O. Mansuri1, C. Steffen1, L. Nelson1, C. Gonzalez2, B. England1, C. Boje1, K. Fenn1, E. Myers1, J. Stothert1 1University Of Nebraska Medical Center,Trauma & Surgical Critical Care / Department Of Surgery,Omaha, NE, USA 2Boston Medical Center,Boston, MA, USA
Introduction:
This study investigates in a hybrid qualitative/quantiative approach how state designation of trauma centers impacts general finances, uncompensated “charity” care and community investment. This is significant given many states are reassessing the definition of charity care in the context of how not-for-profit hospitals are evaluated, and the financial implications thereof.
Methods:
The Return of Organization Exempt From Income Tax (IRS Form 990) for state designated level 2 and level 3 trauma centers in Nebraska were reviewed for a three year period. Number of state licensed hospital beds was also gathered for each trauma center. IRS 990 forms were reviewed for number of employees, volunteers, revenue, assets, charity care, community benefits, bad debt, and Medicare surplus and shortfall. This data was then first analyzed in a descriptive fashion, followed by regression analysis. The relative financial metrics were controlled by hospital bed size.
Results:
When comparing level 2 and level 3 general financial variables, total revenue variance was 7.8%, salaries 2.9%, total expenses 6.0%, total assets 3.9%, total liabilities 17.2%, and net assets 3.4%. These variances were nominal when compared to the variances seen in level 2 and level 3 charity care variables: charity care cost 43.3%, un-reimbursed Medicaid 37.9%, community health improvement 36.6%, health professions education 64.7%, cash-in-kind 82.6%, bad debt expense 6.2%, and Medicare shortfall 28%. Level 2 centers reported higher amounts spent on charity care, un-reimbursed Medicaid, health professions education, cash-in-kind contributions, and had larger Medicare shortfalls.
Conclusion:
This preliminary hybrid qualitative/quantitative pilot study into the charity care of trauma centers demonstrates that level of trauma center influences uncompensated “charity” care financial variables when taking into account size and general financial variables. This raises important considerations for level 1 trauma center funding mechanisms. A broader study of national trauma centers with increased focus on uncompensated care financial variables is in planning to better understand the role and impact of trauma centers on charity care.
