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The Impact of Prospective Reimbursement on Trauma Centers: An Alternative Payment Plan

The Impact of Prospective Reimbursement on Trauma Centers: An Alternative Payment Plan Abstract • We studied 1,526 patients entered into the Trauma Registry by demographic, physiologic, anatomic, investigational, and clinical data. Severely injured patients consumed more resources, had longer hospital stays, and were prospectively reimbursed less than the cost of their hospitalization. Age was not related to severity of injury or cost. The hospital was reimbursed approximately $12,000 less per patient than the cost. A financial projection of reimbursement of trauma patients compared with that of all inpatients revealed that trauma patients were reimbursed less than all patients combined (reimbursement, 77% vs 93%, respectively). Updated reimbursement weighting codes for 1985 increased the losses to the hospital. Trauma patients were reimbursed for 56% of their total bill, a financial loss of $1,800 per patient, and all inpatients were reimbursed 80%, a financial loss of $507 per patient. We suggest an alternative reimbursement system, based on voluntary national norms, objective national outcome criteria, and appropriate trauma management. (Arch Surg 1986;121:479-483) References 1. Coddington DC, Palmquist LE, Trollinger WV: Strategies for survival in the hospital industry . Harvard Business Rev , (May) -June 1985, pp 129-138. 2. Smith D, Kalezny A: The White Labyrinth: Understanding the Organization of Health Care . Berkeley, Calif, McCutchan Publishing Corp, 1975. 3. Jacobs LM: The effect of prospective reimbursement on trauma patients . Bull Am Coll Surg , (February) 1985, pp 17-22. 4. Horn SD, Sharkey PD, Chambers AF, et al: Severity of illness within DRGs: Impact on prospective payment . Am J Public Health 1985;75: 1195-1199.Crossref 5. Champion HR, Sacco WJ, Lepper RL, et al: An anatomic index of severity . J Trauma 1980;10:197-202.Crossref 6. Champion HR, Sacco WJ, Hannan DS, et al: Assessment of injury severity: The triage index . Crit Care Med 1980;8:201-208.Crossref 7. Baker SP, O'Neill B, Haddan W, et al: The injury severity score: A method for describing patients with multiple injuries and evaluating emergency care . J Trauma 1974;14:187-196.Crossref 8. Rules and regulations . Federal Register 1984;49:34728. 9. Horn SD, Bulkley G, Sharkey PD, et al: Interhospital differences in severity of illness: Problems for prospective payment based on diagnosis related groups (DRGs) . N Engl J Med 1985;313:20-24.Crossref 10. Champion HR, Frey CF, Sacco WJ: Determination of national normative outcomes of trauma . J Trauma 1984;24:651. 11. Walker SH, Duncan DB: Estimation of the probability of an event as a function of several independent variables . Biometrika 1967;54:167-179.Crossref 12. Mantel N, Haenszel W: Statistical aspects of the analysis of data from retrospective studies of disease . JNCI 1959;11:719-748. 13. Champion HR, Sacco WJ, Carnazzo AJ, et al: Trauma score . Crit Care Med 1981;9:672-676.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Surgery American Medical Association

The Impact of Prospective Reimbursement on Trauma Centers: An Alternative Payment Plan

Archives of Surgery , Volume 121 (4) – Apr 1, 1986

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Publisher
American Medical Association
Copyright
Copyright © 1986 American Medical Association. All Rights Reserved.
ISSN
0004-0010
eISSN
1538-3644
DOI
10.1001/archsurg.1986.01400040117019
Publisher site
See Article on Publisher Site

Abstract

Abstract • We studied 1,526 patients entered into the Trauma Registry by demographic, physiologic, anatomic, investigational, and clinical data. Severely injured patients consumed more resources, had longer hospital stays, and were prospectively reimbursed less than the cost of their hospitalization. Age was not related to severity of injury or cost. The hospital was reimbursed approximately $12,000 less per patient than the cost. A financial projection of reimbursement of trauma patients compared with that of all inpatients revealed that trauma patients were reimbursed less than all patients combined (reimbursement, 77% vs 93%, respectively). Updated reimbursement weighting codes for 1985 increased the losses to the hospital. Trauma patients were reimbursed for 56% of their total bill, a financial loss of $1,800 per patient, and all inpatients were reimbursed 80%, a financial loss of $507 per patient. We suggest an alternative reimbursement system, based on voluntary national norms, objective national outcome criteria, and appropriate trauma management. (Arch Surg 1986;121:479-483) References 1. Coddington DC, Palmquist LE, Trollinger WV: Strategies for survival in the hospital industry . Harvard Business Rev , (May) -June 1985, pp 129-138. 2. Smith D, Kalezny A: The White Labyrinth: Understanding the Organization of Health Care . Berkeley, Calif, McCutchan Publishing Corp, 1975. 3. Jacobs LM: The effect of prospective reimbursement on trauma patients . Bull Am Coll Surg , (February) 1985, pp 17-22. 4. Horn SD, Sharkey PD, Chambers AF, et al: Severity of illness within DRGs: Impact on prospective payment . Am J Public Health 1985;75: 1195-1199.Crossref 5. Champion HR, Sacco WJ, Lepper RL, et al: An anatomic index of severity . J Trauma 1980;10:197-202.Crossref 6. Champion HR, Sacco WJ, Hannan DS, et al: Assessment of injury severity: The triage index . Crit Care Med 1980;8:201-208.Crossref 7. Baker SP, O'Neill B, Haddan W, et al: The injury severity score: A method for describing patients with multiple injuries and evaluating emergency care . J Trauma 1974;14:187-196.Crossref 8. Rules and regulations . Federal Register 1984;49:34728. 9. Horn SD, Bulkley G, Sharkey PD, et al: Interhospital differences in severity of illness: Problems for prospective payment based on diagnosis related groups (DRGs) . N Engl J Med 1985;313:20-24.Crossref 10. Champion HR, Frey CF, Sacco WJ: Determination of national normative outcomes of trauma . J Trauma 1984;24:651. 11. Walker SH, Duncan DB: Estimation of the probability of an event as a function of several independent variables . Biometrika 1967;54:167-179.Crossref 12. Mantel N, Haenszel W: Statistical aspects of the analysis of data from retrospective studies of disease . JNCI 1959;11:719-748. 13. Champion HR, Sacco WJ, Carnazzo AJ, et al: Trauma score . Crit Care Med 1981;9:672-676.Crossref

Journal

Archives of SurgeryAmerican Medical Association

Published: Apr 1, 1986

References