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Insurance Status a Factor in Trauma Care, Study Says

Cheryl Clark, for HealthLeaders Media, February 24, 2014

The Pennsylvania research team used the 2009 Nationwide Emergency Department Sample to analyze 19,312 encounters involving adult major trauma patients under age 65 in 636 non-trauma center emergency departments whether they were admitted or transferred.

Compared with patients who were uninsured, those who were covered by Medicaid had a rate of admission vs. transfer that was 14.3% higher, the researchers found. Medicare patients were 13.2% more likely to be admitted than transferred, privately insured patients were 11.2% more likely to be admitted and patients with other commercial insurance 13.1% to be admitted to the non-trauma hospital.

Questions About the Study
In an accompanying invited commentary, "Does a Wallet Biopsy Lead to Inappropriate Trauma Patient Care?" Charles Mabry, MD, of the University of Arkansas for Medical Sciences Department of Surgery in Little Rock, raised several concerns about the Penn report:

  • The study assumed all patients who were transferred were transferred to a trauma center, but that may not have been the case, Mabry suggests.
  • The study removed a large segment of the severely injured population, those covered by Medicare, which may have skewed the data.
  • Availability of specialists at trauma centers may have influenced the non-trauma hospital's decision to admit the patient.
  • How did the physicians at the non-trauma center know the patient's insurance status? "It is a common observation that a patient's financial status listed at the time of injury on the ED medical record is often misleading or completely wrong," Mabry wrote.

Lastly, he wrote, with more emergency room physicians becoming hospital employees, "it will be interesting to se if that change in compensation will have any influence on the decisions to admit or transfer."

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