Thursday, November 23, 2017
Health

Trauma centers miles apart, in place and price

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When it comes to the trauma response fee, patients can wind up paying tens of thousands of dollars extra based on nothing more than geography and chance.

Consider the case of Eric Leonhard, a Fort Pierce boat captain whose rented limousine crashed in November 2012.

Leonhard and 15 friends were blocks away from their Vero Beach destination when their driver ran a red light into the path of a Jeep. Leonhard was rushed to the closest trauma center, Lawnwood Regional Medical Center, which has some of the highest response fees in the state.

If the crash had happened at the beginning of the evening, as the group neared Meg O'Malley's in Melbourne, he would have owed a fraction of the price. The Irish pub is just four minutes away from a different trauma center, Holmes Regional.

At the time, state data show that Holmes charged an average trauma fee of about $1,300, compared to $31,000 at Lawnwood.

Leonhard's fee would have been wildly different if he had been injured somewhere else in the state: Orlando ($6,300), Gainesville ($10,000), downtown Miami ($1,400).

In Tampa, the difference could have come down to on which side of Interstate 275 he found himself. The highway divides the territories of the city's two trauma centers, which are just 5 miles apart.

West of the highway, Leonhard likely would have been taken to St. Joseph's Hospital, which charged about $1,200 at the time.

East of it, he likely would have gone to Tampa General Hospital, where the average response fee was $12,000 — almost 10 times more.

Experts say it's fair to allow trauma hospitals to charge for response. They face legitimate costs for specialized doctors and equipment. The question is who should pay and how much.

"It's not fair to ask the person who gets hospitalized with a trauma to pay all of the cost," said Gerard Anderson, director of Johns Hopkins Center for Hospital Finance and Management. "They have already gotten hurt and now you are going to double that hurt by quadrupling the price."

The trade group that invented the fee, now called the Trauma Center Association of America, developed a formula to calculate it. Hospital officials could start with the hourly salaries of everyone who responds to a trauma call, down to the security guard outside and the clerk cataloging the patient's personal items.

They could then add a portion of administrators' paychecks, data entry, and even outreach events to promote injury prevention, like handing out free bike helmets at the health fair.

Said Connie Potter, the recently retired CEO of the group that created the fee, they could throw in the "kitchen sink" — as long as they used real trauma costs to calculate their charges.

Today, she said, many hospitals have gone beyond even her generous formula.

Some are doing little more than "pulling them out of their heinders," she said.

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