Support for theSupport for the Trauma System in Oklahoma Trauma System in Oklahoma

How we got there/here 2003-2005How we got there/here 2003-2005

Roxie M. Albrecht, MD, FACSRoxie M. Albrecht, MD, FACS

Medical Director, Trauma & Medical Director, Trauma & Surgical Critical CareSurgical Critical Care

OU Medical CenterOU Medical Center

Senate Bill 1554Senate Bill 1554

• Trauma Care Assistance Revolving Trauma Care Assistance Revolving FundFund– Reimburse for uncompensated careReimburse for uncompensated care

• HospitalsHospitals• Prehospital provider servicesPrehospital provider services• Physicians – at Medicare ratesPhysicians – at Medicare rates

• Medicaid Matching for Trauma FundMedicaid Matching for Trauma Fund

Past Trauma Fund DistributionsPast Trauma Fund Distributions

YearYear Approved Approved casescases

Total Total Uncompensated Uncompensated cost (million)cost (million)

Total for Total for Distribution Distribution

(Million)(Million)

Reimbursement Reimbursement Ratio Ratio

20002000 N/aN/a 8.858.85 2.122.12 0.240.24

20012001 N/aN/a 10.710.7 2.182.18 0.200.20

20022002 N/aN/a 16.616.6 3.383.38 0.200.20

20032003 33933393 27.027.0 2.512.51 0.090.09

20042004 30243024 21.521.5 4.04.0 0.190.19

Funding InitiativesFunding InitiativesHouse Bill

Estimated Funding

Effective Dates

Source

2600 $ 12.4 million

9/1/04 Failure to maintain liability ins., reinstatement DL, drug offenses

2250 $ 1.8 million

6/3/04 Open Container, Speeding, DUI

2042 $400,000 7/1/04 General Fund

2299 unk 11/1/04 Convictions – driving without a valid DL

2660 $ 17 million

1/1/05 Tobacco Tax

Current Trauma FundCurrent Trauma Fund• CollectionsCollections

– July 04 – July 05 = July 04 – July 05 = 14,465,423.0014,465,423.00• June 05 – 1,409,623 & July 05 – 1,737101June 05 – 1,409,623 & July 05 – 1,737101

• Eligible Physician participantsEligible Physician participants– Tier A – Tier A –

• Emergency Medicine, Neurosurgery, General Emergency Medicine, Neurosurgery, General Surgery, Maxillo-facial surgery, Orthopaedic Surgery, Maxillo-facial surgery, Orthopaedic surgery, Anesthesiology and Trauma surgery, Anesthesiology and Trauma intensivists.intensivists.

– Tier B –Tier B –• Areas not identified in AAreas not identified in A• Funds will be distributed pending excess from Funds will be distributed pending excess from

Tier A allocationTier A allocation

Trauma Fund – Physician ReimbursementTrauma Fund – Physician Reimbursement• Qualifying CasesQualifying Cases

– ICD-9 code of 800.0-959.9ICD-9 code of 800.0-959.9– Limited to contacts within 30 days of injuryLimited to contacts within 30 days of injury– Accompanied by one or moreAccompanied by one or more

• Admission for at least 48 hoursAdmission for at least 48 hours• Transfer from a lower facility for major traumaTransfer from a lower facility for major trauma• Activation of the trauma teamActivation of the trauma team• Admission to an ICUAdmission to an ICU• Admission directly to the OR – for head, chest, abdomen, or Admission directly to the OR – for head, chest, abdomen, or

vascular systemvascular system• Declaration of DOADeclaration of DOA• Declaration of dead in ED or hospital Declaration of dead in ED or hospital • PLUS – PLUS –

– AIS of AIS of >> 3 3– ISS of ISS of >> 9 9– Probability of Survival Probability of Survival << 0.90 0.90

Trauma FundTrauma Fund

• The first claim period for submission of The first claim period for submission of Trauma provider uncompensated care will Trauma provider uncompensated care will be July 1, 2004 to December 31, 2004. be July 1, 2004 to December 31, 2004. 

