AUGUST 1992, VOL 56, NO 2
AORN JOURNAL
Legislation Issues and legislation surrounding trauma care
I
n 1985, the National Academy of Sciences reported injury as the principal public health problem in America.’ Injury is the leading cause of death for people under age 45 and the fourth leading cause of death overall. Every. year, 140,000 Americans die from injuries, and 70 million sustain nonfatal injuries. Of those, 340,000 become permanently disabled. Because young people are involved most often, and thus more years of work life are lost, trauma is the nation’s most costly disease, resulting in $180 billion in total lifetime costs in 1988.* Although trauma care is expensive, appropriate trauma care appears to be highly cost-effective. A recent analysis estimates the value of a life saved to be $2 rnilli~n.~ Legislators and policy makers have begun to address trauma care, but the crisis has not been solved. Together with the public, they must continue to seek solutions. As well as preventing the loss of young, productive lives, trauma systems need to reduce the costs associated with trauma care in the United States.
History
T
he emergency care system concept had its beginnings in military conflicts (ie, World War 11, the Korean and Vietnam conflicts). Physicians began bypassing first aid stations, taking the injured directly from the field to mobile army surgical hospitals (MASH). In these MASH units, surgical treatment was provided within the “golden hour” (ie, the hour past the time of injury, during which lifesaving
treatment is most successful). As this concept moved into civilian emergency care, four key components of a trauma system were identified: 1) access to care, such as the “91 1” telephone number; 2) prehospital care, including triage, treatment by prehospital personnel, and rapid transport; 3) trauma centers with sophisticated equipment and highly trained staff members; and 4) rehabilitative care to restore the injured to the most sound or healthy state possible.
Legislative Activity ith the Omnibus Budget Reconciliation Act of 1985, the public was given virtually uncontested access to emergency care services. Hospitals that participate in Medicare programs and are equipped to treat people who come to the facility needing emergency care are required to provide that care. Federal reimbursement, however, is limited to patients who qualify for federal programs such as Medicaid and Medicare. Through the 1966 Highway Safety Act and
Corinne Z. Koehler, RN, BSN, CRRN, is a fulltime student at the graduate school of public affairs, University of Colorado, Denver. She received her bachelor of science degree in nursing from the University of Colorado, Boulder. 331
AUGUST 1992, VOL 56, NO 2
AORY JOURNAL
1973 Emergency Medical Services (EMS) Systems Act, grants were provided for programs to improve EMS. This grant program was folded into the Preventive Health and Health Services block grant in the 1980s allowing states to decide how much funding would be available for EMS.
Ti-uunmsystems
0
rganized, regional systems of trauma care that have the the four required components have proven successful. They significantly improve survival and disability outcomes following severe injury? 0 have reduced the preventable death rates by 50% in three metro areas,j 0 could save 20,000 to 25,000 Americans if used across the nation,6and return 80% of the severely injured to fulltime work within four years, with most resuming activities within one year after injury.’ The heart of a trauma system is the trauma center. The American College of Surgeons (ACS) has suggested that a trauma center treat a minimum of 350 trauma patients per year and that each physician treat at least 50 patients annually to maintain proficiency. Trauma centers in the United States are classified by the ACS with the following levels.* Level I. A tertiary care, community trauma resource with a research and teaching commitment. Many centers have attending surgeons available in-house on a 24-hour basis. Level ZZ. Provides same care as Level I center without teaching and research commitments. Level ZZZ. Expedites Advanced Trauma Life Support (ATLS) and prompt triage; provides trauma care in rural environments.
