New research sheds light on the toll gun injuries take on patients, healthcare providers, and the American healthcare system.
Although a preventable public health issue, the number of firearm-related injuries in the United States increases every year. In 2015, there were over 36,000 deaths and 85,000 nonfatal injuries caused by firearms. The PLoS One Journal recently published a study that quantified the cost of firearm-related injuries and assessed the risk of hospital readmissions from 2010 to 2015.
The five-year study determined that the average cost of hospitalization for firearm injuries was $32,700 per patient. For initial inpatient hospitalizations and readmissions, the average cost for all patients was $911 million. Medicare and Medicaid government programs shouldered 45% of the expense, while 20% fell upon the uninsured.
Readmissions totaled 9.5%, or $86 million, of the overall $911 million. On initial admission, the payer status for readmitted patients were as follows: Medicare (10.0%), Medicaid (35.9%), private insurance (20.2%), self-pay (20.2%) and other (15.2%), which included patients not charged and those with alternative forms of insurance.
Medicaid patients had a greater readmission risk of 17.6%, while self-pay patients had the lowest readmission risk of 12.1%. It is possible that economic and social factors decreased the likelihood of self-pay patients receiving follow-up care. Self-pay patients are often faced with full charges of their inpatient hospital stays. Since there is no third-party negotiator, it could be difficult to afford a readmission.
Additionally, 84% of Medicaid patients live in zip codes that fall below the 50th income quartile. The average, unadjusted charge of a self-pay patient’s readmission was $49,087, a significant financial expense that warrants further investigation into the risks of readmission.
Another finding was that one in seven, or 15.6%, of patients discharged from the hospital were readmitted within six months over the five year span. Of those readmissions, over 50% occurred within 30 days. The readmission risk was greater for patients who:
- Were older
- Had higher injury severity scores
- Had longer lengths of stay
- Required an operation
- Had a non-routine discharge at initial admission
- Had ongoing, chronic medical and social problems, classified as “chronic trauma syndrome”
If your patient with a firearm injury meets at least some of these criteria, monitor the patient closely to prevent readmission and to alleviate a substantial burden on both patients and the US healthcare system.
There were some drawbacks to this study, such as the exclusion of firearm-related injuries for patients treated and released from the emergency room. Nevertheless, the findings are reliable and support public policy reform to reduce devastating and expensive firearm-related injuries.