From the Department of Orthopaedic Surgery, MetroHealth Medical Center, Cleveland, OH, affiliated with Case Western Reserve University.
J Am Acad Orthop Surg. 2020 Feb 15;28(4):e151-e157. doi: 10.5435/JAAOS-D-17-00871.
In the background of increasing competition between trauma centers, this study investigated the relative reimbursement of trauma care provided in an urban trauma setting, comparing patients previously unknown (new) to the system, representing potential sources of new revenue, and those who were known (established), having received medical care previously in the same system.
A retrospective review of 440 patients with high-energy fractures at a single level 1 trauma center was conducted. Payment to charge (P/C) ratios for professional and facilities services within 6 months of injury were calculated.
Mean professional charges per patient were $35,522 and $30,639 (P = 0.11), between new and established patients, respectively, whereas mean professional payments were statistically different, $7,894 and $4,365 (P < 0.001). Mean differences in P/C for facilities payments for new and established patients were not statistically significant, but professional P/C was higher in new patients (P < 0.001), consistent with better insured patients.
Insurance companies reimburse for professional or facilities services with statistically different P/C ratios. Treating new patients at our institution likely benefits our institution by offering exposure to a more favorable payer mix and more complex patients.
Retrospective level III.
在创伤中心之间竞争日益激烈的背景下，本研究调查了在城市创伤环境中提供的创伤护理的相对报销情况，将先前未知（新）系统的患者与潜在新收入来源的患者进行比较，以及那些已知（已建立）系统，先前在同一系统中接受过医疗的患者。
对单一 1 级创伤中心的 440 名高能骨折患者进行回顾性审查。计算受伤后 6 个月内专业和设施服务的付款与收费（P/C）比率。
新患者和已建立患者的每位患者平均专业费用分别为 35522 美元和 30639 美元（P = 0.11），而平均专业付款则存在统计学差异，分别为 7894 美元和 4365 美元（P < 0.001）。新患者和已建立患者的设施付款 P/C 差异无统计学意义，但新患者的专业 P/C 更高（P < 0.001），表明患者的保险情况更好。
保险公司以具有统计学差异的 P/C 比率报销专业或设施服务。在我们机构治疗新患者可能使我们的机构受益，因为它提供了接触更有利的支付者组合和更复杂患者的机会。
回顾性三级。
