Insult to Injury: Answers to 10 questions about trauma response fees

Q: How are trauma response fees set by hospitals?
A: Letitia Stein, Tampa Bay Times
We’ve been asking hospitals to please provide the math that would justify those kinds of numbers. So far, we have not seen that. Here in Tampa, we have two trauma centers that are five miles apart, St. Joseph’s and Tampa General. St. Joseph’s is charging approximately 12-hundred dollars. Tampa General is charging approximately 11-thousand dollars.
Q: Do people often complain about being billed these trauma response fees?
A: Adam Walser, ABC Action News I-Team
According to medical billing experts we spoke with, most people don’t even notice the fee
since what they receive are “summary bills” which show broad categories of charges for      such things as medications, radiology, surgery, Intensive Care Unit fees, etc.  Only when these bills are broken down, can patients actually see in detail what trauma centers are charging them.  In many cases, insurance covers most of the costs of trauma care and work out settlements with care providers. That means patients often overlook these fees. Medical billing advocates urge every patient to always ask for detailed itemized bills from health care providers.
Q: What effect have the new level 2 trauma centers had on other Florida hospitals’ billing of trauma response fees?
A: Alexandra Zayas, Tampa Bay Times
It’s exploding across Florida. Part of it is because hospitals have seen how other hospitals have behaved and they’re directly increasing their fees because of it.  We found that these big numbers are big numbers for a reason. Some trauma centers have insurance contracts that pay them a percentage of charges. So the more they charge, the more they stand to make.
Q: What do experts believe would be the result of further expansion of Florida’s trauma system?
A: Adam Walser, ABC Action News I-Team
Some of the experts we spoke with feel like an expansion would drive down the level of care and increase costs. They think care would suffer, because studies have shown that the more procedures a trauma center performs, the better the outcomes. More trauma centers dilute the number of potential patients established centers, but don’t constitute enough patients at smaller centers to develop institutional-wide expertise in providing treatment. Trauma center administrators tell the I-Team that expansion of trauma programs has already starting bidding wars for trauma specialists, who must be present at every trauma center. Because there are a limited number of these specialists, the cost of hiring them increases overall cost to the hospital and eventually the patient. Those who support adding more trauma centers say they are moving potentially life-saving resources closer to residents of communities traditionally underserved when it comes to trauma care.
Q: What do you think is a good solution to preventing trauma patients from automatically facing such high fees when their injuries may not be life threatening?
A: Letitia Stein, Tampa Bay Times
The intention for this is that it would always be a scaled fee, so you have a really high level for a severely injured patient. Then you’d have a moderate level for a somewhat injured patient and a relatively low level for a patient who has very minor injuries. Many of the hospitals in our state are not doing that, and as a result, you can have a 33-thousand dollar fee applied, when in fact it turns out to be very minor injuries. 
Q: Will hospitals ever reduce trauma response fees?
A: Adam Walser, ABC Action News I-Team
Patients we have talked to say that in many cases they do. Because many trauma cases involve auto accidents, it may take months to settle bills, as hospitals haggle with insurance companies over how much will be paid. Where no insurance is in play, hospitals have often agreed to reduce bills in cases of indigent or uninsured patients. Billing advocates say if you don’t have insurance, you should explore your options before agreeing to pay the full bill.  
Q: How will the Affordable Care Act affect trauma care?
A: Adam Walser, ABC Action News I-Team
As with many aspects of the law, it’s hard to tell. Hospital administrators and billing advocates tell us that so far, they are seeing more uninsured patients or patients with high deductibles, meaning they pay a larger portion of the bill. While Obamacare is meant to drive down the cost of healthcare, many doctors in Florida say the cost of trauma care is rising faster than ever.
Q: With HIPPA regulations making it difficult to find specific patients to interview about their specific cases, how did the Times locate people willing to share their bills?
A: Alexandra Zayas, Tampa Bay Times
It was like finding a needle in a haystack to find some of these patients. We sent a mass mailing of hundreds of letters all across the state to people named in
hospital liens saying, “We at the Times are interested in learning a little bit more about your hospital bill.” We eventually interviewed dozens of patients.
Q: What is being done in other places to combat the high costs of trauma care?
A: Adam Walser, ABC Action News I-Team
In some states, like Montana, trauma centers are required to develop a formula in which they factor in all of the things that affect the cost of providing trauma care. These things include the costs of specialized equipment, specialized training and on-call pay. The hospitals factor in the number of trauma responses to come up with a good faith estimate of the average additional cost per patient. Where this has been done, the trauma fees have generally been on the lower end of what most hospitals in Florida are currently charging. Medicare uniformly pays a trauma response fee of a little less than one-thousand dollars, but most hospitals typically lose money on Medicare reimbursements.
Q: Why did you think it was so important to look into the financial aspect of trauma care, at a time when the Florida Board of Health is considering changes to the rules which would affect how many trauma centers can open and their locations?
A: Alexandra Zayas, Tampa Bay Times
Up until now, nobody has been talking about money. So at the very least, we, at the Times, hope that finances start getting discussed because this is a very real problem for the trauma patients in Florida. There will be, hopefully, a very illuminating and productive discussion about the state of trauma centers in Tallahassee this session. A lot of it is going to focus on need. A lot of it’s going to focus on medicine. We, at the Times, are also hoping that some of it will focus on money.
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