Journal of the American College of Surgeons
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Comparative Study
Impact of trauma center designation on outcomes: is there a difference between Level I and Level II trauma centers?
Within organized trauma systems, both Level I and Level II trauma centers are expected to have the resources to treat patients with major multisystem trauma. The evidence supporting separate designations for Level I and Level II trauma centers is inconclusive. The objective of this study was to compare mortality and complications for injured patients admitted to Level I and Level II trauma centers. ⋯ Severely injured patients admitted to Level I trauma centers have a lower risk of mortality compared with patients admitted to Level II centers. These findings support the continuation of a 2-tiered designation system for trauma.
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The Affordable Care Act has stimulated discussion to find feasible, alternate payment models. Adopting a global payment (GP) mechanism may dampen the high number of procedures incentivized by the fee-for-service (FFS) system. The evolving payment mechanism should reflect collaboration between surgeon and system goals. Our aim was to model and perform simulation of a GP system for hernia care and its impact on cost, revenue, and physician reimbursement in an integrated health care system. ⋯ Collaboration to achieve shared savings can be accomplished by pooling physician and hospital revenue in order to meet the goals of all parties.