Development of a Trauma System in Oklahoma


Published on

  • Be the first to comment

  • Be the first to like this

No Downloads
Total views
On SlideShare
From Embeds
Number of Embeds
Embeds 0
No embeds

No notes for slide
  • Since most of you were sensors I am going to present this update of what we did in the past year in 10 minutes and not the 15 I was allotted and start with our results and then how were got there. And you must know this is coming from a thinker so it was a bit more difficult to put together since I see sensors as superficial, impulsive and poor planners
  • System within their region, not just send everything into the most populace regions with the tertiary care centers and Level 1 facility. Committees to monitor the system that was protected from discovery.
  • Our next problem is going to be general surgery coverage even within large hospitals in OKC the call panel has decreased to covering 20 out of 30 days Not every hospital or EMS has this capability to check facility status – thus wasted time on the phone.
  • Facts: 3.5 million population, 1/3 uninsured or medicaid/medicare, 410,000 medicaid alone, 23% no insurance at all. 30% of drivers are uninsured, minimum liability coverage is 20,000 30% of patients involved in traumatic events - self pay, medicaid or medicare
  • Oklahoma has the 5 th highest percentage of uninsured patients
  • Medicaid population has hit over 600K (our population is 3.5 million, thus 17% medicaid ) Given the negative profit margin with treating medicaid patients we actually loose money.
  • State wide medicaid/medicare 20% and self pay 27% for trauma patients.
  • John Sacra supplied data on divert within Oklahoma city a 40% increase in the number of patients diverted over 4 years.
  • Since we don’t have other hospitals to take patients nearly all are transported to OUMC, ones that don’t come probably requested other facilities. About 46% of transports to are for mechanism of injury, patients that do not have time sensitive issues or multisystem injuries.
  • Find out what is important to them and get them the data.
  • Development of a Trauma System in Oklahoma

