[Emergency room and major trauma treatment is a "loss-making business" : A Swiss trauma center experience with current DRG reimbursement]

Thomas Gross, Felix Amsler, Thomas Gross, Felix Amsler

Abstract

Background: The study objective was to find out how cost-covering the treatment of patients with a potentially severe injury actually is in a Swiss trauma center and to what extent hospital profits/losses correlate with patient-related accident, treatment and outcome variables.

Methods: Analysis of all patients hospitalized in a Swiss trauma center in 2018 following treatment in the emergency room (ER) and/or with a significant injury (new injury severity score, NISS ≥8). Hospital cost-benefit calculation using current Swiss diagnosis-related groups (DRG) and the REKOLE© billing system (univariate and multivariate analysis; p < 0.05).

Results: From a hospital point of view, the study cohort (n = 513; Ø NISS = 18) generated a deficit of 1.8 million CHF. This corresponded to a total coverage of 86%, with 66% of cases incurring a loss (71% of statutory insurance vs. 42% of privately insured; p < 0.001). On average, the deficit was 3493 CHF per patient (4545 CHF for statutory insurance vs. 1318 CHF for privately insured; p < 0.001), with a loss also in 63% of inliers and underliers (DRG). The ER cases more frequently caused a financial loss than non-ER cases (73% vs. 58%; p = 0.002) or traumatology vs. neurosurgery cases (72% vs. 55%; p < 0.001). In multivariable analysis 43% of the variance of financial returns were explained by the studied parameters. In contrast, only 11% (adjusted R2) of the variance of the hospital cover ratio could be described by the variables ER, surgical specialty, intensive care, thoracic injury and hospital mortality. The case mix index (DRG) and type of insurance added a further 13% to a total of 24% explained variance.

Conclusion: From a Swiss trauma center point of view only one third of emergencies are not loss-making, most of all privately insured patients or cases billable via a combined polytrauma and head trauma DRG.

Keywords: Diagnosis Related Groups (DRG); Economics; Health insurance reimbursement; Hospital costs; Trauma center.

© 2020. The Author(s).

Figures

https://www.ncbi.nlm.nih.gov/pmc/articles/instance/8397679/bin/113_2020_937_Fig1_HTML.jpg
https://www.ncbi.nlm.nih.gov/pmc/articles/instance/8397679/bin/113_2020_937_Fig2_HTML.jpg

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