title: Determining the hospital trauma financial impact in a statewide trauma system.
abstract: BACKGROUND
  There have been no comprehensive studies across an organized statewide trauma system using a standardized method to determine cost.
  
  
  METHODS
  Trauma financial impact includes the following costs: verification, response, and patient care cost (PCC). We conducted a survey of participating trauma centers (TCs) for federal fiscal year 2012, including separate accounting for verification and response costs. Patient care cost was merged with their trauma registry data. Seventy-five percent of the 2012 state trauma registry had data submitted. Each TC's reasonable cost from the Medicare Cost Report was adjusted to remove embedded costs for response and verification. Cost-to-charge ratios were used to give uniform PCC across the state.
  
  
  RESULTS
  Median (mean ± SD) costs per patient for TC response and verification for Level I and II centers were $1,689 ($1,492 ± $647) and $450 ($636 ± $431) for Level III and IV centers. Patient care cost-median (mean ± SD) costs for patients with a length of stay >2 days rose with increasing Injury Severity Score (ISS): ISS <9: $6,787 ($8,827 ± $8,165), ISS 9 to 15: $10,390 ($14,340 ± $18,395); ISS 16 to 25: $15,698 ($23,615 ± $21,883); and ISS 25+: $29,792 ($41,407 ± $41,621), and with higher level of TC: Level I: $13,712 ($23,241 ± $29,164); Level II: $8,555 ($13,515 ± $15,296); and Levels III and IV: $8,115 ($10,719 ± $11,827).
  
  
  CONCLUSIONS
  Patient care cost rose with increasing ISS, length of stay, ICU days, and ventilator days for patients with length of stay >2 days and ISS 9+. Level I centers had the highest mean ISS, length of stay, ICU days, and ventilator days, along with the highest PCC. Lesser trauma accounted for lower charges, payments, and PCC for Level II, III, and IV TCs, and the margin was variable. Verification and response costs per patient were highest for Level I and II TCs.
authors: Arkansas Trauma Education and Research Foundation (ATERF), the Department of Surgery, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR. Electronic address: mabrycharlesd@uams.edu.
authors: Charles D
authors: CD
authors: Mabry
authors: Arkansas Trauma Education and Research Foundation (ATERF), the Department of Surgery, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR.
authors: Kyle J
authors: KJ
authors: Kalkwarf
authors: Arkansas Trauma Education and Research Foundation (ATERF), the Department of Surgery, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR.
authors: Richard D
authors: RD
authors: Betzold
authors: Fay W Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR.
authors: Horace J
authors: HJ
authors: Spencer
authors: Arkansas Trauma Education and Research Foundation (ATERF), the Department of Surgery, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR.
authors: Ronald D
authors: RD
authors: Robertson
authors: Arkansas Trauma Education and Research Foundation (ATERF), the Department of Surgery, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR.
authors: Michael J
authors: MJ
authors: Sutherland
authors: Arkansas Trauma Education and Research Foundation (ATERF), the Department of Surgery, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR.
authors: Robert T
authors: RT
authors: Maxson
mesh_terms: D017046:Cost Savings; D006295:Health Resources / Q000191:economics*; D017721:Hospital Costs / Q000639:trends*; D006760:Hospitalization / Q000191:economics*; D006801:Humans; D007902:Length of Stay / Q000191:economics; D014193:Trauma Centers / Q000191:economics*; D014481:United States; D014947:Wounds and Injuries / Q000191:economics*