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The financial impact of violence on air medical transport
TRANSPORT OF UNSTABLE RESPIRATORY FAILURE PATIENTS ON EXTRACORPOREAL LIFE SUPPORT
T Pranikoff, S Hager, R Hirschl, R Burney, R Bartlett University of Michigan, Ann Arbor, MI I n t r o d u c t i o n : We have u s e d extracorporeal life s u p p o r t (ECLS) to m a n a g e 51 cases of severe adult respiratory failure with a 57% survival. Thirty-eight patients from outside institutions required emergent transport. Fourteen of these patients were too unstable to be safely t r a n s p o r t e d using c o n v e n t i o n a l v e n t i l a t i o n a n d so w e r e placed on bypass at the referring institution. Methods: Diagnoses included ARDS (n = 8), p n e u m o n i a (n = 5), and asthma (n = 1). PreECLS ventilator s u p p o r t included: FiO2 = 0.98 + 0.07, Rate = 19 + 5, PIP = 57 + 12, PEEP = 14 + 7. Physiologic indicators of severity of respiratory failure included: SaO2 = 84 + 11, PaO2 = 67 + 43, PaCO2 = 48 + 22, p H = Z33 + 0.16, Q s / Q t = 0.48 + 0.12, AaDO2 = 586 + 76, M u r r a y Vent Score = 3.62 + 0.51. Results: Transport with the patient on ECLS was p e r f o r m e d b y g r o u n d a m b u l a n c e without adverse effects. The transport team i n c l u d e d two ECLS physicians, two flight nurses, and two ECLS specialists. Distance transported was a m e d i a n of 43 miles (range 6 - 248 miles). M e d i a n transport time was 8.0 h o u r s ( r a n g e 1.9 13.4 h o u r s ) . E v a l u a t i o n , i n i t i a t i o n of b y p a s s a n d stabilization p r i o r to r e t u r n r e q u i r e d a m e d i a n of 4.6 hours (range 1.1 - 7.0 hours). Twelve of the 14 patients (86%) survived to discharge. Total time on bypass was 223 + 201 hours° Conclusion: Patients with severe respiratory failure w h o are too unstable to transport safely using mechanical ventilation alone m a y be t r a n s p o r t e d on ECLS with a high survival rate.
Air Medical Journal
13:10 October 1994
THE F I N A N C I A L IMPACT O F V I O L E N C E MEDICAL TRANSPORT
ON A I R
N e m a M c E l v e e n , M i c h a e l Sharp, Carl R. Boyd, E l a i n e F r a n t z LIFESTAR, M e m o r i a l M e d i c a l Center, Savannah, G A Introduction: Violent acts are i n c r e a s i n g in b o t h n u m b e r and s e v e r i t y w i t h i n c r e a s i n g n u m b e r s of v i c t i m s b e i n g t r a n s p o r t e d by h o s p i t a l - b a s e d h e l i c o p t e r EMS(HHEMS). A retrospective, descriptive study was u n d e r t a k e n to d e t e r m i n e t h e cost of care and to evaluate the financial impact of v i o l e n c e on air m e d i c a l transport. Methods: C l i n i c a l and f i n a n c i a l d a t a on all v i c t i m s of v i o l e n t t r a u m a w h o w e r e transported by H H E M S between January 1990 and F e b r u a r y 1994 w e r e included. Variables s t u d i e d i n c l u d e d age, race, sex, m e c h a n i s m of injury, p a y o r class, t o t a l charges, and t o t a l c o l l e c t i o n s . T y p e s of v i o l e n t i n j u r i e s i n c l u d e d w e r e g u n s h o t w o u n d s (GSW), stab, and assault. Financial records were reviewed for total charges. Collections for each payor class were based on actual p a y m e n t s received. Results: Two h u n d r e d nine (209) p a t i e n t s w e r e t r a n s p o r t e d for i n j u r i e s r e s u l t i n g from v i o l e n t trauma. Total charges generated by those transports was $638,087.08, and the t o t a l r e i m b u r s e d was $ 1 4 1 , 4 9 6 . 9 6 or 22% c o l l e c t e d . The m e c h a n i s m s of i n j u r y w e r e as follows: G S W : N=155 (74%), Stab: N = 3 6 (17%), and Assault: N=I8 (9%). M e a n age w a s 32, m e a n ISS 21, and m e a n p r o b a b i l i t y of survival .677. T h e r e was an a v e r a g e ICU stay of 8 days, w i t h m e a n t o t a l h o s p i t a l days being 12. Collection analysis revealed that 6% was paid by Medicaid/Medicare, 12% by some f o r m of t h i r d p a r t y payor, and 3% was self pay. Conclusion: Although the number of victims of violence that were t r a n s p o r t e d by H H E M S has n e a r l y d o u b l e d d u r i n g the t i m e p e r i o d of the study, the percentage of charges not recovered r e m a i n s a constant. The o v e r a l l impact of v i o l e n c e on h e a l t h care r e s o u r c e s and s o c i e t y is d i r e c t l y i n f l u e n c e d by the financial profile of these patients t r a n s p o r t e d by HHEMS.
