Major trauma: the unseen financial burden to trauma centres, a descriptive multicentre analysis
Kate Curtis A B C G , Mary Lam D , Rebecca Mitchell E , Cara Dickson B and Karon McDonnell FA Sydney Nursing School, University of Sydney, 88 Mallet Street, Camperdown, NSW 2050, Australia.
B St George Hospital, Gray Street, Kogarah, NSW 2217, Australia. Email: cara.dickson@sesiahs.health.nsw.gov.au
C The George Institute for Global Health, George Street, Sydney, NSW 2000, Australia.
D Faculty of Health Sciences, University of Sydney, Sydney, NSW 2141, Australia. Email: mary.lam@sydney.edu.au
E Transport and Road Safety Research, University of New South Wales, NSW 2033, Australia. Email: r.mitchell@unsw.edu.au
F St Vincent’s Hospital, Darlinghurst, Sydney, NSW 2010, Australia. Email: kmcdonell@stvincents.com.au
G Corresponding author. Email: kate.curtis@sydney.edu.au
Australian Health Review 38(1) 30-37 https://doi.org/10.1071/AH13061
Submitted: 22 March 2013 Accepted: 18 September 2013 Published: 18 November 2013
Journal Compilation © AHHA 2014
Abstract
Objective This research examines the existing funding model for in-hospital trauma patient episodes in New South Wales (NSW), Australia and identifies factors that cause above-average treatment costs. Accurate information on the treatment costs of injury is needed to guide health-funding strategy and prevent inadvertent underfunding of specialist trauma centres, which treat a high trauma casemix.
Methods Admitted trauma patient data provided by 12 trauma centres were linked with financial data for 2008–09. Actual costs incurred by each hospital were compared with state-wide Australian Refined Diagnostic Related Groups (AR-DRG) average costs. Patient episodes where actual cost was higher than AR-DRG cost allocation were examined.
Results There were 16 693 patients at a total cost of AU$178.7 million. The total costs incurred by trauma centres were $14.7 million above the NSW peer-group average cost estimates. There were 10 AR-DRG where the total cost variance was greater than $500 000. The AR-DRG with the largest proportion of patients were the upper limb injury categories, many of whom had multiple body regions injured and/or a traumatic brain injury (P < 0.001).
Conclusions AR-DRG classifications do not adequately describe the trauma patient episode and are not commensurate with the expense of trauma treatment. A revision of AR-DRG used for trauma is needed.
What is known about this topic? Severely injured trauma patients often have multiple injuries, in more than one body region and the determination of appropriate AR-DRG can be difficult. Pilot research suggests that the AR-DRG do not accurately represent the care that is required for these patients.
What does this paper add? This is the first multicentre analysis of treatment costs and coding variance for major trauma in Australia. This research identifies the limitations of the current AR-DRGS and those that are particularly problematic. The value of linking trauma registry and financial data within each trauma centre is demonstrated.
What are the implications for practitioners? Further work should be conducted between trauma services, clinical coding and finance departments to improve the accuracy of clinical coding, review funding models and ensure that AR-DRG allocation is commensurate with the expense of trauma treatment.
Additional keywords: cost, injury, health economics, health services.
References
[1] Peden M, McGee K, Krug E. Injury: a leading cause of the global burden of disease, 2000. Geneva: World Health Organisation; 2002.[2] Horton R. GBD 2010: understanding disease, injury, and risk. Lancet 2012; 380 2053–4.
| GBD 2010: understanding disease, injury, and risk.Crossref | GoogleScholarGoogle Scholar | 23245595PubMed |
[3] Lyons RA, Finch CF, McClure R, van Beeck E, Macey S. The injury list of all deficits (LOAD) framework – conceptualising the full range of deficits and adverse outcomes following injury and violence. Int J Inj Contr Saf Promot 2010; 17 145–59.
| The injury list of all deficits (LOAD) framework – conceptualising the full range of deficits and adverse outcomes following injury and violence.Crossref | GoogleScholarGoogle Scholar | 19946813PubMed |
[4] Australian Institute of Health and Welfare (AIHW). Australia’s health 2010. Canberra: AIHW; 2010.
[5] Australian Institute of Health and Welfare. Health expenditure Australia 2008–09. Health and welfare expenditure series no. 42. Cat. no. HWE 51. Canberra: AIHW; 2010.
[6] Australian Institute of Health and Welfare. Australian hospital statistics 2008–09. Health services series no. 17. Cat. no. HSE 84. Canberra: AIHW; 2010.
