From the Icahn School of Medicine (D.A.F.), Mt. Sinai Hospital, New York, New York; and Department of Orthopedic Surgery (D.F.A., S.C., P.R.W.), University of California, Davis, Sacramento, California.
J Trauma Acute Care Surg. 2014 Feb;76(2):529-33. doi: 10.1097/TA.0000000000000093.
We examined the financial ramifications on the orthopedic trauma service after loss of payment to our institution for care of indigent patients. Our institution is the only Level I trauma center located within the county. Before mid-2009, county insurance-eligible patients treated at our institution had their health care paid for by the county. After mid-2009, the county no longer reimbursed our institution for care provided.
A retrospective review was performed on 653 county patients treated by the four orthopedic trauma surgeons during a 4-year period including the 2 years before the loss of county payments as well as the 2-year period following the loss of payment. Data collected included demographics, admitting service, injuries treated, length of stay, surgeon billing, and reimbursement. We also classified the urgency of care that was rendered into one of three categories as follows: emergent, urgent, or elective.
There was a higher frequency of emergent and urgent procedures and a lower frequency of elective cases performed in the noncontracted period versus the contracted period. During the contracted period, we billed and collected $1,161,036. After the loss of reimbursement from the county, we billed $870,590 and were paid $0. County reimbursements made up 33.5% of the total professional fees billed. There was a 20% net drop in total billing during the noncontracted period, of which the money not reimbursed by the county accounted for 31%.
Despite the lack of county payment, our institution continues to provide care to the indigent population. This lack of payment may have significant long-term economic ramifications for the orthopedic trauma surgeons and for our institution. The financial burden preferentially falls on the "safety net" Level I trauma centers and the physicians who take care of patients with urgent and emergent injuries. This burden may be unsustainable in the future.
Economic and value-based evaluation, level V.
我们研究了我们机构为贫困患者提供护理而失去付款后对矫形创伤服务的财务影响。我们的机构是该县唯一的一级创伤中心。在 2009 年年中之前，在我们机构接受治疗的有县保险资格的患者的医疗费用由该县支付。在 2009 年年中之后，该县不再向我们机构报销所提供的护理费用。
对四位矫形创伤外科医生在四年期间（包括失去县付款前两年和失去付款后两年）治疗的 653 名县患者进行了回顾性审查。收集的数据包括人口统计学、入院服务、治疗的损伤、住院时间、外科医生计费和报销。我们还将提供的护理紧急程度分为以下三类之一：紧急、紧急和择期。
在非合同期，紧急和紧急手术的频率更高，择期手术的频率更低。在合同期内，我们计费并收取了 1,161,036 美元。失去县报销后，我们计费 870,590 美元，未收到任何付款。县报销占总计费专业费用的 33.5%。在非合同期内，总计费减少了 20%，其中县未报销的部分占 31%。
尽管缺乏县付款，但我们的机构仍继续为贫困人群提供护理。这种缺乏付款可能对矫形创伤外科医生和我们的机构产生重大的长期经济影响。经济负担主要落在“安全网”一级创伤中心和照顾紧急和紧急伤害患者的医生身上。这种负担在未来可能是不可持续的。
经济和基于价值的评估，等级 V。
