Trauma Designation and the Resulting Bottom-Line Benefits

Posted on Fri, Jan 08, 2016

The Wide-Reaching ROI of Trauma Care


By John Josephs, MD
CEO, EmCare Acute Care Surgery

As CEO of an acute care subsidiary of the nation’s largest physician services company, my primary goal is taking hospitals through trauma designation and recertification. And, despite the fact that I work with many different hospitals of various ages, sizes and situations, I have consistently seen certain positive results stem from the designation.

Achieving trauma center designation or recertification is a complicated process that can seem overwhelming to many hospital administrators. However, completing the processes is well worth the effort. There are both operational and financial benefits outside the trauma department that act as "ripple effect" improvements that stem directly from trauma service implementation.

Trauma surgery is a natural and important offshoot of the broader realm of acute care surgery (sometimes referred to as emergency surgery). While acute care surgery is a less recognizable term to those outside of the healthcare industry, trauma designations have become a widely known, quantifiable benchmark that hospitals nationwide use to demonstrate quality of care.

Meaningful financial advantages
Medicare offers disproportionate funding to hospitals with trauma centers. Additionally, the Patient Protection and Affordable Care Act reinstituted the trauma stabilization act, which will unlock government funding for the development of trauma programs. On top of that, as a designated trauma center, hospitals can actually bill and collect for certain activation fees that are paid by both Medicare and private insurance companies. Those fees can be very meaningful, sometimes more than funding the trauma program itself.

The "halo effect"
"The halo effect" is a term that's used to describe the increase of throughput in the emergency department after a trauma program is developed. What we've found, and it's been well documented in the medical literature, is that when a hospital becomes a designated trauma facility, it receives increased traffic from the emergency medical services agencies that already come there. Additionally, the facility also starts receiving traffic from EMS agencies that traditionally went to other facilities. Once emergency medical technicians and paramedics get comfortable with a certain emergency department, they start going there more and more frequently. The emergency medical services provider no longer comes to the trauma-designated hospital just for trauma, they start bringing chest pain patients, stroke patients and patients with a wide array of conditions. Trauma-designated hospitals simply have busier EDs.

The "halo effect" also impacts the remainder of the hospital simply because the ED gets busier — the inpatient beds are filled more quickly and regularly, there are more higher-acuity patients so there are more X-rays, more laboratory tests and more patients who need the rehab facilities. The general surgery referrals get busier, the orthopedic referrals grow. The volume in the operating rooms tends to grow as well.

A built-in process improvement program
Another key reason for wanting to become trauma-designated is that the trauma program itself can serve as a process improvement program. Trauma designation has been shown to raise the bar throughout a hospital. On the back end of the trauma verification process, I have had many hospital administrators tell me that their hospital just performs better after receiving trauma designation.

Improved surgeon satisfaction
Acute-care surgery programs usually require an on call surgeon for trauma. That surgeon can also be on call for the emergency general surgery. In many cases, this allows practicing general surgeons to take call only if they want to, which makes that hospital the desired location in the community for surgeons to bring their patients. Sometimes surgeons view call as a burden. If a hospital can take call service off the table for the other practicing surgeons, many times that hospital becomes the preferred location for their practice. Not being on call can allow surgeons to run a much more efficient elective general surgery practice. These surgeons also appreciate knowing that the trauma-designated hospital will have a surgeon dedicated to seeing those trauma patients in a timely fashion.

A trauma surgeon taking the general surgery call can also see patients sooner in the emergency department, get them out of the emergency department and on the OR schedule at a time when there's a gap in the schedule. It decreases the after-hours burden of cases and improves the efficiency of utilization of the personnel that hospitals are already paying for during the day.

These benefits for general surgeons and sub-specialists also tend to be duplicated with primary care physicians. When PCPs are aware of the trauma designation and the enhanced surgical coverage and resultant process improvement that comes from trauma designation, they increase their referrals to that location.

Enhanced surgeon recruiting
Allowing general surgeons to avoid being on call can also be a great recruiting advantage. Hospitals often struggle to recruit surgical sub-specialists because being on the medical staff usually means spending time on call. If they know that all the general surgery calls are already taken, or they don't have to participate, it allows the hospital to better recruit subspecialty surgeons.

Additional prestige
Trauma is the first Center of Excellence Designation. It's verified by the American College of Surgeons and can go a long way towards elevating the reputation of a hospital. Each level of trauma designation comes with an implied level of capability. The most prestigious trauma centers in the country are American College of Surgeon verified Level 1 trauma centers. Typically Level 1 trauma centers are major teaching institutions, facilities affiliated with large universities and medical schools. So the idea of taking a community hospital and making it a Level 1 trauma center just conveys that same level of stature within the community and within the trauma region. It can also serve as a beneficial marketing tool.

Improved overall service
Perhaps the most important reason for a hospital to become trauma-designated is it allows that hospital to better serve its community. The mission of every hospital is to provide comprehensive care to the people in its community. Offering trauma care is an added service for the area the hospital serves.

Patients who arrive at a hospital in need of trauma surgery are treated by a surgeon who is on-site and dedicated to that hospital. That surgeon can help speed the patient through their course of care so that the patient gets seen sooner, evaluated sooner and operated on sooner, if surgery is needed. And that means that they're going to recover sooner. Patient satisfaction scores tend to go up when patients are treated quickly.

The Results
I have seen hospitals that were struggling prior to trauma designation — newer facilities in a saturated area or older hospitals unsuccessfully competing with shiny new high-tech sites — go on to become the most robust, well-regarded facilities in their communities. Trauma designation allows challenged hospitals to build strong, positive reputations of quality that can help recapture patients. Becoming a trauma facility truly can help breathe new life into a hospital.

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