BY TED GRIGGS

Arkansas's emergency care system ranked last in the American College of Emergency Physicians' most recent report, but the Arkansas Hospital Association hopes to change that in the upcoming general assembly session.

"Arkansas is the only state that doesn't have a trauma care network," said Paul Cunningham, senior vice president of the hospital association.

In 2002, the Arkansas Board of Health adopted rules and regulations for trauma systems. But Cunningham said no hospitals have adopted the standards, in part because of the expense.

It costs money for hospitals to become level 1 or level 2 trauma centers, Cunningham said. It costs money to keep specialists on call for trauma-related cases and to treat emergency patients who do not have healthcare insurance.

The association hopes to work with the state Department of Health and Human Services and other groups to form a coalition that can put the network together, Cunningham said.

"Unfortunately, a lot of it boils down to you need some additional funding," Cunningham said.

Arkansas, like other states, faces budget strictures, Cunningham said. And the Bush administration's effort to shift more of the Medicare burden to the states is not helping.

Cunningham said those proposed moves could cost Arkansas $100 million to $150 million.

The hospital association is gathering data to support its arguments for a trauma care network, Cunningham said. The association is also studying what other states, such as Oklahoma and Tennessee, did to establish and fund their trauma networks.

Dr. John Sacra, medical director of Emergency Medical Services Authority in Tulsa, Okla., said Oklahoma's trauma care system has been in place since 1999. But it was only in 2004 that state lawmakers put together funding to reimburse hospitals, emergency medical service agencies and doctors for the uncompensated emergency care they provided.

"The key was getting people to start thinking of this as a public health safety net, and not just one hospital coming forward and saying, 'We need money,'" Sacra said.

Trauma is the leading cause of death for Oklahomans aged one to 44 years, according to the Oklahoma State Department of Health. Trauma is the fifth leading cause of death overall.

The department estimates show that traumatic injuries cut more years of productivity off Oklahomans' lives than all types of diseases combined.

In 2005, 6,063 major trauma victims were reported to the trauma registry. More than 9 percent of these patients died. Motor vehicle crashes injured 1,952 Oklahomans, more than 32 percent of the total number of major trauma patients.

Once legislators understood that everyone benefits from the trauma care system, they quickly realized it was society's responsibility to pay for it, Sacra said. Legislators also liked that the providers laid out a detailed plan showing where the money would be used and for what.

The uncompensated care money comes from a number of sources, primarily from the tobacco tax, Sacra said. The fund also gets some money from fees and fines on traffic violations and the reinstatement of expired licenses.

Providers originally hoped to place a $10 fee on license plates because motor vehicle accidents generate the largest number of traumatic injuries, Sacra said. The fee would have generated the $30 million a year needed to fund the network, but lawmakers felt the license plate fee would prove very unpopular.

The $30 million also includes "readiness costs," such as paying doctors and specialists to be on call, Sacra said.

Sacra said the problem with the current system is that the trauma care system's costs are fixed but its revenues can fluctuate.

Still, this year marks the first time that Oklahoma hospitals, emergency medical service agencies and physicians were reimbursed at 100 percent of their eligible costs for uncompensated trauma care.

There was not enough money to cover on-call fees, Sacra explained. However, efforts are underway to examine better ways to fund the system.

In the meantime, Oklahoma has made major progress, Sacra said. The trauma care system divided the state into eight regions, with advisory boards for each, and has also identified the provider resources in each region.

"Patients with major injuries are what we call a time-sensitive problem," Sacra said. "There has got to be a system in place to deal with these types of injuries."

Part of that involves identifying the facilities and physicians that can treat brain or spine injuries and multiple long-bone fractures. Paramedics cannot shop around for a hospital with the correct services or the right specialists during an emergency, he said.

Sacra said more work remains to be done on the trauma system.

Within the next year or two, he hopes to see the system establish regional call centers so that emergency workers can find out immediately where the nearest neurosurgeon, for example, is available.




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November 2006