Urban trauma care is threatened by inadequate reimbursement

BACKGROUND: Hospitals struggle to support trauma care. Recent installation of cost accounting systems now provides information on actual costs for dif ferent categories of patients. This paper examines the cost of trauma care in an urban teaching hospital. METHODS: All patients entered into the hospital trauma registry for the per iod July 1, 1996, through June 30, 1997, were abstracted from the registry. These data were merged with a database of all admitted patients with an in jury-compatible ICD-9 diagnostic code for the same time period that include d cost and estimated revenue from the cost accounting system. Complete data were available for 667 patients and the remaining 96 were uninsured patien ts with missing cost data. RESULTS: The calculated cost of care for the 667 patients was $10,342,130; total expected revenue was $10,396,456; estimated net revenue for insured p atients was $54,326. The estimated cost of care for the 96 uncompensated pa tients was $1,619,989, The hospital had positive net revenue for patients w ith length of stay of 7 days or less, but was unable to recoup costs for pa tients with a longer stay. Reimbursement exceeded hospital cost for blunt i njuries, primarily motor vehicle crash victims, and for other injuries cove red by fee-for-service insurers. Managed care plans and government-funded i nsurance did not reimburse sufficiently to cover hospital costs. CONCLUSIONS: These data confirm that earlier literature, based on charges a nd estimated costs, were correct in documenting a serious threat to the con tinuation of centers providing high volumes of trauma care. Am J Surg. 1999 ;177:371-374. (C) 1999 by Excerpta Medica, Inc.