[7] Willenberg L, Curtis K, Taylor C, Jan S, Glass P, Myburgh J. The variation of acute treatment costs of trauma in high-income countries. BMC 2012; 12 267
| The variation of acute treatment costs of trauma in high-income countries.Crossref | GoogleScholarGoogle Scholar |
[8] Curtis K, Lam M, Mitchell R, Black DA, Taylor C, Dickson C, et al Acute costs and predictors of higher treatment costs of trauma in New South Wales, Australia. Injury 2010;
| Acute costs and predictors of higher treatment costs of trauma in New South Wales, Australia.Crossref | GoogleScholarGoogle Scholar |
[9] NSW Health Department. NSW health episode funding policy 2008/2009. 2010. Available at http://www.health.nsw.gov.au/policies/pd/2008/PD2008_063.html v[verified 16 April 2010]
[10] Curtis K, Bollard L, Dickson C. Coding errors and the trauma patient – is nursing case management the solution? Aust Health Rev 2002; 25 73–80.
| Coding errors and the trauma patient – is nursing case management the solution?Crossref | GoogleScholarGoogle Scholar | 12404969PubMed |
[11] Eager K, Harvey R. Australia not ready to implement ‘best practice’ health financing model. Healthcover 2001; 10 52–6.
[12] Rotondo MF, Bard MR, Sagraves SG, Toschlog EA, Schenarts PJ, Goettler CE, et al What price commitment: What benefit? The cost of a saved life in a developing level 1 Trauma Center. J Trauma Inj Infect Crit Care 2009; 67 915–23.
| What price commitment: What benefit? The cost of a saved life in a developing level 1 Trauma Center.Crossref | GoogleScholarGoogle Scholar |
[13] Campbell A, Vittinghoff E, Morabito D, Paine P, Shagoury C, Praetz P, et al Trauma centres in a managed care environment. J Trauma Inj Infect Crit Care 1995; 39 246–53.
| Trauma centres in a managed care environment.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK2MvgsVOjug%3D%3D&md5=673ff2a1e79456659feb433a17eb3996CAS |
[14] Grotz M, Schwermann T, Lefering R, Ruchholtz S, Schulenburg JMGVD, Krettek C, et al [G-DRG reimbursement for polytrauma patients – a comparison with the comprehensive hospital costs using the German trauma registry Unfallchirurgische 2004; 107 68–75.
| 1:STN:280:DC%2BD2c%2FkvFejtQ%3D%3D&md5=9b0ade9ce0792e04a1203e26f9a521f0CAS |
[15] Curtis K, Mitchell R, Dickson C, Black D, Lam M. Do AR-DRGs adequately describe the trauma patient episode in New South Wales, Australia? Health Information Management Journal 2011; 40 7–13.
| 21430303PubMed |
[16] Jacobs B, Jacobs L. The effect of the new trauma DRGs on reimbursement. J Trauma Inj Infect Crit Care 1992; 33 495–503.
| The effect of the new trauma DRGs on reimbursement.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK3s%2FlvFGjtQ%3D%3D&md5=6db96f26725c290f57559a0eb3601309CAS |
[17] NSW Health. Selected specialty and statewide services plans number six. NSW Trauma Services Plan. North Sydney: NSW Health; 2009.
[18] PowerHealth Solutions. Powerperformance management Adelaide 2006. Available at http://www.powerhealthsolutions.com/products/PPM/ [verified 14 February 2012]
[19] NSW Health Department. 2006–2007 NSW program and product data collection standards incorporating subacute and non-acute and national minimum dataset for mental health establishments’ data collection requirements. North Sydney: NSW Health Department; 2007.
[20] NSW Health Department. Episode funding policy 2008/2009 NSW. Sydney: NSW Health; 2008. Available at: http://www.health.nsw.gov.au/policies/pd/2008/PD2008_063.html. 1–30 [verified October 2013]
[21] Australian Tax Office. Foreign currency exchange rates for financial year 2009 foreign currency equivalent to $1 Aust. Canberra: Australian Government; 2010. Available at http://www.ato.gov.au/taxprofessionals/content.aspx?doc=/content/00228489.htm [verified October 2013]
[22] Association for the Advancement of Automotive Medicine. The abbreviated injury scale 2005 – update 2008. Barrington, IL: Association for the Advancement of Automotive Medicine; 2008.
[23] Palmer C. Major trauma and the injury severity score – where should we set the bar? Annu Proc Assoc Adv Automot Med 2007; 51 13
| 18184482PubMed |
[24] Holbrook T, Hoyt D, Anderson J. The impact of major in-hospital complications on functional outcome and quality of life after trauma. J Trauma Inj Infect Crit Care 2001; 50 91–5.
| The impact of major in-hospital complications on functional outcome and quality of life after trauma.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD3MzmslWhtA%3D%3D&md5=1f72b5f00a9cee42fad8904cc6189fb6CAS |
[25] NSW Institute of Trauma and Injury Management. The NSW trauma registry profile of serious to critical injuries 2007. Sydney: NSW Institute of Trauma and Injury Management; 2012. Available at http://www.itim.nsw.gov.au [verified 29 August 2012]
[26] Cameron PA, Gabbe BJ, Cooper DJ, Walker T, Judson R, McNeil J. A statewide system of trauma care in Victoria: effect on patient survival. Med J Aust 2008; 189 546–50.
| 19012550PubMed |
[27] SPSS. SPSS: Statistical Program for the Social Sciences version 20. Armonk: IBM; 2012.
