Length of stay and trauma center finances: A disparity of payer source at a Level I trauma center.
Journal
The journal of trauma and acute care surgery
ISSN: 2163-0763
Titre abrégé: J Trauma Acute Care Surg
Pays: United States
ID NLM: 101570622
Informations de publication
Date de publication:
01 04 2022
01 04 2022
Historique:
pubmed:
7
1
2022
medline:
28
4
2022
entrez:
6
1
2022
Statut:
ppublish
Résumé
In an effort to reduce costs, hospitals focus efforts on reducing length of stay (LOS) and often benchmark LOS against the geometric LOS (GMLOS) as predicted by the assigned diagnosis-related group (DRG) used by the Centers for Medicare and Medicaid Services. The objective of this cross-sectional study was to evaluate the impact of exceeding GMLOS on hospital profit/loss with respect to payer source. Contribution margin for each insured patient admitted to a Level I trauma center between July 1, 2016, and June 30, 2019, was determined. Age, ethnicity, race, DRG weight, DRG version, injury severity, intensive care unit admission status, mechanical ventilation, payer, exceeding GMLOS, and the interaction between payer and exceeding the GMLOS were regressed on contribution margin to determine significant predictors of positive contribution margin. Among 2,449 insured trauma patients, the distribution of payers was Medicaid (54.6%), Medicare (24.0%), and commercial (21.4%). Thirty-five percent (n = 867) of patient LOS exceeded GMLOS. Exceeding GMLOS by 10 or more days was significantly more likely for Medicaid and Medicare patients in stepwise fashion (commercial, 2.7%; Medicaid, 4.5%; Medicare, 6.0%; p = 0.030). Median contribution margin was positive for commercially insured patients ($16,913) and negative for Medicaid (-$8,979) and Medicare (-$2,145) patients. Adjusted multivariate modeling demonstrated that when exceeding GMLOS, Medicare and Medicaid cases were less likely than commercial payers to have a positive contribution margin (p < 0.001 and p < 0.001). Government-insured patients, despite having a payer source, are a financial burden to a trauma center. Excess LOS among government insured patients, but not the commercially insured, exacerbates financial loss. A shift toward a greater proportion of government insured patients may result in a significant fiscal liability for a trauma center. Economic and Value-Based Evaluation, Level III.
Sections du résumé
BACKGROUND
In an effort to reduce costs, hospitals focus efforts on reducing length of stay (LOS) and often benchmark LOS against the geometric LOS (GMLOS) as predicted by the assigned diagnosis-related group (DRG) used by the Centers for Medicare and Medicaid Services. The objective of this cross-sectional study was to evaluate the impact of exceeding GMLOS on hospital profit/loss with respect to payer source.
METHODS
Contribution margin for each insured patient admitted to a Level I trauma center between July 1, 2016, and June 30, 2019, was determined. Age, ethnicity, race, DRG weight, DRG version, injury severity, intensive care unit admission status, mechanical ventilation, payer, exceeding GMLOS, and the interaction between payer and exceeding the GMLOS were regressed on contribution margin to determine significant predictors of positive contribution margin.
RESULTS
Among 2,449 insured trauma patients, the distribution of payers was Medicaid (54.6%), Medicare (24.0%), and commercial (21.4%). Thirty-five percent (n = 867) of patient LOS exceeded GMLOS. Exceeding GMLOS by 10 or more days was significantly more likely for Medicaid and Medicare patients in stepwise fashion (commercial, 2.7%; Medicaid, 4.5%; Medicare, 6.0%; p = 0.030). Median contribution margin was positive for commercially insured patients ($16,913) and negative for Medicaid (-$8,979) and Medicare (-$2,145) patients. Adjusted multivariate modeling demonstrated that when exceeding GMLOS, Medicare and Medicaid cases were less likely than commercial payers to have a positive contribution margin (p < 0.001 and p < 0.001).
CONCLUSION
Government-insured patients, despite having a payer source, are a financial burden to a trauma center. Excess LOS among government insured patients, but not the commercially insured, exacerbates financial loss. A shift toward a greater proportion of government insured patients may result in a significant fiscal liability for a trauma center.
LEVEL OF EVIDENCE
Economic and Value-Based Evaluation, Level III.
Identifiants
pubmed: 34991123
doi: 10.1097/TA.0000000000003529
pii: 01586154-202204000-00008
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
683-690Informations de copyright
Copyright © 2022 American Association for the Surgery of Trauma.
Références
Osborne P, Orrell B. Length-of-stay management . Emeryville, CA: Berkeley Research Group, LLC: Available at: https://media.thinkbrg.com/wp-content/uploads/2020/11/24122648/CASE-STUDY_LOS-Management_20190823_cleaned.pdf . August 23, 2021.
Fakhry SM, Couillard D, Liddy CT, Adams D, Norcross ED. Trauma center finances and length of stay: identifying a profitability inflection point. J Am Coll Surg . 2010;210(5):817–821, 821–823.
Taheri PA, Butz DA, Greenfield LJ. Length of stay has minimal impact on the cost of hospital admission. J Am Coll Surg . 2000;191(2):123–130.
Cai C, Lindquist K, Bongiovanni T. Factors associated with delays in discharge for trauma patients at an urban county hospital. Trauma Surg Acute Care Open . 2020;5(1):e000535.
Weinberg JA, Chapple KM, Gagliano RA Jr, Israr S, Petersen SR. Back to the future: impact of a paper-based Admission H&P on clinical documentation improvement at a level 1 trauma center. Am Surg . 2019;85(6):611–619.
Reyes C, Greenbaum A, Porto C, Russell JC. Implementation of a clinical documentation improvement curriculum improves quality metrics and hospital charges in an academic surgery department. J Am Coll Surg . 2017;224(3):301–309.
Momin SR, Lorenz RR, Lamarre ED. Effect of a documentation improvement program for an academic otolaryngology practice. JAMA Otolaryngol Head Neck Surg . 2016;142(6):533–537.