Emergency departments are less likely to transfer severely injured patients with health insurance to trauma centers, according to a new study published in JAMA Surgery.
The majority of severely injured patients go directly to trauma centers, but at least one in three go to non-trauma facilities first, according to a study announcement from the Perelman School of Medicine at the University of Pennsylvania in Philadelphia.
In the latter case, it is up to doctors to decide whether to admit these patients or transfer them. After analyzing more than 4,500 trauma cases from 636 hospitals, researchers found insured patients taken first to non-trauma centers were 13 to 15 percent more likely to be admitted, lead author M. Kit Delgado, M.D., and his team, found.
"Insured patients may, ironically, get worse outcomes because they are taken care of at a center where there's a lower volume of resources for critically injured patients," Delgado said. "We hypothesize that non-trauma center hospitals are more likely to want to admit insured patients presumably because they can get reimbursed for their services."
But a Cleveland emergency physician questions whether the study results tell the entire story. "I have to make the [transfer] decision based on whether I have the capacity to care for the patient," Howard Mell, M.D., who is also a spokesman for the American College of Emergency Physicians, told USA Today.
Mell said he does not know or ask about patients' insurance status, and noted that the study also found transfer levels vary based on type of injury and hospital. For example, the study found that hospitals transfer more patients with head injuries than those with abdominal injuries, and more rural hospitals transfer severely injured patients than urban teaching hospitals. Delgado conceded in the USA Today article that it is possible that insured patients prefer transfers to familiar hospitals.
A January study found that hospitals are also less likely to transfer uninsured patients overall, FierceHealthcare previously reported.