Data show that the proportion of unhospitalized Florida trauma activation cases increased from 22% in 2012 to 27% last year. The Brookard Health Medical Center, a Florida facility, had 1,285 cases of trauma activation in 2019 without hospitalization. This is about the same as the number of hospitalizations. Wilfredo Lee AP
Care was normal. A hospital in Modesto, California treated a 30-year-old man with shoulder and back pain after a car accident. He went home in less than three hours.
The bill was extraordinary. The Satter Health Memorial Medical Center was charged to summon the hospital’s top surgeons and charged $ 44,914, including a $ 8,928 “trauma warning” fee, usually associated with the most seriously injured patient.
Buried in 2017 trial records, the case is a rare example of a court challenge to say that billing consultants are becoming more and more common in US hospitals.
Tens of thousands of times a year, hospitals charge huge trauma warning fees for injuries, so minor patients are never hospitalized.
In Florida alone, where the number of trauma centers has exploded, hospitals have charged more than 13,000 such fees in 2019, even though patients returned home on the same day. University of South Florida. According to a database of full payers for hospital claims held by the Florida Health Administration, these cases accounted for more than a quarter of the total activation of the state’s trauma team that year in 2014. It was more than twice the number of similar cases.
While false alarms are expected, frequent billing for very small fees, even with treatment, means that some hospitals see alarms as much as money plugs as clinical emergency tools. The consultant says it suggests that.
“Some hospitals use it as a source of income,” said Tami Rockholt, a registered nurse and medical billing consultant who appeared as an expert witness in a Sutter Health car accident trial. “It’s being used,” she said, and “much more” such cases than they were a few years ago.
The hospital can charge a trauma activation fee when the crack team of doctors and nurses gather after saying that the ambulance crew is approaching a patient in need of trauma treatment. The idea is that life-threatening injuries require immediate attention and that the designated trauma center should be able to recover the cost of preparing the team, even if it does not take action.
These fees, which can exceed $ 50,000 per patient, are charged in addition to the amount the hospital charges for emergency medical care.
Pat Palmer, co-founder of Beacon Healthcare Costs Illuminated, which analyzes thousands of insurers and patients’ invoices, said: Recently, “when the patient stepped into the ER, there was a trauma activation fee,” she said.
Data show that the proportion of unhospitalized Florida trauma activation cases increased from 22% in 2012 to 27% last year. The Brookard Health Medical Center, a Florida facility, had 1,285 cases of trauma activation in 2019 without hospitalization. This is about the same as the number of hospitalizations.
“Trauma alerts are activated by EMS [first responders with emergency medical services]EMS responds when an on-site trauma alert is triggered, not the hospital, “said Jennifer Smith, a spokeswoman for Broward Health.
Florida regulations allow the hospital itself to declare “in-hospital trauma warnings” to “patients not identified as trauma warnings” in the field. Published standards According to the Florida Department of Health.
In some hospitals, cases that warn of trauma are treated and few patients are released on the same day.
At Regions Hospital, a Level I trauma center in St. Paul, Minnesota, patients who are not hospitalized after a trauma team warning are “very rare.” Of the 828 cases last year, 42 cases, or about 5%. The director of the center said,Trauma Pro.. “
“If you charge an activation fee to all these people who go home, it will eventually be a red flag,” he said.
In Modesto’s Satter case, the patient sued the driver who collided with his car and sought damages from the driver and his insurance company. The patient “looks good,” the attending physician wrote in a record that was part of the evidence for the study. He prescribed Tylenol with hydrocodone for pain.
“If someone doesn’t bleed, the heart doesn’t stop, or you don’t intend to stop breathing in the next 30 minutes, you probably don’t need a trauma team,” Rockholt testified.
Like other California hospitals designated as trauma centers, the Sutter Health Memorial Medical Center follows “county-designated criteria” for invoking activation. An event in which the patient is treated and determined to be healthy enough to be released on the same day. “
Dr. Martin Schreiber, Trauma Chief at Oregon Health & Science University and Chairman of the Trauma Center Association of America, an industry group, said the Trauma Center regularly reviews and revise the rules for activating trauma teams. Stated.
