title: Relative value units and payer mix analysis of facial trauma coverage at a level 1 trauma center: is the current model sustainable?
abstract: OBJECTIVE
  We aimed to approximate the annual clinical work that is performed during facial trauma coverage and analyze the economic incentives for subspecialty surgeons providing the coverage.
  
  
  METHODS
  A retrospective, clinical productivity data analysis of 6 consecutive years of facial trauma coverage at an American College of Surgeons-verified Level I trauma center was performed by the use of a trauma database and relative value unit (RVU) data. A payer mix analysis also was completed. SPSS V19 was used for analysis.
  
  
  RESULTS
  Between 2006 and 2011, 526 patients were treated for facial injuries. The annual nonoperative RVUs ranged from 371 to 539, whereas the annual operative RVUs range was 235-426. Trend analysis displayed that most of the annual RVUs were nonoperative until the year 2011, when the operative RVUs surpassed the nonoperative. Payer mix analysis revealed that commercial insurance coverage was the most common (range 21-54%, median 41%) followed by self-pay coverage (18-32%, median 29%). This finding was a consistent phenomenon except in the year 2009, when self-pay covered the majority of the RVUs (32%). Nasal bone fractures (24%) and mandibular fractures (16%) were the two most common diagnoses. Open reduction and internal fixation of mandibular fractures (17%), open reduction and internal fixation orbital bone fractures (15%), and complex facial repair (12%) constituted the most common operative procedures. Facial trauma consultations were obtained 22% (16-24%) of covered days. The percent of days requiring emergency procedures was (0.5-1%).
  
  
  CONCLUSIONS
  The infrequency of subspecialty consultations and operative interventions, and significant payer mix differences between facial trauma patients relative to the current ambulatory surgery population of the covering subspecialties poses economical challenges for both the hospitals and providers that use the traditional coverage models.
authors.affiliation: Brigham and Women's Hospital, Harvard Medical School, Boston, MA; University of Toledo College of Medicine, Toledo, OH. Electronic address: Mohamed.Osman@UToledo.edu.
authors.forename: Mohamed F
authors.initials: MF
authors.lastname: Osman
authors.affiliation: University of Toledo College of Medicine, Toledo, OH.
authors.forename: Reginald F
authors.initials: RF
authors.lastname: Baugh
authors.affiliation: University of Toledo College of Medicine, Toledo, OH.
authors.forename: Aaron D
authors.initials: AD
authors.lastname: Baugh
authors.affiliation: University of Toledo College of Medicine, Toledo, OH.
authors.forename: Marlene C
authors.initials: MC
authors.lastname: Welch
authors.affiliation: ProMedica Health System/The ProMedica Toledo Hospital, Toledo, OH.
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: Sferra
authors.affiliation: University of Toledo College of Medicine, Toledo, OH.
authors.forename: Mallory
authors.initials: M
authors.lastname: Williams
mesh_terms: D016208:Databases, Factual; D004526:Efficiency; D005151:Facial Injuries / Q000191:economics / Q000601:surgery*; D006801:Humans; D015895:Relative Value Scales; D012189:Retrospective Studies; D014193:Trauma Centers / Q000191:economics* / Q000458:organization & administration; D014194:Traumatology / Q000191:economics* / Q000458:organization & administration