Hospital reimbursement for pediatric trauma care

Purpose: Despite the proven efficacy of pediatric trauma centers, their continued development is threatened by the perception that their cost exceeds the reimbursement for their services. The authors reviewed actual reimbursement for a group of pediatric trauma patients and compared it with that for a group of appendectomy patients chosen to reflect the authors' surgical population at large. Methods: The records of 209 consecutively treated trauma patients and 37 age-matched appendectomy patients treated in 1992 and 1993 were reviewed. Trauma patients were divided into two groups: moderate injury (ISS ≤ 9; n = 134) and serious injury (ISS ≥ 10; n = 75). Results: Hospital bills for the appendectomy patients were reimbursed at 72% of charges and 112% of costs. Payment was received at a mean of 36 days (range, 9 to 62 days) after discharge. Reimbursement for moderately injured patients was 104% of charges end 137% of costs and was received at a mean of 81 days (range, 3 to 270 days) after discharge. Six months postdischarge, reimbursement for seriously injured patients was 63% of charges and 86% of costs. Reimbursement was slow for some children who sustained severe injury, but as legal actions brought by patients' families were completed, open accounts were settled, and revenue in both groups totaled 76% of charges and 103% of costs 18 months postdischarge. Conclusion: Hospital reimbursement for care at a level I pediatric trauma center exceeds 75% of charges and 100% of costs, no different from the overall rate for the general hospital surgical population. Analysis of reimbursement rates for trauma patients may be time- dependent.