Vallier, J Orthop Trauma 2016 - Early Appropriate Care: A Protocol to Standardize Resuscitation Assessment and to Expedite Fracture Care Reduces Hospital Stay and Enhances Revenue - Article Summary

Early Appropriate Care: A Protocol to Standardize Resuscitation Assessment and to Expedite Fracture Care Reduces Hospital Stay and Enhances Revenue

Vallier, Moore, et al.·J Orthop Trauma·2016·34 citations·Prospective cohort

Purpose

We hypothesized that a standardized protocol for fracture care would enhance revenue by reducing complications and length of stay.

Methods

Design: Prospective consecutive series.

Setting: Level 1 trauma center.

Patients: 253 adult patients with a mean age of 40.7 years and mean Injury Severity Score of 26.0.

Intervention: Femur, pelvis, or spine fractures treated surgically.

Main Outcome Measures:

Hospital and professional charges and collections were analyzed.
Fixation was defined as early (<36 hours) or delayed.
Complications and hospital stay were recorded.

Results

Mean charges were US $180,145 with a mean of US $66,871 collected (37%).
The revenue multiplier was US $59,882/$6989 (8.57), indicating hospital collection of US $8.57 for every professional dollar, less than half of which went to orthopaedic surgeons.
Delayed fracture care was associated with more intensive care unit (4.5 vs. 9.4) and total hospital days (9.4 vs. 15.3), with mean loss of actual revenue US $6380/patient delayed (n = 47), because of the costs of longer length of stay.
Complications were associated with the highest expenses: mean of US $291,846 charges and US $101,005 collections, with facility collections decreased by 5.1%.
An uncomplicated course of care was associated with the most favorable total collections: (US $60,017/$158,454 = 38%) and the shortest mean stay (8.7 days).

Conclusions

Facility collections were nearly 9 times more than professional collections. Delayed fixation was associated with more complications, and facility collections decreased 5% with a complication. Furthermore, delayed fixation was associated with longer hospital stay, accounting for US $300K more in actual costs during the study. A standardized protocol to expedite definitive fixation enhances the profitability of the trauma service line.

Supplemental

Early Appropriate Care: A Protocol to Standardize Resuscitation Assessment and to Expedite Fracture Care Reduces Hospital Stay and Enhances Revenue.

Vallier, Moore, et al.J Orthop Trauma201634 citationsProspective cohort