Is Treating Oral and Maxillofacial Trauma Profitable? An Analysis of Hospital and Surgeon Reimbursement at an Academic Medical Center.
OBJECTIVE
During the past 2 decades, there has been a marked decrease in the willingness of community-based oral and maxillofacial surgeons to participate in trauma call. Although many factors can influence the decision not to take trauma call, 1 primary disincentive is the perception that managing facial trauma might be profitable for the hospital, but not profitable for the surgeon. The purpose of this study was to compare the profitability of facial trauma management for the hospital and the surgeon at the Virginia Commonwealth University (VCU) Medical Center (Richmond, VA).


METHODS
In this retrospective cohort study, records were collected for patients who were seen for primary trauma management by the Department of Oral and Maxillofacial Surgery at VCU (VCUOMS) from June 2011 through July 2014. Cost and reimbursement data were analyzed for these patients from the VCU Health System (VCUHS) and the VCUOMS. For the hospital, actual cost data were provided; for the surgeon, cost was calculated based on an average overhead of 50%. For uniformity, patients were excluded if they remained in the hospital for longer than a 23-hour observation period. Patients younger than 18 years also were excluded.


RESULTS
In total, 169 patients met the inclusion criteria. There was a statistically relevant difference in the percentage of costs recouped and the actual profit. The average percentage of costs recouped was 230% for the VCUHS versus 47% for the VCUOMS. This amounts to an average profit per case of $3,461 for the hospital versus a loss of $1,162 for the surgeon.


CONCLUSIONS
The results of this study indicate that in the VCU Medical Center, maxillofacial trauma yields a net profit for the hospital and a net loss for the operating surgeon. Although the results are limited to outpatient management at 1 academic institution, they suggest that hospitals in some settings might be in a position to incentivize surgeons for trauma management.
Associate Professor and Director of Predoctoral Oral and Maxillofacial Surgery, Virginia Commonwealth University School of Dentistry and Virginia Commonwealth University Medical Center, Richmond, VA. Electronic address: dmdeluke@vcu.edu.
Dean M
DM
DeLuke
Student, Virginia Commonwealth University School of Dentistry, Richmond, VA.
Vickas
V
Agarwal
Resident, Department of Oral and Maxillofacial Surgery, Virginia Commonwealth University Medical Center, Richmond, VA.
Trevor
T
Holleman
Assistant Professor, Virginia Commonwealth University School of Dentistry, Richmond, VA.
Caroline K
CK
Carrico
Adjunct Clinical Professor and Chairman Emeritus, Virginia Commonwealth University School of Dentistry and Virginia Commonwealth University Medical Center, Richmond, VA.
Daniel M
DM
Laskin
D000046:Academic Medical Centers / Q000191:economics / Q000706:statistics & numerical data; D000293:Adolescent; D000328:Adult; D000368:Aged; D017721:Hospital Costs; D006801:Humans; D008446:Maxillofacial Injuries / Q000191:economics* / Q000601:surgery; D008875:Middle Aged; D009055:Mouth / Q000293:injuries*; D012051:Reimbursement Mechanisms / Q000191:economics / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013515:Surgery, Oral / Q000191:economics* / Q000706:statistics & numerical data; D014768:Virginia; D055815:Young Adult