Wednesday, December 13, 2017
Opinion

Column: For best trauma care, volume tops location

In all my years working for hospitals, I've never seen anything as misleading and inflammatory as the advertising campaign being waged against trauma centers like Tampa General. They employ the same baseless scare tactics found in political attack ads.

Here's a simple question: Would you rather go to a trauma center that is convenient, or one that treats so many of these cases that it improves your chances for a better outcome?

Multiple studies have shown that patients have better outcomes at high-volume trauma centers like our Level 1 facility. When it comes to trauma, closer isn't always better. Please urge your legislators to keep this in mind when deciding how many trauma centers Florida truly needs.

The for-profit HCA hospital system, which is obligated to maximize profits for its shareholders, wants patients to focus on convenience rather than studies linking high volumes to better patient quality. The recent ad campaign by a third-party group that attacks TGH and other safety-net hospitals employs a simple formula — instill fear in the public to get what cannot be justified legally or supported by science.

It is a $250,000 campaign of inflammatory TV, radio and online ads that reference ongoing litigation to close HCA's new provisional, lower-volume trauma centers in places such as Pasco and Manatee counties. They say we want to deny Floridians access to trauma care right in their back yard. But we only want a trauma system that produces the best patient outcomes while not adding extraordinary health care costs — a trauma system that provides the best care through the existing regional network.

Recently published research proves this point. Experts caution that too many trauma facilities in one area can result in higher cost and reduced quality. When trauma centers operate too close to one another, they compete for specialists and have fewer patients to justify the high cost for staffing and technology.

Research in the journal Health Affairs concluded that when an elderly person is classified as a trauma patient simply because he or she is elderly — not because of the severity of the injury — that person pays as much as 40 percent more without having a better outcome.

That is what some for-profit hospitals have done. The concentration of too many centers in one area can also undermine quality. Studies show that trauma centers and surgeons who treat a large number of seriously injured patients have better outcomes.

When centers operate too close to each other, health care costs rise for everyone. As of 2009, more than 97 percent of all Floridians lived within 60 minutes of a trauma center, which is better than any of our nation's five most populous states and more than 21 percent better than the national average.

Florida was meeting the trauma needs of its citizens with a superb system of regional centers. Prior to the addition of the HCA trauma centers, the number of trauma cases in the state had actually been declining.

HCA's provisional trauma centers are adding to the cost of health care by duplicating services. Each Level 2 trauma center has cost HCA $6 million to $10 million to open, and about $8 million a year to operate. As a for-profit system, HCA needs to show stockholders on Wall Street a healthy return on its investment. To approve these additional trauma centers where real need has not been proven means you will pay more for care.

The American College of Surgeons reviewed Florida's existing trauma regulatory structure and found that any expansion should be done through an open and inclusive process that solicits feedback from all stakeholders. We hope the state Department of Health will heed those recommendations and concentrate resources where they are most needed.

Florida's trauma system is already one of the best in the world, with trauma centers strategically located to provide efficient and high-quality trauma care to all Floridians. Why compromise a system that consistently outperforms other states and delivers the best possible outcomes to Florida's trauma patients?

Let's not make Floridians pay the hidden tax of opening trauma centers that aren't needed. On balance, more lives are saved with a statewide trauma system that regionalizes care in high-volume centers justified by location and population. Remember, if faced with a life and death situation, do you want convenience or the best chance to return to a normal life?

Jim Burkhart is president and chief executive officer of Tampa General Hospital.

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