Report Finds ‘Service Gaps’ in State’s Trauma Centers
Almost all of the Central Valley and large portions of Northern California lack immediate access to "high-level" trauma centers, and the 42 existing centers "maintain records so flawed" that advocates cannot determine how much funding is necessary to keep the system operating, according to a CDC-funded report conducted by the Sierra-Sacramento Valley Emergency Medical Services Agency. The Los Angeles Times reports that the number of trauma centers statewide has decreased due to squeezed managed care reimbursements and "low government payments" and "could become even less stable if hospitals continue to drop their emergency rooms and trauma centers." The Times reports that money is a "huge part of the problem," as centers care for many uninsured individuals and also deal with insurers who either refuse or delay payment (Bernstein, Los Angeles Times, 1/24). Each year, California trauma facilities lose an estimated $183 million caring for the state's seven million uninsured residents. Overall, hospitals lost more than $400 million on emergency and trauma services for the fiscal year ending June 30, 1999 (Rapaport, Sacramento Bee, 1/24).
Adding to the problem, many California counties lack comprehensive trauma plans, which allow paramedics to coordinate care for patients through a regional hospital that is equipped to handle serious injuries. Without such plans, patients generally are taken to the closest hospital, which may or may not have expertise in dealing with such injuries. Leonard Inch, regional executive director of the Sierra-Sacramento Valley emergency agency, said, "If you're not in an area where there's a trauma plan, your chances of survival are nearly nil. A lot of deaths are preventable." But the Times says "there's no way to tell how much money it would take to fix the system," as none of the trauma centers surveyed for the study was "willing or able" to determine how much it costs to treat injured patients (Los Angeles Times, 1/24).
According to the report, funding shortages prevent acute care hospitals from participating in the system, leading to the "service area gaps" (Sacramento Bee, 1/24). Two state legislators are investigating ways to deal with the situation. Assembly Health Committee Chair Helen Thomson (D-Davis) will hold a hearing Feb. 13 to find ways to "improve and pay for trauma care." Thomson "favors setting up a statewide system for coordinating care." Such a system would cost $11 million to implement and would be coordinated statewide but built on the local emergency services network, the Times reports. In addition, state Sen. Jackie Speier (D-Hillsborough) introduced a bill Tuesday that would "encourage more doctors and hospitals to stay in the trauma system" by requiring health plans to pay for emergency care at whatever hospital treats a seriously injured patient. Speier said that making health plans pay reassures doctors of payment and makes them more willing to treat emergency room patients. The bill also would outlaw use of "middlemen," such as physician groups, to cover emergency care (Los Angeles Times, 1/24).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.