Problems
C
urrently, 370 of the 6,640 hospitals in the United States are designated as trauma centers. Even though the ACS has its classification levels, there is no national standard or 332
requirement for designation as a trauma center. The 370 ACS-designated trauma centers serve only 25% of the population because they are concentrated in urban areas, leaving rural America largely uncovered. Other problems cause trauma centers to close their doors. Many of the trauma centers are closing because of financial problems. Studies indicate many urban trauma centers lose between $1 and $6 million in actual costs in one year of operation for several reasons.’ These include 0 high costs of providing trauma care, which can be three times higher than the cost of average acute care, decreasing reimbursement rates under Medicaid, Medicare, and third-party payers, and increasing numbers of uninsured trauma patients. Administrators knew trauma centers could be expensive ventures before they applied for the designation. They believed, however, that the investment would pay off in indirect benefits, such as increased prestige, visibility, ability to attract professional staff, and reputation for critical care expertise. They hoped these benefits eventually would lead to more paying patients and increased revenue. The reality has been that maintaining trauma center standards for those who do not pay results in financial losses hospitals cannot continue to absorb. Cost shifting. In past years, hospitals were able to shift uncompensated care costs to privately insured patients. With changes in employer self-insure plans, managed care plans, and reduced Medicaid and Medicare payments, cost shifting is no longer possible. The vast majority of uncompensated care costs are generated by uninsured patients. The number of uninsured individuals under age 65 grew from 28.4 million in 1979 to 36.8 million in 1986.”’The lack of insurance is most common among younger adults (ie, under age 45) who make up the vast majority of trauma patients.” Nationally, estimates indicate 68% of uncompensated care can be attributed to the uninsured.” Domino effect. Compounding the problem is
AUGUST 1992, VOL 56, NO 2
the “domino effect” caused when a trauma center closes. When a trauma center closes its doors, patients who would have been treated are taken to other trauma centers in the system. With the additional burden of more uninsured and government-assisted program patients, the open center may be financially unable or unwilling to absorb additional loses, choosing instead to close. Such a domino effect can doom a trauma system to failure. Increasing violence. Other problems relate to an increase in violence. At many urban trauma centers, rises in unreimbursed trauma care costs have paralleled the increases in penetrating injuries (eg, gunshot wounds, stabbings) associated with domestic, criminal, and drugrelated violence. Not only has the number of penetrating injuries increased, but many gunshot injuries are more severe because of semiautomatic weapons. Urban trauma centers see victims of violent crime and drug wars because of their location and environment. These centers are mandated by law to treat the severely injured who often are uninsured and do not pay their bills. This leads to a greater likelihood of financial loss. Assessing the patient’s ability to pay in the face of treating life-threatening injury is incompatible with good patient care. Other negative effects. Adding to a hospital’s decision to close are the negative effects trauma centers may have on the hospital. These include disruption of hospital services, potential loss of paying patients, and physicians’ reluctance to provide trauma care. Because trauma patients require immediate treatment, hospital routines are disrupted, which may require surgery and x-ray services to be rescheduled and limit intensive care unit beds for paying patients. As revenue-producing patients become frustrated with schedule delays or become frightened by trauma patients, they may seek care at other facilities, resulting in a loss of income to the hospital. Physicians are affected as well. Providing trauma care disrupts their private practice and their personal and social lives. In addition, they may receive little or no reimbursement for their trauma services. Level I and I1 trauma centers
AORN JOURNAL
require a trauma surgeon and an anesthesiologist to be in-house 24 hours a day. In addition, a neurosurgeon and an orthopedic surgeon must be on call at all times. Because most trauma injuries occur at night or on weekends, surgeons can find themselves up all night caring for a nonpaying trauma patient and having to cancel a paying elective case the next day.
Proposed Solutions
R