[28] Rowell D, Connelly L, Webber J, Tippett V, Thiele D, Schuetz M. What are the true costs of major trauma? J Trauma Inj Infect Crit Care 2011; 70 1086–95.
| What are the true costs of major trauma?Crossref | GoogleScholarGoogle Scholar |
[29] Gabbe BJ, Biostat GD, Lecky FE, Bouamra O, Woodford M, Jenks T, et al The effect of an organized trauma system on mortality in major trauma involving serious head injury: a comparison of the United Kingdom and Victoria, Australia. Ann Surg 2011; 253 138–43.
| The effect of an organized trauma system on mortality in major trauma involving serious head injury: a comparison of the United Kingdom and Victoria, Australia.Crossref | GoogleScholarGoogle Scholar | 21233612PubMed |
[30] Celso B, Tepas J, Langland-Orban B, Pracht E, Papa L, Lottenberg L, et al A systematic review and meta-analysis comparing outcome of severely injured patients treated in trauma centers following the establishment of trauma systems. J Trauma Inj Infect Crit Care 2006; 60 371–8.
| A systematic review and meta-analysis comparing outcome of severely injured patients treated in trauma centers following the establishment of trauma systems.Crossref | GoogleScholarGoogle Scholar |
[31] Curtis KA, Mitchell RJ, Chong SS, Balogh ZJ, Reed DJ, Clark PT, et al Injury trends and mortality in adult patients with major trauma in New South Wales. Med J Aust 2012; 197 233–7.
| Injury trends and mortality in adult patients with major trauma in New South Wales.Crossref | GoogleScholarGoogle Scholar | 22900875PubMed |
[32] Taheri P, Butz D, Watts C, Giffes L, Greenfield L. Trauma services: a profit center? J Am Coll Surg 1999; 188 349–54.
| Trauma services: a profit center?Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK1M3htVSqsA%3D%3D&md5=d74b7bef1da79c34a8b47394f2af1f9aCAS | 10195717PubMed |
[33] Curtis K, Bollard L, Dickson C.. Coding errors and the trauma patient – is nursing case management the solution? Aust Health Rev 2002; 25 73–80.
| Coding errors and the trauma patient – is nursing case management the solution?Crossref | GoogleScholarGoogle Scholar | 12404969PubMed |
[34] Watson WL, Ozanne-Smith J, Monash University Accident Research Centre. The cost of injury to Victoria. Melbourne: Monash University Accident Research Centre; 1997.
[35] Moczygemba J, Fenton SH. Lessons learned from an ICD-10-CM clinical documentation pilot study. Perspec Health Info Manag 2012; (Winter): 9.
[36] Santos S, Murphy G, Baxter K, Robinson KM. Organisational factors affecting the quality of hospital clinical coding. Health Inf Manag 2008; 37 25–37.
[37] Health Education and Training Institute. Clinical Coding Workforce Enhancement Project. Sydney: NSW Ministry of Health 2012. Available at http://www.heti.nsw.gov.au/programs/clinical-coding-workforce-enhancement-project/ [verified 15 October 2013]
[38] Butcher N, Balogh ZJ. The definition of polytrauma: the need for international consensus. Injury 2009; 40 S12–22.
| The definition of polytrauma: the need for international consensus.Crossref | GoogleScholarGoogle Scholar | 19895948PubMed |
[39] Pape HC, Neugebauer E, Ridley SA, Chiara O, Nielsen TG, Christensen MC. Cost-drivers in acute treatment of severe trauma in Europe: a systematic review of literature. Eur J Trauma Emerg Surg. 2009; 35 61–6.
| Cost-drivers in acute treatment of severe trauma in Europe: a systematic review of literature.Crossref | GoogleScholarGoogle Scholar |
[40] Callaway DW, Wolfe R. Geriatric trauma. Emerg Med Clin North Am 2007; 25 837–60.
| Geriatric trauma.Crossref | GoogleScholarGoogle Scholar | 17826220PubMed |
[41] World Health Organization. Global status report on road safety: time for action. Geneva: WHO; 2009.
[42] Hayen A, Mitchell R. A description of interpersonal violence-related hospitalisations in NSW. NSW Public Health Bull 2006; 17 8–12.
[43] Forum on Global Violence Prevention Institute of Medicine. Medicine Io. Social and economic costs of violence: workshop summary. Washington DC: National Academies Press; 2012.
[44] Ivers R. School based programs for prevention of violence: do they work? Inj Prev 2006; 12 351
| School based programs for prevention of violence: do they work?Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD28rovVOrsA%3D%3D&md5=540d09e7d58a2f9fbb4829d9717ffa77CAS | 17018681PubMed |
[45] Banfield JM, Gomez M, Kiss A, Redelmeier DA, Brenneman F. Effectiveness of the PARTY (prevent alcohol and risk-related trauma in youth) program in preventing traumatic injuries: a 10-year analysis. J Trauma 2011; 70 732–5.
| Effectiveness of the PARTY (prevent alcohol and risk-related trauma in youth) program in preventing traumatic injuries: a 10-year analysis.Crossref | GoogleScholarGoogle Scholar | 21610366PubMed |
