title: Who will cover the cost of undocumented immigrant trauma care?
abstract: BACKGROUND
  Health care reform under the "Patient Protection and Affordable Care Act" (PPACA) will lead to changes in reimbursement. Although this legislation provides a mechanism for uninsured Americans to obtain coverage, it excludes undocumented immigrants (UDI). Reimbursement for UDIs comes from the disproportionate share hospital (DSH) program and was previously supported by Section-1011 of the 2003 Medicare Modernization Act (S1011). The PPACA details a cut of DSH funds starting in 2014. This could impose a significant financial burden on trauma centers.
  
  
  METHODS
  From May 2005 to May 2008, we retrospectively reviewed all trauma-related emergency room visits by UDIs. We quantified charges for three entities: emergency department physicians, trauma surgeons, and the hospital. We applied our average institutional collection rate to these charges and compared these projected collections with the actual collections.
  
  
  RESULTS
  Over a three-year period, we identified 1,325 trauma UDIs. The financial records revealed a projected emergency department physicians collection of $452,686, a projected trauma surgeons collection of $1.2 million, and a projected hospital collection of $6.9 million (total $8.6 million). Actual funding from S1011 provided $1.7 million and DSH provided $1.9 million (total $3.6 million). Texas State Funding and UDI self-payment contributed $611,082. Overall, our institution had a reimbursement discrepancy of $4.3 million with DSH/S1011 assistance. This increased to $6.0 million after the termination of S1011 and may increase to $7.9 million under PPACA.
  
  
  CONCLUSIONS
  These figures underestimate the total cost of UDI trauma care as it only includes three entities. Our data represent a fraction of national figures. Failure to address these issues could result in ongoing financial problems for trauma centers.
  
  
  METHODS
  II, economic and decision analysis.
authors.affiliation: Department of Surgery, Methodist Dallas Medical Center, Dallas, Texas 75203, USA. chris.drumm.mitchell@gmail.com
authors.forename: Christopher D
authors.initials: CD
authors.lastname: Mitchell
authors.forename: Michael S
authors.initials: MS
authors.lastname: Truitt
authors.forename: Vanessa K
authors.initials: VK
authors.lastname: Shifflette
authors.forename: Van
authors.initials: V
authors.lastname: Johnson
authors.forename: Alicia J
authors.initials: AJ
authors.lastname: Mangram
authors.forename: Ernest L
authors.initials: EL
authors.lastname: Dunn
mesh_terms: D054242:Emigrants and Immigrants; D017722:Hospital Charges; D017721:Hospital Costs; D006786:Hospitals, Urban / Q000191:economics; D006801:Humans; D007349:Insurance, Health, Reimbursement / Q000191:economics*; D008499:Medical Records; D058991:Patient Protection and Affordable Care Act / Q000191:economics*; D012189:Retrospective Studies; D013781:Texas / Q000453:epidemiology; D014193:Trauma Centers / Q000191:economics*; D014947:Wounds and Injuries / Q000191:economics / Q000208:ethnology / Q000628:therapy*