Urban trauma care is threatened by inadequate reimbursement

The impact of injury severity and transfer status on reimbursement for care of femur fractures

“…3,4 In contrast, we found that patients with multiple-system trauma had 21% higher overall and facility reimbursement rates compared with patients with minor injury. This finding reflects the higher proportion of self-pay patients in the minor injury group (25% vs. 14%, p = 0.005).…”

“…1,2 Despite providing effective care, regional trauma centers struggle to remain financially solvent. 3,4 Current reimbursement structure may contribute to these difficulties by underestimating the cost of providing care to patients with severe injury. 6 Furthermore, ''patient dumping,'' a phenomenon in which patients are transferred to trauma centers owing to race, date or time of presentation, payer status, or other factors not related to a clear medical indication for transfer, may compromise the financial ability of regional trauma centers to maintain essential services.…”

“…Nevertheless, trauma centers struggle to cover costs. 3,4 In a study of trauma center closures between 1990 and 2005, net negative profit margin was found to be independently associated with closure. 5 Trauma center viability may remain a challenge because reimbursement structure organized by diagnostic related groups, a commonly used system for reimbursement, severely underestimates the cost of trauma care.…”

The cost and compensability of trauma patients

“…A number of the published articles relating to the financial survival of trauma centres in the United States report that cost recovery is a major problem, primarily because third party reimbursement meets only 40%-60% of the costs of patient care. [21][22][23] In addition, the diagnosisrelated group (DRG) method of describing complex trauma patients' injuries is insufficient and underestimates the true cost of the patients' treatment requirements. [24][25][26] Furthermore, as has been highlighted by this study, the cost of trauma care for elderly patients will continue to rise with the proportional increase in the ageing population [27][28][29][30] -particularly as, by 2020, 18% of the population will be over 65.…”

Pediatric trauma care: a profitable enterprise?

“…A compilation of expert panels from all 50 states suggests that economic shortfalls threaten the viability of current trauma systems nationwide [6]. These difficulties are often blamed upon managed care and government-insured patients, which may provide inadequate reimbursement for trauma care [7][8][9][10]. There are, however, dissenting articles that question this financial burden, and individual institutions have shown that trauma care can be profitable [11,12].…”