Hospital-level differences linked to medical debt after traumatic injury

Researchers conducted a retrospective cohort study of 20,613 adults hospitalized for traumatic injury at 29 Level I and II trauma centers from 2019 to 2020. Trauma registry records were linked to quarterly consumer credit reports spanning 12 months before injury to 18 months afterward. The primary outcome was change in medical debt in collections from baseline to months 9–18 after injury. Models adjusted for demographics, injury severity and treatment intensity.

Mean debt in collections increased by $314 (SD $3,464). Four hospitals (14%) were high outliers, with $365–$566 more debt per patient than expected; four (14%) were low outliers, with $292–$676 less than expected. Low-outlier hospitals cared for younger, lower-income and higher-risk patients, yet had lower-than-predicted debt. Findings were robust across sensitivity analyses.

The results identify hospital-level variation in financial outcomes after trauma and suggest billing, financial assistance and collection practices as potential targets for reducing hardship. The study is observational, and its findings do not establish which specific hospital practices account for the differences. The cohort was drawn from one statewide collaborative, which may limit generalizability.