Researchers study relationship between insurance status and head injury patient transfer

The Emergency Medical Treatment & Labor Act (EMTALA) was enacted in 1986 to provide access to emergency medical care and transfer for all patients, regardless of immigration status or ability to pay. The two major stipulations of EMTALA: (1) All individuals who walk into an emergency room must be screened and receive treatment irrespective of immigration status or ability to pay; (2) Level I Trauma Centers (facilities with the most comprehensive trauma resources, equipment, and personnel) must accept transferred trauma patients from Level II and III facilities if capacity exists within the center.

Researchers at Massachusetts General Hospital/Harvard Medical School studied the relationship between insurance status and head injury patient transfer in patients with a primary diagnosis of open or closed head trauma. The results of this study, The Influence of Insurance Status on Transfer for Head Injury Patients at Massachusetts General Hospital from 1993-2009, will be presented by Maya Babu, BS, 4:01 to 4:15 pm, Monday, May 3, 2010, during the 78th Annual Meeting of the American Association of Neurological Surgeons in Philadelphia. Co-authors are Brian V. Nahed, MD, Marc A. DeMoya, MD, and William T. Curry, MD.

"Soon after EMTALA's passage, trauma specialists at Level I Centers raised doubts over the medical 'need' of some transfers, hypothesizing that other factors, such as finances, motivated the decision to transfer patients, particularly patients with less serious injuries," remarked Ms. Babu.

According to recent statistics, an estimated 1.6 million people experience a traumatic brain injury every year in the United States, and of those, 75 percent are considered mild traumatic brain injuries.

In this study, the role of insurance status (privately insured vs. uninsured) on transfer patterns in a nationalized database was investigated over a 5-year period, and these findings were compared to transfers at the largest Level I Trauma Center in Massachusetts over a 16-year period. The analysis was limited to patients with mild head injuries as measured by the injury severity score. The analysis revealed the following:

•Within a nationalized database, a patient's insurance status was related to the decision to be accepted as a transfer at a hospital, that is, insured patients were more likely than uninsured patients to be accepted for transfer.

•Community hospitals were less likely to accept uninsured transfers compared to insured transfers in patients with mild head injury.

•Transfers received at one Level I Trauma Center revealed that uninsured patients with mild head injuries were more likely to be transferred between the hours of midnight and 6 a.m. compared to any other period during a 24-hour period.

•Uninsured patients with mild head injuries were slightly more likely to be transferred on Sundays compared to other days of the week.

•The likelihood of a transfer coming from a hospital more than 10 miles away from the Level I Center was higher for uninsured patients with mild injury compared to insured patients with mild head injury.

•No significant differences in transfer were noted for age, race or sex.

"Given the current healthcare reform climate and additional unfunded mandates being placed on hospitals to measure and report patient outcomes and financial metrics, we believe these findings raise concerns about the pressures faced by Level I Centers due in part to existing legislation," stated Ms. Babu.

"We hope that additional work to refine the questions posed in this study can inform thoughtful policy-making for the purpose of strengthening the trauma infrastructure in the U.S., ultimately leading to improved patient outcome," concluded Ms. Babu.