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  1. Opinion

Editorial: Rein in hospitals' outrageous trauma fees

Doctors take an oath to do no harm. Hospitals should aspire to the same. But in Florida, most hospitals that have trauma centers are exploiting patients at their most vulnerable moment by charging indefensible five-figure trauma center fees. It is a scheme unworthy of the medical profession and highlights the duplicity that occurs when an industry operates without transparency in pricing. Florida legislators, who write the regulations that allow trauma centers to exist, should stop the abuse. Trauma center response fees should reflect the cost of maintaining the centers, not pad profit margins.
Published Mar. 7, 2014

Doctors take an oath to do no harm. Hospitals should aspire to the same. But in Florida, most hospitals that have trauma centers are exploiting patients at their most vulnerable moment by charging indefensible five-figure trauma center fees. It is a scheme unworthy of the medical profession and highlights the duplicity that occurs when an industry operates without transparency in pricing. Florida legislators, who write the regulations that allow trauma centers to exist, should stop the abuse. Trauma center response fees should reflect the cost of maintaining the centers, not pad profit margins.

As Letitia Stein and Alexandra Zayas reported in today's Tampa Bay Times, the 25 hospitals in Florida that provide trauma care charge trauma patients an average of more than $10,800 just to come in the door. But the unluckiest of trauma patients are ferried by paramedics to trauma centers that charge closer to $33,000. Just how greedy have hospitals gotten? Seven years ago, the average trauma center response fee in Florida was $2,555.

There is no justification for these high prices. Hospital officials acknowledged to the Times that they raised prices when they saw competing hospitals charging more; others acknowledged actual costs weren't considered in setting the prices. One hospital — UF Health Shands in Gainesville — actually reduced its $10,000 charge to $4,000 when the Times started asking questions, acknowledging it was out of whack with actual costs.

The impact of such egregious policy is clear: Since 2010, the Times found at least 7,200 patients were charged the fee to access a center for "life-threatening injuries" even though they spent less than 24 hours in the hospital. For another 3,500 patients, the response fee eclipsed the actual medical charges on their bill.

The odds are low that hospitals collect the full trauma center response fee they charge because of lower negotiated rates with insurance and government (Medicare reimburses trauma centers about $1,000 for response fees). And hospitals frequently discount bills for those paying out of pocket. But trauma centers are often paid based on a percentage of a patient's total charge, no matter the line item. Those higher prices ripple through the entire health care economy, raising premiums for private health insurance.

This didn't need to happen. After a national committee in 2002 recognized that hospitals needed a way to recoup some of the cost of maintaining trauma centers' special medical personnel, states could have included oversight of the resulting new fee in regulation of trauma centers. But Florida doesn't, even as it already collects the data it needs to do it. That needs to change.

Lawmakers looking for inspiration should turn to their own backyards. The private, for-profit HCA Regional Medical Center Bayonet Point in Pasco County — home of House Speaker Will Weatherford — charges the highest trauma fee in the state: $33,000. The 2014 legislative session has 54 more days. That's plenty of time to create a regulatory structure that requires reasonable trauma center response fees and outlaws outrageous ones.

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