Between 2007 and 2009 Medicare reimbursement of professional fees increased slightly, and the number of Medicare maxillofacial trauma patients increased from 2% to 5%. The future of Medicare will depend on recent health care legislation, the aging of the population, and the health of federal budgets. Emergency departments and trauma centers are the safety net for trauma care in the United States, and oral and maxillofacial surgeons (OMS) are on the front lines of treating facial trauma. Articulation of OMS contributions are necessary to inform organizations like the American College of Surgeons who removed “oral/maxillofacial surgery” from its 2006 publication, Resources for Optimal Care of the Injured Patient. This study is a comprehensive analysis of the Medicare facial trauma care provided by OMS with comparison to other payer groups at a level one trauma center. Deidentified data were collected for all facial trauma patients treated by the OMS department at Nashville, Tennessee's only level one trauma center during 2010. Patients were identified by ICD-9 codes to include all maxillofacial trauma. Patients with isolated dentoalveolar injuries were excluded, but isolated soft tissue injuries were included. Data collected included patient age, race, sex, length of stay, maxillofacial injury (ICD-9 code), maxillofacial procedures performed (CPT), charges, collections, contractuals, and necessary write-offs to the patients, provider, and insurer. Summary statistics were collected based on payer status and demographics and compared across different groups with the use of independent T-test where appropriate. The variance in reimbursement of professional charges across payers was calculated with a charge recovery ratio (collections/charges). Correlation statistics and χ2 tests were used as measures of association and variance between demographics, procedures, and financial variables. In 2010, 335 patients (611 procedures) were treated for facial trauma, and 29 (8.7%) of these patients were Medicare patients. Mean age was 36.01 (1.49-90.53, SD 19.23), while mean Medicare age was 67 (31-91, SD 19). Professional fees averaged $6,632 overall, while Medicare patient bills averaged $8,235. Average charges for individual procedures based on ICD-9 was $2,825, and average collections were $739, compared to average Medicare charges and collections of $3,227 and $475, respectively. Medicare average charge per procedure was second only to charges to workers compensation patients ($3,336 vs $3,227), and the collections were lowest of any payer group ($475). Percent reimbursement (collections/charges) was also lowest for Medicare patients at 13.8%, nearly 3.5 times less than the highest reimbursement group. As age increased, charges decreased and collections increased, but these associations were loosely correlated. Medicare had the lowest reimbursement for midface procedures at 13% with an average of only $394 collected per procedure. Mandible (15%) and soft tissue (10%) reimbursement was also the lowest for Medicare patients. Across all patients and procedures, Medicare soft tissue procedures averaged the least at $67. In this sample hospital charges averaged $97,829 (SD $127,136) with length of stay averaging 5.35 days. Medicare maxillofacial trauma patients currently comprise a small percentage of overall patients at this level one trauma center; however, with expected increases in Medicare enrollment, hospitals will struggle to compensate for the alarmingly low reimbursements. Epidemiologic and financial awareness of Medicare patients will equip OMS clinicians with the information needed to advocate for Medicare financing, and ensure continued involvement for OMS at trauma centers and through residency training.
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Jun 1, 2014
T Lugarinho + 5
Open Access