Determining the Hospital Trauma Financial Impact in a Statewide Trauma System

Abstract

BACKGROUND There have been no comprehensive studies across an organized statewide trauma system using a standardized method to determine cost. STUDY DESIGN Trauma financial impact includes the following costs: verification, response, and patient care cost (PCC). We conducted a survey of participating trauma centers (TCs) for federal fiscal year 2012, including separate accounting for verification and response costs. Patient care cost was merged with their trauma registry data. Seventy-five percent of the 2012 state trauma registry had data submitted. Each TC’s reasonable cost from the Medicare Cost Report was adjusted to remove embedded costs for response and verification. Cost-to-charge ratios were used to give uniform PCC across the state. RESULTS Median (mean ± SD) costs per patient for TC response and verification for Level I and II centers were $1,689 ($1,492 ± $647) and $450 ($636 ± $431) for Level III and IV centers. Patient care cost–median (mean ± SD) costs for patients with a length of stay >2 days rose with increasing Injury Severity Score (ISS): ISS <9: $6,787 ($8,827 ± $8,165), ISS 9 to 15: $10,390 ($14,340 ± $18,395); ISS 16 to 25: $15,698 ($23,615 ± $21,883); and ISS 25+: $29,792 ($41,407 ± $41,621), and with higher level of TC: Level I: $13,712 ($23,241 ± $29,164); Level II: $8,555 ($13,515 ± $15,296); and Levels III and IV: $8,115 ($10,719 ± $11,827). CONCLUSIONS Patient care cost rose with increasing ISS, length of stay, ICU days, and ventilator days for patients with length of stay >2 days and ISS 9+. Level I centers had the highest mean ISS, length of stay, ICU days, and ventilator days, along with the highest PCC. Lesser trauma accounted for lower charges, payments, and PCC for Level II, III, and IV TCs, and the margin was variable. Verification and response costs per patient were highest for Level I and II TCs.

Factors influencing the use of health services by trauma patients according to insurance type and injury severity score in South Korea: Based on Andersen’s behavioral model

“…Total cost of care increased with increasing ISS, which was consistent with the findings of Garnett and Browne [11], and Kuwabara et al [30]. This again confirmed that the ISS enables the prediction of necessary resources for trauma patient management [9] and is a major predictor of healthcare utilization in trauma patients [9,[11][12][13]. Therefore, analysis and interpretation based on the ISS is expected to produce more reliable results pertaining to trauma patients' healthcare utilization, particularly the total cost of care.…”

“…Apart from its use in assessing injury severity in trauma patients, the ISS is an anatomical scoring system effective in predicting mortality, hospital stay, length of recovery, and demands for resources to manage trauma patients [ 10 ]. Moreover, it is a major predictor of healthcare utilization in such patients [ 11 – 13 ] and is actively utilized in healthcare providers’ communications and triage [ 9 ]. Therefore, analyzing healthcare utilization in trauma patients according to the ISS is a systematic method of analysis, where trauma patients’ healthcare service needs are relatively homogeneously divided.…”

Comparison of Outcomes in Level I vs Level II Trauma Centers in Patients Undergoing Craniotomy or Craniectomy for Severe Traumatic Brain Injury

“…Our findings concur with recent literature on the topic. Mabry et al 18 found that of all trauma centers, level I centers have the highest mean ICU and hospital length of stay.…”

Head injury alert: A new level of trauma activation?

“…Though difficult to quantify in a monetary sum, trauma team activation is significantly resourceconsuming, and this burden increases as the number of the trauma team member grows. 1 Though a reduced trauma response does decrease the burden of specialists and departments mobilized, it typically still requires multiple residents, ED physicians, nurses, respiratory therapists, as well as placing CT and XR departments on hold for preferential imaging. Ideally, the trauma team should be sufficient enough to ensure patient safety but limited enough as to not overtriage.…”