It was an ordinary experience. After a car accident, a man in his 30s was treated at a hospital in Modesto, California, for back and shoulder pain. In under three hours, he went home. We were charged an extraordinary amount. There was an additional charge of $8,928 for the hospital’s “trauma alert” service, often associated with the most seriously injured patients at Sutter Health Memorial Medical Center.
The Fees Hospitals Charge For Treating Minor Injuries Are Astronomical
An increasingly common practice, billing consultants say, is being challenged in courtrooms in the U.S., according to court documents from a 2017 trial. For injuries that are so minor the patient doesn’t even need to be admitted, hospitals charge enormous trauma alert fees tens of thousands of times every year.
KHN analysis of state data by an economist at the University of South Florida, Etienne Pracht, found that hospitals in Florida, where the number of trauma centers has exploded, charged such fees over 13,000 times in 2019. Florida’s Agency for Health Care Administration kept an all-payer database of hospital claims, which shows that trauma cases accounted for more than a quarter of activations of trauma teams that year.
There will always be false alarms, but frequent charging of hospitals for little help suggests some hospitals see the alerts as more of a moneymaker than a truly life-saving tool, claims consultants say.
In an interview, Tami Rockholt, a nurse and witness in the Sutter Health car accident trial said that some hospitals are using it to generate revenue. This privilege is being misused, and there are more cases today than there were a few years ago, she said.
When an ambulance crew approaches a patient in need of trauma care, hospitals can charge a trauma-activation fee. Having a trauma team ready – even if it is never called upon – should be recoupable by trauma centers so that life-threatening injuries can be addressed instantly. Fees comparable to those for emergency medical care are billed in addition to the hospital’s charges for emergency care.
In addition, Pat Palmer said they see a fair amount of charges not related to trauma – higher than five years ago. He co-founded Beacon Healthcare Costs Illuminated, which works with insurers and patients on thousands of bills.
Statistics show that 27% of trauma cases in Florida did not require an admission last year, up from 22% in 2012. An educational facility in Florida, Broward Health Medical Center, reported 1,285 trauma activation cases without admission in 2019 – almost one and a half times as many as had admissions.
EMS [first responders with emergency medical services] activate trauma alerts, not hospitals. According to Jennifer Smith, a Broward Health spokesperson, Broward Health responds accordingly to an EMS trauma alert.
As stated by the Florida Department of Health, hospitals may declare an “in-hospital trauma alert” for patients who have not been classified as trauma alerts outside the hospital. A small number of trauma patients are treated and discharged on the same day at some hospitals.
Patients not admitted after a trauma team alert are “very rare,” said regional hospital director Dr. Michael McGonigal, who blogs at “The Trauma Pro.” 42 of 828 cases were not admitted last year or about 5% of cases, he said.
As in the Sutter case in Modesto, the patient sought damages from the driver and the driver’s insurer after her vehicle hit his. A doctor in the emergency department wrote in the patient’s medical records, which were used as trial evidence, that “he looks good.”. His pain prescription included Tylenol with hydrocodone.
A trauma team is probably not necessary if a patient does not have a bleeding injury, or if their heart does not stop, or if they do not cease breathing in the next 30 minutes. This was Rockholt’s opinion in her testimony.
“County-designated criteria” are followed by Sutter Health Memorial Medical Center, like other trauma centers in California: The goal is to handle trauma patients at all times – even if they are deemed stable enough to be treated and released within 24 hours.
The Trauma Center Association of America, an industry group, regularly reviews and revises its rules for activating trauma teams, according to Trauma Chief Dr. Martin Schreiber.
He is not aware of trauma centers making money through activities, he said. Trauma specialists do not believe that activating patients unnecessarily is okay.
Following a rule change by Medicare in 2008, hospitals are now allowed to charge trauma teams to all types of insurers for injuries notified to hospitals before a patient arrives. As a result, hospitals sometimes activate trauma teams themselves rather than leaving those alerts up to paramedics, trauma surgeons say.
There are many complications in reimbursing trauma activations. A hospital’s trauma fee isn’t always covered by insurance. A bill for activating an emergency response team requires that ERs provide 30 minutes of critical care after a trauma alert, as mandated by Medicare and an insurance association and health care providers committee. Billing consultants say trauma team fees are sometimes rolled into other charges for inpatients.
In general, however, increased trauma team activation fees have allowed trauma operations to become profit centers, helping turn what was often a financial drain into a source of income. The trauma activated fee is only charged to hospitals that have been designated as trauma centers.