Surgical case costing: trauma is underfunded according to resource intensity weights.
OBJECTIVE
To determine whether rate-based funding using resource intensity weights (RIWs) adequately represents trauma case costs.


METHODS
A prospective time-in-motion resource utilization pilot study to assure the effectiveness of the computerized hospital Transition-One data acquisition system, followed by a retrospective observational case costing study. Patient costs with no identifing data were used, and all costs were tabulated as mean cost per group.


METHODS
London Health Sciences Centre, London, Ont., a tertiary care "lead" trauma hospital.


METHODS
A modified random selection of 4 control case mix groups (CMGs) of surgical patients for the fiscal year 1996-97. The trauma group was selected as a representative resource-intensive CMG. Each patient was assigned to a CMG by Health Records according to the most responsible diagnosis.


METHODS
Total case costs were tabulated for each patient then combined for a mean case cost per CMG. The RIW assignments for each patient were combined to create a mean RIW per CMG and mean length of stay per CMG.


RESULTS
There was no statistically significant difference between the control surgical CMGs and the trauma CMG for mean RIW-adjusted length of stay per CMG, but there was a significant difference (p < 0.0001) between the control CMGs and the trauma CMG for RIW-adjusted mean case cost per CMG.


CONCLUSIONS
RIWs underrepresent trauma case costs by a factor of 3.5, which could result in underfinding and potential fiscal difficulties for leading trauma hospitals as has occurred in the United States.
Brackstone
Muriel
M
Trauma Program, London Health Sciences Centre, University of Western Ontario, London.
Doig
Gordon S
GS
Girotti
Murray J
MJ
D003953:Diagnosis-Related Groups / Q000191:economics*; D005260:Female; D006295:Health Resources / Q000706:statistics & numerical data; D006302:Health Services Research; D017721:Hospital Costs / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009864:Ontario; D013996:Time and Motion Studies; D014193:Trauma Centers / Q000191:economics* / Q000706:statistics & numerical data*; D014600:Utilization Review / Q000191:economics* / Q000379:methods; D014947:Wounds and Injuries / Q000191:economics* / Q000601:surgery