• www.health.ok.gov/program/injury/www.health.ok.gov/program/injury/trauma/tfund.html trauma/tfund.html 

• Reporting is due into OSDH by October Reporting is due into OSDH by October 31. 31. 

Senate Bill 1554Senate Bill 1554

• Establish the Oklahoma Trauma Systems Improvement and Development Advisory Council– Makes recommendations to the DOH regarding

the trauma system– 18 members

• Public health, trauma registrar, rural hospital, EMT, orthopaedic surgeon, specialty hospitals (ASC), ED physician, EMS director, rehabilitation, hospital administrators (Level 1 or II, urban, rural), administrative director of pre-hospital service, trauma surgeon, general public

Senate Bill 1554Senate Bill 1554

• Rulemaking authority for the OSDH to regulate the trauma system– Every hospital (including medical staff)

must participate in a regional system of providing 24-hour emergency hospital care

– Reciprocal Transfer Agreements

Senate Bill 1554Senate Bill 1554

• Established 8 regional trauma boards– must develop a trauma system within the

region based on State approved guidelines

Oklahoma CountyOklahoma County

• Priority I and Priority II call schedulePriority I and Priority II call schedule- Baptist- Baptist

- OUMC (Mercy will take single system neurological trauma)- OUMC (Mercy will take single system neurological trauma)

- Southwest- Southwest

- Mercy/Edmond (Edmond is primary hospital for Orthopedics) - Mercy/Edmond (Edmond is primary hospital for Orthopedics)

- Deaconess (OUMC will take single system neurological trauma)- Deaconess (OUMC will take single system neurological trauma)

- OUMC (Mercy will take single system neurological trauma)- OUMC (Mercy will take single system neurological trauma)

- Midwest City - Midwest City

Oklahoma County SystemOklahoma County System

• When “on call”, each hospital will provide When “on call”, each hospital will provide orthopedics, neurosurgery, general surgery, facial orthopedics, neurosurgery, general surgery, facial trauma, and anesthesia….or arrange coverage trauma, and anesthesia….or arrange coverage through hospital transfer agreements.through hospital transfer agreements.

• This schedule is for This schedule is for unassigned, Priority 2unassigned, Priority 2 patients patients with single-system injury, or at risk for injury but with single-system injury, or at risk for injury but currently stable, currently stable, picked up by EMSA in its service picked up by EMSA in its service area or transported into the metropolitan area from area or transported into the metropolitan area from other regions of the State.other regions of the State.

• Each hospital will provide care for the patients Each hospital will provide care for the patients who arrive in their ED even on the nights they are who arrive in their ED even on the nights they are not the designated hospital….or will arrange not the designated hospital….or will arrange transfer.transfer.

• It is understood that the other hospitals may have It is understood that the other hospitals may have to provide back-up coverage for a designated to provide back-up coverage for a designated hospital.hospital.

Senate Bill 1554Senate Bill 1554

• Trauma Transfer and Referral Centers– Each County and contiguous communities

with > 300, 000 persons– Direct ambulance patients to facilities with

clinical capacity and capability

• EMSystem®– Internet based computer application– Real time access to regional and statewide

information on hospital ED divert and air transport status

Regional Transfer CentersRegional Transfer Centers

• Based at EMSA – Based at EMSA – – OKCOKC 888-658-7262888-658-7262– TulsaTulsa 866-778-7262866-778-7262

Senate Bill 1554Senate Bill 1554

• Appointed State/Regional PI Committees and a Medical Audit committee– Protection from discovery

• PI indicators have been establishedPI indicators have been established• Medical Audit Committee functionalMedical Audit Committee functional

– Developing referral form and phone numberDeveloping referral form and phone number– Currently call Patrice Greenawalt or Dr. Tim Currently call Patrice Greenawalt or Dr. Tim

Cathey at the Department of Health – Trauma Cathey at the Department of Health – Trauma DivisionDivision