ecognizing that states had been slow to develop regional trauma systems, Congress passed PL 101-590, the 1990 Trauma Care Systems Planning and Development Act, to help states develop, implement, and improve regional trauma care systems. Even though it was enacted in 1990, the program did not receive funding until fiscal year 1992. No money was spent on the program because the Department of Health and Human Services had not issued a formal delegation of authority. That delegation has been issued, giving authority for managing the trauma program to the Health Resources and Services Administration. Legislation (HR 3636) is still pending, however, to shift the program to the guidance of the Centers for Disease Control, Atlanta. AORN has joined a coalition of 51 other organizations in support of this program. The coalition is asking Congress to appropriate $30 million for trauma systems programs in fiscal year 1993; however the program received $5 million last year, and that is what is expected again. AORN President Kay A. Ball, RN, MSA, CNOR, also wrote to members of the House Appropriations Committee urging their support and requesting $30 million. President Bush’s proposed budget for fiscal year 1993 eliminates funding for the trauma program. Clearly, reimbursement for trauma care threatens public access to definitive care, causing increased death and disability. Several other legislative solutions to the trauma crisis have been proposed. (See “Proposed Legislation Regarding Trauma Care.”) In addition to legislative proposals, other solutions have been recommended by 333
AUGUST 1992, VOL 56, NO 2
AORh JOURNAL
Proposed Legislation Bill: Purpose:
Statits:
Bill: Piii pose:
Status:
Bill:
Prrrpose:
Statirs:
Bill: P1rrpose:
stati1.s:
Bill: Pirrpose:
HR 1656 Trauma Center Revitalization Act, introduced by Rep Henry A. Waxman (D-Calif). To provide financial assistance for certain trauma centers operating in geographic areas with a significant incidence of violence arising from drug abuse. Priority would be given to centers 1) receiving state or political subdivision support not connected to any federal program or 2 ) in areas where a trauma center has ceased participation or, because of uncompensated costs, will be unable to participate in the trauma care system. Incorporated as an amendment to HR 337 1, a wide-ranging crime control bill. HR 25 17 Trauma Research Act of 1991, introduced by Rep Edward J. Markey (D-Mass). To establish a comprehensive program of research on trauma and the Trauma Research Interagency Coordinating Committee. Referred to the House Committee on Energy and Commerce. HR 3636 Trauma Amendment to the Health Promotion and Disease Prevention Act of 1991, introduced by Rep Henry Waxman (D-Calif). To transfer trauma program of PL 101-590 (ie, the Trauma Care Systems Planning and Development Act) from Health Resources and Services Administration to the Centers for Disease Control. Pending Conference Committee negotiations. HR 4243 Brain Injury Rehabilitation Quality Act of 1992, introduced by Rep Ron Wyden (D-Ore). To provide for optional coverage under state Medicaid plans of case-management services for individuals who suffer traumatic brain injuries. Referred to the House Committee on Energy and Commerce. HR 4256 Emergency Medical Services Amendments of 1992, introduced by Rep Steven C. Gunderson (R-Wis). To establish an Office of Emergency Medical Services. Three key components of this legislation are to establish a federal EMS office to maintain appropriate numbers of health care professionals in prehospital and
AUGUST 1992, VOL 56, NO 2
AORN JOURNAL
Regarding Trauma Care
Status:
Bill: Purpose:
Status:
Bill:
Purpose:
Status:
Bill: Purpose:
Status:
hospital-based activities; develop EMS guidelines regarding health professionals, equipment, and training; and examine the unique needs of EMS in inner city and rural areas; 0 establish or enhance state EMS offices through a federalhtate matching grant program over three years; and provide for a demonstration telecommunications program to enable patients and health care professionals in rural communities to link up with medical specialists in larger health facilities for consultations regarding life-saving treatment. Referred to the House Energy and Commerce Committee.
HR 4285 Trauma Care Center Alien Compensation Act of 1992, introduced by Rep Bill Lowery (R-Calif). To establish a program of formula grants for compensating certain trauma care centers for unreimbursed costs incurred with respect to undocumented aliens. This measure was incorporated into HR 3698, the Community Mental Health and Substance Abuse Service Improvement Act, which was incorporated into S 1306, the Alcohol, Drug Abuse, and Mental Health Administration (ADAMHA) Reorganization Act of 1991. This latter bill is pending in Conference Committee. S 1306 ADAMHA Reorganization Act of 1992 and Trauma Center Revitalization Act introduced by Sen Edward Kennedy (D-Mass). To transfer function of ADAMHA to National Institutes of Health, provide grants for the operating expenses of hospital trauma centers with substantial uncompensated costs, and incorporate HR 4285 as an amendment. Sent to Conference Committee.
