title: Trauma care reimbursement in rural hospitals: implications for triage and trauma system design.
abstract: American College of Surgeons triage guidelines recommend rapid identification and transfer of seriously injured patients to regional trauma centers, bypassing local hospitals if necessary. This approach raises concerns about the potential negative financial impact of implementing such triage strategies on already strained rural hospitals.
  
  
  OBJECTIVE
  The purpose of this study was to determine the association between injury severity and reimbursement for trauma care in rural hospitals. It was our hypothesis that the seriously injured would be high cost and relatively low reimbursement patients, and thus be a significant financial liability to the rural hospital. This would imply that concerns by the rural hospital about triage of such patients to trauma centers would be unfounded.
  
  
  METHODS
  Data on every injured patient seen in the emergency department during two 3-month periods were obtained from three rural hospitals in the state using the American College of Surgeons Trauma Registry data base.
  
  
  RESULTS
  One thousand six hundred thirty patients had complete data available for analysis. The analyses demonstrated that as the injury severity increased, there was an increase in hospital charges, length of stay, and risk of dying. In contrast, the reimbursement changed little as the charges and severity increased. Thus, hospital losses increased in an exponential fashion as injury severity increased above 15.
  
  
  CONCLUSIONS
  The study demonstrates that as injury severity increases, costs and charges increase, but reimbursement does not keep pace with these increased charges. The rural hospital was projected to lose an average of $25,000 for each patient with an Injury Severity Score over 15. This study supports the rapid triage and transport of the seriously injured patient from the rural hospital to the regional trauma center both for improved patient outcome and for the hospital's best interest. The potential impact of such a system on the trauma center also needs to be addressed.
authors.affiliation: University of North Carolina Hospitals, University of North Carolina at Chapel Hill 27599, USA.
authors.forename: R
authors.initials: R
authors.lastname: Rutledge
authors.forename: V D
authors.initials: VD
authors.lastname: Shaffer
authors.forename: J
authors.initials: J
authors.lastname: Ridky
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D005260:Female; D017722:Hospital Charges; D006780:Hospitals, Rural / Q000191:economics*; D006801:Humans; D007223:Infant; D015601:Injury Severity Score; D007349:Insurance, Health, Reimbursement; D008297:Male; D008875:Middle Aged; D009657:North Carolina; D011787:Quality of Health Care; D012042:Registries; D014193:Trauma Centers / Q000191:economics*; D014218:Triage