Abstract:
Objectives: To determine service utilization, costs, and payor source associated with traumatic brain injury one-year post discharge from initial rehabilitation.
Design: cost analysis of a representative cohort.
Setting: A rehabilitation hospital and community during the first year post discharge from initial rehabilitation.
Participants: 60 participants who sustained a TBI and who had an inpatient rehabilitation hospitalization.
Interventions: Not applicable.
Main Outcome Measures: Included itemized billing records of services received during inpatient rehabilitation up to one year post discharge from rehabilitation.
Results: The average per person charges totaled $40,348 in the first year post inpatient rehabilitation discharge. In descending order of the percent of total charges, services in that first year included therapy, medical services, other services, personal assistance, equipment, psychological services, and transportation. More than half of all cases received each service type except personal assistance (which only 20% of the individuals received, making it the most expensive service on a per person served basis). At Craig Hospital, the payors of outpatient services, in descending order included Auto no-fault insurance, Commercial insurance, Medicaid, and Worker's Compensation. Providers of both inpatient and outpatient charges were required to write-off portions of uncollected dollars. The data indicated a shifting of payments from Auto no-fault and Commercial insurance toward Medicaid and higher levels of provider write-offs during the first year post inpatient acute care.
Conclusions: Cost associated with TBI extends beyond acute and initial inpatient rehabilitation. Individuals continue to receive services through out the first year after discharge from initial rehabilitation. Finally, There is clear evidence of "coordination of benefits", with multiple insurance types paying for services to individual clients.