If it has seemed a mystery why so many hospitals want to have trauma centers, the answer has now been supplied in an eye-opening series by the Tampa Bay Times(paywall alert): They can charge a "trauma response fee," a hidden road to riches. That arbitrary fee is in addition to the already whopping bill. (Correction: An earlier version of this article said that a state-issued certificate-of-need was necessary for a hospital to open a trauma center, but that is incorrect.)
Some trauma centers, in the Times' words, are "exploiting the fee, charging large sums even to patients whose injuries require little more than first aid." In fact, the fee may be imposed even if the trauma center lacks the skill or equipment to handle a case and has to transfer the patient.
The Times offered examples, such as this one: An uninsured man who suffered a crushed pelvis in an auto accident was charged almost $44,000 by Lawnwood Regional Medical Center in Fort Pierce just for the the 40 minutes it took the doctors there to figure out they didn't have the right specialist and that he had to be sent elsewhere. Almost $33,000 of the bill was for the trauma response fee.
The trauma response fee is charged only if paramedics tell the hospital they have a trauma case coming in, which alerts the center to assemble its trauma team. But that happens frequently.
The Times said its team of reporters and researchers spent a year on the project and focused on hundreds of thousands of billing records from the state's 26 hospitals that were operating trauma centers during all or part of the period 2006 to 2013. The records, from Florida's Agency for Healthcare Administration, did not have patient identifiers.
The Times reported a number of conclusions, including:
- A trauma patient would be charged vastly different amounts depending on which trauma center paramedics take him to. There is no real rhyme or reason to the amount of the fee.
- Centers that are part of for-profit chains have much higher trauma response fees, on average, than the ones that are non-profit or publicly owned. HCA hospitals charged the highest response fees, the Times reported: an average of nearly $28,000. (The Medicare program says a fair fee based on costs is around $1,000, The Times reported.)
- HCA has succeeded in forcing insurers to pay the higher rates. On Monday The Times, citing confidential documents from Florida Blue, said the state's largest insurer paid HCA almost twice what it paid other trauma centers.
In their defense, trauma centers say that few people pay the billed charges. Insurers have negotiated contracts, and the uninsured usually can negotiate a big discount.
But the Times points out that many insurers pay a percentage of the bill, so the higher the bill, the higher the payment. That leads to inflated premiums for employers and workers.
And for uninsured patients, even a big discount can still leave them stuck with a five-figure bill. Medical bills are the chief cause of bankruptcy in the United States, an analysis published last summerfound.