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Success Stories

Transfer Center ROI: 7 Key Benefits

Lessons Learned from Mountain States Health Alliance


In healthcare, minutes become lives saved and lives lost. The quicker patients arrive at their definitive level of care the higher the chance for positive outcomes. However, healthcare providers nationwide face complicated processes to transfer patients. The delays associated with overly complex care transitions directly impact patient safety.

Mountain States Health Alliance (MSHA) has streamlined transfers, reduced wait times, and literally saved lives by using a transfer center. The patient care and market share increases measured through the MSHA transfer center are game changers for the hospital system.

Using its transfer center MSHA increases admissions, reduces patient leakages to competitors, and collects critical business intelligence to enhance resource utilization. Since 1995, MSHA’s transfer center net revenue contribution margin totals more than $650 million, enabling the system to consistently place more resources into quality patient care.

From Hospital to System

As the flagship facility for MSHA, Johnson City Medical Center (JCMC) has been providing quality patient care for more than 100 years. Founded in 1911, JCMC functioned as an independent institution for decades. In 1998, JCMC’s administrative team began purchasing additional hospitals, leading to the creation of MSHA. The 13-hospital MSHA system is now the largest healthcare provider in southwest Virginia and northeast Tennessee.

Prior to becoming MSHA’s hub, JCMC was affiliated with a network of area hospitals. In a satisfaction survey network hospitals were asked, “If JCMC could do one thing better, what would that be?” The resounding answer: “Make it easier to transfer patients into JCMC.”

To meet the requests of its network affiliates, JCMC’s CEO Dennis Vonderfecht drove the creation of a transfers-only physician hotline. This service was added to the hospital’s established Medical Call Center. At the time, the call center offered a nurse triage line and scheduling for an outpatient diagnostic center.

A typical transfer line—or transfer center—coordinates inbound transfers of patients from primary care providers’ offices, free- standing emergency clinics, and community hospitals into acute care settings where a higher level of care can be provided. Acting as the link between referring and accepting providers, transfer centers allow clinicians to send their patients directly to the appropriate level of care, avoiding delays in treatment.

Adding the transfer center to JCMC was a strategic step towards substantial market growth and enhanced patient care. Yet, only after JCMC expanded to form MSHA was the impact of this innovative service truly recognized.

Call Center Conundrum: Where’s the ROI?

In 1999 Rick Newman joined MSHA as the Medical Call Center Director. Vonderfecht tasked Newman with determining the call center’s ROI. “Medical call centers nationwide were closing because they appeared to lack value,” said Newman. “Mr. Vonderfecht sincerely felt our call center was important, but we needed to show a return on the investment.”

Considering the three services offered in the call center, Newman hypothesized that the nurse triage line contributed the most value. “As I worked through the ROI from triage and diagnostic services, I found the added revenue did not entirely justify the call center’s costs,” said Newman.

The transfer center facilitated 850 transfers that year. With such a small number, the ROI was calculated by hand. “And there I hit the jackpot,” stated Newman. “When I started running the numbers, I was shocked. The revenue generated by the transfer center alone was enough to sustain the entire call center and add profit.”

Newman coordinated with MSHA’s CFO to confirm his findings. Running a series of calculations to double check Newman’s original conclusions, the numbers held true. Newman took his findings to Vonderfecht: “I told my CEO that instead of closing the call center, I wanted to double its patient transfer business.”

With a revamped focus in the call center, Newman’s team more than doubled transfers in the next year, easily fulfilling his promise to Vonderfecht.

Transfer Center Meets Technology

The success of MSHA’s transfer center was clear. Admissions increased and feedback from regional providers was extremely positive. “But we began hitting a wall,” states Newman. “We did not have a reliable way to track and manage all the data we were processing. If we really were going to leverage the transfer center’s strategic capabilities, we needed a way to analyze the captured information.”

After extensive research, in 2009 Newman collaborated with patient flow solutions company Central Logic to implement the ForeFrontTM transfer center software.


“MSHA runs one of the most progressive transfer centers in the nation,” says Darin Vercillo, MD, Chief Medical Officer at Central Logic. “When we consulted with their group in 2009, the correct processes were in place. MSHA just needed technology to support its workflows and capture business intelligence.”

