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Invited Commentary

Josef E. Fischer, MD
Arch Surg. 1997;132(6):611. doi:10.1001/archsurg.1997.01430300053011.
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This interesting report is an early and, as the authors readily admit, a preliminary look at the results of a deliberate effort of a financially troubled health care system to redistribute resources to achieve more efficient use of the resources available. The primary beneficial effect appears to be the grouping of lower-acuity cases in specific community health centers in which a high volume of limited-acuity procedures can be performed efficiently and with short turnover times between cases. In a higher-acuity medical center or large hospital, in which cases are more complex and emergencies interrupt, it is terribly difficult to maintain an accurate operating schedule when longer, complex, less predictable cases are mixed with lower-acuity, high-volume, rapid-turnover cases. A model that separates lower-acuity cases from higher-acuity complex cases theoretically should be more efficient.

Emergency and higher-acuity cases are sent to a referral center, but in the short term there do not

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