S 2536 Senate companion bill to HR 4285, the Trauma Care Center Alien Compensation Act of 1992, introduced by Sen John Seymour (R-Calif). To establish a program of formula grants for compensating certain trauma care centers for unreimbursed costs incurred with respect to undocumented aliens. Referred to the Senate Committee on Labor and Human Resources. 335
Champion and Mabee.13They suggest a trauma financing pool with revenues from increased taxes on alcoholic beverages, surcharges on drivedmotor vehicle registration fees, and traffic violation penalties, expanded Medicaid coverage to include a catastrophic plan for uninsured trauma patients, 0 adjustments to diagnosis-related group (DRG)-based reimbursement for trauma care, including trauma and accompanying rehabilitative care in all uninsured health care benefit plans, and regional systems of trauma care. Health care is a top agenda item for policy makers in the local, state, and federal government. The crisis in trauma care affects everyone. Traumatic injuries happen to us as well as our family members and friends. Everyone must be part of the solution. COFUNNE 2. KOEHLER, RN Notes 1. Committee on Trauma Research, Commission on Life Sciences, National Research Council, Institute of Medicine, Injury in America: A Continuing Public Health Problem (Washington, DC: National Academy Press, 1985). 2. €3 R Champion, M S Mabee, An American Crisis in Trauma Care Reimbursement (Washington, DC: The Washington Hospital Center, 1990). 3. T R Miller, S Juchter, P C Brinkman, “Crash costs and safety investment,” 32nd Annual Proceedings (Seattle: Association of the Advancement of Automotive Medicine, September 1988). 4. Champion, Mabee, An American Crisis in Trauma Care Reimbursement. 5. R H Cales, “Trauma mortality in Orange County: The effect of implementation of a regional trauma system,” Annals of Emergency Medicine 13 (January 1984) 1-10; National Highway Traffic Safety Administration, Emergency Medical Services Program and its Relationship to Highway Safety, pub1 no DOT HS 806 832 (Washington, DC: US Department of Transportation, 1985); Division of Emergency Medical Services, First Year Trauma System Assessment (San Diego: County of San Diego, November 1985). 6. Champion, Mabee, An American Crisis in
Trauma Care Reimbursement. 7. E J MacKenzie, S Shapiro, J H Siegel, “The economic impact of traumatic injuries,” Journal of the American Medical Association 260 (Dec 9, 1988); E J MacKenzie et al, “Functional recovery and medical costs of trauma: An analysis by type and severity of injury,” Journal of Trauma 28 (March 1988); E J MacKenzie et al, “Factors influencing return to work following hospitalization for traumatic injury,” American Journal of Public Health 77 (March 1987). 8. American College of Surgeons Committee on Trauma, Resources for Optimal Care of the Injured Patient (Chicago: American College of Surgeons, 1990). 9. Champion, Mabee, An American Crisis in Trauma Care Reimbursement. 10. Ibid. 11. United States General Accounting Office, Trauma Care, Lifesaving System Threatened by Unreimbursed Costs and Other Factors, Report to the chairman, subcommittee on Health for Families and the Uninsured, Committee on Finance, US Senate, GAO/HRD 9 1-57 May 1991.
Correction The “Legislation” column in the July issue contains an error. Florida House bill 11 1, regarding human immunodeficiency virus testing of patients and health care workers, did not pass. This bill, along with a Senate companion bill 3303, died in committee. The Journal regrets the error.
337
AORN JOURNAL
Legislation Issues and legislation surrounding trauma care
I
n 1985, the National Academy of Sciences reported injury as the principal public health problem in America.’ Injury is the leading cause of death for people under age 45 and the fourth leading cause of death overall. Every. year, 140,000 Americans die from injuries, and 70 million sustain nonfatal injuries. Of those, 340,000 become permanently disabled. Because young people are involved most often, and thus more years of work life are lost, trauma is the nation’s most costly disease, resulting in $180 billion in total lifetime costs in 1988.* Although trauma care is expensive, appropriate trauma care appears to be highly cost-effective. A recent analysis estimates the value of a life saved to be $2 rnilli~n.~ Legislators and policy makers have begun to address trauma care, but the crisis has not been solved. Together with the public, they must continue to seek solutions. As well as preventing the loss of young, productive lives, trauma systems need to reduce the costs associated with trauma care in the United States.
History
T
he emergency care system concept had its beginnings in military conflicts (ie, World War 11, the Korean and Vietnam conflicts). Physicians began bypassing first aid stations, taking the injured directly from the field to mobile army surgical hospitals (MASH). In these MASH units, surgical treatment was provided within the “golden hour” (ie, the hour past the time of injury, during which lifesaving
treatment is most successful). As this concept moved into civilian emergency care, four key components of a trauma system were identified: 1) access to care, such as the “91 1” telephone number; 2) prehospital care, including triage, treatment by prehospital personnel, and rapid transport; 3) trauma centers with sophisticated equipment and highly trained staff members; and 4) rehabilitative care to restore the injured to the most sound or healthy state possible.
Legislative Activity ith the Omnibus Budget Reconciliation Act of 1985, the public was given virtually uncontested access to emergency care services. Hospitals that participate in Medicare programs and are equipped to treat people who come to the facility needing emergency care are required to provide that care. Federal reimbursement, however, is limited to patients who qualify for federal programs such as Medicaid and Medicare. Through the 1966 Highway Safety Act and
Corinne Z. Koehler, RN, BSN, CRRN, is a fulltime student at the graduate school of public affairs, University of Colorado, Denver. She received her bachelor of science degree in nursing from the University of Colorado, Boulder. 331
AUGUST 1992, VOL 56, NO 2
AORY JOURNAL
1973 Emergency Medical Services (EMS) Systems Act, grants were provided for programs to improve EMS. This grant program was folded into the Preventive Health and Health Services block grant in the 1980s allowing states to decide how much funding would be available for EMS.
