Improving trauma center financial performance through operational efficiency

A prominent Level I Trauma Center in the northeast was looking to improve their billing procedure processes to become more efficient and increase revenue. The hospital partnered with Philips to perform a financial performance evaluation and develop a strategic approach for optimal trauma center billing management. 

It is well established that the expense of maintaining a trauma center is substantial. If not properly managed, trauma services can become a financial drain on the institution. The hospital had recently undergone two performance improvement initiatives which resulted in improved time to reversal agents from four hours to ninety minutes and a reduced non-surgical admission rate from 28% to 5%, exceeding the national standard of 10%. However, these efficiencies were not translated into expected financial gain. 

Analysis of the data provided by the hospital included all patients who received a “Full” or “Modified” trauma team activation. A discrepancy identified a difference of 210 records without FL 14, Type 5 designation who met criteria for inclusion. Omission of FL 14, Type 5 for these patients indicated the inability to submit a bill for the activation fee (UB 681). Review of the UB 681 identified another discrepancy in coding critical care time of more than $460,000 in lost charges. In addition, UB 208 had not been implemented which would add more than $650,000 in additional annual charge capture.

Philips consultants recommended creating a finance committee to implement suggested changes, which could result in an estimated increase in annual gross charges of more than $1.5 million. But more importantly they could reduce over and under triage rates to industry norms.