![]() All service areas demonstrated inadequate reimbursement for UC ( table 2). The level I and II facilities within these TSAs met or exceeded the recommended 1.0 facility per million people.ĭespite a positive correlation between compensation and costs of UC (ρ=0.78 p<0.001), data demonstrated that reimbursement for providing UC by level I centers were inadequate ( figure 3). Residential areas greater than a 30-minute drive from a designated trauma center within TSA-E, TSA-O, or TSA-Q are rare. As of May 2020, TSA-E (n=4) and TSA-Q (n=8) contained multiple hospitals actively seeking designation. All three TSAs include an urban hub with a cluster of designated trauma facilities. TSA-E (n=25), TSA-O (n=6), and TSA-Q (n=15) are the largest TSAs in Texas in regard to both service population and number of designated trauma centers ( table 1). Therefore, we sought to describe how the unregulated proliferation of trauma centers in Texas could negatively affect the financial stability of existing centers. Observed trends within our TSA suggested the current UC funding apparatus to be inadequate. 11 12 Trauma service area (TSA) need must also consider available resources, both financial and personnel. ![]() In an attempt to meet this need, the Needs-Based Assessment of Trauma Systems (NBATS) and NBATS-2 tools were defined, but they have been ineffective at establishing specific community needs. To date, no effective universal means for needs-based designation of trauma centers has been accepted. 10ĭesignation based on population density, admission volumes, or geographic location is essential for responsible use of resources. The number of designated level I–III trauma centers has increased by 38.9% in Texas since 2010 with 22 institutions ‘in active pursuit of (trauma) designation’. The total available funding resources have remained static whereas the number of organizations pulling from the funding pool continues to expand. However, the number of trauma care providers continues to grow without corresponding increases in financial support to cover UC or patient need. Compensation rates received by level I, II, and III centers are 28.3%, 18.1%, and 3.1%, respectively, of their Medicaid volume and standard dollar amount (SDA) (RULE §355.8052). 9 Account 5111 dispersals for UC occur in the form of a trauma add-on. In Texas, financial support to cover UC historically came from the Driver Responsibility Program and state traffic fines (Account 5111). 8 This estimate does not take into account undocumented residents in Texas. 7 Currently, approximately 5.3 million Texans are uninsured, making Texas the state with the highest rate of uninsured individuals (21.8%) in the USA. In 2015, the Texas Medical Association estimated 4.3 million adult residents lacked insurance coverage, representing a 75% increase over the national average. Texas is 1 of 19 states that chose not to expand Medicaid program coverage to low-income adults as provided under the ACA ( figure 1). 6 Consistent expansion of the uninsured population has increased the cost of providing UC. The AHA calculates UC by adding a hospital’s bad debt and the financial assistance it provides for services for which hospitals neither received, nor expect to receive, payment due to the patient’s inability to pay. The American Hospital Association (AHA) defines uncompensated care (UC) as the overall measure of hospital care provided for which no payment was received from the patient or insurer. ![]() Previous studies have suggested that there is a correlation between inadequate reimbursement and patient transfer practices. Trauma-related healthcare costs and trauma-specific administrative expenses threaten to overwhelm institutions treating large numbers of uninsured, severely injured patients. 3 In the USA, trauma-related healthcare expenditures are second only to those related to cardiovascular disease. 2 Given the low reimbursement rates for patients without insurance, trauma centers are often considered the most financially vulnerable healthcare entities. National estimates suggest one in five trauma patients lacks health insurance. Unfortunately, by 2017 the number of individuals without insurance coverage started to rise again. As a result, the number of uninsured patients nationwide decreased. In 2014, the Affordable Care Act (ACA) expanded coverage to nearly 20 million of previously uninsured Americans through the expansion of Medicaid and the establishment of the Health Insurance Marketplace. In 2013, an estimated 44 million Americans lacked health insurance coverage. Gaps in the public insurance system and the lack of affordable private coverage have left millions of Americans without health insurance.
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