Ti-uunmsystems
0
rganized, regional systems of trauma care that have the the four required components have proven successful. They significantly improve survival and disability outcomes following severe injury? 0 have reduced the preventable death rates by 50% in three metro areas,j 0 could save 20,000 to 25,000 Americans if used across the nation,6and return 80% of the severely injured to fulltime work within four years, with most resuming activities within one year after injury.’ The heart of a trauma system is the trauma center. The American College of Surgeons (ACS) has suggested that a trauma center treat a minimum of 350 trauma patients per year and that each physician treat at least 50 patients annually to maintain proficiency. Trauma centers in the United States are classified by the ACS with the following levels.* Level I. A tertiary care, community trauma resource with a research and teaching commitment. Many centers have attending surgeons available in-house on a 24-hour basis. Level ZZ. Provides same care as Level I center without teaching and research commitments. Level ZZZ. Expedites Advanced Trauma Life Support (ATLS) and prompt triage; provides trauma care in rural environments.
Problems
C
urrently, 370 of the 6,640 hospitals in the United States are designated as trauma centers. Even though the ACS has its classification levels, there is no national standard or 332
requirement for designation as a trauma center. The 370 ACS-designated trauma centers serve only 25% of the population because they are concentrated in urban areas, leaving rural America largely uncovered. Other problems cause trauma centers to close their doors. Many of the trauma centers are closing because of financial problems. Studies indicate many urban trauma centers lose between $1 and $6 million in actual costs in one year of operation for several reasons.’ These include 0 high costs of providing trauma care, which can be three times higher than the cost of average acute care, decreasing reimbursement rates under Medicaid, Medicare, and third-party payers, and increasing numbers of uninsured trauma patients. Administrators knew trauma centers could be expensive ventures before they applied for the designation. They believed, however, that the investment would pay off in indirect benefits, such as increased prestige, visibility, ability to attract professional staff, and reputation for critical care expertise. They hoped these benefits eventually would lead to more paying patients and increased revenue. The reality has been that maintaining trauma center standards for those who do not pay results in financial losses hospitals cannot continue to absorb. Cost shifting. In past years, hospitals were able to shift uncompensated care costs to privately insured patients. With changes in employer self-insure plans, managed care plans, and reduced Medicaid and Medicare payments, cost shifting is no longer possible. The vast majority of uncompensated care costs are generated by uninsured patients. The number of uninsured individuals under age 65 grew from 28.4 million in 1979 to 36.8 million in 1986.”’The lack of insurance is most common among younger adults (ie, under age 45) who make up the vast majority of trauma patients.” Nationally, estimates indicate 68% of uncompensated care can be attributed to the uninsured.” Domino effect. Compounding the problem is
AUGUST 1992, VOL 56, NO 2
the “domino effect” caused when a trauma center closes. When a trauma center closes its doors, patients who would have been treated are taken to other trauma centers in the system. With the additional burden of more uninsured and government-assisted program patients, the open center may be financially unable or unwilling to absorb additional loses, choosing instead to close. Such a domino effect can doom a trauma system to failure. Increasing violence. Other problems relate to an increase in violence. At many urban trauma centers, rises in unreimbursed trauma care costs have paralleled the increases in penetrating injuries (eg, gunshot wounds, stabbings) associated with domestic, criminal, and drugrelated violence. Not only has the number of penetrating injuries increased, but many gunshot injuries are more severe because of semiautomatic weapons. Urban trauma centers see victims of violent crime and drug wars because of their location and environment. These centers are mandated by law to treat the severely injured who often are uninsured and do not pay their bills. This leads to a greater likelihood of financial loss. Assessing the patient’s ability to pay in the face of treating life-threatening injury is incompatible with good patient care. Other negative effects. Adding to a hospital’s decision to close are the negative effects trauma centers may have on the hospital. These include disruption of hospital services, potential loss of paying patients, and physicians’ reluctance to provide trauma care. Because trauma patients require immediate treatment, hospital routines are disrupted, which may require surgery and x-ray services to be rescheduled and limit intensive care unit beds for paying patients. As revenue-producing patients become frustrated with schedule delays or become frightened by trauma patients, they may seek care at other facilities, resulting in a loss of income to the hospital. Physicians are affected as well. Providing trauma care disrupts their private practice and their personal and social lives. In addition, they may receive little or no reimbursement for their trauma services. Level I and I1 trauma centers
AORN JOURNAL
require a trauma surgeon and an anesthesiologist to be in-house 24 hours a day. In addition, a neurosurgeon and an orthopedic surgeon must be on call at all times. Because most trauma injuries occur at night or on weekends, surgeons can find themselves up all night caring for a nonpaying trauma patient and having to cancel a paying elective case the next day.
