RE: Pt. Scenario

["Paul M. Wright, Jr." <pmwright@home.com>]

> As you may know, auto insurance companies pay claims
> on a "first
> come, first serve" basis, until the maximum payout is reached.  Therefore,
> the scenerio plays out like this.  The small hospital gets the
> patient for a
> couple of hours, they do a complete work up (which will just be
> repeated at
> the trauma center) and then they send them on to an appropriate
> facility for
> definitive care.  Within a couple of days the small hospital's billing
> department makes a claim to the auto insurance and it is paid.  Meanwhile,
> the large trauma center who still has this patient in their ICU, is
> continuing to run up a bill, but can't file a claim until the
> patients care
> is complete.
> >

I'm glad you brought this point up and I had a couple of additional thoughts
to offer.  First is that the air medical company is often able to get their
claim in ahead of even the small hospital.  Minimum liability automobile
coverage in Arizona is about $15k and with air ambulance rates being what
they are, up to 2/3 of that amount can be paid out just to settle the
transport claim.  That being the case, the small hospital and the air
medical company are competing for the same small pot of money and I think
one would have to be naive to think that decisions are not influenced by
that competition.

Second, I think we forget that the demographics of trauma patients differ
with the setting.  In the rural areas, most trauma results from auto
accidents or industrial injury and patients in both categories almost always
have resources from which to recover medical costs.  In the urban areas,
particularly the inner cities, most trauma is crime-related and the patients
tend to have less resources available to cover medical costs.

Additionally, one other trend in hospital finance with regards to trauma
patients covered by HMO plans is to provide the care and accept payment from
the HMO at contract rates but then also file a lien against any money
received by the patient in connection with that accident to recover the
difference between the HMO contract rate and the hospital's full rates.
This can make a big difference as HMO contract rates are often half, or
less, of the hospital's "list" price.  This practice is being challenged as
"double-billing" but as far as I know it is still going on.

Like it or not, decisions about transport destinations often *are* about
money so I think it is useful to avoid unproven axioms such as "trauma
patients always lose money for the hospital" and concentrate instead on
understanding the financial side of healthcare and using that knowledge to
influence decision-making in a way that benefits our patients.  Simply
raging against the machine or pretending money doesn't matter isn't going to
get us where we want to be.

regards!

paul


Paul M. Wright, Jr.
Mesa, AZ









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