CrisisCrisis

November 5, 2003November 5, 2003

OU Medical Center to close Level 1 OU Medical Center to close Level 1 Trauma Center on December 31, 2003Trauma Center on December 31, 2003

OUMC – Only State Level I/IIOUMC – Only State Level I/II

• Financial LossesFinancial Losses– $35-39 million/year – Emergency Care$35-39 million/year – Emergency Care– $9 million over 3 years - Trauma$9 million over 3 years - Trauma

• Increase Uncompensated careIncrease Uncompensated care• Insurance Status of patientsInsurance Status of patients

– Inability to placeInability to place in rehabilitation in rehabilitation• Increases Length of StayIncreases Length of Stay

– Limits bed capacityLimits bed capacity

• Limited State FundingLimited State Funding

Percent UninsuredPercent Uninsured

StateState % Uninsured% Uninsured

TexasTexas 23.523.5

New MexicoNew Mexico 20.720.7

CaliforniaCalifornia 19.519.5

LouisianaLouisiana 19.319.3

OklahomaOklahoma 18.318.3

ArizonaArizona 17.917.9

FloridaFlorida 17.517.5

GeorgiaGeorgia 16.616.6

U.S. AverageU.S. Average 14.614.6

Oklahoma Medicaid PopulationOklahoma Medicaid Population

414201469389

529858 543628594219

626077

0

100000

200000

300000

400000

500000

600000

700000

'97 '98 '99 '00 '01 '02

OHCA 2003

Major Trauma by Primary Major Trauma by Primary Payor Payor

Oklahoma, 2001-2003*Oklahoma, 2001-2003*

Unknown11%

Medicare/Medicaid

20%

Other6%

Self Pay27%

Commercial Ins

30%

Other Government

2%

Worker's Comp4%

N = 7245N = 7245*1/1/01 – 6/30/03*1/1/01 – 6/30/03

Payor Source OUMC Trauma

January 1 - June 30, 2003

29%

1%

33%

4%

4%

20%

9%

Insurance

Fund/Charity

Self Pay

Worker's Comp

Gov't Funded

Medicaid

Medicare

1

20

00

20

01

20

02

20

03

2540

15701203936

0500

10001500200025003000

Patients Diverted

Oklahoma City Metropolitan AreaOklahoma City Metropolitan Area

John Sacra,MD, Medical Director EMSAJohn Sacra,MD, Medical Director EMSA

Current ISS Distribution

0100200300

261 285 162

ISS 10-15 ISS 16-20 ISS 20 +

ISS Volume

Tra

um

a

OUMC

ELSEWHERE

EMS Triage/TransportEMS Triage/TransportJan – July 2003Jan – July 2003

• OKC Metro Area - OUMC receivedOKC Metro Area - OUMC received• 84 % of the major trauma84 % of the major trauma• 86 % of the serious injured trauma86 % of the serious injured trauma

FundingFundingOklahoma Trauma FundOklahoma Trauma Fund

– SupportSupport• $1 per license tag $1 per license tag

– DistributionDistribution• 2002 - $ 3 million2002 - $ 3 million 2003 - $ 2.5 million2003 - $ 2.5 million• Pre-Hospital services & Acute care facilitiesPre-Hospital services & Acute care facilities

– Submissions - Uncompensated CareSubmissions - Uncompensated Care• 2002 – $16 million total - $6 million from OUMC2002 – $16 million total - $6 million from OUMC• 2003 – $ 25 million total - $ 13 million from OUMC2003 – $ 25 million total - $ 13 million from OUMC

• No provisionNo provision– PhysicianPhysician – reimbursement/stipends – reimbursement/stipends– Long term care providersLong term care providers

• Crisis Announced

• Press Conference – November 5, 2003– Level 1 Closure – December 31, 2003

• Unless improvements the state of the trauma system and funding

– Potential for increased fatalities from trauma

Governor AppointedGovernor AppointedEmergency Task ForceEmergency Task Force

• Secretary of Health, Senator, Representative• Physicians – Trauma Centers, ED, Specialty

hospitals, Acute Care Hospitals• Board of Health Members• Hospital Administrators – Urban and Rural• Pre-Hospital Providers• Payor Representatives

