Saving the most critically injured patients is a money-loser for the local hospitals that do it. So why would a savvy, for-profit hospital chain suddenly see trauma care as a winning business?
Many are asking that question as the HCA health care system muscles its way into Florida's politically charged trauma landscape. Despite legal challenges from local hospital competitors, the chain recently received approval from the Florida Department of Health to open new trauma centers in Pasco and Manatee counties.
The company expects big returns from new trauma centers at Regional Medical Center Bayonet Point in Hudson and Blake Medical Center in Bradenton, which are among the five HCA hospitals statewide now offering trauma service in partnership with the University of South Florida.
Leaders at HCA, formerly headed by Gov. Rick Scott, boldly predict they will deliver trauma care more efficiently than other trauma hospitals in Florida.
"You're not going to make a bundle of money on trauma, but we believe that we can make money," said Daniel Miller, president and CEO of the HCA West Florida Division, who also anticipates a prestige boost at the hospitals. "The second piece of it is some halo effect that you get from being a trauma center."
Miller expects the high-profile trauma physicians will draw additional patients by performing advanced, non-emergency procedures at the hospitals.
It's a smart move for HCA, according to some industry experts. Trauma services can be profitable, especially at suburban hospitals that treat a lot car crash victims, who are more likely to have health or car insurance to cover their medical bills. Meanwhile, inner-city hospitals often see more uninsured patients.
And with the USF partnership, HCA gains an asset in recruiting hard-to-find general surgeons. Officials at the Tampa-based medical school are also considering whether to place newly graduated doctors at the HCA trauma centers for residency training. Many would be likely to stay where they trained.
"You've got a surgeon shortage in America, and this is a prime solution," said Peter Young, a Fort Myers-based health care consultant. "And you've got a good payer mix at our suburban hospitals. That's what's doing it."
But the HCA push stands to hurt the existing trauma centers in Tampa Bay, their leaders say. Bayfront Medical Center, Tampa General Hospital and St. Joseph's Hospital have sued to stop HCA from entering the trauma field, saying there's no need for additional services. A Tallahassee administrative judge has ruled in their favor, and the state is appealing the decision.
These not-for-profit trauma hospitals, including Shands Jacksonville Medical Center, recently asked the court to stay the state's decision to allow the HCA trauma centers to begin operating provisionally.
Yet trauma volume is already slightly down at Bayfront, leaders say. And St. Joseph's officials are worried about the example set by an emergency room doctor who has threatened to stop working at two of its affiliated hospitals — North Bay in New Port Richey and St. Joseph's North in Lutz — because he can make better money at HCA's Bayonet Point.
"It has a snowball effect," said Dr. Mark Vaaler, St. Joseph's chief medical officer. "It's not just you open up a facility, and new doctors come in and you have more services. Often times, you are stealing services from other hospitals."
At Bayfront, chief financial officer Bob Thornton anticipates that one-third of its trauma business could be diverted to the HCA hospitals to the north and south. In court filings, Bayfront estimated that its losses could exceed $2.3 million a year.
Bayfront officials haven't determined how they would cover a shortfall, Thornton said. But if unsuccessful in blocking HCA in court, the St. Petersburg hospital would likely consider cuts to other operations and seek higher reimbursement rates for other services.
"This isn't going to do anything other than increase the cost of health care in Florida and in the local region," Thornton said, explaining that more hospitals are competing for the same trauma funding. "We just redistributed the revenue around. Somebody is going to have to pay."
Beyond the money at stake, existing trauma hospitals worry about keeping their trauma surgeons and staff busy enough to maintain quality. Even without the added competition, fewer people need trauma care these days, possibly because of a decline in auto accidents.
Thornton and Vaaler also questioned whether the HCA trauma centers would see sufficient cases to stay proficient. But Bayonet Point and Blake are expected to stay busy with a projected 750 patients per year at each hospital, said Dr. James Hurst, chief trauma medical director of the USF/HCA network.
Most of the trauma surgeons joining the HCA centers have been hired from out of state, Hurst said. University and hospital officials are recruiting locally and beyond for other key specialists who must be available around the clock, such as neurosurgeons and orthopedic surgeons. Many of the physicians involved in trauma care will engage in research and other academic efforts through the university.
"We look at ourselves under a big microscope," Hurst said. "It really increases the overall quality of many programs throughout the hospital — and that brings a higher level of care throughout the community."
Independently, USF will continue to run the trauma center at Tampa General, which sees many of the region's most seriously injured patients. Tampa General officials declined to comment for this story.
"It's not like we're developing profit centers in areas that don't need it," said Miller of HCA's west Florida division. "There's a need, and we're going to save a lot of people's lives."
Times researcher Natalie Watson contributed to this story. Letitia Stein can be reached at firstname.lastname@example.org or (727) 893-8330.