danger of trauma centers closing

[uclakid]

Is there STILL a danger of trauma centers closing down? I heard about this briefly a few years ago...

thanks

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[Kalel]

This is an issue in my state, despite having one of the best trauma systems in the nation. Trauma centers are dependent on state governments and private donations for funding because most gun-shot victims and a surprising number of car accident victims are uninsured. States partially reimburse hospitals for uncompensated patient care, and they have a special system for reimbursing trauma physicians (regular physicians usually don't get reimbursed at all and have to work for free when dealing with uninsure patient care), but legislators tend to cut reimbursement every time there is a "fiscal crisis". Thus, with low reimburesment rates (sometimes below the cost of caring for these patients, even with many of the physicians involved working for "free"), many trauma centers have difficulty staying financially afloat. Those that are able to stay afloat have difficulty hiring or keeping their trauma surgeons, who must cover the hospital 24 hrs a day at lower wages then their colleagues out in private practice in general surgery who also have much more stable hours. There are only 2 free-standing trauma centers in this country, one in Maryland and I think that the other one is in Florida. The rest are just extensions of some ER's (some ER's aren't equipped to deal with trauma patients). That's why EMS services have a system of sending patients to particular ER's, they oftentimes can't just go to the closest ER for trauma patients because the closest ER may not be equipped to deal with trauma patients.

 

[DrMom]

Problem in OK, too. Our only level 1 trauma center was about to shut down until the state gave them some $$. Just a stop-gap measure, though.

 

[hakksar]

I heard that the problem with some of them closing is that trauma surgeons are having a hard time affording/keeping malpractice insurance (that is why the one in Las Vegas closed down until the Nevada Governor stepped in a few years ago). Thankfully, in Colorado our tort laws are written in a way that this has not been much of a problem here. In fact we just added our third full level 1 trauma center in Denver in the past couple of years. Not sure about elsewhere, but I would imagine that any place that is having insanely high malpractice rates would also be at risk of having trauma centers close down.

 

[Gleevec]

One thing I never understood is how EM reimbursement/salaries are so high if their patient population is uninsured and poor. Generally in medicine only those specialties that deal with patients who have private insurance or can pay out of pocket have that level of salary. Where is the money coming from? The state? The hospital?

I dont mean to imply that EM docs should be more/less/differently reimbursed, Im just curious as to the economics of the field.

 

[hakksar]

One thing I never understood is how EM reimbursement/salaries are so high if their patient population is uninsured and poor. Generally in medicine only those specialties that deal with patients who have private insurance or can pay out of pocket have that level of salary. Where is the money coming from? The state? The hospital?

I dont mean to imply that EM docs should be more/less/differently reimbursed, Im just curious as to the economics of the field.

I am not really in a position to answer this question but I would assume that it is a complicated situation dealing with a high patient volume (EM Physicians can have a pretty high number of patients per hour compared to a lot of other specialties), amount charged per patient (treatment in the ED is a lot more expensive than being seen by a primary care provider even though a lot of patients in the ED are in for primary care chief complaints), and a high demand for EM Physicians since most locations require hospitals to have an ED operating 24 hours a day to be allowed operate as a hospital (and therefore the hospital would have to contract with either a large EM Practice or lots of moonlighters/independant contractors to stay in business).