7 - 9 Moreover, data from 1 study 10 found a large variation in trauma activation fees at trauma centers in Florida, with for-profit hospitals charging substantially more. 6 While a trauma activation fee may be justified, popular media articles have decried the large amounts charged for trauma activation for, in some cases, very minor injuries. Trauma activation fees were first approved in 2002 after it was argued that the high cost of running trauma centers threatened to shut down many essential trauma centers. 5 These patients or their insurance payers may thus bear the monetary expense of a visit to a trauma center without having a medical need for it.Īmong the charges that may be accrued for a visit to a trauma center is the trauma activation fee, which is a charge for the mobilization of the medical professionals who make up the trauma team. 3, 4 At the same time, previous data have suggested that more than one-third of patients brought to trauma centers do not meet field triage guidelines for transport to trauma centers. 2 However, trauma centers have been found to improve survival rates among patients with serious injuries. 1 Patients with serious traumatic injuries often receive care at trauma centers where the cost is high, at least in part because trauma centers must be continuously prepared to treat life-threatening injuries. Traumatic injuries are a major contributor to total US health care spending. Therefore, standardization of trauma activation fees is warranted. These findings suggest that some patients with serious traumatic injuries will incur disproportionately high trauma activation fees depending on the trauma center to which they are brought. In addition, for-profit hospitals charged more than other types of hospitals. Regional variation in these fees was substantial, with hospitals in the West charging substantially more than those in other locations. Trauma activation fees were also higher at for-profit hospitals, most of which were owned by the HCA Healthcare system, which had 43 trauma centers and a median (IQR) tier 1 trauma activation fee of $29 999 ($20 196-$37 589).Ĭonclusions And Relevance In this study, trauma activation fees varied widely among hospitals in the US. Median (IQR) trauma activation fees were highest in the West ($18 099 ), especially in California, where the median (IQR) activation fee was $24 057 ($15 979-$33 618). Overall, the median (IQR) tier 1 trauma activation fee was $9500 ($5601-$17 805), and the mean (SD) tier 1 trauma activation fee was $13 349 ($11 034) these fees ranged from $1000 to $61 734. There were 176 adult level I trauma centers and 200 adult level II trauma centers 69 centers had for-profit status, and 415 were academic. Results Of 523 trauma centers included in the analysis, most were located in the Midwest (180 centers) and West (129 centers). Main Outcomes and Measures Median and mean trauma activation fees nationally and stratified by location, hospital system, and other hospital characteristics. Linear regression analyses were performed to assess potential associations between hospital characteristics (type of control, hospital system, number of staffed beds, and academic vs nonacademic status) and trauma activation fees. All data were collected between January 2 and March 11, 2022. Hospital-specific data were obtained from the American Hospital Association website. Two levels of trauma activation fees were recorded: tier 1 (full activation) and tier 2 (partial activation). Each hospital’s publicly available chargemaster (a comprehensive list of a hospital’s products, procedures, and services) was searched to obtain its trauma activation fees. Five military hospitals were excluded, and trauma activation fees could not be found for 18 trauma centers the remaining 523 hospitals were included in the analysis. Objective To evaluate the variability of trauma activation fees from trauma centers across the US and examine whether certain hospital characteristics are associated with higher activation fees.ĭesign, Setting, and Participants This cross-sectional study used data from the American College of Surgeons website to identify all trauma centers in the US that were listed as verified from inception of the verification database through Ma(N = 546). Regional and hospital-related variations in trauma activation fees across the US have not been formally assessed. Importance Trauma centers must be readily equipped to handle a variety of life-threatening injuries and consequently may charge a fee for the activation of their trauma team. Shared Decision Making and Communication.Scientific Discovery and the Future of Medicine.Health Care Economics, Insurance, Payment.Clinical Implications of Basic Neuroscience.
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