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Trauma center funding: time for an update

BACKGROUND: Uncompensated care (UC) is healthcare provided with no payment from the patient or an insurance provider. UC directly contributes to escalating healthcare costs in the USA and potentially impacts patient care. In Texas, there has been a steady increase in the number of trauma centers and...

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Autores principales: Grossman Verner, Heather M, Figueroa, Brian A, Salgado Crespo, Marcos, Lorenzo, Manuel, Amos, Joseph D
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8340286/
https://www.ncbi.nlm.nih.gov/pubmed/34423132
http://dx.doi.org/10.1136/tsaco-2020-000596
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author Grossman Verner, Heather M
Figueroa, Brian A
Salgado Crespo, Marcos
Lorenzo, Manuel
Amos, Joseph D
author_facet Grossman Verner, Heather M
Figueroa, Brian A
Salgado Crespo, Marcos
Lorenzo, Manuel
Amos, Joseph D
author_sort Grossman Verner, Heather M
collection PubMed
description BACKGROUND: Uncompensated care (UC) is healthcare provided with no payment from the patient or an insurance provider. UC directly contributes to escalating healthcare costs in the USA and potentially impacts patient care. In Texas, there has been a steady increase in the number of trauma centers and UC volumes without an increase in trauma funding of UC. The method of calculating UC trauma funds in Texas is imprecise as it is driven by Medicaid volumes and not actual trauma care costs. METHODS: Five years of annual trauma UC disbursement reports from the Texas Department of State Health Services were used to determine changes in UC economic considerations for level I, II, and III trauma centers in the largest urban trauma service areas (TSAs). Data for UC costs, compensation, and TSA demographics were used to assess variations. Statistical significance was determined using a Kruskal-Wallis test with Dunn’s pairwise comparison post-hoc analysis and logistic regression. RESULTS: TSA-E (Dallas-Fort Worth area) has 33% of the level I trauma centers in Texas (n=6) and yet serves only 27% of the total state population across 14 metropolitan and 5 non-metropolitan counties. Since 2015, TSA-E has shown higher UC costs (p<0.02) and lower reimbursement (p<0.01) than the second largest urban hub, TSA-Q (Houston area). TSA-E level I trauma centers trended towards decreased UC reimbursements. DISCUSSION: The unregulated expansion of trauma centers in Texas has led to an unprecedented increase in hospitals participating in trauma care. The unbalanced allocation of UC funding could lead to further economic instability, compromise resource allocation, and negatively impact patient care in an already fragile healthcare environment. LEVEL OF EVIDENCE: Level IV; Retrospective economic analysis and evaluation.
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spelling pubmed-83402862021-08-20 Trauma center funding: time for an update Grossman Verner, Heather M Figueroa, Brian A Salgado Crespo, Marcos Lorenzo, Manuel Amos, Joseph D Trauma Surg Acute Care Open Original Research BACKGROUND: Uncompensated care (UC) is healthcare provided with no payment from the patient or an insurance provider. UC directly contributes to escalating healthcare costs in the USA and potentially impacts patient care. In Texas, there has been a steady increase in the number of trauma centers and UC volumes without an increase in trauma funding of UC. The method of calculating UC trauma funds in Texas is imprecise as it is driven by Medicaid volumes and not actual trauma care costs. METHODS: Five years of annual trauma UC disbursement reports from the Texas Department of State Health Services were used to determine changes in UC economic considerations for level I, II, and III trauma centers in the largest urban trauma service areas (TSAs). Data for UC costs, compensation, and TSA demographics were used to assess variations. Statistical significance was determined using a Kruskal-Wallis test with Dunn’s pairwise comparison post-hoc analysis and logistic regression. RESULTS: TSA-E (Dallas-Fort Worth area) has 33% of the level I trauma centers in Texas (n=6) and yet serves only 27% of the total state population across 14 metropolitan and 5 non-metropolitan counties. Since 2015, TSA-E has shown higher UC costs (p<0.02) and lower reimbursement (p<0.01) than the second largest urban hub, TSA-Q (Houston area). TSA-E level I trauma centers trended towards decreased UC reimbursements. DISCUSSION: The unregulated expansion of trauma centers in Texas has led to an unprecedented increase in hospitals participating in trauma care. The unbalanced allocation of UC funding could lead to further economic instability, compromise resource allocation, and negatively impact patient care in an already fragile healthcare environment. LEVEL OF EVIDENCE: Level IV; Retrospective economic analysis and evaluation. BMJ Publishing Group 2021-08-04 /pmc/articles/PMC8340286/ /pubmed/34423132 http://dx.doi.org/10.1136/tsaco-2020-000596 Text en © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. https://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) .
spellingShingle Original Research
Grossman Verner, Heather M
Figueroa, Brian A
Salgado Crespo, Marcos
Lorenzo, Manuel
Amos, Joseph D
Trauma center funding: time for an update
title Trauma center funding: time for an update
title_full Trauma center funding: time for an update
title_fullStr Trauma center funding: time for an update
title_full_unstemmed Trauma center funding: time for an update
title_short Trauma center funding: time for an update
title_sort trauma center funding: time for an update
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8340286/
https://www.ncbi.nlm.nih.gov/pubmed/34423132
http://dx.doi.org/10.1136/tsaco-2020-000596
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