Proposed Solutions
R
ecognizing that states had been slow to develop regional trauma systems, Congress passed PL 101-590, the 1990 Trauma Care Systems Planning and Development Act, to help states develop, implement, and improve regional trauma care systems. Even though it was enacted in 1990, the program did not receive funding until fiscal year 1992. No money was spent on the program because the Department of Health and Human Services had not issued a formal delegation of authority. That delegation has been issued, giving authority for managing the trauma program to the Health Resources and Services Administration. Legislation (HR 3636) is still pending, however, to shift the program to the guidance of the Centers for Disease Control, Atlanta. AORN has joined a coalition of 51 other organizations in support of this program. The coalition is asking Congress to appropriate $30 million for trauma systems programs in fiscal year 1993; however the program received $5 million last year, and that is what is expected again. AORN President Kay A. Ball, RN, MSA, CNOR, also wrote to members of the House Appropriations Committee urging their support and requesting $30 million. President Bush’s proposed budget for fiscal year 1993 eliminates funding for the trauma program. Clearly, reimbursement for trauma care threatens public access to definitive care, causing increased death and disability. Several other legislative solutions to the trauma crisis have been proposed. (See “Proposed Legislation Regarding Trauma Care.”) In addition to legislative proposals, other solutions have been recommended by 333
AUGUST 1992, VOL 56, NO 2
AORh JOURNAL
Proposed Legislation Bill: Purpose:
Statits:
Bill: Piii pose:
Status:
Bill:
Prrrpose:
Statirs:
Bill: P1rrpose:
stati1.s:
Bill: Pirrpose:
HR 1656 Trauma Center Revitalization Act, introduced by Rep Henry A. Waxman (D-Calif). To provide financial assistance for certain trauma centers operating in geographic areas with a significant incidence of violence arising from drug abuse. Priority would be given to centers 1) receiving state or political subdivision support not connected to any federal program or 2 ) in areas where a trauma center has ceased participation or, because of uncompensated costs, will be unable to participate in the trauma care system. Incorporated as an amendment to HR 337 1, a wide-ranging crime control bill. HR 25 17 Trauma Research Act of 1991, introduced by Rep Edward J. Markey (D-Mass). To establish a comprehensive program of research on trauma and the Trauma Research Interagency Coordinating Committee. Referred to the House Committee on Energy and Commerce. HR 3636 Trauma Amendment to the Health Promotion and Disease Prevention Act of 1991, introduced by Rep Henry Waxman (D-Calif). To transfer trauma program of PL 101-590 (ie, the Trauma Care Systems Planning and Development Act) from Health Resources and Services Administration to the Centers for Disease Control. Pending Conference Committee negotiations. HR 4243 Brain Injury Rehabilitation Quality Act of 1992, introduced by Rep Ron Wyden (D-Ore). To provide for optional coverage under state Medicaid plans of case-management services for individuals who suffer traumatic brain injuries. Referred to the House Committee on Energy and Commerce. HR 4256 Emergency Medical Services Amendments of 1992, introduced by Rep Steven C. Gunderson (R-Wis). To establish an Office of Emergency Medical Services. Three key components of this legislation are to establish a federal EMS office to maintain appropriate numbers of health care professionals in prehospital and
AUGUST 1992, VOL 56, NO 2
AORN JOURNAL
Regarding Trauma Care
Status:
Bill: Purpose:
Status:
Bill:
Purpose:
Status:
Bill: Purpose:
Status:
hospital-based activities; develop EMS guidelines regarding health professionals, equipment, and training; and examine the unique needs of EMS in inner city and rural areas; 0 establish or enhance state EMS offices through a federalhtate matching grant program over three years; and provide for a demonstration telecommunications program to enable patients and health care professionals in rural communities to link up with medical specialists in larger health facilities for consultations regarding life-saving treatment. Referred to the House Energy and Commerce Committee.
