The economic impact of DRG payment policies on air-evacuated trauma patients

This study assessed the injury severity, patient outcome, the cost of care, and the economic impact of Medicare DRG payment policies on patients referred to a Level I trauma center. Only 11 of 283 admitted traumatized patients were Medicare patients. Yet, these 11 Medicare patients left the trauma center with a deficit of $249,601. No significant differences were found between the Medicare and non-Medicare groups for Trauma Score, CRAMS Score, Glasgow Coma Score, Injury Severity Score, ICU or hospital length of stay, disability, or mortality. Under DRG's, Medicare payments ($4,237 +/- 2,351/patient) have fallen to 20% of prior cost-based Medicare reimbursements ($21,542 +/- 34,170/patient), are providing only 16% of hospital costs ($26,928 +/- 42,713/patient), and are significantly (p less than 0.0001) less than non-Medicare reimbursements ($15,288 +/- 17,111/patient). Despite the high financial losses occurring when the trauma center treats referred traumatized Medicare patients, when all referred Medicare and non-Medicare patient trauma reimbursements are combined, overall trauma revenues have declined by only 4.3% under DRG's. If Medicare DRG payments were to be adopted by all third-party payers, reimbursement ($5,058 +/- 4,090/patient) would be significantly (p less than 0.0001) less than current hospital reimbursements ($14,801 +/- 16,537/patient) and costs ($16,121 +/- 17,624/patient). These results indicate that although high financial losses result when caring for traumatized Medicare patients, DRG's have not had a major financial effect upon centers receiving referred trauma patients because of the low numbers of admitted traumatized Medicare patients. However, if third-party payers were to enact the Medicare payment system, devastating economic losses would be inflicted upon major trauma centers.

When an indigent patient needs a helicopter: a case report and an accepted institutional policy

Emergency aeromedical systems have become an integral part of the practice of critical care medicine. These systems provide specialized care to the severely injured, including transport to the nearest trauma center with the highest level. Aeromedical physicians and nurses called to care for injured indigent patients, however, may be placed at odds with the financial interests of their institution. "Patient dumping" in aeromedicine may lead to ethical, legal, professional, and regulatory dilemmas for emergency professionals and health care institutions. Institutional policy for aeromedical transport of severely injured patients must be instituted, regardless of their ability to pay.

Reducing the costs of patient transfers

This study examined the potential cost savings of a new patient transfer device that uses air pressure to assist in the movement of patients. The analysis for a single hospital indicates that this new technology is no less expensive than traditional patient transfer methods if only the direct costs of staff utilization are considered. However, reductions are projected for indirect costs associated with work-related back injuries. A methodology is recommended for conducting similar evaluations at other institutions.

[Cost of the individual treatment of Trypanosoma brucei gambiense trypanosomiasis in a focus of infection in Niari (Congo)]

A survey carried out on 101 patients has shown that the treatment of human sleeping sickness, theoretically free, is relatively costly. The average total cost amount to 58,000 F C.F.A., ranging from free treatment up to much as 110,000 F C.F.A. This high cost in part explains the cases where treatment is refused, something which has frequently been observed in the Congo. It would therefore be desirable for patients, who are significant epidemiological reservoirs of T. b. gambiense, to receive economic aid.

Savings from outpatient antibiotic therapy for osteomyelitis. Economic analysis of a therapeutic strategy

Clinical, economic, and epidemiologic data were used to compare the costs of conventional inpatient care of osteomyelitis with the costs of early-discharge treatment using a once-daily parenteral antibiotic at home. Estimated expenses included inpatient medical care, outpatient visits, supplies, child care, home care, transportation, and lost productivity. Early-discharge treatment was associated with lower medical direct, non-medical direct, and indirect expenses than conventional inpatient treatment. Estimated savings per patient ranged from $510 to $22,232 (demonstrating the wide differences in estimated savings when different sources of data on hospital costs are used). These savings are due to large decreases in inpatient costs, which are partially offset by increased outpatient costs. However, because outpatient costs are more often borne by patients than are inpatient costs, early-discharge treatment could be more expensive from the patient's perspective, despite its savings for the hospital and for society as a whole.

Impact of prospective payments on a tertiary care center receiving large numbers of critically ill patients by aeromedical transport

To determine the economic impact of federal prospective payments and the potential effect if private insurance payers were to implement similar prospective payments, we examined payments under Medicare diagnosis-related grouping (DRG) reimbursement policies for 105 Medicare and 357 non-Medicare patients admitted to a tertiary care center via air transport. Among the 105 Medicare patients, the average length of stay was 11.4 days and the mortality rate was 24%. Hospital charges exceeded DRG reimbursement for 74% of Medicare patients. A comparison of previous Medicare payment policies to current federal DRG reimbursement resulted in a revenue loss to the hospital of $667,229 ($6335 per patient). For the 357 non-Medicare patients, the average length of stay was 10.8 days, the mortality rate was 10%, and hospital charges exceeded Medicare DRG reimbursement for 78% of the patients. Implementation of DRG-like payments by non-Medicare insurers would create a hospital revenue loss of $2,493,048 ($6983 per patient). We conclude that unless current and planned prospective payment policies are modified, the use of aeromedical transport services to recruit large numbers of critically ill patients to tertiary care centers is economically prohibitive.