    1. 1. Support for the Trauma System in Oklahoma How we got there/here 2003-2005 Roxie M. Albrecht, MD, FACS Medical Director, Trauma & Surgical Critical Care OU Medical Center
    2. 2. Senate Bill 1554 <ul><li>Trauma Care Assistance Revolving Fund </li></ul><ul><ul><li>Reimburse for uncompensated care </li></ul></ul><ul><ul><ul><li>Hospitals </li></ul></ul></ul><ul><ul><ul><li>Prehospital provider services </li></ul></ul></ul><ul><ul><ul><li>Physicians – at Medicare rates </li></ul></ul></ul><ul><li>Medicaid Matching for Trauma Fund </li></ul>
    3. 3. Past Trauma Fund Distributions 0.19 4.0 21.5 3024 2004 0.09 2.51 27.0 3393 2003 0.20 3.38 16.6 N/a 2002 0.20 2.18 10.7 N/a 2001 0.24 2.12 8.85 N/a 2000 Reimbursement Ratio Total for Distribution (Million) Total Uncompensated cost (million) Approved cases Year
    4. 4. Funding Initiatives Convictions – driving without a valid DL 11/1/04 unk 2299 Tobacco Tax 1/1/05 $ 17 million 2660 General Fund 7/1/04 $400,000 2042 Open Container, Speeding, DUI 6/3/04 $ 1.8 million 2250 Failure to maintain liability ins., reinstatement DL, drug offenses 9/1/04 $ 12.4 million 2600 Source Effective Dates Estimated Funding House Bill
    5. 5. Current Trauma Fund <ul><li>Collections </li></ul><ul><ul><li>July 04 – July 05 = 14,465,423.00 </li></ul></ul><ul><ul><ul><li>June 05 – 1,409,623 & July 05 – 1,737101 </li></ul></ul></ul><ul><li>Eligible Physician participants </li></ul><ul><ul><li>Tier A – </li></ul></ul><ul><ul><ul><li>Emergency Medicine, Neurosurgery, General Surgery, Maxillo-facial surgery, Orthopaedic surgery, Anesthesiology and Trauma intensivists. </li></ul></ul></ul><ul><ul><li>Tier B – </li></ul></ul><ul><ul><ul><li>Areas not identified in A </li></ul></ul></ul><ul><ul><ul><li>Funds will be distributed pending excess from Tier A allocation </li></ul></ul></ul>
    6. 6. Trauma Fund – Physician Reimbursement <ul><li>Qualifying Cases </li></ul><ul><ul><li>ICD-9 code of 800.0-959.9 </li></ul></ul><ul><ul><li>Limited to contacts within 30 days of injury </li></ul></ul><ul><ul><li>Accompanied by one or more </li></ul></ul><ul><ul><ul><li>Admission for at least 48 hours </li></ul></ul></ul><ul><ul><ul><li>Transfer from a lower facility for major trauma </li></ul></ul></ul><ul><ul><ul><li>Activation of the trauma team </li></ul></ul></ul><ul><ul><ul><li>Admission to an ICU </li></ul></ul></ul><ul><ul><ul><li>Admission directly to the OR – for head, chest, abdomen, or vascular system </li></ul></ul></ul><ul><ul><ul><li>Declaration of DOA </li></ul></ul></ul><ul><ul><ul><li>Declaration of dead in ED or hospital </li></ul></ul></ul><ul><ul><ul><li>PLUS – </li></ul></ul></ul><ul><ul><ul><ul><li>AIS of > 3 </li></ul></ul></ul></ul><ul><ul><ul><ul><li>ISS of > 9 </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Probability of Survival < 0.90 </li></ul></ul></ul></ul>
    7. 7. Trauma Fund <ul><li>The first claim period for submission of Trauma provider uncompensated care will be July 1, 2004 to December 31, 2004.  </li></ul><ul><li>  </li></ul><ul><li>Reporting is due into OSDH by October 31.  </li></ul>
    8. 8. Senate Bill 1554 <ul><li>Establish the Oklahoma Trauma Systems Improvement and Development Advisory Council </li></ul><ul><ul><li>Makes recommendations to the DOH regarding the trauma system </li></ul></ul><ul><ul><li>18 members </li></ul></ul><ul><ul><ul><li>Public health, trauma registrar, rural hospital, EMT, orthopaedic surgeon, specialty hospitals (ASC), ED physician, EMS director, rehabilitation, hospital administrators (Level 1 or II, urban, rural), administrative director of pre-hospital service, trauma surgeon, general public </li></ul></ul></ul>
    9. 9. Senate Bill 1554 <ul><li>Rulemaking authority for the OSDH to regulate the trauma system </li></ul><ul><ul><li>Every hospital (including medical staff) must participate in a regional system of providing 24-hour emergency hospital care </li></ul></ul><ul><ul><li>Reciprocal Transfer Agreements </li></ul></ul>
    10. 10. Senate Bill 1554 <ul><li>Established 8 regional trauma boards </li></ul><ul><ul><li>must develop a trauma system within the region based on State approved guidelines </li></ul></ul>
    11. 12. Oklahoma County <ul><li>Priority I and Priority II call schedule </li></ul><ul><ul><li>- Baptist </li></ul></ul><ul><ul><li>- OUMC (Mercy will take single system neurological trauma) </li></ul></ul><ul><ul><li>- Southwest </li></ul></ul><ul><ul><li>- Mercy/Edmond (Edmond is primary hospital for Orthopedics) </li></ul></ul><ul><ul><li>- Deaconess (OUMC will take single system neurological trauma) </li></ul></ul><ul><ul><li>- OUMC (Mercy will take single system neurological trauma) </li></ul></ul><ul><ul><li>- Midwest City </li></ul></ul>
