The financial burden of mandibular trauma.
OBJECTIVE
Patients with mandibular trauma in the greater Seattle region are frequently transferred to Harborview Medical Center (HMC) despite trained providers in the surrounding communities. HMC receives poor reimbursement for these services, creating a disproportionate financial burden on the hospital. In this study we aim to identify the variables associated with increased cost of care, measure the relative financial impact of these variables, and quantify the revenue loss incurred from the treatment of isolated mandibular fractures.


METHODS
A retrospective chart review was conducted of patients treated at HMC for isolated mandibular fractures from July 1999 through June 2010, using International Classification of Diseases, Ninth Revision and Current Procedural Terminology coding. Data collected included demographics, injury, hospital course, treatment, outcomes, and billing.


RESULTS
The study included 1,554 patients. Total billing was $22.1 million. Of this, $6.9 million was recovered. We found that there are multiple variables associated with the increased cost of treating mandibular fractures; 4 variables--length of hospital stay, treatment modality, service providing treatment, and method of arrival--accounted for 49.1% of the total variance in the amount billed. In addition, we found that the unsponsored portion of our patient population grew from 6.7% to 51.4% during the study period.


CONCLUSIONS
Our results led to specific cost-efficiency recommendations: 1) perform closed reduction whenever possible; 2) encourage performing procedures with patients under local anesthesia (closed reductions and arch bar removals); 3) provide improved and shared training among the services treating craniofacial trauma; 4) encourage arrival by privately owned vehicle; 5) provide outpatient treatment, when applicable; 6) offer provider incentives to take trauma call; and 7) offer hospital incentives to treat patients and not transfer them.
Department of Oral & Maxillofacial Surgery, Harborview Medical Center, University of Washington, Seattle, WA 98104, USA. dillonj5@uw.edu
Jasjit K
JK
Dillon
Brian
B
Christensen
Tyler
T
McDonald
Steve
S
Huang
Peter
P
Gauger
Preston
P
Gomez
D000328:Adult; D000772:Anesthesia, Local / Q000191:economics; D015331:Cohort Studies; D003362:Cost-Benefit Analysis / Q000706:statistics & numerical data; D005260:Female; D005593:Fracture Fixation, Internal / Q000191:economics; D017048:Health Care Costs / Q000706:statistics & numerical data; D017722:Hospital Charges / Q000706:statistics & numerical data; D017721:Hospital Costs / Q000706:statistics & numerical data*; D006748:Hospital Departments / Q000191:economics; D006801:Humans; D007182:Income / Q000706:statistics & numerical data; D007348:Insurance, Health / Q000191:economics; D007902:Length of Stay / Q000191:economics; D008297:Male; D008337:Mandibular Fractures / Q000191:economics* / Q000209:etiology / Q000628:therapy; D009042:Motivation; D010044:Outpatient Clinics, Hospital / Q000191:economics; D010343:Patient Admission / Q000191:economics; D010350:Patient Credit and Collection / Q000191:economics; D010360:Patient Transfer / Q000191:economics; D010564:Personnel, Hospital / Q000193:education; D011183:Postoperative Complications / Q000191:economics; D012017:Referral and Consultation / Q000191:economics; D012051:Reimbursement Mechanisms / Q000191:economics; D012189:Retrospective Studies; D013503:Surgery Department, Hospital / Q000191:economics; D014187:Transportation of Patients / Q000191:economics; D014861:Washington