Trauma services: A profit center?

Background: Previous studies have demonstrated inadequate reimbursement for severely injured patients with a resultant negative economic impact for th e trauma service and hospital. The purpose of this study was to assess the total cost of care for all injured patients discharged from the trauma serv ice in fiscal year 1997, and to determine the proportion of costs for the m ost severely injured on total cost. In addition, we assessed the total serv ice costs and the revenue for treatment of the most severely ill. The final result nas the determination of the profit (loss) margin for the entire se rvice. Study Design: All patients discharged from our Level I Trauma Center in fis cal year 1997 were included (n = 696). The population was then stratified i nto 2 subgroups using the Injury Severity Score (ISS). Patient grouping was facilitated by integration of the trauma registry with the hospital cost a ccounting system. The population was sub-divided into 2 distinct groups. Gr oup A represented all patients with an ISS > 15 (n = 192). Group B containe d all patients with an ISS < 15 (n = 504). Length of stay and mortality of each group was recorded. Cost of care was determined by the hospital cost a ccounting system TSI (Transition System Incorporated, Boston, MA), which is designed to generate cost center data on a cost per patient basis. Total c osts were determined for the entire population and Groups A and B. The prop ortion of costs consumed by each group was then calculated. Reimbursement w as determined by calculating expected payments for each patient. These calc ulations are based on previously agreed upon allowances from each insurer a nd are reconciled at the end of each fiscal year to ensure accuracy. Results: The average length of stay for the population and Groups A and B w ere 7.5, 9.8, and 6.7 days respectively. Mortality in each group was 9.7%, 19.3%, and 6%. Over 92% of the population sustained blunt mechanism injury and only 8% were penetrating. When controlled for length of stay, the profi t margin for Group A is $1,242/day and for Group B is $519/day. Comparison of mean cost/patient between Group A and Group B was $35,727 versus $17,623 , respectively. Conclusion: Trauma centers can be profitable. Group A is responsible for 44 % of the total service cost while accounting for only 28% of the discharges . Moreover, this group is responsible for 57% of the profit, and yields the greatest return. The ability to care for the sickest patients, while enorm ously costly, is essential to the economic viability of the trauma center a nd its future growth. (J Am Coil Surg 1999;188:349-354. (C) 1999 by the Ame rican College of Surgeons).