Background: Academic children’s hospitals are increasingly partnering with community hospitals to provide inpatient neonatal and pediatric care in the patient’s own community. Although some academic hospitals are hesitant to form these partnerships due to concern for decreasing incoming transfers, few studies report the true effect of such collaboration. Our strategy involved such a partnership that would allow for patients who need to be kept in the community to be taken care of in their own community, thus reducing unnecessary patient transfers to an otherwise full academic hospital. Return on investment was conducted using a varying range of data points to determine if this strategy may be replicable in other like-institutions.

Methods: In July 2018, we established a partnership between an urban tertiary care academic medical center and a not-for-profit 194-bed community hospital, located 37 miles away. The partnership involved 1) staffing the community inpatient unit with academic-affiliated pediatric hospitalists, 2) obtaining level-II NICU certification and initiating neonatal rounds via telemedicine, 3) providing training for existing nurses and staff at the community site, and 4) developing pediatric protocols and policies. We utilized two-sample t-tests to compare one-year pre- and post-partnership time periods (July 2017-June 2018 versus July 2018-June 2019) to analyze the community hospital’s volume of transferred inpatient cases, case mix index (CMI) of patient transfers, and resulting net revenues, contribution margin, and overall net gain for the academic medical center associated with the transferred cases.

Results: In our results we observed significant differences between the two periods (pre- and post-partnership) for both the community hospital and academic medical center. The community hospital experienced a 44% increase in annual admissions which had a 23% increase in average daily census, from 5.6 to 6.9 patients per day. Furthermore the community hospital average length of stay decreased by 15%, from 2.31 to 1.97 days. The academic medical center experienced a slight increase in transfers (7%) after implementation, seeing an increase in the annual inpatient transfers from 186 to 223 pediatric patients. The weighted average CMI of these patients also increased 35% from 1.19 to 1.61. From a financial perspective, we observed a 50% increase in total revenue, contribution margin increased by 44%, and overall net gain increased by 96%.

Conclusions: Our data suggest that the community-academic partnership results in a win-win for both institutions, while simultaneously having a positive impact to the quality of care for the community hospital’s inpatient pediatric population. Our affiliation model demonstrates the success between an academic institution and a community hospital to serve the patient population in our community more effectively.