title: The impact of injury severity and transfer status on reimbursement for care of femur fractures.
abstract: BACKGROUND
  This study investigates the impact of injury severity, patient origin, and payer on charges and payments associated with treatment of femoral fractures at a Level I trauma center. We hypothesized that transfer patients and patients with minor injury would be underinsured, whereas reimbursement rate would be higher for patients with severe injury.
  
  
  METHODS
  Medical and financial records of 420 adult patients treated for femoral fractures at a public, urban Level I trauma center were reviewed. Facility and professional charges and payments were determined. Reimbursement rate was defined as the ratio of payment to charge. Payer groups included Medicare, Medicaid, commercial, managed care, workers' compensation, and self-pay. Severe injury was defined by Injury Severity Score of 18 or higher.
  
  
  RESULTS
  Patients with Injury Severity Score of less than 18 were more often uninsured compared with the severe injury group (25% vs. 14%, p = 0.005). Patients with severe injury had higher facility (0.47 vs. 0.39, p = 0.005) and total reimbursement rates (0.41 vs. 0.34, p = 0.002) compared with patients with minor injury. Likewise, transfer patients trended toward higher overall reimbursement rate compared with nontransfer patients (0.42 vs. 0.37, p = 0.056). Patients with severe injury were more likely to have commercial insurance (28 vs. 20%, p = 0.06), and transferred patients were more likely to have insurance (88% vs. 79%, p = 0.034).
  
  
  CONCLUSIONS
  The higher proportion of self-pay in the nontransfer group may be caused by the large population of uninsured patients in the area surrounding our trauma center. Favorable payer mix and higher facility reimbursement rate for patients with severe injury may be an incentive for trauma centers to continue providing care for patients with multiple injuries.
  
  
  METHODS
  Prognostic/epidemiologic study, level III. Economic analysis, level IV.
authors: Department of Orthopaedic Surgery, MetroHealth Medical Center, Cleveland, Ohio, USA.
authors: Nickolas J
authors: NJ
authors: Nahm
authors: Brendan M
authors: BM
authors: Patterson
authors: Heather A
authors: HA
authors: Vallier
mesh_terms: D000328:Adult; D017281:Cost of Illness; D005260:Female; D005264:Femoral Fractures / Q000175:diagnosis / Q000191:economics*; D006801:Humans; D015601:Injury Severity Score; D007349:Insurance, Health, Reimbursement / Q000191:economics*; D008297:Male; D008484:Medicaid / Q000191:economics*; D006278:Medicare / Q000191:economics*; D010360:Patient Transfer / Q000191:economics*; D012189:Retrospective Studies; D014193:Trauma Centers / Q000191:economics*; D014481:United States; D014505:Urban Population