Sat., 10/20/07 Pediatrics/Spine, Paper #60, 3:15 pm OTA-2007
Expanding Pediatric Orthopaedic Trauma Volume at a Pediatric Level 1
Trauma Hospital
Dan Chan, MD (n); David A. Podeszwa, MD (n); Debra Brown, RN (n);
Adam Starr, MD (e-Smith+Nephew);
University of Texas Southwestern Medical Center, Dallas, Texas, USA
Purpose: Our objective was to analyze the decade change in patient volume, demographics, and reimbursement at a growing, tertiary care, Level 1 pediatric trauma center.
Methods: This study was a retrospective analysis of pediatric orthopaedic trauma between 1996 and 2006 at a pediatric Level 1 trauma center. Data analyzed included the changes in general trauma and orthopaedic trauma admissions, orthopaedic trauma surgery volumes, patient and population demographics, and hospital reimbursement.
Results: Total general trauma patient admissions on average increased 10% yearly from 648 in 1996 to 1605 in 2006. Total orthopaedic admissions increased annually an average of 18%, from 166 to 717 during that same time (annual increases ranged from -5% to 71%). Orthopaedic trauma admissions that required operative treatment also increased annually an average of 18% (114 procedures in 1996 to 492 in 2006; annual increases ranged from -13% to 58%). These increases were far greater than the 2% to 3% average annual increase in the local population over the same time. The orthopaedic trauma admissions remained relatively constant at 40% to 45% of all trauma admissions throughout the decade. The proportion of patients from outside the immediate county has also increased from approximately 10% to 30%. On average, 26% of orthopaedic trauma admissions before 2001 were uninsured; that proportion has now decreased to <4%. The hospital’s gross charges for pediatric orthopaedics have increased annually on average 26% between 1996 and 2005, but the percent reimbursed has decreased from 67% in 1997 to 28% in 2005.
Conclusions/Significance: The volume of pediatric orthopaedic trauma at this Level 1 trauma center has consistently risen over the last decade and is expected to continue to increase as the local population continues to expand. Even with a decrease in uninsured patients, the percent of reimbursement significantly decreased. Our experience reflects that of other growing metropolitan areas. Expanding volumes of pediatric orthopaedic trauma, dwindling numbers of pediatric orthopaedic surgeons, and decreasing reimbursements will significantly impact nonpediatric specialized orthopaedic surgeons, hospitals, and the communities they serve. Efficient and innovative methods of delivering care, by both surgeons and hospitals, will be needed to match the demand.
If noted, the author indicates something of value received. The codes are identified as a-research or institutional support; b-miscellaneous funding; c-royalties; d-stock options; e-consultant or employee; n-no conflicts disclosed, and *disclosure not available at time of printing.
• The FDA has not cleared this drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off label” use). ◆FDA information not available at time of printing.