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Report indicates trauma centers facing funding problems, closures
The rate of closings could increase 10% to 20% in the next three years, according to the report.
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U.S. trauma centers are in a state of crisis due to economic problems, according to a report by the Irvine, Calif.-based National Foundation for Trauma Care, a nonprofit association. This could result in insufficient care for the 678,000 patients annually who need to be treated at these facilities or increased casualties in the event of a major catastrophic event.
According to the 16-page report “U.S. Trauma Center Crisis: Lost in the Scramble for Terror Resources,” what could occur in the wake of the continued financial woes of trauma centers are closures, level I centers being downgraded to level II, or centers that operate with too few surgeons or under-qualified personnel.
Thirty trauma centers have closed since 2001, and 10% to 20% of the remaining ones are at risk for closing in the next three years. This loss of valuable trauma resources cannot continue, authors of the report wrote, calling this “a wake up call for this nation. We need the Federal Government to take notice and act.”
Approximately 120 trauma centers are in jeopardy of closing due to lack of funding, National Foundation for Trauma Care (NFTC) officials said in a press release. “These facilities are an integral part of our homeland security front line and right now they are in serious jeopardy. This growing crisis puts our nation at risk of not being prepared to respond to the next terrorist attack,” NFTC President Greg Bishop said.
The report is condensed from a full-length report the NFTC prepared for the U.S. Department of Health and Human Services’ (HHS) Health Resources Agency. “According to this study, trauma care is not on the Department of Homeland Security’s agenda, let alone a priority,” Congressman Curt Weldon (R-PA) said during a May press conference he held in Washington to release the report.
Many states are having economic problems maintaining their trauma systems and large regions such as Houston are faced with complete system breakdowns, the report said.
“The cost of doing business is getting so prohibitively expensive that from an economic standpoint it’s not working for the hospitals and health systems that run most of the trauma centers,” Christopher Born, MD, told Orthopedics Today's. He is co-director of Temple University’s orthopedic trauma service in Philadelphia and chairman of the Orthopaedic Trauma Association’s Mass Casualty Committee.
When strapped for finances, hospitals and health systems typically try to figure out how to get out of running a trauma center, something that was once considered prestigious, Born said.
But funding alone may not provide the solutions needed to keep trauma centers operational and the system working. “Instead of throwing money at it, look at why the cost of doing business is so great. That drives you into the dreaded area of malpractice and insurance issues, claims,” he said.
Declining revenue has led to trauma centers absorbing $1 billion in losses, the report said.
HHS funding
Federal funding that recently became available may prove useful in some areas. It includes approximately $1.34 billion that HHS announced in June it has earmarked for better emergency response to bioterror attacks, new strains of infectious diseases and natural disasters. A portion of it is for helping hospitals improve their response capability, according to a press release. But, according to Born, that money would more likely be used to help hospitals develop disaster response systems than aid day-to-day trauma center operations.
“I don’t see how it’s really going to affect the people who are in motor vehicle accidents or injured in industrial accidents, people who sustain blunt trauma and the inner city people who are shooting each other. … These people need to be taken care of,” Born said.
The global challenges affecting all centers are similar, including standby capacities that have diminished as a result of cutbacks, said orthopedic trauma surgeon Andrew N. Pollak, MD, member of Orthopedics Today's editorial board in the trauma section. “There’s inadequate funding for trauma care patients. The medical system in general is strained financially because of decreasing reimbursements and increasing costs. You have to look at … either the costs or the reimbursements and figure out how to fix it.”
If left uncorrected, trauma resources will simply not be available for mass casualty events, said Pollak, medical director for the Baltimore (Md.) County Fire Department. The available number of trauma specialists is dwindling. Approximately 15 to 25 orthopedic trauma surgeons are being trained annually, he noted. “That’s going to create another crisis down the road.”
In the interim, Pollak proposed the development of a baseline program, “a broader program of advanced trauma life-support” that enables all physicians working at hospitals to deliver early emergency care. “Some basic expertise in the acute management of the injured patient needs to remain in the individual hospitals, even those that aren’t trauma centers.”
Another problem that needs attention is the growing cost associated with physician standby. “It’s kind of silly to keep trauma centers open because of potential for mass casualty events, when, in fact, you’re cutting them down so thin that they can’t respond to day-to-day activities.”
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For more information:
- The full report “U.S. Trauma Center Crisis: Lost in the Scramble for Terror Resources” can be found at http://www.traumacare.com/foundation.html.