An Analysis of the Critical Problem of Trauma Center Reimbursement

Impact Of Violence On The Nation's Trauma Care

“…In 1990 Brent Eastman and colleagues reported at the annual meeting of the American Association for the Surgery of Trauma some of the reimbursement problems of trauma centers. 9 They demonstrated in a nonrandomized survey that trauma care is underfunded, which confirmed the views of many trauma center directors. The causes of this underfunding include ( 1 ) more self-pay patients compared with other hospitalized patients; (2) a reduced bill-collection ratio for patients covered by Medicaid and Medicare; (3) inability to shift the cost of all of the losses to other payers; and (4) inappropriate assignment and poor definition of diagnosis-related groups (DRGs) for Medicare prospective payment.…”

Needed Dialog

“…Traditionally, trauma hospitals have been considered generally unprofitable because of the high proportion of Medicaid and uninsured patients served, often resulting in significant losses in reimbursement. 64,65 In fact, trauma center closure has been a common phenomenon because of such losses during the past 2 decades 65 ; hospitals receiving supplemental indigent care payments may be more likely to weather these financial pressures. 66 Further complicating this burden is that hospital costs are usually larger at higher tiered trauma centers and a minority of trauma patients continue to be overtriaged and sent inappropriately to higher levels of care than needed.…”

O custo do atendimento emergencial às vítimas de violências em dois hospitais do Rio de Janeiro

“…Por um lado, por ter aumentado demasiadamente a demanda, pela maior complexidade das lesões ocasionadas pelo uso de armas mais modernas e potentes e pela necessidade de atenção que envolve complexa tecnologia. Por outro lado, por estes custos serem reembolsados apenas parcialmente, cabendo aos fundos públicos arcar com cerca de 70% a 90% deste montante (Clancy et al, 1994;Eastman et al, 1991). Tal situação ocasionou o fechamento de 92 centros de trauma entre 1985 e 1991.…”