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Issues arise over funding trauma plan: health care groups express concerns.

ALTHOUGH THE ARKANSAS trauma system is still about two years away from being fully established, some health care groups are already questioning whether the approximately $25 million in annual state funding will be sufficient.

The Arkansas Ambulance Association said last week that the ambulance sector's allocation of $7.3 million won't cover its costs. Ambulance services would need about $6 million more, said Arkansas Ambulance Association President Denise Carson.

Hospitals that become part of the system also could see steep costs.

"All hospitals, I think, will require a fairly significant amount of work and investment to do the things necessary to qualify as a level 2 or 3 center," said Dr. James Graham, chairman of the Arkansas Trauma Advisory Council and a professor of pediatrics at the University of Arkansas for Medical Sciences.

Graham, who also is chief of emergency medicine at Arkansas Children's Hospital, said he didn't know what it would cost Children's Hospital to be a level 1 pediatrics trauma center, which is what it is aiming for.

The Arkansas Hospital Association said it doesn't have any estimates yet on how much it would cost hospitals to be included in the trauma system. On March 13, Gov. Mike Beebe signed the bill creating the system.

For hospitals that have trauma centers, though, the cost of delivering the critical care has risen during the last decade, said Connie Potter, president of the National Foundation for Trauma Care.

Potter said trauma centers don't pay for themselves. Trauma centers lose a total of $230 million annually for treating uninsured patients or patients whose treatment is reimbursed below the cost of providing care.

Trauma centers currently don't receive federal funding, but Potter hopes to change that.

On March 27, Sen. Patty Murray, D-Wash., introduced a bill in Congress that if approved would divide $100 million annually among all trauma centers for each of the fiscal years 2010 through 2015.

Potter said the bill is vital to the survival of trauma centers. Since 2000, 20 hospitals have closed their trauma centers and 13 others have downgraded their trauma service. There are about 600 regional trauma centers in the United States.

Potter said the cost of operating a trauma center is higher than an emergency room department because a full trauma staff has to be at the hospital 24 hours a day, every day. An emergency department can have some of its staff on call.

While emergency rooms can handle a broken leg or concussion, a trauma center would treat multiple fractures, stab wounds and brain injuries.

"Trauma centers are like fire departments," Potter said. "They are a public utility. They need to be ready for whatever, whenever."

Not all trauma centers are losing money and the profitability or loss depends on what kind of patient mix the trauma centers are treating, said Harry Teter executive director of the American Trauma Society, based in Upper Marlboro, Md.

"If they're seeing a lot of uninsured [patients] in the inner cities, they can be losing money," he said.

Trauma centers have been proven to save lives, Teter said.

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"A John Hopkins study showed that the same patient that goes to a level 1 trauma center as opposed to a nontrauma center, his chance for survival is 25 percent greater," he said. "With trauma, there is no time for a second opinion. There's no time for consults. You have to have the care there when they need it, and they need it immediately, or they'll die."

Arkansas is the only state without a trauma center and one of very few states without a trauma system.

Ambulance Runs

Although hospitals can decline to be a part of a trauma system, ambulance companies can't.

Under the trauma system, an ambulance crew would rush the critically injured patient to the nearest hospital that could treat the patient.

The protocol now is for the ambulance driver to deliver the patient to the nearest hospital. The patient then is transferred to a hospital that can handle the case, but that eats up valuable time, a delay that could result in further injury or death.

For rural ambulance services, delivering a critically injured patient to a bigger hospital would mean taking the ambulance crew out of its county, said Carson, of the Arkansas Ambulance Association.

"It is going to be difficult for some rural services, ... because when they go out of the service area, they're still going to be responsible for covering their service area," Carson said. "All services are shorthanded now. It's going to put a burden on the ambulance services around the state."

Buying another ambulance and staffing it would cost about $250,000 annually, Carson said.

Carson said the Ambulance Association is lobbying the Arkansas Health Department, which will administer the trauma system, for more money.

An advisory committee is looking at ways to divide the money among the ambulance companies, either with equipment or training, said Donnie Smith, the director for the center for health protection at the Arkansas Department of Health.

The trauma system could create a financial burden for Columbia County Ambulance Service, its owner, Amanda Warren, said.

Warren said she doesn't have the call volume to support adding a third crew, but would need one under the new trauma system regulations.

Warren said she would need the extra crew on standby while the one crew is transporting a trauma patient out of the county.

Warren said she would end up "paying that crew to just sit there and not do anything."

Carson said even if the extra money were available, finding paramedics is difficult. She said that a survey of ambulance companies the association conducted in November showed that, on average, each company had openings for six paramedics.

Carson said she would like the trauma system money used to help increase the pay for paramedics. Currently, a paramedic earns between $28,000 and $40,000 annually.

"The main objective is getting these patients to the level of care that they need," Carson said. "And it's going to take money."

First Steps

In May, the Department of Health will ask hospitals if they are interested in being part of the voluntary system, Smith said.

Hospitals first will have to apply to be a level 1 through 4 center, depending on the care they can provide. A level 1 trauma center would care for the most critically injured people.

The University of Arkansas for Medical Sciences said it would seek level 1 status, along with Children's Hospital.

Between May and June, the Department of Health will determine what steps the hospitals must take to reach the level they want, Smith said.

Smith said he hopes the hospitals receive the first phase of funding in the fall. The pressure, though, is to move as quickly as possible, he said.

"We know that, unfortunately, there are lives that are lost each day that we don't have a system in place," Smith said.

The Roots of a Trauma System

THE ROOTS OF THE ARKANSAS trauma system date back to 1993 when the state Legislature established the Trauma Advisory Council. The Arkansas Department of Health's section of EMS & Trauma Systems was in charge of the development of a statewide trauma system, according to a report issued by the department in January, "Arkansas Statewide Trauma System."

"It appears that funding cuts and a lack of clear focus have led to limited development," Dr. Michael Rotondo, chair of the Trauma Systems Evaluation & Planning Committee for the American College of Surgeons, wrote in the state Health Department's report.

Establishing a trauma system in Arkansas became a top priority in the 2009 Legislative secession, however.

Between 2001 and 2005, if Arkansas' death rate from injuries had been the same as that of the United States as a whole, 485 lives would have been saved, the state Health Department's report said.

Health care officials lobbied for and received funding for a trauma system to be paid with the proceeds from a 56-cent per pack increase in cigarette taxes that the state Legislature approved this year. The tax is projected to generate $72 million annually.

The trauma system is expected to receive $25 million for fiscal year 2010 and $28 million in 2011. The rest of the tax money will go toward 20 other health-related projects.

Some of that money also will pay for a trauma registry, which will collect and store information about trauma cases. Researchers will study the information in an attempt to prevent injuries.

Also being developed is a call center that would help steer patients to the best hospital for treatment.

By Mark Friedman

mfriedman@abpg.com
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Title Annotation:Trends in Medicine
Author:Friedman, Mark
Publication:Arkansas Business
Geographic Code:1U7AR
Date:Apr 6, 2009
Words:1435
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