IMPROVEMENT IN COST RECOVERY AT AN URBAN LEVEL-I TRAUMA CENTER

With escalating health care costs and health reimbursement reorganization, the greatest danger to trauma centers will remain expensive uncompensated care, This is caused primarily by costs incurred in treating complex, life-threatening injuries and to the large population of trauma patients with no, or inadequate, means of compensation. In 1986 and 1987, this urban level I trauma center experienced an operating loss totaling $2,335,200. To attempt to reverse this expense, annual tracking of the trauma service's financial performance was begun in 1989, In addition, changes were made, Early multidisciplinary baseline assessment of each admission was instituted for financial profiling and discharge planning, Attempts were made on admission to identify health and vehicular insurance information, Processing for Medicaid and Medicare reimbursement was begun as soon as possible, and coding for diagnoses was checked by medical records personnel and the trauma nurse coordinator, If appropriate, Missouri Crime Victims Compensation was sought. Base on costs incurred in providing trauma services, as required by the state of Missouri and the American College of Surgeons, a trauma response charge was developed and instituted, Over a 5-year period, 1989 to 1993, financial audits were conducted, The cost recovery ratio (CRR) (collections/cost) was utilized as the measure of financial success, The CRR improved from 0.74 in 1989 to 0.93 in 1993, and in 2 years, 1991 and 1992, was 1.03 and 0.99, Over this period, the acuity of injury, as measured by the Injury Severity Score, remained essentially the same, but length of hospital stay decreased from 10.0 to 8.7 days, The CRR was greatest for private insurance. Major improvements in Medicaid and Medicare reimbursements were also realized, although the CRR for the sizable population of patients with no insurance (37%) did not improve and remained at similar to 0.15, The trauma response charge has enabled some of the costs to be recovered, and has been received well by most insurance carriers and managed care plans, As managed care assumes a large role in health care reimbursement in the future, the trauma response charge will become even more important. With measures taken and our experience to date, we have significantly improved the financial picture of our trauma center and all but ensured its viability in the years to come.