Alternative payment models: can (should) trauma care be bundled?

Area of Science:

• Trauma Surgery
• Health Economics
• Healthcare Policy

Background:

• Legislation mandates a shift from fee-for-service to alternative payment models (APMs), including service bundling.
• Trauma care feasibility for APMs requires analysis of current practices.
• A state-designated level I trauma center's two-year experience was evaluated.

Purpose of the Study:

• To determine the feasibility of implementing service bundling for trauma care within APMs.
• To analyze the consistency and predictability of injury profiles in trauma patients.
• To identify potential areas for process improvement in trauma care delivery.

Main Methods:

• Patient data from 2014-2015 were reviewed to create unique 'trauma bundles' based on Abbreviated Injury Scale (AIS) scores.
• Injury profiles were analyzed for frequency and variations between years.
• Correlations between injury profiles, survival probability (Ps), and intensive care unit length of stay (ICU LOS) were assessed.

Main Results:

• Over two years, 5813 patients generated 858 distinct injury profiles, with only 8% occurring frequently (>12 times).
• Significant frequency variations in injury profiles were observed between 2014 and 2015.
• Analysis of frequent injury patterns revealed an inverse correlation between standard deviation (SD) of Ps (R²=0.68) and a direct correlation for ICU LOS (R²=0.84).

Conclusions:

• The heterogeneity of injury patterns and physiological responses makes predictable bundling for trauma APMs challenging.
• Increasing SD in injury profiles correlates with decreased survival probability and increased ICU LOS, indicating potential for process optimization.
• The study suggests that while direct bundling may be infeasible, understanding injury variability can guide quality improvement initiatives.