Revenue for Initial Orthopaedic Trauma Care: Effects of Patient and Injury Characteristics.
J Orthop Trauma
; 32(9): 433-438, 2018 09.
Article
en En
| MEDLINE
| ID: mdl-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:
Four hundred forty consecutive, adult, trauma patients. INTERVENTION Fixation for fracture of the spine, pelvis, acetabulum, and/or femur fractures. MAIN OUTCOMEMEASURES:
Professional and technical (facility) charges and collections from the initial inpatient management and 6 months of subsequent related care.RESULTS:
Patients were predominantly male (74.3%) and white (63.2%) with a mean age of 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 the 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).CONCLUSIONS:
Trauma patients often present without insurance, which compromises hospital revenue. Expectedly, charges are higher in more severely injured patients, those with longer LOS, 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.
Texto completo:
1
Colección:
01-internacional
Base de datos:
MEDLINE
Asunto principal:
Heridas y Lesiones
/
Traumatismo Múltiple
/
Costos de Hospital
/
Fracturas Óseas
/
Fijación de Fractura
Tipo de estudio:
Diagnostic_studies
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Límite:
Adult
/
Aged
/
Female
/
Humans
/
Male
/
Middle aged
País/Región como asunto:
America do norte
Idioma:
En
Revista:
J Orthop Trauma
Asunto de la revista:
ORTOPEDIA
/
TRAUMATOLOGIA
Año:
2018
Tipo del documento:
Article