Dillon Jasjit K, Christensen Brian, McDonald Tyler, Huang Steve, Gauger Peter, Gomez Preston
Department of Oral & Maxillofacial Surgery, Harborview Medical Center, University of Washington, Seattle, WA 98104, USA.
J Oral Maxillofac Surg. 2012 Sep;70(9):2124-34. doi: 10.1016/j.joms.2012.04.048.
Patients with mandibular trauma in the greater Seattle region are frequently transferred to Harborview Medical Center (HMC) despite trained providers in the surrounding communities. HMC receives poor reimbursement for these services, creating a disproportionate financial burden on the hospital. In this study we aim to identify the variables associated with increased cost of care, measure the relative financial impact of these variables, and quantify the revenue loss incurred from the treatment of isolated mandibular fractures.
A retrospective chart review was conducted of patients treated at HMC for isolated mandibular fractures from July 1999 through June 2010, using International Classification of Diseases, Ninth Revision and Current Procedural Terminology coding. Data collected included demographics, injury, hospital course, treatment, outcomes, and billing.
The study included 1,554 patients. Total billing was $22.1 million. Of this, $6.9 million was recovered. We found that there are multiple variables associated with the increased cost of treating mandibular fractures; 4 variables--length of hospital stay, treatment modality, service providing treatment, and method of arrival--accounted for 49.1% of the total variance in the amount billed. In addition, we found that the unsponsored portion of our patient population grew from 6.7% to 51.4% during the study period.
Our results led to specific cost-efficiency recommendations: 1) perform closed reduction whenever possible; 2) encourage performing procedures with patients under local anesthesia (closed reductions and arch bar removals); 3) provide improved and shared training among the services treating craniofacial trauma; 4) encourage arrival by privately owned vehicle; 5) provide outpatient treatment, when applicable; 6) offer provider incentives to take trauma call; and 7) offer hospital incentives to treat patients and not transfer them.
在大西雅图地区，尽管周边社区有受过专业培训的医疗人员，但下颌骨创伤患者仍常常被转送至哈伯维尤医疗中心（HMC）。HMC为这些服务获得的报销费用很低，给医院造成了不成比例的经济负担。在本研究中，我们旨在确定与护理成本增加相关的变量，衡量这些变量的相对财务影响，并量化因孤立性下颌骨骨折治疗而产生的收入损失。
对1999年7月至2010年6月期间在HMC接受孤立性下颌骨骨折治疗的患者进行回顾性病历审查，使用国际疾病分类第九版和当前程序术语编码。收集的数据包括人口统计学、损伤情况、住院过程、治疗方法、治疗结果和计费情况。
该研究纳入了1554名患者。总计费金额为2210万美元。其中，690万美元得到了报销。我们发现有多个变量与下颌骨骨折治疗成本的增加相关；4个变量——住院时间、治疗方式、提供治疗的科室以及到达方式——占计费金额总方差的49.1%。此外，我们发现研究期间我们的自费患者比例从6.7%增长到了51.4%。
我们的研究结果得出了具体的成本效益建议：1）尽可能进行闭合复位；2）鼓励在局部麻醉下对患者进行手术（闭合复位和拆除牙弓夹板）；3）在治疗颅面创伤的科室之间提供更好的共享培训；4）鼓励乘坐私家车前来就诊；5）在适用时提供门诊治疗；6）为承担创伤呼叫任务的医疗人员提供激励措施；7）为收治患者而非将其转诊的医院提供激励措施。
