Fri., 10/17/08 Geriatrics/Reconstruction, Paper #45, 5:22 pm OTA-2008
Financial Viability of an Orthopaedic Trauma System
Peter L. Althausen, MD, MBA (n); Daniel Coll, BS, PA-C (n);
Michael Cvitash, BMS, PA-C (n); Timothy J. O’Mara, MD (n); Timothy J. Bray, MD (n);
Reno Orthopedic Clinic, Reno, Nevada, USA
Purpose: The AAOS and OTA have released guidelines for the provision of orthopaedic trauma services such as adequate stipends, designated operating rooms, ancillary staff, and guaranteed reimbursement for indigent care. Hospital administrators who resist these recommendations often question the financial viability of the orthopaedic trauma patient. Our hypothesis is that trauma patients with orthopaedic injuries bring substantial financial reward to hospital systems and that orthopaedic trauma systems should be supported.
Methods: The trauma registry at a Level 2 trauma center was reviewed to capture all trauma activations from January 1, 2006 to December 31, 2006. All patients with orthopaedic diagnoses were selected as our study population. The hospital charges for trauma activation fees, radiographs, CT, MRI, laboratory tests, ICU length of stay, and hospital length of stay were calculated. The payer mix and reimbursement rates for each group were obtained and means and standard deviations were calculated.
Results: Our center is currently the busiest nonacademic trauma center in the nation, with 68,013 emergency department admissions a year. Of these, 3531 are trauma activations, with 1225 (34.6%) having an orthopaedic diagnosis. 28% of these patients sustained injuries not requiring hospital admission. The mean length of stay for inpatients was 8.9 days, with an average of 3.5 ICU days. Total charges were $77,719,354. Overall these patients generated $7,420,000 in trauma activation charges, $2,424,083 in radiography charges, $12,638,411 in CT charges, $612,480 in MRI charges, and $3,400,270 in laboratory fees during their hospital stay. This means that the average trauma patient with an orthopaedic injury generates $6057 in trauma activation charges, $1978 in radiography charges, $10,317 in CT charges, $500 in MRI charges, and $2776 in laboratory fees. In addition, these patients also use an average of 3.6 consults, supporting other hospital departments and physicians. At our institution, the payer mix consists of 8% commercial, 13% indigent, 17% managed care, 8% Medicare, 8% Medicaid, 8% workers’ compensation, and 38% auto insurance. Their respective reimbursement rates at our facility are 83% commercial, 20% indigent, 45% managed care, 15% Medicaid, 31% workers’ compensation, and 41% auto insurance. The overall reimbursement rate was 38%. Despite beliefs that orthopaedic trauma is a cost center, our institution was able to profit $5,176,456 in the year 2006 on these services alone.
Conclusions: Given the appropriate payer mix and contract negotiations, the provision of orthopaedic trauma services is clearly in the financial best interests of the supporting hospital. Without orthopaedic trauma care, the hospital would stand to lose substantial income and should support their orthopaedic department with adequate resources and reimbursement for care.
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. Δ OTA Grant.