B. C. Branco1, P. Rhee1, B. Joseph1, A. L. Tang1, G. Vercruysse1, T. O’Keeffe1 1University Of Arizona,Trauma,Tucson, AZ, USA
Introduction: Trauma centers often report unfavorable financial performance by caring for injured patients Penetrating trauma in particular has a significant impact on health care systems, with up to one third of these patients reported as uninsured. The financial impact on trauma surgery practice is unknown. The purpose of this study was to evaluate the financial implications of managing penetrating trauma patients in a level I trauma center.
Methods: All trauma patients admitted to a level I trauma center over a fiscal year (July 2011 to June 2012) were retrospectively identified. Demographics, clinical data and outcomes were extracted. Hospital and trauma surgeon financial data were also extracted. Outcomes were total charges, costs, net margin and reimbursements. Patients were compared according to injury mechanism. What stats did you use?
Results: 3,343 trauma patients were admitted of which 513 (15.3%) sustained penetrating trauma (51.3% GSW and 48.7% SW) and 2,830 (84.7%) blunt. Penetrating trauma patients had lower overall ISS (8.4 ± 11.3 vs. 9.2 ± 9.4, p<0.001) but were more likely to undergo an intra-cavitary procedure (39.3% vs. 26.7%, p<0.001). Patients who sustained penetrating trauma were more often uninsured (19.4% vs. 9.1%, p<0.001) and had Medicaid (55.8% vs. 36.9%, p<0.001). There were no significant differences in hospital LOS (penetrating: 4.2 ± 6.5 days vs. blunt: 4.7 ± 6.8 days, p=0.271). Overall, hospital net margin was $1.2 ± 1.3 k per trauma patient (1.9 ± 1.3 k for blunt vs. -2.4 ± 1.3 for penetrating, p<0.001). The average % hospital reimbursement was 25 ± 23% for blunt and 15 ± 18% for penetrating trauma (p<0.001). There were no differences in total hospital costs (10.4 ± 2.9 k vs. 10.1 ± 1.9 k, p=0.841) or patient charges (40.8 ± 8.1 k vs. 44.9 ± 7.4 k, p=0.302). Nevertheless, trauma surgeon professional charges were significantly higher for penetrating trauma (3.9 ± 7.3 k vs. 1.6 ± 3.2 k, p<0.001), in particular after GSWs (4.7 ± 8.9 k vs. 1.7 ± 3.4 k, p<0.001), as were surgeon’s reimbursement (1.4 ± 1.9 k vs. 0.6 ± 1.0 k, p<0.001.
Conclusions: Penetrating trauma was found to be a significant source of revenue loss for hospitals. This data may help inform mission support efforts in critical access hospitals that have high rates of penetrating trauma. Trauma surgeon reimbursement were however significantly higher after penetrating trauma, in particular after gunshot wounds, due to the associated operative interventions.