Length of stay and trauma center finances: A disparity of payer source at a Level I trauma center

Abstract

BACKGROUND:In an effort to reduce costs, hospitals focus efforts on reducing length of stay (LOS) and often benchmark LOS against the geometric LOS (GMLOS) as predicted by the assigned diagnosis-related group (DRG) used by the Centers for Medicare and Medicaid Services. The objective of this cross-sectional study was to evaluate the impact of exceeding GMLOS on hospital profit/loss with respect to payer source. METHODS:Contribution margin for each insured patient admitted to a Level I trauma center between July 1, 2016, and June 30, 2019, was determined. Age, ethnicity, race, DRG weight, DRG version, injury severity, intensive care unit admission status, mechanical ventilation, payer, exceeding GMLOS, and the interaction between payer and exceeding the GMLOS were regressed on contribution margin to determine significant predictors of positive contribution margin. RESULTS:Among 2,449 insured trauma patients, the distribution of payers was Medicaid (54.6%), Medicare (24.0%), and commercial (21.4%). Thirty-five percent (n = 867) of patient LOS exceeded GMLOS. Exceeding GMLOS by 10 or more days was significantly more likely for Medicaid and Medicare patients in stepwise fashion (commercial, 2.7%; Medicaid, 4.5%; Medicare, 6.0%; p = 0.030). Median contribution margin was positive for commercially insured patients ($16,913) and negative for Medicaid (−$8,979) and Medicare (−$2,145) patients. Adjusted multivariate modeling demonstrated that when exceeding GMLOS, Medicare and Medicaid cases were less likely than commercial payers to have a positive contribution margin ( p < 0.001 and p < 0.001). CONCLUSION:Government-insured patients, despite having a payer source, are a financial burden to a trauma center. Excess LOS among government insured patients, but not the commercially insured, exacerbates financial loss. A shift toward a greater proportion of government insured patients may result in a significant fiscal liability for a trauma center. (

Emergency Department and Inpatient Utilization Reductions and Cost Savings Associated with Trauma Center Mental Health Intervention

“…A key issue in the current study is that over 95% of patients were either covered by public insurance, such as Medicaid/Medicare, or were uninsured 17 . Of particular note, Medicaid and Medicare relative to private payors generally contribute negative contribution margins for trauma centers, and overall lower reimbursement to health systems 46–48 …”

“…17 Of particular note, Medicaid and Medicare relative to private payors generally contribute negative contribution margins for trauma centers, and overall lower reimbursement to health systems. [46][47][48] The investigation is novel in its use of EDIE data which provides 5-year population-level follow-up ED and inpatient utilization data for the intent-to-treat sample. The use of EDIE allows for consolidation of emergency and inpatient utilization from all regional health care facilities in Washington State.…”

Clinical Efficacy of Intra‐articular Tranexamic Acid Injection in the Management of Hemophilia with Total Hip Arthroplasty: A 24‐month Retrospective Cohort Study

“…This suggests that the use of TXA in THA for PWH may alleviate the economic burden on patients and potentially reduce the financial burden on the government. Studies have indicated that reducing hospitalization duration can alleviate the economic burden on patients 35 . Additionally, research has shown that reducing the hospitalization duration for elderly patients can lower overall economic costs 36 .…”

“…Studies have indicated that reducing hospitalization duration can alleviate the economic burden on patients. 35 Additionally, research has shown that reducing the hospitalization duration for elderly patients can lower overall economic costs. 36 The mean values for length of stay and hospitalization costs were lower in the TXA group than in the non‐TXA group, but there was no statistical difference between the two groups.…”