Factors affecting revenue from the management of pelvis and acetabulum fractures

摘要

Objectives: The purpose was to define charges and reimbursement in the management of pelvis and acetabulum fractures and to identify opportunities for revenue enhancement. DESIGN: Retrospective review. SETTING: Level 1 trauma center. PATIENTS/PARTICIPANTS: Four hundred sixty-five patients with 210 pelvic ring injuries and 285 acetabulum fractures. INTERVENTION: All fractures were treated surgically. MAIN OUTCOME MEASUREMENTS: Professional and facility charges and collections were determined for each patient. Costs of care and profitability were calculated for patients with isolated pelvis or acetabulum fractures. RESULTS: Definitive fixation was ≤24 hours of injury in 35% and >72 hours in 24%. Mean hospital length of stay (LOS) was 9.2 days, with mean 3.1 days in the intensive care unit (ICU). Mean facility charges were $51,069 with collections of $22,702 (44%). Mean orthopaedic professional charges were $20,184 with collections of $4629 (23%). Combined pelvis and acetabulum fractures had the highest facility collection rates (49%) with lower professional collections (21%) versus isolated fractures (25%, P = 0.03). The payer mix had significantly more commercial (27%), managed care (27%), and Bureau of Worker's Compensation (10%) versus the entire hospital, despite progressively more patients with Medicaid or no insurance during the study. Uninsured patients were significantly younger with lower injury severity score. Fractures managed definitively ≤24 hours had shorter LOS, shorter ICU stay, and fewer complications, with mean net facility revenue over costs of $2376. Longer LOS due to complications increased initial hospital costs by a mean of $14,829. CONCLUSIONS: Patients with multiple injuries generated higher facility charges and collection rates. Professional collection rates were lower in patients with more than 1 surgical procedure in the same setting. Trauma patients were more likely to have commercial, managed care, and Bureau of Worker's Compensation insurance versus the entire hospital. Fractures managed definitively within 24 hours were associated with shorter LOS, shorter ICU stay, and fewer complications, resulting in lower treatment expenses. Fracture care was profitable to the hospital when definitively completed within 72 hours. Prolonged LOS and complications were associated with larger costs of care. LEVEL OF EVIDENCE: Economic Level IV. See Instructions for Authors for a complete description of levels of evidence.