Total inpatient treatment costs in patients with severe burns: towards a more accurate reimbursement model

Abstract

PRINCIPLES: Reimbursement systems have difficulties depicting the actual cost of burn treatment, leaving care providers with a significant financial burden. Our aim was to establish a simple and accurate reimbursement model compatible with prospective payment systems. METHODS: A total of 370 966 electronic medical records of patients discharged in 2012 to 2013 from Swiss university hospitals were reviewed. A total of 828 cases of burns including 109 cases of severe burns were retained. Costs, revenues and earnings for severe and nonsevere burns were analysed and a linear regression model predicting total inpatient treatment costs was established. RESULTS: The median total costs per case for severe burns was tenfold higher than for nonsevere burns (179 949 CHF [167 353 EUR] vs 11 312 CHF [10 520 EUR], interquartile ranges 96 782–328 618 CHF vs 4 874–27 783 CHF, p <0.001). The median of earnings per case for nonsevere burns was 588 CHF (547 EUR) (interquartile range –6 720 – 5 354 CHF) whereas severe burns incurred a large financial loss to care providers, with median earnings of –33 178 CHF (30 856 EUR) (interquartile range –95 533 – 23 662 CHF). Differences were highly significant (p <0.001). Our linear regression model predicting total costs per case with length of stay (LOS) as independent variable had an adjusted R2of 0.67 (p <0.001 for LOS). CONCLUSIONS: Severe burns are systematically underfunded within the Swiss reimbursement system. Flat-rate DRG-based refunds poorly reflect the actual treatment costs. In conclusion, we suggest a reimbursement model based on a per diem rate for treatment of severe burns.

Keywords

• Cost
• prospective payment system
• SwissDRG
• earnings
• economics