HR 4285 Trauma Care Center Alien Compensation Act of 1992, introduced by Rep Bill Lowery (R-Calif). To establish a program of formula grants for compensating certain trauma care centers for unreimbursed costs incurred with respect to undocumented aliens. This measure was incorporated into HR 3698, the Community Mental Health and Substance Abuse Service Improvement Act, which was incorporated into S 1306, the Alcohol, Drug Abuse, and Mental Health Administration (ADAMHA) Reorganization Act of 1991. This latter bill is pending in Conference Committee. S 1306 ADAMHA Reorganization Act of 1992 and Trauma Center Revitalization Act introduced by Sen Edward Kennedy (D-Mass). To transfer function of ADAMHA to National Institutes of Health, provide grants for the operating expenses of hospital trauma centers with substantial uncompensated costs, and incorporate HR 4285 as an amendment. Sent to Conference Committee.
S 2536 Senate companion bill to HR 4285, the Trauma Care Center Alien Compensation Act of 1992, introduced by Sen John Seymour (R-Calif). To establish a program of formula grants for compensating certain trauma care centers for unreimbursed costs incurred with respect to undocumented aliens. Referred to the Senate Committee on Labor and Human Resources. 335
Champion and Mabee.13They suggest a trauma financing pool with revenues from increased taxes on alcoholic beverages, surcharges on drivedmotor vehicle registration fees, and traffic violation penalties, expanded Medicaid coverage to include a catastrophic plan for uninsured trauma patients, 0 adjustments to diagnosis-related group (DRG)-based reimbursement for trauma care, including trauma and accompanying rehabilitative care in all uninsured health care benefit plans, and regional systems of trauma care. Health care is a top agenda item for policy makers in the local, state, and federal government. The crisis in trauma care affects everyone. Traumatic injuries happen to us as well as our family members and friends. Everyone must be part of the solution. COFUNNE 2. KOEHLER, RN Notes 1. Committee on Trauma Research, Commission on Life Sciences, National Research Council, Institute of Medicine, Injury in America: A Continuing Public Health Problem (Washington, DC: National Academy Press, 1985). 2. €3 R Champion, M S Mabee, An American Crisis in Trauma Care Reimbursement (Washington, DC: The Washington Hospital Center, 1990). 3. T R Miller, S Juchter, P C Brinkman, “Crash costs and safety investment,” 32nd Annual Proceedings (Seattle: Association of the Advancement of Automotive Medicine, September 1988). 4. Champion, Mabee, An American Crisis in Trauma Care Reimbursement. 5. R H Cales, “Trauma mortality in Orange County: The effect of implementation of a regional trauma system,” Annals of Emergency Medicine 13 (January 1984) 1-10; National Highway Traffic Safety Administration, Emergency Medical Services Program and its Relationship to Highway Safety, pub1 no DOT HS 806 832 (Washington, DC: US Department of Transportation, 1985); Division of Emergency Medical Services, First Year Trauma System Assessment (San Diego: County of San Diego, November 1985). 6. Champion, Mabee, An American Crisis in
Trauma Care Reimbursement. 7. E J MacKenzie, S Shapiro, J H Siegel, “The economic impact of traumatic injuries,” Journal of the American Medical Association 260 (Dec 9, 1988); E J MacKenzie et al, “Functional recovery and medical costs of trauma: An analysis by type and severity of injury,” Journal of Trauma 28 (March 1988); E J MacKenzie et al, “Factors influencing return to work following hospitalization for traumatic injury,” American Journal of Public Health 77 (March 1987). 8. American College of Surgeons Committee on Trauma, Resources for Optimal Care of the Injured Patient (Chicago: American College of Surgeons, 1990). 9. Champion, Mabee, An American Crisis in Trauma Care Reimbursement. 10. Ibid. 11. United States General Accounting Office, Trauma Care, Lifesaving System Threatened by Unreimbursed Costs and Other Factors, Report to the chairman, subcommittee on Health for Families and the Uninsured, Committee on Finance, US Senate, GAO/HRD 9 1-57 May 1991.
Correction The “Legislation” column in the July issue contains an error. Florida House bill 11 1, regarding human immunodeficiency virus testing of patients and health care workers, did not pass. This bill, along with a Senate companion bill 3303, died in committee. The Journal regrets the error.
337
