The Economics of Trauma Patients

A new retrospective study of 440 adults from a Level-1 trauma center has quantified the economics of treating trauma patients.

The research, “Revenue for Initial Orthopaedic Trauma Care: Effects of Patient and Injury Characteristics,” appears in the September 2018 edition of the Journal of Orthopaedic Trauma.

Co-author Christopher D. Flanagan, M.D., with Department of Orthopaedics at Case Western Reserve University School of Medicine in Cleveland, Ohio, explained the goals of the study to OTW, “My co-authors and I undertook this study in order to better understand some of the financial aspects associated with the care of orthopaedic trauma patients. As healthcare costs continue to grow, payers are looking for ways to reduce overall expenditures. Our goal was to better define the economic profile of orthopaedic trauma patients, as well as the charges and payments associated with the care of this patient group.”

The study, which examined fixation for fracture of the spine, pelvis, acetabulum, and/or femur fractures, audited professional and facility charges and collections from the initial inpatient management and six months of subsequent related care.

The authors reported the following 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.”

“Professional and technical collections totaled US $2,418,096 (US $5,496/patient) and US $16,921,959 (US $38,459/patient). 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.”

Dr. Flanagan told OTW, “Our work demonstrates the many differences between this group of patients and elective surgery patients, including substantially higher rates of self-pay and unemployment. We suggest that reforms to reduce overall costs must respect these differences in order to avoid inappropriately applying ‘bundles’ that would further reduce hospital and physician reimbursement and hinder the ability to provide patient care.”