31. Profitable vs. Unprofitable Expansion Of Trauma and Critical Care Surgery
Jorge L. Rodriguez, MD*, Hiram C. Polk, Jr., MD
University of Louisville, Louisville, KY

OBJECTIVE(S): The American Association for the Surgery of Trauma (AAST) has proposed that the specialty of Trauma/Critical Care (TrCC) include Emergency Surgery (ES). The goals of these changes are to best serve the needs of patients, enhance operative experience, and offer an attractive and sustainable career and lifestyle. This study assesses if these changes will have an impact on the financial challenge that TrCC currently confront; inadequate reimbursement for effort exerted
METHODS: In 2002 and 2003 we collected financial data {payor, charges (Chg), reimbursement (R), total relative value units (RVU), and a reimbursement to cost ratio (R/Cost)} on six full time faculty members. Three were TrCC surgeons that included ES as part of their practice but no private elective component (TrCCES). They were compared to three other TrCC that included both ES and a private elective component as part if their practice (TrCCEPS). A p value < 0.05 was significant (*).
RESULTS: By payor status:

	2002				2003
TrCCES	Government	Commercial	Un- funded	Total	Government	Commercial	Un- funded	Total
Chg	$710,038	$1,573,019	$756,936	$3,039,993	$759,267	$1,099,304	$1,042,918	$2,901,489
R	$208,901	$554,126	$60,154	$823,182	$195,533	$376,349	$44,849	$616,731
RVU	5,998 (23%)	13,389 (52%)	6,935 (25%)	25,682	6,479 (26%)	9,380 (38%)	8,899 ( 36%)	24,758
R/Cost	$1.51	$1.77	$0.40	$1.37	$1.25	$1.65	$0.20	$1.03
TrCCEPS	Government	Commercial	Un- funded	Total	Government	Commercial	Un- funded	Total
Chg	$1,504,983	$2,216,165	$514,755	$4,235,203	$1,794,622	$2,581,589	$598,121	$4,974,332
R	$393,649	$1,030,798	$43,431	$1,467,829	$477,527	$983,376	$44,587	$1,505,490
RVU	13,477 (36%)	19,846 (52%)	4,610 (12%)	37,933	15,295 (36%)	22,002 (52%)	5,098 (12%)	42,394
R/Cost	2.85 *	3.30 *	$0.29	2.45 *	2.21 *	3.15 *	0.62 *	2.51 *

CONCLUSIONS: The addition of ES did not improve the financial viability of TrCC but in fact it is more threatened. Without significantly increased hospital or government financial support, the only viable financial option is for TrCCES surgeons to develop a substantial private practice that cross-subsidize the practice of TrCCES. The AAST should incorporate changes in work process that will allow the specialty to survive not only professionally but also financially.

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