Session VII - Polytrauma
Sat, 10/9/04 Polytrauma, Paper #40, 11:04 am
Orthopaedic Traumatology: The Hospital Side of the Ledger
Purpose: The purpose of the study was to determine the multiplier relationship between technical and professional revenue for inpatient care delivered by an orthopaedic surgeon at a level I trauma center for patients with multiple orthopaedic injuries.
Methods: The authors searched the records of a major urban level I trauma center to identify adult patients admitted with major multiple orthopaedic trauma. Patients were included if they had a significant pelvis/acetabulum injury associated with at least two extremity fractures, or if they had three or four extremities requiring surgical care. All patients had limited injury to other body systems, and all had completed their care related to the injury within the study period. We identified 39 patients who met the inclusion criteria. The mean Injury Severity Score was 20.4 (range, 9 to 41) and the mean New Injury Severity Score was 35.7 (range, 27 to 50). The trauma center has an integrated economy. The surgeons are employed by the hospital, and the financial systems for technical and professional services are shared through a unified financial structure. Inpatient hospital charges related to the initial trauma admission and subsequent hospital-based outpatient care were abstracted from the SMS billing system. All medical and financial records were reviewed to exclude inpatient hospital charges related to the delivery of care by nonorthopaedic services. Orthopaedic professional fees were abstracted from the EPIC billing system used for physician services.
Results: The average technical charge (N = 39) was $97K, (range, $28K to $340K, SD = $58K), and the average professional charge was $22K, (range, $3.4K to $58K, SD = $14.6K). The total technical charge for the study patients was $3,789, 967, and the total orthopaedic professional charge was $844,779. The average orthopaedic trauma multiplier, the dollars of technical charge created by a single dollar of professional charge, was 4.49, (range, 1.99 to 16.63, SD = 3.67).
Conclusion/Significance: The majority of the charges related to the care of trauma patients fall on the hospital side of the ledger. The significant multiplier for orthopaedic care delivered in the inpatient setting increases the value of the orthopaedic traumatology service above and beyond the value of the labor component as reflected by the professional fee. Understanding the value of the multiplier in different clinical situations frames the interdependent relationship between physicians and hospitals. Changes in malpractice coverage, declining professional reimbursement, and reported difficulties in securing on-call coverage contribute to an emerging crisis in trauma care. The relationship between technical charges and professional activity provides a firm basis to negotiate institutional support for orthopaedic traumatology.