Opportunity Cost of Surgical Management of Craniomaxillofacial Trauma: A Longitudinal Study.

Study design: Single-institution retrospective financial analysis.

Objective: Trauma care is consistently linked to inadequate reimbursement, posing a significant financial burden for large trauma centers. Data show that declining Medicare reimbursement rates have indirectly led to declining payment for all procedures covered by insurance. The goals of this study are to investigate the opportunity cost associated with contemporary surgical management of CMF trauma at our institution and to evaluate longitudinal financial trends.

Methods: Patients with operative facial fractures between 2015 and 2022 at Duke University Medical Center were included and compared to patients undergoing general otolaryngology, plastic surgery and oral surgery operations in the same period. Procedural codes, payor type, charges billed, collections, relative value units (RVUs) and other financial data were obtained and analyzed among the 2 patient populations. Comparative analysis was performed to assess the financial trends in data reported previously from 2007-2015.

Results: The collection rate at Duke University Medical Center for operatively managed CMF fractures remains significantly lower than non-CMF counterparts. Interestingly, the collection rate gap between CMF and non-CMF surgeries has narrowed when comparing to the data from 2007-2013. This is largely due to a decrease in collection rates for non-CMF procedures from 29.61% (2007-2013) to 26.57% (2015-2022) [P = 0.0001] and an increase in collection rates for CMF procedures from 17.25% (2007-2013) to 18.05% (2015-2022) [P = 0.0001].

Conclusions: Despite a slight improvement of the gap in reimbursement rates for CMF and non-CMF surgeries over the last several years, trauma care continues to have a negative financial impact on health care institutions.