Ziran Bruce H, Barrette-Grischow Mary Kate, Marucci Kate
St. Elizabeth Health Center, Youngstown, Ohio 44501, USA.
J Orthop Trauma. 2008 Apr;22(4):227-33. doi: 10.1097/BOT.0b013e31816bae67.
We evaluated the economic aspects of an orthopaedic trauma section at a regional Level I, semi-academic community hospital. This study analyzes the economics of a dedicated hospital-based orthopaedic trauma program.
Institutional financial reports were analyzed for 2 time periods. In the pre-program (PRE) period (2 years), we estimated the amount of forsaken revenue resulting from cases transferred to other institutions. In the post-program (POST) period (2 years), we analyzed financial reports to evaluate fiscal solvency. Health Care Cost and Utilization Project National Inpatient Sample (HCUP-NIS) data, International Classification of Diseases, 9th Revision (ICD-90 codes, and Eclipsys software were used. Standard accounting definitions for gross revenue, net revenue, direct costs, contribution margin, indirect costs, and net profit/loss were used.
In the PRE-program period 88 patients were transferred; forsaken charges were about $1.25 million/year. Based on historic collection rates, there was about $450,000/year of actual lost revenue. In the POST-program period net revenue was about $7 million with a $1.5 million contribution margin, which increased 9%-11% in year 2. With inclusion of indirect costs, there was a net loss of nearly $5 million/year, but the financial software uses the direct cost expense as a major determinant of indirect costs. Based on the definition of indirect costs (overhead for lights, maintenance, etc) and with such expenses being used prior to the program, we felt that indirect cost was not an accurate variable and contribution margin is the better measure of economic value.
We found that orthopaedic trauma is a financially viable program. Understanding the determination and interpretation of financial data is essential for any such analysis.
我们评估了一家地区一级的半学术性社区医院骨科创伤科的经济状况。本研究分析了一个专门的医院骨科创伤项目的经济情况。
对两个时间段的机构财务报告进行了分析。在项目前（PRE）阶段（2年），我们估算了因病例转至其他机构而损失的收入金额。在项目后（POST）阶段（2年），我们分析财务报告以评估财政偿付能力。使用了医疗保健成本和利用项目国家住院样本（HCUP-NIS）数据、国际疾病分类第九版（ICD-90编码）以及Eclipsys软件。采用了总收入、净收入、直接成本、边际贡献、间接成本以及净利润/亏损的标准会计定义。
在项目前阶段，有88例患者被转出；每年损失的费用约为125万美元。根据历史收款率，每年实际损失的收入约为45万美元。在项目后阶段，净收入约为700万美元，边际贡献为150万美元，在第2年增长了9% - 11%。计入间接成本后，每年净亏损近500万美元，但财务软件将直接成本费用作为间接成本的主要决定因素。根据间接成本的定义（照明、维护等间接费用）以及这些费用在项目开展前就已存在的情况，我们认为间接成本不是一个准确的变量，而边际贡献是衡量经济价值的更好指标。
我们发现骨科创伤项目在财务上是可行的。理解财务数据的确定和解释对于任何此类分析都至关重要。
