NEW ORLEANS — Charges for traumatic brain injury combined with other trauma are much higher than for trauma alone—and they climb in the months after discharge, a factor that should be taken into account when negotiating reimbursement rates with managed care organizations, Dr. Bartholomew Tortella said at the annual meeting of the American Association for the Surgery of Trauma.
Dr. Tortella, a trauma surgeon and professor of surgery at Drexel University, Philadelphia, presented an analysis of claims for 12,554 adults who were hospitalized for blunt or penetrating trauma from January 2003 to February 2005.
The data came from managed care claims tabulated by Ingenix Inc., a consulting subsidiary of UnitedHealth Group. The database included only charges, not actual costs, and was more representative of the South and Midwest than the North and West, said Dr. Tortella, who is also global trauma program director at Novo Nordisk Inc.
Dr. Tortella and his colleagues looked at charges for isolated trauma, isolated traumatic brain injury (TBI), and combined trauma and TBI. There were 8,203 patients with isolated trauma, 2,133 with isolated TBI, and 2,218 with trauma combined with TBI. The mean age was close to 50 years for each of the cohorts. The Abbreviated Injury Scale (AIS) at initial injury was 2.25 for trauma without TBI and 2.55 for isolated TBI. Half of the combined trauma and TBI group had an extremely high AIS score (16 or higher); the mean for the group was 2.98.
Although most patients with severe trauma were treated at level I trauma centers, 40% overall—and almost half of isolated trauma or isolated TBI patients—did not go to a trauma center, he said.
The combined trauma and TBI patients spent about 10 days as inpatients than did isolated trauma or isolated TBI patients, and 5 of those days were spent in the intensive care unit, he said.
Analysis of inpatient charges showed that isolated TBI was lowest at $32,000, trauma without TBI ran $43,000, and combination charges were $103,000.
In the months after discharge, outpatient costs were surprisingly high, Dr. Tortella said. For trauma without TBI, those charges ran $11,600, and for isolated TBI, they were $9,300. For combined trauma and TBI, outpatient and ancillary charges were $16,000.
“If you're not building [those charges] into the cost structure you negotiate with the insurers, that's a large opportunity for you to lose money,” he said.
Novo Nordisk funded the study.
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