Thursday, February 22, 2018
Opinion

Column: Let's focus on improving trauma care, not on sensationalizing fees

The Hippocratic Oath requires that doctors put the best interests of patients first and foremost, regardless of where we practice. For trauma surgeons, this means that oftentimes we fight for our patients' lives. Despite our passion, there is a contentious debate about how best to provide access to high-quality trauma care in Florida. Considering that trauma is the leading cause of death for people ages 1 to 44, getting this right can mean the difference between life and death.

I believe that access to care is our greatest barrier to better patient outcomes, and others do as well. Earlier this year, the American College of Emergency Physicians gave Florida an "F" grade for access to emergency care. Peer-reviewed scientific research from Florida also shows that we have poor access to trauma care. Only about half of our critically injured trauma patients are discharged from a trauma center. Floridians deserve better. We need a statewide system that addresses underserved communities and meets the needs of a growing population. In the past three years, Florida's population has increased by more than 750,000 people. Such staggering growth will leave Florida even farther behind in access to life-saving care with the current trauma system.

With four verified trauma centers and one provisional trauma center, HCA Florida hospitals have spent more than $31 million to develop a trauma network providing much-needed access to care in previously underserved communities.

According to publicly available data, our trauma centers are achieving excellent results for our patients, providing quality care and outperforming other trauma centers across Florida. For instance, 100 percent of the six Florida trauma service areas served by HCA's trauma network improved their residents' survival rates, while 42 percent of the 12 TSAs serviced by other trauma centers did not improve their survival rates. HCA Florida's 96.8 percent survival rate is higher than all other trauma centers collectively. The average length of stay in the HCA Trauma Network is shorter by more than a day, despite having comparable injury severity to other Florida trauma centers. Most important, the number of trauma-related deaths in Florida is lower after HCA started its trauma network.

Despite these results and HCA Florida's commitment to the communities we serve, we have continuously faced legal challenges and unwarranted attacks from opponents whose agenda is to protect the status quo. A recent Tampa Bay Times article mischaracterized our patient service charges, focusing on activation fees rather than the amounts patients actually pay for medical care.

In 2012, the cost to HCA Florida hospitals for treating uninsured patients exceeded $700 million while only receiving 4.7 percent of the Low Income Pool funding the state of Florida sets aside for uninsured care (approximately $53 million). HCA hospitals also paid more than $236 million in taxes to Florida in 2012.

The Times challenges the notion of charging patients for trauma activation services in instances where patients' injuries were ultimately found not to be life threatening or did not require surgery or other very invasive procedures. There are two important facts to consider. No. 1, first responders must use criteria defined by the state of Florida to determine when to activate a hospital's trauma team. Second, as medical professionals, we are grateful to see patients leave without critical injuries, but that does not negate the costs of the multidisciplinary trauma team being called to evaluate and treat a trauma patient. Other medical specialties such as oncology have a similar multidisciplinary approach. It takes significant resources and clinical expertise to make a final diagnosis. It may not always be cancer, just like there may not always be a life-threatening injury.

Improving trauma care and saving lives is what's at stake. Do we want to keep the status quo where access to life-saving care is lacking, or do we want progress? Instead of sensationalizing hospital charges that are not an accurate reflection of true collections, we should not lose sight of the real problem. Florida needs better trauma outcomes. The HCA trauma network has been part of this solution. We have improved overall survival from trauma in our state by improving access and providing life-saving care to our injured patients.

In the end, no matter where we stand in this debate, we should all be part of the solution. Preventing change is not the answer. We remain committed to improving the quality of trauma care in Florida and to an inclusive integrated system to further our mission of saving lives.

Dr. Darwin Noel Ang is trauma medical director for Ocala Health, director of research and quality for the HCA Trauma Network and an associate professor at the University of South Florida.

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