Copyright © 2007 by The Journal of Bone and Joint Surgery, Inc.
Commentary & Perspective
Commentary & Perspective by
Marc F. Swiontkowski, MD*,
University of Minnesota Medical School, Minneapolis, MN
Posted December 2007
With the number of uninsured patients increasing in the United States, trauma centers have an increasing concern that they will become the recipients of a disproportionate share of trauma patients with orthopaedic injuries. Indeed, trauma centers currently treat minor orthopaedic injuries that should be cared for in community hospitals.
In their study, Archdeacon et al. focused on femoral shaft fractures, a relatively common musculoskeletal injury in a young and generally male population that is frequently uninsured. The data set was obtained from the billing department of a health-care system composed of six hospitals. The diagnosis of a femoral shaft fracture is fairly straightforward, and the treatment is one that is well accepted. Also, it is fairly broadly accepted that appropriate management of a femoral shaft fracture is well within the training of most general orthopaedic surgeons.
The investigators focused on a cohort that had been definitively managed within the level-I center (71% of the 243 patients), as well as the thirty-eight patients (16%) who were transferred. After using well-accepted transfer criteria to identify the patients who were appropriately transferred and after taking care to adjust for injury severity and orthopaedic coverage, they then looked at the status of insurance coverage for the patients who were transferred to the level-I center and the patients who were retained and treated in their community hospitals. Fifty-eight percent of those transferred were uninsured, and all thirty-three who were not transferred were insured.
This study documents a situation that should be of increasing concern to the orthopaedic community. We must recognize the negative impact that transfer of uninsured patients with a straightforward orthopaedic condition has on the financial performance of the practitioner as well as the level-I institution. This is a matter for resolution at the community level and is one that will require orthopaedic leadership. It should not be left for the legislative arena.
*The author did not receive any outside funding or grants in support of his research for or preparation of this work. Neither he nor a member of his immediate family received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the author, or a member of his immediate family, is affiliated or associated.
|
