Trauma System Needed, Stat on Arkansas Medical News Inc.

Trauma System Needed, Stat

By: JENNIFER BOULDEN

Also Up: Credentialing, Reimbursement, Doc Web Ratings

After the failure to pass a trauma system bill in the state's 2007 legislative session, getting a new bill passed this spring is top priority for Arkansas healthcare advocates.

Bo Ryall, executive vice-president of the Arkansas Hospital Association, said AHA is working hard with other advocacy groups to get the plan proposed by Arkansas Surgeon General Joe Thompson passed. The proposed bill would fund a trauma system for the state, estimated at $28-$35 million, and provide block payments to hospitals committed to achieving designation as Level 1, 2, 3 or 4 trauma centers.

Arkansas is one of three states without a statewide trauma system, and the only state without a Level 1 trauma center.

The state took the first concrete step toward a trauma system in November by establishing a statewide Trauma Dashboard. The Dashboard—a Web site that lists the capacity and capability of each hospital in the state that accepts trauma patients—is already a big help, Ryall said.

"Before, if a small hospital had a trauma patient come in, they were calling all over the state trying to find who had the right doctor and who could accept the patient. That was taking forever. Now, they can go online from the Emergency Room, look to see who has the closest hospital with an available doctor to care for the patient, contact that hospital and speed up the transfer time. It's more of a coordinated effort now, but we certainly need to have the training and get the trauma teams ready at certain hospitals, especially Level 1's and 2's," Ryall said. "We have a long way to go."

The Arkansas Medical Society is also on board. Scott Smith, AMS director of governmental affairs, said the trauma legislation is AMS' top legislative priority for the session. "Trauma is front and center for us right now," Smith said.

Trauma system advocates are putting their combined weight behind Governor Mike Beebe's proposed $87.8 million tobacco excise tax plan, enough to fund the trauma system fully, with significant funds left over for other beneficiaries like community health centers and the UAMS campus in Northwest Arkansas. Smith said AMS has been in talks with legislators, but has many more to reach.

"When you're talking about a tobacco tax increase, you've got to have more than a simple majority. So far, some like it and some aren't crazy about it. Mostly it's been a positive response," he said.

Ryall said the coalition in support of a tobacco tax was strong, particularly with the trauma system attached.

"Certainly, when you mention trauma, everyone — legislators and citizens — wants to see a trauma system. The tobacco tax has gotten a lot of support out there."

Smith said the trauma bill is a step ahead this time because of awareness raised for the trauma system last time around.

"We're doing a better job educating people about it now," he said. "There was some confusion before whether this was bricks-and-mortar for new hospitals. It isn't. We've already got the hospitals in place; it's just a matter of them being properly staffed, outfitted, and designated appropriately. That takes funding, but it will save hundreds of lives each year."

Studies from other states that have implemented trauma systems (almost all of them have) show that establishing a trauma system could decrease the mortality rate from 10 to 40 percent. Smith said 40 percent was probably high, but there is a general consensus that the 10 percent estimate is low.

"Even looking at that conservative 10 percent number, that's more than 200 lives saved in Arkansas each year," he said. "Those are lives of all ages, and many of them young people who die in trauma accidents because they can't get to a trauma center. We're losing so much of their potential each year, and we can do something about that. It's something positive that the legislature can do to impact real lives."

Physicians and healthcare professionals can assist the coalition supporting the trauma bill by contacting their legislators directly and making the case for why Arkansas must establish a trauma system.

"It's going to take a grassroots effort," Ryall said. "We're ahead of where we were last time, but we still need help getting this passed."

"We're one of the few states that haven't stepped up and addressed this issue yet," Smith said. "We've got over 200 lives in the balance, so it's time to figure out a way to make it work."

Other Initiatives

The Arkansas Medical Society is also working on a credentialing bill that would shorten the time it takes insurance companies to credential Arkansas doctors.

Currently, insurance companies are given 180 days to credential a physician.

"That's an awfully long time and can be a pretty big inconvenience to the patients when you're dealing with paperwork of seeing an out-of-network physician," Smith said. "It's really not helpful for the physicians and there's really no reason to take that long. Most states get it done in at least 90 days. There are a number of states that get it done in 30, 45, or 60."

He said the insurance companies had some problems with the bill proposed in the last session, but that AMS has more recently had some good discussions with them.

Medicaid reimbursement is a perennial problem for hospitals, and Ryall said AHA was once again urging legislators to take a look at the issue.

He said Arkansas hospitals get paid below cost for Medicaid patients, losing more than $100 million a year serving the Medicaid population.

"Like every industry out there, we're concerned about the economy," Ryall said. "Hospitals are seeing their uncompensated care going through the roof right now. As we do in every session, we're trying to work on Medicaid payments that go to hospitals. Those are very low. Outpatient Medicaid payments haven't been increased since the early 1990s, so those are woefully low."

Getting that increase approved may be an uphill battle.

"Right now, it's not a great time to be looking for money," Ryall conceded. "Everybody's kind of leery about the economy and how it's going to affect the state budget. But we're working on finding a way."

A new issue AMS is looking at is requiring a consistent methodology and defined parameters for online rating systems of physicians by insurers.

Smith said the practice by some insurance companies of rating physicians—for example, giving a doctor a one-star rating for cost and a two-star for quality of care — is troubling.

"We're concerned about how that is interpreted and how it is put out there for folks to interpret. If you're going to profile physicians, we need to have some sort of framework and methodology for how it's done, something that makes sense. We're looking at a bill that would help set up that framework," Smith said, citing a recent settlement in New York between the Attorney General and a number of insurance companies that established similar parameters for profiling physicians.