With the implementation of ForeFront, MSHA gained a tool to enhance system-wide visibility. This was particularly important as the hospital system continued to grow. ForeFront helped streamline quick delivery of patient care and enhanced MSHA’s market share. Today, MSHA maintains its trajectory of growth and development.

Transfer Center ROI: 7 Key Benefits

Transfer centers are gateways to the entire patient care continuum. If the initial transfer occurs quickly—and leads a patient to the appropriate level of care—positive outcomes are increased, LOS is reduced, and satisfaction is improved. Transfer centers enable hospitals to stay agile in an ever- competitive healthcare market. Consider the following seven benefits a transfer center provided for MSHA:

1.   Quick and Accurate Patient Admissions

“We have saved lives using transfer center technology,” states Mark Wilkinson, MD, Medical Director for the MSHA call center.

Optimal care is delivered when the correct provider sees a patient as soon as possible. This is what transfer centers facilitate. When a transfer is needed, transfer centers find an accepting physician to take the patient. Using technology, such as ForeFront, transfer center staff have all the appropriate contact information at their fingertips to swiftly sort through and identify an appropriate accepting physician.

“Since ForeFront allows us to quickly say yes to a transfer, we have reduced the loss of heart muscle and sped other time-sensitive clinical situations,” says Wilkinson. “STEMI patients and traumas depend on us. With technology we are shaving minutes off transfer times.”

2.   Reliability and Ease of Access for Providers

Prior to creating the transfer center, referring groups made multiple phone calls to find an on-call and willing accepting provider (which could take hours). Now, referring providers make one call to the transfer center and can immediately start the care transition process. The MSHA transfer center has significantly reduced the effort of all clinics, EDs, and hospitals wanting to transfer patients to facilities in the system.

“Making the transfer process as easy and reliable as possible has made regional providers more inclined to use MSHA,” said Wilkinson. “We’ve built the loyalty of referring physicians by quickly placing patients with an appropriate provider.”

Transfer centers connect referring and accepting providers, allowing them to discuss critical patient care milestones. This data is captured and enables the receiving facility to prepare for patients’ specific needs while they are being transported.

3.   Reduced Congestion in the Emergency Department

Not all patients need to visit the ED. MSHA uses its transfer center to help avoid ED overuse and reduce congestion in this critical department.

MSHA runs transfer services and community triage with the same call center nurses. “We direct callers to the most appropriate level of care, redirecting many who would otherwise end up in the ED to urgent care centers, their MD office, or to use home care,” said Newman. “This reduces the inappropriate volume of ED visits and directs the appropriate cases to the nearest ED with the lowest wait time.”

Additionally, physicians used to call EMS or send patients to an ED waiting room when they needed a higher level of care. Providers now call the transfer center to coordinate direct admits, typically bypassing an ED visit.

Newman states, “A primary reason MSHA created our transfer center was as a tool for referring emergency departments, which comprise 60% of our transfers.” Now, referring EDs can quickly transfer patients, reducing crowding and delays.

4.   Reporting / Business Intelligence

As transfers occur, information is collected, tracked, and managed with ForeFront. The captured data is used to streamline care delivery and guide business decisions.

Every weekday morning Newman sends out a summary of transfer center activities to all C-level staff. “In this daily report we analyze the efficiency of our patient flow process,” says Newman.  “We check patient acceptance stats, such as the number of transfers from each system hospital, how quickly they were transferred, if we sent them to the correct location, and if the beds were available on time. We analyze transfers we did not accept, and we determine whether or not there are any declining acceptance/ transfer rates from certain facilities or physicians.”


MSHA’s administrative team leverages these reports to make informed quality and strategic decisions. “The visibility afforded by the reports from ForeFront allows our leadership team to do as close to real-time management of patient flow as we have had in this system,” said Wilkinson. “As we continue to grow, an understanding of patient movements throughout the system is critical.”

5.   Quick and Accurate Patient Admissions

Quicker access to patient care encourages providers to use MSHA’s transfer services. The reliability and ease of access helps MSHA stand out from regional competitors, thus increasing admissions and market share.

