The impact of prospective reimbursement on trauma centers. An alternative payment plan.

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.