431
T Pranikoff, S Hager, R Hirschl, R Burney, R Bartlett University of Michigan, Ann Arbor, MI I n t r o d u c t i o n : We have u s e d extracorporeal life s u p p o r t (ECLS) to m a n a g e 51 cases of severe adult respiratory failure with a 57% survival. Thirty-eight patients from outside institutions required emergent transport. Fourteen of these patients were too unstable to be safely t r a n s p o r t e d using c o n v e n t i o n a l v e n t i l a t i o n a n d so w e r e placed on bypass at the referring institution. Methods: Diagnoses included ARDS (n = 8), p n e u m o n i a (n = 5), and asthma (n = 1). PreECLS ventilator s u p p o r t included: FiO2 = 0.98 + 0.07, Rate = 19 + 5, PIP = 57 + 12, PEEP = 14 + 7. Physiologic indicators of severity of respiratory failure included: SaO2 = 84 + 11, PaO2 = 67 + 43, PaCO2 = 48 + 22, p H = Z33 + 0.16, Q s / Q t = 0.48 + 0.12, AaDO2 = 586 + 76, M u r r a y Vent Score = 3.62 + 0.51. Results: Transport with the patient on ECLS was p e r f o r m e d b y g r o u n d a m b u l a n c e without adverse effects. The transport team i n c l u d e d two ECLS physicians, two flight nurses, and two ECLS specialists. Distance transported was a m e d i a n of 43 miles (range 6 - 248 miles). M e d i a n transport time was 8.0 h o u r s ( r a n g e 1.9 13.4 h o u r s ) . E v a l u a t i o n , i n i t i a t i o n of b y p a s s a n d stabilization p r i o r to r e t u r n r e q u i r e d a m e d i a n of 4.6 hours (range 1.1 - 7.0 hours). Twelve of the 14 patients (86%) survived to discharge. Total time on bypass was 223 + 201 hours° Conclusion: Patients with severe respiratory failure w h o are too unstable to transport safely using mechanical ventilation alone m a y be t r a n s p o r t e d on ECLS with a high survival rate.
Air Medical Journal
13:10 October 1994
THE F I N A N C I A L IMPACT O F V I O L E N C E MEDICAL TRANSPORT
ON A I R
N e m a M c E l v e e n , M i c h a e l Sharp, Carl R. Boyd, E l a i n e F r a n t z LIFESTAR, M e m o r i a l M e d i c a l Center, Savannah, G A Introduction: Violent acts are i n c r e a s i n g in b o t h n u m b e r and s e v e r i t y w i t h i n c r e a s i n g n u m b e r s of v i c t i m s b e i n g t r a n s p o r t e d by h o s p i t a l - b a s e d h e l i c o p t e r EMS(HHEMS). A retrospective, descriptive study was u n d e r t a k e n to d e t e r m i n e t h e cost of care and to evaluate the financial impact of v i o l e n c e on air m e d i c a l transport. Methods: C l i n i c a l and f i n a n c i a l d a t a on all v i c t i m s of v i o l e n t t r a u m a w h o w e r e transported by H H E M S between January 1990 and F e b r u a r y 1994 w e r e included. Variables s t u d i e d i n c l u d e d age, race, sex, m e c h a n i s m of injury, p a y o r class, t o t a l charges, and t o t a l c o l l e c t i o n s . T y p e s of v i o l e n t i n j u r i e s i n c l u d e d w e r e g u n s h o t w o u n d s (GSW), stab, and assault. Financial records were reviewed for total charges. Collections for each payor class were based on actual p a y m e n t s received. Results: Two h u n d r e d nine (209) p a t i e n t s w e r e t r a n s p o r t e d for i n j u r i e s r e s u l t i n g from v i o l e n t trauma. Total charges generated by those transports was $638,087.08, and the t o t a l r e i m b u r s e d was $ 1 4 1 , 4 9 6 . 9 6 or 22% c o l l e c t e d . The m e c h a n i s m s of i n j u r y w e r e as follows: G S W : N=155 (74%), Stab: N = 3 6 (17%), and Assault: N=I8 (9%). M e a n age w a s 32, m e a n ISS 21, and m e a n p r o b a b i l i t y of survival .677. T h e r e was an a v e r a g e ICU stay of 8 days, w i t h m e a n t o t a l h o s p i t a l days being 12. Collection analysis revealed that 6% was paid by Medicaid/Medicare, 12% by some f o r m of t h i r d p a r t y payor, and 3% was self pay. Conclusion: Although the number of victims of violence that were t r a n s p o r t e d by H H E M S has n e a r l y d o u b l e d d u r i n g the t i m e p e r i o d of the study, the percentage of charges not recovered r e m a i n s a constant. The o v e r a l l impact of v i o l e n c e on h e a l t h care r e s o u r c e s and s o c i e t y is d i r e c t l y i n f l u e n c e d by the financial profile of these patients t r a n s p o r t e d by HHEMS.
431