However, transfer center utilization is not solely organic. In 1999 MSHA started actively advertising its new service by visiting regional providers. Since the transfer center was a timesaving tool, these outreach efforts were well received and successfully promoted the MSHA system. Following this, MSHA experienced a 25% growth in transfers year-over-year for several years. Both Wilkinson and Newman credit the transfer center and call center as key components in the success and growth of the MSHA system.

Technology solutions enable MSHA to handle increasing admissions. “The tactical aspects of our transfer center technology help us organize day-to-day operations, but the visibility of data provided through reporting tools helps us manage our expanding business,” said Newman.

6.   Keeping Patients in the System

Managing “patient leakage” (the transfer of patients already in one hospital system to a facility outside the system) is a continual effort at MSHA. In the early years, the transfer center was mainly a tool to bring in new patients. As the system has expanded and grown market share, the transfer center also owns the initiative of keeping patients in the system.


“Whether a hospital is part of our system or not, they are a customer and they have a choice of where to go for services,” said Wilkinson. “People within our system do not have to transfer inside the network. Each hospital is independent. We must earn the right to serve our customers. This perspective helps us maintain a high service level.”

With the transfer center, MSHA keeps patient movement simple for system and non-system providers. Additionally, with reporting technology MSHA knows when a patient is transferred to an external group. “When this happens we ask ourselves, ‘Why is it that Physician X didn’t transfer within the system? What do we need to do to ensure his or her needs are met for the next transfer?’” said Wilkinson.

7.   Increased Admissions / Revenue Generation

When the transfer center was opened, MSHA processed 850 transfers per year. Currently, the organization tracks 1,200 transfers per month. As volume grew, technology became critical. “I wouldn’t know any other way to manage patient flow and resources as a system than with technology,” said Newman.

After its installation, ForeFront streamlined documentation for staff and reduced time spent on each transfer by 10 minutes. “This was an instant enhancement,” says Newman. “The increased efficiency was a phenomenal help and allowed us to process even more transfers.”

The increased admissions have had significant impact on the system. “Many of the transfers represent incremental business, patients we would not have had,” says Newman. “I’ve had sessions with our CFO to go through the metrics . . . we are talking millions of dollars added.” From its inception, MSHA’s transfer center net revenue contribution margin totals more than $650 million. This is mainly a result of increased admissions.


Transfer Center ROI: 7 Key Benefits

  1. Quick and Accurate Patient Admissions
  2. Reliability and Ease of Access for Providers
  3. Reduced Congestion in the Emergency Department
  4. Reporting / Business Intelligence
  5. Market Share Enhancements
  6. Keeping Patients in the System
  7. Increased Admissions / Revenue Generation


Wrapping It All Up...

Healthcare leaders recognize efficiency leads to sustainability. Initiatives to increase quality care and appropriately use resources are being adopted nationwide. Transfer centers support and bolster these efforts.

Beyond being sustainable, hospitals want to thrive. Reporting tools give administrators the real-time data needed to make strategic decisions and engage regional and system providers. Through streamlined processes and added system visibility, transfer centers facilitate incremental business to hospitals and reduce patient leakage. Also, ease of access into the system, reliability, and quick care delivery ensure the loyalty of regional providers. With the increased admissions stimulated by transfer centers, hospitals increase market share, revenues, and financial margins.

MSHA embarked on a journey to increase provider and patient satisfaction by streamlining the transfer process. Ongoing growth at MSHA highlights the success of this initiative. As seen in the awards for quality and care the organization continues to receive, MSHA remains an innovation leader in healthcare. The organization is looking optimistically toward future opportunities to improve care and reduce costs.



About MSHA

Mountain States Health Alliance, a not-for-profit healthcare organization based in Johnson City, Tennessee, operates a family of hospitals serving a 29-county, four-state region (Northeast Tennessee, Southwest Virginia, Southeastern Kentucky and Western North Carolina). MSHA offers a large tertiary hospital, several community hospitals, two critical access hospitals, rehabilitation, a children’s hospital, a behavioral health hospital, home care and hospice services, retail pharmacies, a comprehensive medical management corporation, and the region’s only provider-owned health insurance company. Its 13,500 team members, associated physicians, and volunteers are committed to its mission of bringing loving care to health care. For more information, visit: www.msha.com.


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