“It’s not my impression that the trauma center is using activation to make money,” he said. “Unnecessarily activating patients is not considered acceptable in the trauma community.”
After Medicare approved, hospitals began charging trauma team fees to insurers of all kinds From 2008 If the hospital is notified of a serious injury before the patient arrives. According to trauma surgeons, hospitals often call for trauma activation themselves based on information from the field, instead of leaving the trauma team’s warnings to emergency care.
Redemption for trauma activation is complex. Insurance companies do not always pay hospital trauma fees. Under the rules established by the Commission of Medicare and insurance companies and healthcare providers, the emergency department must provide 30 minutes of critical care after a trauma warning paid to rejuvenate the team. .. For inpatients, the trauma team fee may be incorporated into other fees, says the billing consultant.
But overall, the increasing size and frequency of activation fees for trauma teams, including unhospitalized patients, has helped turn trauma surgery (formerly a financial waste) into a profit center. In recent years, hundreds of hospitals have called for a trauma center designation. This is required to charge a trauma activation fee.
“There must have been a consultant who ran around the country and said,’Hospital, why don’t you start claiming this,'” said Mark Chapman, the founder of. Chapman ConsultingDisagree with large hospital bills for car insurance companies and other payers. “In many of these cases, the patient is never hospitalized.”
According to the American College of Surgeons, the national number of Level I and Level II trauma centers that can treat the most severely injured patients increased from 305 in 2008 to 567 last year. Hundreds of other hospitals have Level III or Level IV trauma centers that can treat less serious injuries and claim activation of the trauma team, but often at lower rates. I will.
Emergency surgeons are too careful and unnecessarily activating the team (known as “overtriage”) and endangering the patient by not calling the team when serious injuries are not apparent. It is said to walk the narrow road between them.
“I don’t know if the patient is seriously injured in the field,” said Dr. Craig Newgard, a professor of emergency medicine at Oregon Health & Science University. “EMS providers use the best information they have.”
Newguard argues that if too many patients are severely injured, they will not receive the care they need from the trauma center or team.
“From a system perspective, we’re trying to make the most money for the largest number of people. We realize that it’s basically impossible to triage correctly every time.” He said. “You’re going to take some patients to a major trauma center, but they don’t really get serious injuries, and it’s going to be a bit more expensive, but the trade-off is survival. Is to optimize. “
At Oregon Health & Science University, 24% of patients who received trauma warnings in the 12 months to this spring were not hospitalized, Schreiber said.
“If this number is much lower, patients in need of activation may be at risk if they are not activated,” he said.
On the other hand, increasing numbers and fees for trauma centers will drive up medical costs. Fees are passed on through higher premiums and costs paid not only by health insurance companies, but also by car insurance companies, which are often the first to line up to care for accident victims.
Audits are rare and often the system is tuned to pay bills with little or no scrutiny, billing specialists say. Legal objections such as the Satter case are extremely rare.
“Most of these insurers, especially car insurance, aren’t considering the bill,” said Beth Morgan, CEO of Medical Bill Detectives, a consulting firm that helps insurers challenge hospital claims. I will. “They pay for it automatically.”
Trauma activation fees can also have a direct impact on the patient.
“Insurers sometimes don’t pay them, so people can get stuck in the bill,” Morgan said.
A few years ago, Zuckerberg San Francisco General Hospital $ 15,666 Trauma support fee For a family of toddlers who have fallen from a hotel bed. He was fine. Treatment was a bottle of powdered milk and a nap. The hospital exempted the fee after KHN and Vox wrote about it.
Trauma alert fatigue can result in uneconomical costs for the trauma team itself, McGonigal said.
“Every time a pager disappears, many people just look away from work. [patients] Go home in an hour or two, “he said.
“Some trauma centers are facing problems because they are moving erratically, and all the resources needed to evaluate and manage their patients are probably unnecessary. It costs money. ”
The Trauma Center charges huge fees to treat minor injuries and send people home-WUSF Public Media
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