title: Trauma center finances and length of stay: identifying a profitability inflection point.
abstract: BACKGROUND
  Trauma centers frequently report unfavorable financial results for the care of injured patients. Many variables contribute to these results. The objective of this study was to determine the relationship of adult trauma patient hospital length of stay (LOS) to trauma center profitability.
  
  
  METHODS
  The trauma registry of a Level I trauma center was queried for patients older than 18 years for the period July 1, 2003 to June 30, 2008. Hospital financial records were matched to patient trauma registry data.
  
  
  RESULTS
  There were 7,990 patients who met selection criteria: 71% were men, mean age was 40 years, mean Injury Severity Score was 12 +/-10, 84.2% of injuries were blunt, and mean LOS was 6.23 days. In the 5 years of the study, total charges were $329,315,191, total costs were $137,680,039, and overall profit was $7,644,894. Total costs rose each year and percent collections fell. The bulk of the profit was realized from patients with LOS < 11 days, with progressively escalating cost per case, lower collections, and resultant lower profitability as LOS increased. A notable "inflection point" at 11 days defined the cohort of profitable patients.
  
  
  CONCLUSIONS
  Trauma patient LOS correlates closely with profitability. In this center, the vast majority of profit was realized from patients with LOS < 11 days and was eroded by most patient cohorts with longer LOS. Identification of an institution's "inflection point" may help direct efforts at increasing profitability and reflects the current reimbursement environment, which rewards shorter LOS over severity and quality.
authors.affiliation: Department of Surgery, Medical University of South Carolina, Charleston, SC 29425, USA.
authors.forename: Samir M
authors.initials: SM
authors.lastname: Fakhry
authors.forename: Debbie
authors.initials: D
authors.lastname: Couillard
authors.forename: Casey T
authors.initials: CT
authors.lastname: Liddy
authors.forename: David
authors.initials: D
authors.lastname: Adams
authors.forename: E Douglass
authors.initials: ED
authors.lastname: Norcross
mesh_terms: D000328:Adult; D015331:Cohort Studies; D005260:Female; D005377:Financial Management, Hospital / Q000191:economics*; D017048:Health Care Costs; D006801:Humans; D015601:Injury Severity Score; D007902:Length of Stay / Q000191:economics*; D008297:Male; D012189:Retrospective Studies; D014193:Trauma Centers / Q000191:economics*; D014481:United States; D014947:Wounds and Injuries / Q000191:economics / Q000628:therapy*