• J. Am. Coll. Surg. · Sep 2022

    Financial Vulnerability of American College of Surgeons-Verified Trauma Centers: A Statewide Analysis.

    • Derek A Benham, Richard Y Calvo, Kyle Checchi, Matthew J Carr, Joseph Diaz, Andrea Krzyzaniak, Vishal Bansal, and Matthew J Martin.
    • From the Department of Surgery, Naval Medical Center San Diego, San Diego, California (Benham, Checchi, Carr, Diaz).
    • J. Am. Coll. Surg. 2022 Sep 1; 235 (3): 430-435.

    BackgroundAlthough trauma centers represent an integral part of healthcare in the US, characterization of their financial vulnerability has not been reported. We sought to characterize the financial health and vulnerability among California trauma centers and identify factors associated with high and low vulnerability.Study DesignThe RAND Hospital Data financial dataset was used to evaluate all American College of Surgeons (ACS)-verified trauma centers in California. Financial vulnerability of each center was calculated using 6 metrics to calculate a composite Financial Vulnerability Score (FVS). Tertiles of the FVS were generated to classify trauma centers as high, medium, or low financial vulnerability. Hospital characteristics were also analyzed and compared.ResultsForty-seven ACS trauma centers were identified. Nine were Level I, 27 were Level II, and 8 were Level III. Level I centers encompassed the greatest proportion of the high FVS tier (44%), whereas Level II and III centers were the most likely to be in the middle and lower tiers, respectively (44%; 63%). Lower FVS centers had greater asset:liability ratios, operating margins, and days cash on hand compared with the 2 higher tiers, whereas high FVS centers showed a greater proportion of uncompensated care, outpatient share rates, outpatient surgeries, and longer days in net accounts. Lower FVS centers were more likely to be teaching hospitals and members of a larger corporate entity.ConclusionMany ACS trauma centers are at moderate/high risk for financial vulnerability and disparate impacts of stressor events, and the FVS may represent a novel metric that could be used at the local or statewide level.Copyright © 2022 by the American College of Surgeons. Published by Wolters Kluwer Health, Inc. All rights reserved.

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