Task Force Task Force Recommendations to DOHRecommendations to DOH

• Department of Health – Emergency RulesDepartment of Health – Emergency Rules– Hospital LicensureHospital Licensure

• Hospital/Physicians Participate in Regional System Hospital/Physicians Participate in Regional System DevelopmentDevelopment

– Triage/Transport RevisionsTriage/Transport Revisions– Central Dispatch/Transfer CenterCentral Dispatch/Transfer Center– Reciprocal Transfer AgreementsReciprocal Transfer Agreements– New Trauma Systems Improvement and New Trauma Systems Improvement and

Development Task Force/Regional Advisory Development Task Force/Regional Advisory BoardsBoards

– FundingFunding

OCMS Ad Hoc CommitteeOCMS Ad Hoc Committee• Proposed County-Wide Call ScheduleProposed County-Wide Call Schedule

• Priority II Patients within OK CountyPriority II Patients within OK County• Initial Meeting AttendeesInitial Meeting Attendees

• OMSAOMSA• Governor’s OfficeGovernor’s Office• DOHDOH• Pre-Hospital ProvidersPre-Hospital Providers• Greater Oklahoma City Hospital CouncilGreater Oklahoma City Hospital Council• Hospital AdministratorsHospital Administrators• Physicians – ED, Surgical Specialists, General Physicians – ED, Surgical Specialists, General

surgeonssurgeons• Call Schedule Sub-Committee Meets MonthlyCall Schedule Sub-Committee Meets Monthly

• 10 Members +10 Members +• Call Schedule First implemented – May 2004Call Schedule First implemented – May 2004

Advocacy StrategiesAdvocacy StrategiesFundingFunding

• Legislative Meetings– Speaker of the House and representatives– Senate Pro Tempore and senators– Governor’s Director of Finance

• Data– Definitions –

• Trauma System• Trauma center levels• Priority I, II, III patients

– Comparison to neighboring states• Trauma centers, physicians, admissions

– Impact on other training programs/bed capacity

– Cost, reimbursement and outcome data– Transfers in – types and geographic locations– Length of stay – funded v. unfunded

Advocacy StrategiesAdvocacy Strategies

• Trauma Center Tours– Senators and Representatives– State Finance personnel

• Lobbyist – University, OHA

• Doctor of the Day

• State and County Medical Societies

• ACS – Advocacy and Health Policy

SSLAC SupportSSLAC Support• Letter

• As a trauma care provider in Oklahoma,

• I urge you to support a number of bills to increase funding for the Trauma Care Assistance Revolving Fund: HB 2600 – increases the Fund to provide reimbursement for uncompensated care to recognized facilities that care for trauma patients; HB 2250 – provides for increases in court fees to be deposited in the Fund; HB 2382 – increases fines on driver’s license suspensions, DUI, narcotics and child safety seat violations to be deposited in the Fund; and HB 2660 – places on the ballot a referendum for Oklahoma voters to support creation in the State Treasury of a “Special Health Care Revolving Fund” to help pay for future health care costs.

• Monies from the Trauma Care Assistance Revolving Fund are used to reimburse recognized trauma facilities and licensed ambulance services for uncompensated trauma care. Passage of this legislation is extremely critical because hospitals across our state are suffering huge financial losses when providing emergency trauma care for uninsured patients. Should this trend continue, the viability of emergency care services at many of these institutions will be threatened - resulting in significantly reduced access to trauma care for Oklahomans across the state.

• As more hospitals cease to provide emergency trauma care, victims of injury will have to be transported over increased distances to reach definitive trauma care, pushing the limits of the critical "golden hour." Injury victims who fail to receive comprehensive treatment within the first hour suffer greater risk of death or life-long disability.

• The legislature must not adjourn without adopting these critical bills. Please show your support for our trauma system by voting “YES” on HB 2600, HB 2250, HB 2382, and HB 2660!

