Debate over Florida trauma response fees moves to Tallahassee (w/video)

HCA has opened a trauma center at Regional Medical Center Bayonet Point in Hudson.
HCA has opened a trauma center at Regional Medical Center Bayonet Point in Hudson.
Published March 15, 2014

The Safety Net Hospital Alliance, which represents 12 Florida trauma centers, says there are clear abuses in the way hospitals are levying "trauma response" fees, and it would support legislation to rein in overcharging.

But Hospital Corporation of America, which a yearlong Tampa Bay Times investigation revealed to have the highest average trauma fees ever seen in Florida, is not part of that group. A relative newcomer to the Florida trauma market, it operates five of the state's 25 adult trauma centers. It charges as much as $33,000 for what is effectively a cover charge, even charging patients who are not seriously injured.

Asked whether HCA would support fee-control legislation, company spokeswoman J.C. Sadler wrote: "We support pricing transparency and were one of the first to post pricing for uninsured patients on our web sites in 2006.''

The sites, however, do not list the Florida centers' trauma fees.

Some legislators have expressed interest in the trauma fee, but no one has proposed a bill to control it.

House members this week did advance a bill protecting HCA against lawsuits seeking to shut down three of its trauma centers. By "grandfathering'' the centers, legislators would shield the company from competitors who claim that the state should never have allowed them to open.

HCA wields considerable clout in Tallahassee, where it has registered 25 lobbyists to influence legislators this session. Since November 2012, it has made $1.3 million in campaign contributions, including $100,000 to the governor's re-election campaign.

Some of its lobbyists represented HCA back when the hospital chain was headed by Gov. Rick Scott. Others include a former House speaker, a former state agency chief and the brother of the next House speaker, Richard Corcoran, R-Trinity.

Corcoran, whose county is home to a new HCA trauma center, told the Times his brother's job will have no bearing on how he deals with trauma charges.

"We're looking at it and trying to see where we can make improvements," Corcoran said of findings in the Times investigation, which revealed how the fee has spiraled out of control with no state oversight.

The federal government's Medicare program pays just under $1,000 for the fee, intended to help cover costs of being prepared to receive injured patients. But the Times found that the average fee at Florida trauma centers ranges from about $1,200 to $33,000, averaging more than $10,000.

The Times found thousands of patients charged the fee even though their injuries were so minor, they spent just hours in the hospital. Many patients faced trauma fees that were higher than all the charges for their actual medical care combined.

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There are numerous ways in which Florida could regulate the fee, said three national medical pricing experts contacted by the Times. Among the suggestions:

• Cap the fee: "The state can come in and say, no trauma center can charge more than 200 percent of what Medicare has agreed to pay," said Suzanne Delbanco, executive director of Catalyst for Payment Reform. That would be less than $2,000. Because of the voluminous cost data Medicare collects, its payments are widely seen as a guide to fair value.

• Analyze and publish trauma response fees: The state Agency for Health Care Administration collects data on trauma fees, but does not publicize them. "Fresh air is a huge disinfectant," said Anne F. Weiss, senior program officer for the Robert Wood Johnson Foundation. "Transparency about what hospitals charge for different kinds of care is good for all of us."

Require hospitals to tier their response fees: Connie Potter, a trauma industry leader who helped create the response fee more than a decade ago, said it should be charged at different levels depending on the severity of a trauma case. The Times found that half of the state's trauma centers charge the same one-size-fits-all fees.

• Require hospitals to justify their fees based on actual costs: The Times contacted every trauma center in the state, and not a single one could show a line-by-line analysis to justify their fees; some admitted they based their rate on what other trauma centers charged.

Potter said the Department of Health, which approves new trauma centers, should require hospitals to prove that their fees are based on actual costs. But the agency says it does not have authority over hospital charges.

"I think your Department of Health needs to grow a spine," Potter said.

The Times asked for Scott's thoughts on whether the state should do more to police the fees.

"I believe efforts to increase competition, transparency and empower consumers are critical to making health care more affordable and accessible with higher quality,'' he responded in a statement. "Unfortunately, Obamacare does exactly the opposite . . . In Florida, making health care more affordable is a priority.''

When the Times asked for a response that answered the question, Scott's office wrote, "You have our statements thanks."

House Speaker Will Weatherford, who spoke in support of the HCA trauma center in Pasco County, where he lives, said the Times raised "reasonable questions that need to be answered and addressed in a committee format."

Senate President Don Gaetz, who last year helped to carve out a special exception to state rules to allow an HCA trauma center in Fort Walton Beach, his district, did not reply to repeated requests for comment.

"Where is the outrage?" asked former legislator Mike Fasano, who supported opening the HCA trauma center in Pasco, where he now is tax collector. "You can't sit here and say health care costs are too high and ignore what we just found out.''

Fasano said Pasco residents have been approaching him with "disgust" over what they learned in the Times.

"If a trauma care center in the state of Florida is abusing their certification," he said, "their certification should be suspended or revoked."

He still supports having a trauma center in his community — with limits. "I now understand the fight for and against trauma centers is not so much about care as it is about the almighty dollar," he said. "I don't know if it will sink in in Tallahassee. . . .

"Unfortunately, money talks."

Times/Herald staff writers Tia Mitchell, Steve Bousquet, Michael Van Sickler and Mary Ellen Klas contributed to this report. Alexandra Zayas can be reached at or (727) 893-8413. Letitia Stein can be reached at or (727) 893-8330.