Revenue for Initial Orthopaedic Trauma Care: Effects of Patient and Injury Characteristics.

OBJECTIVE

To characterize the charges and collections associated with the initial inpatient management of trauma patients who undergo operative fracture management.

DESIGN

Retrospective.

SETTING

Level 1 trauma center.

PARTICIPANTS

Four hundred forty consecutive, adult, trauma patients.

INTERVENTION: Fixation for fracture of the spine, pelvis, acetabulum, and/or femur fractures.

MAIN OUTCOME MEASURES: Professional and technical (facility) charges and collections from the initial inpatient management and 6 months of subsequent related care.

RESULTS

Patients were predominantly male (74.3%) and white (63.2%) with a mean age of 41 years and mean injury severity score of 18.5. Uninsured (self-pay) patients represented the largest payer class (35.0%), and 34.5% of all patients were unemployed. Professional and technical charges totaled US $12,382,028 (US $28,140/patient) and US $39,682,225 (US $90,187/patient), respectively. Injury severity score, longer lengths of stay (LOS), and the presence of a complication were positive predictors of initial charges (P < 0.0001; adjusted R = 0.799). Professional and technical collections totaled US $2,418,096 (US $5,496/patient) and US $16,921,959 (US $38,459/patient) (percent of charge: 21.5% vs. 41.3%; P < 0.0001). Of the self-pay patients, 34.4% had no collections, resulting in potential lost revenue of US $2,513,988. Greater collections were predicted to occur in females, employed patients, and those with insurance (P < 0.0001; adjusted R = 0.35).

CONCLUSIONS

Trauma patients often present without insurance, which compromises hospital revenue. Expectedly, charges are higher in more severely injured patients, those with longer LOS, and those experiencing complications. A bundled model will proportionately decrease reimbursements for a given episode of care in the event of longer LOS or occurrence of complications.