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Economic Viability of a Community-Based Level-II Orthopaedic Trauma System
Peter L. Althausen, MD, MBA1; Daniel Coll, BS, PA-C2; Michael Cvitash, BMS, PA-C2; Al Herak2; Timothy J. O'Mara, MD1; Timothy J. Bray, MD1
1 Reno Orthopaedic Clinic, 55 North Arlington Avenue, Reno, NV 89503. E-mail address for P.L. Althausen: palthausen@sbcglobal.net. E-mail address for T.J. O'Mara: swimntim@hotmail.com. E-mail address for T.J. Bray:bray@renoortho.com
2 Renown Regional Medical Center, 1155 Mill Street, Reno, NV 89502. E-mail address for D. Coll: danielcoll@sbcglobal.net. E-mail address for M. Cvitash: mcvitash@renown.org. E-mail address for A. Herak: aherak@renown.org
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Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.

The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2009 Jan 01;91(1):227-235. doi: 10.2106/JBJS.H.00592
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In 2006, the American Academy of Orthopaedic Surgeons (AAOS) and the Orthopaedic Trauma Association (OTA) released position statements addressing on-call coverage and the provision of orthopaedic emergency care1,2. This action was prompted by the nationwide crisis occurring in access to trauma care. Over the past decade, there has been an ever-increasing number of patients seeking emergency care, a decrease in the total number of hospital emergency rooms, a steady decline of specialists available to take call, and a shortage of hospital resources to support emergency orthopaedic care1,3. The AAOS and OTA position statements call for emergency operating-room access twenty-four hours a day and 365 days a year, operating-room staffing, one physician assistant per full-time-equivalent orthopaedic surgeon, reliable image intensifiers and dedicated radiology technicians, funded call support coverage, available implant systems, support for a research coordinator, funds for continuing medical education, and clinic facilities. In exchange for these resources, the surgeons agree to provide full-time coverage and promise to see all trauma patients within a specified period of time. These position statements also call for an appointed trauma director to provide quality assurance, direction, and commitment to limit variation in implant use. This director will also attend a regular review of the fiscal impact of the service with the hospital administration. While these demands seem reasonable to orthopaedic surgeons who provide emergency services, hospital administrators have resisted many of these recommendations by questioning the financial viability of orthopaedic trauma services. Our objective was to demonstrate that trauma patients with orthopaedic injuries bring substantial financial reward to hospital systems and that orthopaedic trauma systems should be supported. In fact, given an appropriate demographic and payer mix, orthopaedic trauma services can actually be very profitable for a hospital system. In the process, we also hope to educate the readers about the basics of hospital finance and provide a framework for physicians to determine whether a trauma system is a viable option in a specific city or region.
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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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