[Medical transfers in pediatric oncology. Reflections apropos of economic, technical and ethical problems (Oran 1977-1983)]

In an underdeveloped country such as Algeria [20 million inhabitants, 2,140 US Dollars per capita gross national product (GNP)], satisfying a high level of health demand is difficult both in primary care and hospital. Limited facilities (hospital beds 2.3%; physicians 1:2,500; public health expenditure: 2% of GNP) combined with demographic pressure (population under 15 years of age: 47%) further compromise medical benefits. Qualitatively severe diseases such as pediatric cancers cannot be wholly managed locally. Thus administrative regulations permit sending patients with such situations abroad. We tested the feasibility of managing locally to a great extent (radiotherapy excepted) pediatric cancers. For leukemias and lymphomas, actuarial life expectancies corresponded to middle values of internationally published data. Cost-benefit estimations seemed good compared with other severe diseases managed both locally and abroad. Our present problem deals with balancing oncologic activity (more than 100 new cases a year) within a general pediatric department practice.

Economic analysis of regionalized neonatal care for very low-birth-weight infants in the state of Rhode Island

Cost-benefit analysis was utilized to evaluate the economic outcome of regionalized neonatal care in the state of Rhode Island, with specific reference to newborns weighing less than 1,500 g at birth. Two time periods consisting of two calendar years each, were analyzed: 1974 to 1975 (initiation of perinatal regionalization) and 1979 to 1980 (regionalization established). The neonatal mortality for infants weighing between 501 and 1,500 g decreased significantly between the two time periods. Neurodevelopmental morbidity was unchanged. The costs per survivor (hospital charges plus estimated costs of long-term care of handicapped survivors) were consistent over the time periods studied. The estimated benefits per survivor increased between the time periods, although this increase was not statistically significant. Benefits outweighed costs in both study periods. When one compares the economic data of 1974 to 1975 with that of 1979 to 1980, the increase in the absolute number of normal survivors since the establishment of regionalized neonatal care has resulted in benefits surpassing costs by $2 million (a greater than twofold increase). Regionalized neonatal care in the state of Rhode Island has had a positive economic outcome.

Financial analysis of an inner city trauma center: charges vs collections

The changes in the economy and in tax rules have caused hospitals to assess the financial viability of different areas within their institutions. While emergency departments generally have become recognized as a cost-effective portal of entry for patients, trauma centers, particularly those located in the inner city, usually are seen as areas of large investment and small financial return. This study looks at a large, inner-city trauma service and the charges, collections, and demographics of the trauma population it serves. For patients admitted to the trauma service, total collections were 77% of charges. There was no difference in collections between those patients with blunt injuries and those with penetrating injuries; violent vs nonviolent injuries; patients transferred in vs primary receivals; or patients transferred out after stabilization vs those retained at the trauma center.

Implications of hospital cost control for administrators

By examining a group of hospitals in California, one can see the effects of cost control legislation on hospital administrators. Problems can be studied and decisions analyzed for their appropriateness, both to the California hospitals and to hospitals in general.

Rapid nighttime evacuation of a veterans hospital

Loss of essential utilities and danger of explosion forced a rapid nighttime winter evacuation of 229 patients from an acute-care Veterans Administration hospital. Although distribution of patients to recipient hospitals was not optimal, and the location of several patients could not be documented for more than 24 hours, the evacuation in subfreezing weather went smoothly. Continuity of care and careful planning permitted an orderly return to the hospital five days later. Although financial costs were high, no excess mortality or morbidity was associated with the evacuation. No changes in pharyngeal gram-negative bacterial flora of the patients were noted. Further, a critique is presented to aid in planning for similar emergencies elsewhere.

Neonatal back-transport. Cost-effectiveness

This study examines the cost-effectiveness of returning previously ill neonates to community hospitals after treatment in a tertiary center, a concept known as "back-transport." The authors compared the charges for medical care during convalescence of a group of back-transported infants (BT infants; n = 20) with a similar group of infants who remained in a tertiary center for convalescence (NT infants; n = 20). The total charges for convalescent care (inpatient plus transport charges) for 20 representative BT infants was $61,840, compared with $68,240 for 20 matched NT infants, an average savings of $320 per BT infant. The average daily bed charge and charges for laboratory tests and medications were significantly less for BT infants compared with NT infants, and these reductions offset the transport charges for BT infants. The authors conclude that back transport decreases the charges for medical care for most infants. Therefore, the decision to back-transport an individual infant usually can be based on factors other than cost.