RT Journal Article
SR Electronic
T1 Trauma center funding: time for an update
JF Trauma Surgery & Acute Care Open
JO Trauma Surg Acute Care Open
FD BMJ Publishing Group Ltd
SP e000596
DO 10.1136/tsaco-2020-000596
VO 6
IS 1
A1 Heather M Grossman Verner
A1 Brian A Figueroa
A1 Marcos Salgado Crespo
A1 Manuel Lorenzo
A1 Joseph D Amos
YR 2021
UL http://tsaco.bmj.com/content/6/1/e000596.abstract
AB Background Uncompensated care (UC) is healthcare provided with no payment from the patient or an insurance provider. UC directly contributes to escalating healthcare costs in the USA and potentially impacts patient care. In Texas, there has been a steady increase in the number of trauma centers and UC volumes without an increase in trauma funding of UC. The method of calculating UC trauma funds in Texas is imprecise as it is driven by Medicaid volumes and not actual trauma care costs.Methods Five years of annual trauma UC disbursement reports from the Texas Department of State Health Services were used to determine changes in UC economic considerations for level I, II, and III trauma centers in the largest urban trauma service areas (TSAs). Data for UC costs, compensation, and TSA demographics were used to assess variations. Statistical significance was determined using a Kruskal-Wallis test with Dunn’s pairwise comparison post-hoc analysis and logistic regression.Results TSA-E (Dallas-Fort Worth area) has 33% of the level I trauma centers in Texas (n=6) and yet serves only 27% of the total state population across 14 metropolitan and 5 non-metropolitan counties. Since 2015, TSA-E has shown higher UC costs (p<0.02) and lower reimbursement (p<0.01) than the second largest urban hub, TSA-Q (Houston area). TSA-E level I trauma centers trended towards decreased UC reimbursements.Discussion The unregulated expansion of trauma centers in Texas has led to an unprecedented increase in hospitals participating in trauma care. The unbalanced allocation of UC funding could lead to further economic instability, compromise resource allocation, and negatively impact patient care in an already fragile healthcare environment.Level of evidence Level IV; Retrospective economic analysis and evaluation.Data are available in a public, open access repository. Data may be obtained from a third party and are not publicly available. Service area data aggregated in this study are immediately available open access through the US Census, the Texas Department of State Health Services, and Texas Trauma Regional Advisory Councils to anyone who wishes to access the data. Center-specific data may be requested from the Dallas-Fort Worth Hospital Council Foundation with appropriate credentials.