Hospital chain HCA’s push to have its Augusta hospital designated as a trauma center has unsettled leaders in the state’s hospital industry.
A trauma center is a medical facility that’s specially equipped and staffed to treat seriously injured people. Georgia authorizes four levels of such centers, depending on their capabilities.
The critics of the HCA effort point to the trauma center growth in the Florida market. Such centers in the Sunshine State are charging a “response fee” – essentially an entry fee into the hospital – for each trauma case that averages more than $10,000 per patient, according to a Tampa Bay Times investigation in March.
HCA’s Doctors Hospital said through a spokesman that if it receives trauma center status, it plans to set its trauma activation fee at about $9,900 for each such case at the Augusta facility. The HCA initiative in Georgia was first reported by Tom Corwin of the Augusta Chronicle.
The two current trauma centers in Augusta, Georgia Regents Medical Center and Trinity Hospital, said they charge activation fees of $1,949 and zero, respectively, for a comparable Level III trauma patient, the Chronicle reported.
Nashville-based HCA’s bid for trauma designation has drawn strong opposition from the Georgia Alliance of Community Hospitals, an organization of nonprofit hospitals.
In a recent letter to a Department of Public Health official, the Georgia Alliance said the HCA effort to get trauma designations is targeting areas of the state “that are already well served by existing hospital trauma centers and will be adversely impacted.’’
HCA has seven hospitals in Georgia. An HCA spokesman, Adam Landau, told GHN on Wednesday that Doctors Hospital is the only HCA affiliate in Georgia currently planning to open a trauma center.
“We have been providing lifesaving trauma services to Augusta residents and visitors for 20 years, and now we are seeking formal designation as a Level III trauma center,” said Landau in an email statement.
One HCA hospital, Redmond Regional Medical Center in Rome, already has a Level III trauma designation. That means the hospital can provide prompt assessment, resuscitation, surgery, intensive care and stabilization of injured patients, and emergency operations.
Levels I and II must offer a full range of trauma resources 24 hours a day to handle all types of traumatic injury.
A national study found that the risk of death is 25 percent lower when care is provided in a Level I trauma center compared to a non-designated hospital.
Funding is a recurring issue
Trauma care has been a major health issue in Georgia for several years.
Health care experts, calling the state’s trauma network inadequate, have estimated that on average, 700 lives are lost per year in Georgia because of the lack of accessible trauma services.
A survey of the 17 hospitals within the Georgia trauma network in 2007 showed that the combined operating loss on trauma services exceeded $70 million.
In 2010, a referendum was put before Georgia voters to impose a $10 annual fee on vehicle license tags to help pay for trauma care. It was narrowly defeated.
Money in the current Trauma Commission budget helps defray the expenses of operating such a center, including uncompensated care of patients who have no ability to pay.
In recent years, despite the funding situation, several new trauma centers have been established at Georgia hospitals, including WellStar Kennestone in Marietta and Northeast Georgia Medical Center in Gainesville. Atlanta Medical Center’s trauma center was upgraded to a Level I status – the kind that handles the most serious cases.
A total of 27 trauma centers exist in Georgia currently, though one of them, Lower Oconee Community Hospital, has recently closed.
Wide areas of South Georgia remain largely uncovered by this network, Jim Pettyjohn, executive director of the Georgia Trauma Commission, told GHN on Wednesday.
When asked about trauma activation fees, Pettyjohn said, “We don’t get into internal financial activities of trauma centers.”
The Tampa Bay Times reported that since 2006, at least 120,000 Florida patients have been charged a trauma fee, with the most expensive hospital regularly charging $33,000. The fees are intended to help offset the high costs of specialists and equipment needed to save the most severely injured.
HCA’s average $28,000 trauma response fee is the highest in the state, the Tampa Bay newspaper reported. “The hospitals do not collect every dollar they charge,’’ the article said. “But trauma centers commonly are paid a percentage of what they bill, meaning the more they charge, the more they stand to make.”
There is virtually no government oversight on these fees, the Tampa article reported.
Poor allocation of surgeons?
The letter from the Georgia Alliance of Community Hospitals’ Monty Veazey said trauma centers must have a certain volume of patients to remain high-quality and cost-effective. He said trauma surgeons may end up being shared between HCA trauma centers and existing ones, thus hampering the surgeons’ ability to serve patients.
Landau said Wednesday that Doctors Hospital “was first approached by local EMS providers to consider applying for Level III trauma status, and our application to the state was unanimously approved by the Regional EMS Council.”
“We have made significant investments to increase access to trauma care and recruited surgeons and other staff from outside Georgia’s existing trauma network,” he said
Landau said the trauma activation will be based on the costs of assembling the trauma team.
“Patients who do not have insurance (including third party liability coverage) receive an uninsured discount, including a 100 percent discount on trauma activation,’’ he said. “Insured patients are only responsible for their out-of-pocket expenses, co-pays or deductibles.”
Still, Dr. Patrick O’Neal, the director of health protection for the state Department of Public Health, who will make the decisions on trauma designation, said he was concerned about adding trauma centers, the Chronicle reported.
“My great concern with the HCA situation is that there may be a fairly marked change in the number of cases that a given trauma surgeon is able to handle because they get divided up among more hospitals than they need to be,” he said.
The long-established view that trauma hospitals lose money has been changing, Kaiser Health News reported in 2012. That’s especially true in suburban communities, where trauma patients are more likely to be car crash victims who have health or auto insurance to pay for their care.
“Trauma centers make money,” Mike Williams, president of the consulting firm Abaris Group in Martinez, Calif., told KHN. “If a hospital is not making money on trauma, then it’s not structured the right way.”