1. Health

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 Mar. 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.

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.


  1. Tampa Bay Lightning owner Jeff Vinik has invested $3 million in Bridge Connector, a Nashville-based medical technology company.
    Bridge Connector already had ties to Tampa. Its founder graduated from the University of South Florida.
  2. Florida's Baker Act was written in 1971 by Maxine Baker, a 65-year-old grandmother and a freshman Florida legislator from Miami-Dade County, seen here in a 1965 photo. [Associated Press]
    The law was written in 1971 by Maxine Baker, a legislator from Miami-Dade County who pushed for the rights of people with mental illness.
  3. Sarah Henderson with her son, Braden, who was committed under the Baker Act after a joking remark at school. [JOHN PENDYGRAFT  |  Tampa Bay Times]
    A cop car comes. A child is handcuffed and taken to a mental health facility. The scene is all too frequent at public schools across the state.
  4. Congressional aides maneuver a Christmas tree to the office of Sen. Mitt Romney, R-Utah, on Capitol Hill earlier this month. No word on whether they washed it first, but experts say hosing down a live tree can be a good way to keep allergens from causing respiratory problems during the holiday season. [J. SCOTT APPLEWHITE  |  AP]
    Hosing off a live tree or wiping off an artificial one are two ways to keep allergens at bay during the holidays.
  5. A helicopter lands at Tampa General Hospital, one of 66 Florida hospitals that could benefit from a proposal contained in Gov. Ron DeSantis' new budget, a new analysis finds. [JOHN PENDYGRAFT  |  Tampa Bay Times]
    Tampa General is among the hospitals that would receive money from a proposal seeking to hand out $10 million in new funding.
  6. Work nears completion Wednesday on a common area inside the new USF Health building that will serve as a centerpiece of the Water Street Tampa development in downtown. The 13-story tower is set to open in January. [OCTAVIO JONES  |  Times]
    The long-anticipated building, part of Water Street Tampa, will welcome students on Jan. 13.
  7. One way to research options is through Medicare's online Plan Finder, available at [THOMAS TOBIN  |  Tampa Bay Times]
    For those who haven’t reviewed coverage for 2020, there is still time.
  8. North Tampa Behavioral Health in Wesley Chapel [JOHN PENDYGRAFT   |  Times]
    Regulators also found widespread problems with patient care after a Tampa Bay Times investigation into the facility
  9. Lorraine Bonner, a retired Oakland, Calif., doctor who is now a sculptor, says she spent a year recovering after surgical staples were used to seal her colon. A newly uncovered federal database reveals previously hidden problems with the staples that were used in her operation. [HEIDI DE MARCO  |  California Healthline]
    Millions of injuries and malfunctions once funneled to a hidden government database are now available, prompting many to take a closer look.
  10. Employees are paying more for health insurance. [MICHAEL MCCLOSKEY  |  iStockPhoto]
    Employees in only two other states paid more relative to their household income.