{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,19]],"date-time":"2025-09-19T07:41:40Z","timestamp":1758267700569},"reference-count":14,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"9","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2018,9]]},"abstract":"\n Objective:<\/jats:title>\n To characterize the charges and collections associated with the initial inpatient management of trauma patients who undergo operative fracture management.<\/jats:p>\n <\/jats:sec>\n \n Design:<\/jats:title>\n Retrospective.<\/jats:p>\n <\/jats:sec>\n \n Setting:<\/jats:title>\n Level 1 trauma center.<\/jats:p>\n <\/jats:sec>\n \n Participants:<\/jats:title>\n Four hundred forty consecutive, adult, trauma patients.<\/jats:p>\n <\/jats:sec>\n \n Intervention:<\/jats:title>\n Fixation for fracture of the spine, pelvis, acetabulum, and\/or femur fractures.<\/jats:p>\n <\/jats:sec>\n \n Main Outcome Measures:<\/jats:title>\n Professional and technical (facility) charges and collections from the initial inpatient management and 6 months of subsequent related care.<\/jats:p>\n <\/jats:sec>\n \n Results:<\/jats:title>\n Patients were predominantly male (74.3%) and white (63.2%) with a mean age of 41 years and mean injury severity score of 18.5. Uninsured (self-pay) patients represented the largest payer class (35.0%), and 34.5% of all patients were unemployed. Professional and technical charges totaled US $12,382,028 (US $28,140\/patient) and US $39,682,225 (US $90,187\/patient), respectively. Injury severity score, longer lengths of stay (LOS), and the presence of a complication were positive predictors of initial charges (P<\/jats:italic> < 0.0001; adjusted R<\/jats:italic>\n 2<\/jats:sup> = 0.799). Professional and technical collections totaled US $2,418,096 (US $5,496\/patient) and US $16,921,959 (US $38,459\/patient) (percent of charge: 21.5% vs. 41.3%; P<\/jats:italic> < 0.0001). Of the self-pay patients, 34.4% had no collections, resulting in potential lost revenue of US $2,513,988. Greater collections were predicted to occur in females, employed patients, and those with insurance (P<\/jats:italic> < 0.0001; adjusted R<\/jats:italic>\n 2<\/jats:sup> = 0.35).<\/jats:p>\n <\/jats:sec>\n \n Conclusions:<\/jats:title>\n Trauma patients often present without insurance, which compromises hospital revenue. Expectedly, charges are higher in more severely injured patients, those with longer LOS, and those experiencing complications. A bundled model will proportionately decrease reimbursements for a given episode of care in the event of longer LOS or occurrence of complications.<\/jats:p>\n <\/jats:sec>","DOI":"10.1097\/bot.0000000000001192","type":"journal-article","created":{"date-parts":[[2018,5,9]],"date-time":"2018-05-09T05:42:16Z","timestamp":1525844536000},"page":"433-438","source":"Crossref","is-referenced-by-count":14,"title":["Revenue for Initial Orthopaedic Trauma Care: Effects of Patient and Injury Characteristics"],"prefix":"10.1097","volume":"32","author":[{"given":"Christopher D.","family":"Flanagan","sequence":"first","affiliation":[{"name":"Department of Orthopaedics, Case Western Reserve University School of Medicine, Cleveland, OH;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexander S.","family":"Rascoe","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, Case Western Reserve University School of Medicine, Cleveland, OH;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David M.","family":"Wang","sequence":"additional","affiliation":[{"name":"Case Western Reserve University School of Medicine, Cleveland, OH; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Heather A.","family":"Vallier","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, MetroHealth Medical Center, Cleveland, OH."}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","reference":[{"key":"R2-20230828","doi-asserted-by":"crossref","first-page":"166","DOI":"10.1377\/hlthaff.2016.1330","article-title":"National health spending: faster growth in 2015 as coverage expands and utilization increases","volume":"36","author":"Martin","year":"2017","journal-title":"Health Aff."},{"key":"R3-20230828","doi-asserted-by":"crossref","first-page":"701","DOI":"10.1056\/NEJMp1006602","article-title":"New technology and health care costs\u2014the case of robot-assisted 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