Trauma Activation Fees—A Fair Approach to Reimburse Trauma Readiness Costs or a Pathway to Profitability?

Knowlton, Lisa Marie; Haut, Elliott R.

doi:10.1001/jamanetworkopen.2022.52526

JAMA Netw Open

2023

DOI: 10.1001/jamanetworkopen.2022.52526

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Trauma Activation Fees—A Fair Approach to Reimburse Trauma Readiness Costs or a Pathway to Profitability?

Lisa Marie Knowlton

Elliott R. Haut

Abstract: Hospitals providing specialized trauma care incur substantial readiness costs associated with being able to provide round-the-clock emergency services-24 hours a day, every day of the year. The components of trauma readiness, including administrative and clinical staffing, in-house operating rooms, blood banks, and educational and community outreach, are described in the American

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Cited by 4 publications

(2 citation statements)

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“…Costs include administrative and clinical staffing expenditures, running emergency departments (EDs) and operating theaters, providing education, and engaging in community outreach. [1][2][3] The annual cost of maintaining level I TC "readiness" is roughly 10 million dollars. 1 In addition to high costs of care, the financial health of TCs is affected by the payer mix of patients being treated.…”

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confidence: 99%

“…Trauma centers (TCs) provide essential emergency services to the community but also incur significant operating costs that are not always reimbursed. Costs include administrative and clinical staffing expenditures, running emergency departments (EDs) and operating theaters, providing education, and engaging in community outreach 1–3 . The annual cost of maintaining level I TC “readiness” is roughly 10 million dollars 1 .…”

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confidence: 99%

See 1 more Smart Citation

Do hospital-based emergency Medicaid programs benefit trauma centers? A mixed-methods analysis

Knowlton,

Logan,

Arnow

et al. 2023

J Trauma Acute Care Surg

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Introduction Hospital Presumptive Eligibility (HPE) is a temporary Medicaid insurance at hospitalization which can offset patient costs of care, increase access to post-discharge resources, and provide a path to sustain coverage through Medicaid. Less is known about the implications of HPE programs on trauma centers (TCs). We aimed to describe the association with HPE and hospital Medicaid reimbursement, as well as characterize incentives for HPE participation among hospitals and TCs. We hypothesized there would be financial, operational, and mission-based incentives. Methods We performed a convergent mixed methods study of HPE hospitals in California (including all verified TCs). We analyzed Annual Financial Disclosure Reports from California’s Department of Health Care Access and Information (HCAI) (2005-2021). Our primary outcome was Medicaid net revenue. We also conducted thematic analysis of semi-structured interviews with hospital stakeholders to understand incentives for HPE participation (n = 8). Results Among 367 California hospitals analyzed, 285 (77.7%) participate in HPE 77 (21%) of which are TCs. As of early 2015, 100% of trauma centers had elected to enroll in HPE. There is a significant positive association between HPE participation and net Medicaid revenue. The highest Medicaid revenues are in HPE level I and level II trauma centers. Controlling for changes associated with the Affordable Care Act, HPE enrollment is associated with increased net patient Medicaid revenue ( b = 6.74, p < 0.001) and decreased uncompensated care costs ( b = −2.22, p < 0.05). Stakeholder interviewees’ explanatory incentives for HPE participation included: reduction of hospital bad debt, improved patient satisfaction and community benefit in access to care. Conclusion HPE programs are a promising pathway not only for long-term insurance coverage for trauma patients, but also play a role in TC viability. Future interventions will target streamlining the HPE Medicaid enrollment process to reduce resource burden on participating hospitals and ensure ongoing patient engagement in the program. Level of Evidence Economic/decision study, Level II

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confidence: 99%

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confidence: 99%

Do hospital-based emergency Medicaid programs benefit trauma centers? A mixed-methods analysis

Knowlton,

Logan,

Arnow

et al. 2023

J Trauma Acute Care Surg

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Trauma centers: an underfunded but essential asset to the community

Fracasso,

Ahmed

2024

Trauma Surg Acute Care Open

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Research indicates that specialized trauma centers, especially those of level I and II designation, can generate revenue if financial support is provided, and most importantly provide better outcomes for an injured patient by reducing length of stay and mortality when compared with treatment at hospitals without trauma center designation.Costs associated with trauma center operation have risen over the past few years in association with growing patient volumes and inflation. Documentation regarding costs for trauma center operations is sparse, and there exists a large variance between reported numbers based on their region. In most cases, the greatest proportion of funds are spent on clinical personnel while the smallest fraction is dedicated to educational and prevention programs. Studies confirm that as a product of these rising costs and a lack of state and federal funding that trauma centers remain uniquely financially vulnerable.Multiple strategies have been implemented to mitigate these costs but have proven insufficient. Legislations providing patients with expanded access to healthcare such as the Affordable Healthcare Act have failed to deliver on their intended purposes, and managed care organizations have moved to protect their own interest at the expense of trauma patient mortality. In lieu of concerted federal support, states and municipalities have explored solutions to support trauma centers such as small fees added to fines or encouraging charitable donations, although these programs have not seen ubiquitous implementation. Most trauma centers have begun incorporating activation costs to recoup losses from their low reimbursement rate, but these have continued to inflate, and pose a growing burden on vulnerable patients.Lack of funding from external sources such as state or federal appropriations poses a tangible threat to trauma centers for closure, and with multiple trauma centers acting as critical pillars of healthcare infrastructure for disadvantaged communities as well as the impact of this lack of funding being so broad and systemic, multiple ‘trauma deserts’ may emerge, leaving communities—especially disadvantaged communities which rely on the safety-net function of many high designation trauma centers—deprived of an essential treatment resource and increasing annual mortalities that could have otherwise been averted.

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Trauma systems in high socioeconomic index countries in 2050

Gauss,

de Jongh,

Maegele

et al. 2024

Crit Care

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Considerable political, structural, environmental and epidemiological change will affect high socioeconomic index (SDI) countries over the next 25 years. These changes will impact healthcare provision and consequently trauma systems. This review attempts to anticipate the potential impact on trauma systems and how they could adapt to meet the changing priorities. The first section describes possible epidemiological trajectories. A second section exposes existing governance and funding challenges, how these can be met, and the need to incorporate data and information science into a learning and adaptive trauma system. The last section suggests an international harmonization of trauma education to improve care standards, optimize immediate and long-term patient needs and enhance disaster preparedness and crisis resilience. By demonstrating their capacity for adaptation, trauma systems can play a leading role in the transformation of care systems to tackle future health challenges.

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Trauma Activation Fees—A Fair Approach to Reimburse Trauma Readiness Costs or a Pathway to Profitability?

Cited by 4 publications

References 7 publications

Do hospital-based emergency Medicaid programs benefit trauma centers? A mixed-methods analysis

Do hospital-based emergency Medicaid programs benefit trauma centers? A mixed-methods analysis

Trauma centers: an underfunded but essential asset to the community

Trauma systems in high socioeconomic index countries in 2050

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