Florida lawmakers have three weeks to decide if they are going to stand with trauma patients and for rationally priced health care, or with hospitals that are charging indefensible trauma center response fees and driving up costs across the health care system. Florida trauma center regulation needs to return to an era where it was based on saving lives, not making money, and a modest Senate plan would be a step in that direction.
It's no wonder health care is such a mess, considering last week's machinations in Tallahassee. The House loaded up a slew of good and bad health care changes onto a single bill, making it easier for opponents of any one idea to band together and kill all of them. Buried in the heap in HB 7113 are bad and good trauma center plans: language that protects three recently opened Hospital Corporation of America trauma centers of questionable need from legal challenges, and that creates a cap for the first time on trauma center response fees, $15,000. The Senate has a similar trauma center plan but puts it in a standalone bill, SB 1276. The Senate also wisely calls for a one-year moratorium on the establishment of any new trauma centers while the state reviews its methodology for permitting them.
Such a review is more than warranted. As a Tampa Bay Times' yearlong investigation disclosed last month, trauma center response fees, designed to help defray the costs of the facilities' extensive staffing and infrastructure, have risen from an average of $2,555 just seven years ago to $10,800. And even that number is misleading for patients who are transported to an HCA facility, where response fees run as high as $33,000. The proposed Senate cap of $15,000 is still too high, but it's better than the status quo.
The for-profit HCA tried to head off some of the outrage generated by the Times' findings last week, saying it would forgo charging uninsured patients a trauma fee. But no one should be fooled by this transparent public relations move, which experts say means little to HCA's bottom line since it is unlikely to collect much money now from uninsured patients. This is really more about HCA trying to ensure lawmakers don't scuttle plans to protect three of its five trauma centers from legal challenges from competitors.
HCA has claimed it added the trauma centers in response to unmet need and has saved lives because more patients have quicker access. But health executives and experts are dubious and wonder about the broader implications now that teaching facilities with trauma centers have fewer patients to help keep skills sharp. HCA will not release its research methods, so its findings cannot be independently verified. Plus, Florida deaths from traumatic injury began declining in 2006, before HCA opened its centers.
More illuminating are the comments of Alan Levine, head of the Agency for Health Care Administration under former Gov. Jeb Bush. He told the Times that when he was an executive with for-profit Health Management Associates, he crunched the numbers for adding a trauma center and realized it would just add costs for the community: "My gain would have come at the expense of another trauma center, or by just converting patients that I was already taking care of very successfully in my own hospital."
Trauma center regulation should be about patient care — not profits. It would be unconscionable for this session to end without lawmakers addressing the exploitation of trauma patients. Lawmakers need to rein in trauma center response fees. And then they need to examine the entire trauma system.