The growth in hospital trauma center designations has coincided
with increases in improper "trauma alert" coding and billing, leading
to astronomical bills for patients and payers. This finding, reported in an investigation by Kaiser Health News (KHN), means
payers will have to step up their scrutiny of emergency claims, experts say.
High-level trauma centers boomed:
- Trauma centers are special designations given to
hospitals that can provide the highest standard of care in cases of
severe, time-sensitive injuries. Growth in the number of high-level trauma
centers has boomed in recent years. Yet the volume of emergency room visits has been fairly stable,
according to federal data. So why have so many hospitals sought high-level
trauma center designations?
- "Profits and because they can," says Health
Strategy Associates principal Joe Paduda via email. "Most are exempt
from Certificate of Need laws."
Trauma center boom added costs:
- A 2013 study in the journal Health Affairs conducted
by professors of emergency medicine and surgery at leading West Coast
medical schools found that "the average adjusted per episode cost of
care was $5,590 higher in a Level 1 trauma center than in a nontrauma
hospital."
- Michael Abrams, a principal at Numerof &
Associates, says that he suspects the trauma unit trend has bloated health
insurance premiums.
What can payers do?
- Jeff Levin-Scherz, M.D., population health leader at
Willis Towers Watson and an assistant professor at the Harvard T.H. Chan
School of Public Health, says that distinguishing between legitimate and
inflated trauma center coding is difficult for payers.
- According to Abrams, insurers may not have noticed the
inflationary effects of trauma center charges. "Up until now, it
seems that many carriers have not paid that much attention to this
area," he says. "They've paid [the bills] because it didn’t seem
to them to be quite as big as it probably is." He suggests payers
need to step up scrutiny of ER reimbursement.
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