The Trauma Service Line: Revenue From Subsequent Injury- and Noninjury-Related Care.

ABSTRACT

OBJECTIVE: To calculate the revenue generated for injury- and noninjury-related services after the initial injury event in an orthopaedic trauma population. DESIGN: Retrospective cohort study. SETTING: Single Level 1 trauma center. PARTICIPANTS: Four hundred forty adult trauma patients treated operatively for spine, pelvis, and/or upper or lower extremity fractures with ≥1 night stay. INTERVENTION Operative fracture management. MAIN OUTCOME MEASUREMENT Revenue for follow-up care and for noninjury-related indications for 24 months. RESULTS: Most patients returned for follow-up (92.3%), generating 6704 visits with professional and technical collections of $8,135,022 and $37,292,722, respectively, per 1000 unique patients. The greatest revenue was from rehabilitation services. Patients were less likely to return if they resided outside adjacent counties [odds ratio (OR) = 0.16], experienced a complication (OR = 0.38), or were older (OR per 10-year increase 0.66) (all P < 0.0001). More than 70% of trauma patients were new to our system, accounting for 33% of all subsequent noninjury-related visits, most for primary care (25.6%). Male patients [OR = 3.28, 95% confidence interval (CI), 1.08-9.93], nonwhites (OR = 3.41; 95% CI, 1.41-8.28), and patients residing near the trauma center (OR = 16.1, 95% CI, 2.13-121) were more likely to return (P < 0.0001). Realized noninjury-related professional and technical revenue was $506 per operative orthopaedic trauma case. CONCLUSIONS: Demographics and outcomes predict likelihood of follow-up. Rehabilitation services account for the greatest revenue per patient. The greatest number of return visits was for primary care services; awareness of such services, especially in men and in those residing near the hospital system, could improve retention.