State's trauma system seeks infusion of $15 million a year

Panel briefs legislators on `imminent crisis,' fear of shutdown in rural areas

January 15, 2003|By M. William Salganik | M. William Salganik,SUN STAFF

The state should contribute $15 million a year to the trauma system to avoid another shutdown such as the one that closed the center at Washington County Hospital for four months last summer, the chairmen of a study panel told legislators yesterday.

"When we talk about a $22 billion budget, $15 million is pocket change," Del. John F. Wood Jr., a Southern Maryland Democrat who co-chaired the study, told a legislative briefing in Annapolis. Wood said the panel was working on the financial details of its recommendations, which should be ready in a few weeks.

"There's an imminent crisis we're facing, especially in the rural areas," said Sen. Nathaniel J. McFadden, a Baltimore Democrat who co-chaired the study with Wood.

A group of trauma surgeons and hospital administrators agreed that help is needed to avoid shutdowns at any of the state's nine trauma centers.

Dr. Thomas Lawrence, vice president for medical affairs at Peninsula Regional Medical Center in Salisbury, said he was afraid that, without extra aid, his hospital might have to shut its trauma service in July, when a new contract with its trauma surgeons is expected to mean higher costs. Already, Lawrence said, Peninsula Regional is facing about $1 million a year in costs to pay doctors to be on standby and to cover care for the uninsured.

Winfield M. Kelly Jr., chief executive officer of Dimensions Healthcare System, said Dimensions was "seriously considering eliminating the trauma program" at Prince George's Hospital Center, one of two hospitals it owns. He said 35 percent of the 2,500 trauma patients at Prince George's each year are uninsured, and the hospital pays $11 million a year for doctors to provide coverage.

While a few hospitals, such as the Maryland Shock Trauma Center in Baltimore, have full-time medical staffs, most of the trauma centers depend on surgeons and other specialists in the community to take turns being on call around the clock, able to respond quickly to accidents, shootings and other trauma cases.

In the past, they often did this as volunteers, but, the hospital representatives said, the doctors are increasingly unwilling to devote long hours to standing by -- perhaps giving up the chance to take cases for pay -- for no compensation. Sometimes, doctors on call rush to the hospital to treat patients, but they receive no fee if the patient is uninsured, and get inadequate reimbursement from Medicaid and HMOs, the hospital officials said.

The Washington County Hospital trauma center, which is in Hagerstown, closed in June when not enough doctors agreed to be on call, and reopened in October after the hospital agreed to give the doctors standby pay.

In general, legislators from four committees -- Senate Finance, Senate Budget and Taxation, House Appropriations and House Health and Governmental Operations -- expressed concern over keeping the trauma system functioning, and discussed a number of possible mechanisms to finance the additional support.

The state already collects $49.6 million a year from an $11 surcharge on motor vehicle registrations to support the trauma system. Lawmakers asked about increases in alcohol taxes, more mandates on auto insurance and surcharges on driver registration fees as possible ways to raise money.

Wood, however, said about half of trauma cases involve vehicle accidents, with the rest coming from gunshots, falls from ladders and other causes. His committee, he said, believes the trauma system should be supported from the general state budget.

Among the draft recommendations of the panel were a state fund to pay doctors for uncompensated care and/or being on call, an increase in Medicaid payments for trauma care, and legislation forcing HMOs and other private insurers to pay higher rates for trauma care.

At the same joint legislative briefing, Insurance Commissioner Steven B. Larsen said he expected to have a ruling by Feb. 20 on a proposal by CareFirst BlueCross BlueShield to convert to for-profit operation and be sold.

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