Department of Surgery, Methodist Dallas Medical Center, Dallas, Texas 75203, USA.
J Trauma Acute Care Surg. 2012 Mar;72(3):609-12; discussion 612-3. doi: 10.1097/TA.0b013e31824765de.
Health care reform under the "Patient Protection and Affordable Care Act" (PPACA) will lead to changes in reimbursement. Although this legislation provides a mechanism for uninsured Americans to obtain coverage, it excludes undocumented immigrants (UDI). Reimbursement for UDIs comes from the disproportionate share hospital (DSH) program and was previously supported by Section-1011 of the 2003 Medicare Modernization Act (S1011). The PPACA details a cut of DSH funds starting in 2014. This could impose a significant financial burden on trauma centers.
From May 2005 to May 2008, we retrospectively reviewed all trauma-related emergency room visits by UDIs. We quantified charges for three entities: emergency department physicians, trauma surgeons, and the hospital. We applied our average institutional collection rate to these charges and compared these projected collections with the actual collections.
Over a three-year period, we identified 1,325 trauma UDIs. The financial records revealed a projected emergency department physicians collection of $452,686, a projected trauma surgeons collection of $1.2 million, and a projected hospital collection of $6.9 million (total $8.6 million). Actual funding from S1011 provided $1.7 million and DSH provided $1.9 million (total $3.6 million). Texas State Funding and UDI self-payment contributed $611,082. Overall, our institution had a reimbursement discrepancy of $4.3 million with DSH/S1011 assistance. This increased to $6.0 million after the termination of S1011 and may increase to $7.9 million under PPACA.
These figures underestimate the total cost of UDI trauma care as it only includes three entities. Our data represent a fraction of national figures. Failure to address these issues could result in ongoing financial problems for trauma centers.
II, economic and decision analysis.
“患者保护与平价医疗法案”（PPACA）下的医疗改革将导致报销方式的改变。尽管这项立法为没有保险的美国人提供了获得保险的途径，但它将无证移民（UDI）排除在外。UDI 的报销来自于不成比例的份额医院（DSH）计划，此前由 2003 年医疗保险现代化法案（S1011）第 1011 节支持。PPACA 详细规定了从 2014 年开始削减 DSH 资金。这可能会给创伤中心带来巨大的财务负担。
从 2005 年 5 月到 2008 年 5 月，我们回顾性地审查了所有由 UDI 引起的与创伤相关的急诊室就诊。我们量化了三个实体的费用：急诊室医生、创伤外科医生和医院。我们将我们的平均机构收款率应用于这些费用，并将这些预计收款与实际收款进行了比较。
在三年期间，我们确定了 1325 名创伤 UDI。财务记录显示，预计急诊室医生的收款为 452686 美元，预计创伤外科医生的收款为 120 万美元，预计医院的收款为 690 万美元（总计 860 万美元）。S1011 提供了 170 万美元，DSH 提供了 190 万美元（总计 360 万美元）。德克萨斯州的拨款和 UDI 自付支付了 611082 美元。总体而言，我们机构在 DSH/S1011 援助下有 4300 万美元的报销差额。S1011 终止后，这一数字增加到 6000 万美元，根据 PPACA，这一数字可能增加到 7900 万美元。
这些数字低估了 UDI 创伤护理的总成本，因为它只包括三个实体。我们的数据代表了全国数据的一小部分。如果不解决这些问题，可能会导致创伤中心持续面临财务问题。
II，经济和决策分析。
