Hospitals put on notice about trauma care
State requiring facilities to participate in system or pay to opt out
Jerry Mitchell
jmitchell@clarionledger.com
Mississippi has begun sending out notices for the nation’s first “pay or play” trauma care system.
Starting Sept. 1, hospitals in must agree to be part of the state’s trauma care system or opt out by paying up to $1.492 million - the estimate it would cost a hospital for that trauma care. The statewide system officially begins Jan. 1.
“I’m proud of our state for stepping up to the front,” said State Health Officer Dr. Ed Thompson. “People are going to be alive five years from now that wouldn’t be if we hadn’t passed this thing.”
Until this change, Mississippi’s voluntary trauma system had been in danger. In 2002, 23 Level III or higher hospitals participated in the system. Now 12 participate.
Thompson said the result is huge holes in the trauma care system for Mississippians who live in east central Mississippi and have no Level III or higher hospital. The same is true, he said, for those living in southwest Mississippi.
The first hour of trauma care is called the “golden hour” and is critical, he said. “If you get patients to the right level of trauma care within that first hour, you have a much better chance of saving their lives and preserving their functions.”
Thompson anticipates more Mississippi hospitals coming back into the system, but he wouldn’t speculate on which ones they might be.
One Jackson hospital that hasn’t taken part in the past is now considering joining the trauma system.
“We haven’t come to a conclusion yet,” said Paul Arrington, vice president of St. Dominic Hospital. “We want to figure out what’s best.”
Two out-of-state hospitals expected to take part in Mississippi’s trauma system are the Med of Memphis and the University of South Alabama Medical Center in Mobile.
Depending on how many hospitals participate, the trauma fund could receive as much as $20 million annually from the hospitals that opt out. A combination of fees collected from driver’s license renewals, traffic fines, car tag collections, gun permit renewals, inspection stickers, boat registration renewals, motorcycle and ATV fees are expected to generate another $14 million annually toward trauma care. Those funds would then be used to compensate participating hospitals for treating uninsured trauma patients.
Connie Potter, executive director for the National Foundation for Trauma Care, called Mississippi’s new system “a fairly innovative solution” that’s easily the most ambitious among state plans.
Arizona is supposed to take in $20 million for trauma care through casino gaming. Tennessee is dedicating two cents of its cigarette tax to trauma care.
Nationwide, the foundation is pushing for $100 million in legislation before Congress to help cover the costs of uncompensated trauma care, Potter said. “There are too many people who are uninsured, too many people not covered by Medicaid.”
The challenge for Mississippi will be “attracting and retaining trauma specialists,” she said. “There is a dwindling supply of physicians.”
Then-Gov. Kirk Fordice signed the Mississippi Trauma Care Act in 1998, not long after suffering a near-fatal car wreck.
That created the state’s voluntary trauma care system and funded it through traffic fines and tobacco settlement monies.
But over time, because the system was voluntary, an increasing numbers of hospitals dropped out of it.
Adding to that problem was the fact money for the system continued to decrease. The money that would have been available in 2009 for uncompensated trauma care would have been $3 million - $37 million less than needed.
In 2007, Gov. Haley Barbour created the Trauma Care Task Force, which found Mississippi ranks third in the U.S. in accidental deaths from injuries.
Earlier this year, Barbour signed legislation that created the “pay or play” trauma care system.
Chuck Stokes - who co-chaired the task force and is president of North Mississippi Medical Center in Tupelo - said physicians play a critical role in the trauma care system. “If we don’t do something to compensate doctors, they’re going to stop taking care of patients and migrate out of state.”
Stokes believes what Mississippi is doing could become a model for the nation. In the meantime, officials are going to monitor the trauma care system to see how it can be improved, he said.
National trauma expert Dr. Frank Ehrlich, chief medical officer at Mountainside Hospital in Montclair, N.J., said other states will watch Mississippi but will struggle to find the same levels of revenue.
“I think Mississippi is going to do something very important, to show the ideal way to develop a trauma system is to pay for it, and the ideal way to pay for it is ‘pay or play,’ ” he said. “On a national level trauma care is struggling right now. It shouldn’t be struggling because it should be part of the terrorist defense mechanism.”
Dr. James Keeton, who served on the trauma task force for the University of Mississippi Medical Center, said the ultimate goal of a trauma care system would be a control center that would update the status of hospitals every 15 minutes, assessing which hospitals already have trauma patients and where surgeons are available. “Then we’d really be helping people,” he said.
What also could save lives is having more Mississippians wear seat belts, he said. “Personal responsibility would save a lot of lives.”
Bill Oliver, CEO of Forrest General Hospital who co-chaired the task force, said the key will be to make this transition as smooth as possible.
How the system works will undoubtedly have to be modified as it goes on, he said. “I’m proud of where we’re going. .”
He recalled meeting a doctor from Boston who was bragging about what the hospital has done with trauma care.
Oliver replied that Mississippi already had being doing that for several years. “It shocked her that Mississippi has tried to make that very important,” he said. “Every one of us is potentially a trauma patient. It doesn’t matter how rich or poor you are, it doesn’t matter what kind of insurance you have, if you are riding in a car, you are a potential trauma patient.”
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