Session I - Polytrauma / Pelvis / Post-Traumatic Reconstruction

Thurs., 10/10/13 Polytrauma/Pelvis/Post-Trauma, PAPER #32, 3:49 pm OTA 2013

Early Appropriate Care: A Protocol to Standardize Resuscitation Assessment and to Expedite Fracture Care Reduces Hospital Stay and Enhances Revenue

Heather A. Vallier, MD; Andrea Dolenc, BS; Timothy A. Moore, MD;
MetroHealth Medical Center, Cleveland, Ohio, USA

Purpose: Previous study has demonstrated a substantial multiplier effect for professional activity related to care of polytraumatized patients, such that the trauma center collects revenue several times larger than that of the surgical providers. We hypothesized that our trauma service line would have a favorable payer mix within our hospital and would be the beneficiary of a large multiplier effect. We further hypothesized that a standardized protocol for trauma care would enhance revenue by decreasing length of stay, reducing complications, and thus generating a larger percentage of collections for care of a given type of injury.

Methods: Financial records were obtained for patients prospectively treated with a standardized protocol for resuscitation after multiple system trauma. 253 consecutive adult patients with mean age of 40.7 years and mean ISS of 26.0 (all >16) who were treated surgically during 18 months for fractures of the femur, pelvis, or spine were included. The trauma center is a large urban, public hospital, and the physicians are hospital employees. Hospital facility charges and collections and professional charges and collections for the injury inpatient and related outpatient care for 6 months were analyzed. Timing of fracture fixation was defined as early (within 36 hours after injury) or delayed. Complications were recorded and hospital stay was characterized.

Results: Mean facility charges were $142,533 with mean $59,882 in collections (42%). Mean professional charges were $37,612 with mean $6989 in collections (19%). Mean total facility charges were $180,145 with mean $66,871 in collections (37%). The revenue multiplier effect was $59,882/$6989 (8.57), indicating a hospital collection of $8.57 for every dollar of professional collections, less than half of which went to orthopaedic surgeons. The trauma payer mix was favorable compared to the hospital with over three times as much Workers’ Compensation (BWC) and less than half as much Medicare in the trauma group. Commercial and BWC were the best payers with 58.5% and 59.3% collected, respectively, on facility charges. When fracture care was delayed, mean ICU days increased from 4.5 to 9.4 days, and the total hospital stay increased from 9.4 to 15.3 days. Mean loss of revenue based on actual hospital costs for the increased length of stay alone was $6380 per patient delayed (n = 47). Interestingly, professional collection percentages increased by 4.3% in patients with delayed care, with more total episodes of surgical care on different days, likely due to limited discounting for multiple procedures in the same surgical setting. Complications were associated with the largest treatment expenses: mean $291,846 charges and $101,005 collections (35%). Facility collections decreased by 5% when a complication occurred. In contrast, an uncomplicated course of care was associated with the most favorable total collections: ($54,213/$140,797 = 38.5%) and the shortest mean total stay (8.0 days).

Conclusion: The trauma service line appears favorable in terms of payer mix. Facility collections were nearly 9 times those of the providers. An uncomplicated course of care resulted in the greatest total percent collections. Delays in fracture care were associated with more complications and longer hospital stays. Facility collections decreased by 5% when a complication occurred. Furthermore, delayed fracture care significantly increased hospital stay, accounting for ~$300K more in actual hospital costs alone over the course of the study. A standardized protocol to expedite definitive fracture fixation when patients are physiologically optimized appears efficacious in enhancing the profitability of the trauma service line.

Alphabetical Disclosure Listing

• 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.