Citation

Flanagan CD, Rascoe AS, Wang DM, Vallier H. J. Orthop. Trauma 2018; 32(9): 433-438.

Affiliation

Department of Orthopaedic Surgery, MetroHealth Medical Center, Cleveland, OH.

Copyright

(Copyright © 2018, Lippincott Williams and Wilkins)

DOI

10.1097/BOT.0000000000001192

PMID

29738398

Abstract

OBJECTIVE: To characterize the charges and collections associated with the initial inpatient management of trauma patients who undergo operative fracture management DESIGN:: Retrospective SETTING:: Level 1 trauma center PARTICIPANTS:: 440 consecutive adult trauma patients INTERVENTION:: fixation for fracture of the spine, pelvis, acetabulum, and/or femur fractures MAIN OUTCOME MEASUREMENT:: Professional and technical (facility) charges and collections from the initial inpatient management and 6 months of subsequent related care RESULTS:: Patient were predominantly male (74.3%) and Caucasian (63.2%) with mean age 41 years and mean Injury Severity Score of 18.5. Uninsured (self-pay) patients represented the largest payer class (35.0%), and 34.5% of all patients were unemployed. Professional and technical charges totaled US $12,382,028 (US $28,140/patient) and US $39,682,225 (US $90,187/patient), respectively. Injury Severity Score, longer lengths of stay (LOS), and presence of a complication were positive predictors of initial charges (p<0.0001, adjusted R=0.799). Professional and technical collections totaled US $2,418,096 (US $5,496/patient) and US $16,921,959 (US $38,459/patient) (percent of charge: 21.5% vs 41.3%, p<0.0001). Of the self-pay patients, 34.4% had no collections, resulting in potential lost revenue of US $2,513,988. Greater collections were predicted to occur in females, employed patients, and those with insurance (p<0.0001, adjusted R=0.35).

CONCLUSION: Trauma patients often present without insurance, which compromises hospital revenue. Expectedly, charges are higher in more severely injured patients, those with longer lengths of stay, and those experiencing complications. A bundled model will proportionately decrease reimbursements for a given episode of care in the event of longer LOS or occurrence of complications. LEVEL OF EVIDENCE: Economic; Level IV.

Language: en