidents were hospitalized in New York City in 1982; this figure represents 10.4 percent of all patients in city hospitals. Over 80 percent of nonresident patients come from 14 counties surrounding New York City. Nonresident patients are a crucial component of the patient population at six hospitals that are the principal affiliates of a medical school and the six specialty hospitals. At academic health centers, nonresidents represent 25 percent of all inpatients; at the specialty hospitals, they represent 36 percent. Manhattan hospitals account for 69 percent of all nonresident discharges in the city. Outside of Manhattan, only Montefiore Medical Center and Long Island Jewish Medical Center have substantial numbers of nonresident patients. Among nonresident patients, 75 percent of admissions are scheduled in advance and 72 percent of hospital stays are for surgical procedures. In contrast, among resident patients, only 50 percent of admissions ares scheduled and 52 percent are for surgical procedures. Almost two-thirds of nonresident patients are covered by private insurance, compared to one-third of residents. Nonresident patients require more hospital resources on average than residents do. The average Diagnosis Related Group (DRG) weight, a measure of expected resource intensity, is 22.5 percent higher for nonresidents than for residents. However, nonresidents also come to New York City hospitals for relatively routine care. For example, the most common diagnoses among nonresidents and residents are uncomplicated deliveries and abortions. At New York University Medical Center and Columbia-Presbyterian Medical Center, nonresidents have higher average charges than residents, but the charge differences are much smaller than the DRG weight differences. Thus, within a given DRG, nonresidents consume fewer resources than residents. Under Medicare's Prospective Payment System bases on DRGs, nonresidents appear to be financially attractive to New York hospitals, based on the experience of New York University Medical Center.
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