• EmailEmail

• Contact Your State Senator to Support Trauma System Funding

• Dear Oklahoma Surgeon:

• The Oklahoma House of Representatives recently passed a number of bills to address funding issues for the Trauma Care Assistance Revolving Fund: HB 2600 – increases the Fund to provide reimbursement for uncompensated care to recognized facilities that care for trauma patients; HB 2250 – provides for increases in court fees to be deposited in the Fund; HB 2382 – increases fines on driver’s license suspensions, DUI, narcotics and child safety seat violations to be deposited in the Fund; and HB 2660 – places on the ballot a referendum for Oklahoma voters to support creation in the State Treasury of a “Special Health Care Revolving Fund” to help pay for future health care costs.

• These bills now await action by the Oklahoma Senate. Please take a moment to advocate on behalf of them by clicking on

• the following link – http://capwiz.com/sslac/mail/oneclick_compose/?alertid=5522761 – and sending a letter you may easily personalize to your state senator asking them to vote for this legislation.

• Thank you for your help in advocating for: HB 2250; HB 2382; HB 2600; and HB 2660. We must do all we can to preserve our state’s trauma system, and your efforts will greatly help in this endeavor.

• Roxie Albrecht, MD, FACS

• State Chair, Oklahoma COT

Advocacy StrategiesAdvocacy Strategies

• Education Material– Trauma System– Trauma Center– How to contact your senator/representative

• Media

• Patient/Family Testimonials

• Letters to the Editor– Chair of University

Hospital Authority and Trust, Patients families, employees and families, TMD, CMO

• CHANCE MEETINGS

November Vote – Tobacco TaxNovember Vote – Tobacco Tax• Oklahoma Hospital

Association– Solicitations for funding

• Hospitals, Universities• Foundations, Individuals

– Flyers, buttons, billboards, radio ads

– Presentations• Rotary, Junior league,

professional society meetings

• Media

• Trauma Survivor Picnic – week before vote– Speaker of the House– Governor– Patient/Family Testimonials– Trauma Center Personnel

ACS Advocacy and Health Care ACS Advocacy and Health Care Policy DivisionPolicy Division

• Dear Oklahoma Surgeons:• I’m writing to you today in my capacity as the state chair of the Oklahoma Committee on

Trauma (COT). Earlier this year, a number of bills passed our state’s legislature to increase funding for our trauma system, and I asked you at that time to write your legislators in support of them. One of these trauma funding initiatives included an increase in the tobacco tax that will be going before the voters on November 2. State Question (SQ) 713, the Oklahoma Health Initiative, will increase the excise tax on cigarettes by 80 cents. Other tobacco products such as chewing tobacco and cigars will see an increase, too.

• Some of the revenues generated from the increased tobacco tax are allocated to the trauma care assistance fund. In fact, if the voters approve SQ 713, $17 million will be made available to the trauma system. Combined with the $13 million already allocated through the state budget, we would have $30 million for our trauma system, with one-third of that potentially eligible for federal matching funds.

• As you can see, it is critical to our state’s trauma system that SQ 713 be passed. I encourage you to support SQ 713, and to talk to your patients and your physician colleagues about supporting it as well. I’ve attached a two-page handout that provides greater detail on the impact this tax will have, not only in increased revenues for health care programs but also reduced use of tobacco by our patients.

• If you have any questions about this ballot initiative, please feel free to drop me a line at roxie-albrecht@ouhsc.edu. I would be glad to speak with you.

• Thank you for your support for and involvement in this important trauma funding advocacy effort.

•• Sincerely,• Roxie M. Albrecht, MD, FACS• Chair, Oklahoma Committee on Trauma

2005 Trauma System2005 Trauma System

• Still DevelopingStill Developing– Awaiting further ‘rural’ regional plansAwaiting further ‘rural’ regional plans

• FundedFunded– Projected 14-20 millionProjected 14-20 million

• FragileFragile– Specialty Surgical CoverageSpecialty Surgical Coverage