title: Does Fracture Care Make Money for the Hospital? An Analysis of Hospital Revenues and Costs for Treatment of Common Fractures.
abstract: OBJECTIVE
  To determine the relative profitability for a hospital of treatment of common fractures within a state-regulated reimbursement system.
  
  
  METHODS
  Retrospective cohort.
  
  
  METHODS
  Regional trauma referral center with state-regulated hospital reimbursement system.
  
  
  METHODS
  We reviewed hospital medical and financial records of 1228 patients admitted from 2008 through 2012 with a principle diagnosis of acute traumatic fracture requiring surgical treatment. Patients whose principle diagnosis fit into 1 of 6 common anatomic categories were included. Sixty-five pelvic, 275 acetabular, 277 hip, 255 femoral shaft, 148 tibial shaft, and 208 ankle fractures were identified. Patients with a different principle diagnosis were excluded. Net revenue, total cost of inpatient care, and direct margin for each patient's acute inpatient hospital course were recorded.
  
  
  METHODS
  Direct margins, costs.
  
  
  RESULTS
  Per patient, the overall mean net revenue was $39,813, overall mean cost of inpatient care was $21,231, and overall mean direct margin (profitability) was $18,582. Mean direct variable expense was $14,898 per patient, and mean direct fixed expense was $6333 per patient. Factors most influencing cost included length of stay, supplies, and operating room use. Of 1228 patients, 46 (3.7%) had a negative direct margin (net loss to hospital). The most profitable diagnosis was pelvic fracture (mean direct margin, $21,767).
  
  
  CONCLUSIONS
  The state-regulated reimbursement system allows analysis of hospital profitability in the context of a normalized revenue stream that should approximate the overall fiscal realities of other states. Providing orthopaedic trauma care can be economically feasible and profitable for a hospital.
  
  
  METHODS
  Economic Level IV. See Instructions for Authors for a complete description of levels of evidence.
authors.affiliation: R Adams Cowley Shock Trauma Center, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD.
authors.forename: Conor P
authors.initials: CP
authors.lastname: Kleweno
authors.forename: Robert V
authors.initials: RV
authors.lastname: OʼToole
authors.forename: Jeromie
authors.initials: J
authors.lastname: Ballreich
authors.forename: Andrew N
authors.initials: AN
authors.lastname: Pollak
mesh_terms: D059019:Clinical Coding; D015331:Cohort Studies; D003362:Cost-Benefit Analysis / Q000706:statistics & numerical data; D003365:Costs and Cost Analysis; D050723:Fractures, Bone / Q000191:economics* / Q000453:epidemiology / Q000601:surgery; D017721:Hospital Costs / Q000706:statistics & numerical data*; D006801:Humans; D007349:Insurance, Health, Reimbursement / Q000191:economics*; D007902:Length of Stay / Q000706:statistics & numerical data; D008396:Maryland / Q000453:epidemiology; D009985:Orthopedics / Q000191:economics*; D017063:Outcome Assessment, Health Care; D012189:Retrospective Studies; D014193:Trauma Centers / Q000191:economics*; D014947:Wounds and Injuries