    12. 13. Oklahoma County System <ul><li>When “on call”, each hospital will provide orthopedics, neurosurgery, general surgery, facial trauma, and anesthesia….or arrange coverage through hospital transfer agreements. </li></ul><ul><li>This schedule is for unassigned, Priority 2 patients with single-system injury, or at risk for injury but currently stable, picked up by EMSA in its service area or transported into the metropolitan area from other regions of the State. </li></ul><ul><li>Each hospital will provide care for the patients who arrive in their ED even on the nights they are not the designated hospital….or will arrange transfer. </li></ul><ul><li>It is understood that the other hospitals may have to provide back-up coverage for a designated hospital. </li></ul>
    13. 14. Senate Bill 1554 <ul><li>Trauma Transfer and Referral Centers </li></ul><ul><ul><li>Each County and contiguous communities with > 300, 000 persons </li></ul></ul><ul><ul><li>Direct ambulance patients to facilities with clinical capacity and capability </li></ul></ul><ul><li>EMSystem ® </li></ul><ul><ul><li>Internet based computer application </li></ul></ul><ul><ul><li>Real time access to regional and statewide information on hospital ED divert and air transport status </li></ul></ul>
    14. 16. Regional Transfer Centers <ul><li>Based at EMSA – </li></ul><ul><ul><li>OKC 888-658-7262 </li></ul></ul><ul><ul><li>Tulsa 866-778-7262 </li></ul></ul>
    15. 17. Senate Bill 1554 <ul><li>Appointed State/Regional PI Committees and a Medical Audit committee </li></ul><ul><ul><li>Protection from discovery </li></ul></ul><ul><li>PI indicators have been established </li></ul><ul><li>Medical Audit Committee functional </li></ul><ul><ul><li>Developing referral form and phone number </li></ul></ul><ul><ul><li>Currently call Patrice Greenawalt or Dr. Tim Cathey at the Department of Health – Trauma Division </li></ul></ul>
    16. 18. Crisis <ul><li>November 5, 2003 </li></ul><ul><li>OU Medical Center to close Level 1 Trauma Center on December 31, 2003 </li></ul>
    17. 19. OUMC – Only State Level I/II <ul><li>Financial Losses </li></ul><ul><ul><li>$35-39 million/year – Emergency Care </li></ul></ul><ul><ul><li>$9 million over 3 years - Trauma </li></ul></ul><ul><li>Increase Uncompensated care </li></ul><ul><li>Insurance Status of patients </li></ul><ul><ul><li>Inability to place in rehabilitation </li></ul></ul><ul><ul><ul><li>Increases Length of Stay </li></ul></ul></ul><ul><ul><li>Limits bed capacity </li></ul></ul><ul><li>Limited State Funding </li></ul>
    18. 20. Percent Uninsured 18.3 Oklahoma 16.6 Georgia 17.9 Arizona 17.5 Florida 14.6 U.S. Average 20.7 New Mexico 19.5 California 19.3 Louisiana 23.5 Texas % Uninsured State
    19. 21. Oklahoma Medicaid Population OHCA 2003
    20. 22. Major Trauma by Primary Payor Oklahoma, 2001-2003* N = 7245 *1/1/01 – 6/30/03
    21. 24. Oklahoma City Metropolitan Area John Sacra,MD, Medical Director EMSA
    22. 25. EMS Triage/Transport Jan – July 2003 <ul><li>OKC Metro Area - OUMC received </li></ul><ul><ul><ul><li>84 % of the major trauma </li></ul></ul></ul><ul><ul><ul><li>86 % of the serious injured trauma </li></ul></ul></ul>
    23. 26. Funding <ul><li>Oklahoma Trauma Fund </li></ul><ul><ul><li>Support </li></ul></ul><ul><ul><ul><li>$1 per license tag </li></ul></ul></ul><ul><ul><li>Distribution </li></ul></ul><ul><ul><ul><li>2002 - $ 3 million 2003 - $ 2.5 million </li></ul></ul></ul><ul><ul><ul><li>Pre-Hospital services & Acute care facilities </li></ul></ul></ul><ul><ul><li>Submissions - Uncompensated Care </li></ul></ul><ul><ul><ul><li>2002 – $16 million total - $6 million from OUMC </li></ul></ul></ul><ul><ul><ul><li>2003 – $ 25 million total - $ 13 million from OUMC </li></ul></ul></ul><ul><li>No provision </li></ul><ul><ul><li>Physician – reimbursement/stipends </li></ul></ul><ul><ul><li>Long term care providers </li></ul></ul>
    24. 27. <ul><li>Crisis Announced </li></ul><ul><li>Press Conference – November 5, 2003 </li></ul><ul><ul><li>Level 1 Closure – December 31, 2003 </li></ul></ul><ul><ul><ul><li>Unless improvements the state of the trauma system and funding </li></ul></ul></ul><ul><ul><li>Potential for increased fatalities from trauma </li></ul></ul>
    25. 28. Governor Appointed Emergency Task Force <ul><li>Secretary of Health, Senator, Representative </li></ul><ul><li>Physicians – Trauma Centers, ED, Specialty hospitals, Acute Care Hospitals </li></ul><ul><li>Board of Health Members </li></ul><ul><li>Hospital Administrators – Urban and Rural </li></ul><ul><li>Pre-Hospital Providers </li></ul><ul><li>Payor Representatives </li></ul>
    26. 29. Task Force Recommendations to DOH <ul><li>Department of Health – Emergency Rules </li></ul><ul><ul><li>Hospital Licensure </li></ul></ul><ul><ul><ul><li>Hospital/Physicians Participate in Regional System Development </li></ul></ul></ul><ul><ul><li>Triage/Transport Revisions </li></ul></ul><ul><ul><li>Central Dispatch/Transfer Center </li></ul></ul><ul><ul><li>Reciprocal Transfer Agreements </li></ul></ul><ul><ul><li>New Trauma Systems Improvement and Development Task Force/Regional Advisory Boards </li></ul></ul><ul><ul><li>Funding </li></ul></ul>
    27. 30. OCMS Ad Hoc Committee <ul><li>Proposed County-Wide Call Schedule </li></ul><ul><ul><li>Priority II Patients within OK County </li></ul></ul><ul><li>Initial Meeting Attendees </li></ul><ul><ul><li>OMSA </li></ul></ul><ul><ul><li>Governor’s Office </li></ul></ul><ul><ul><li>DOH </li></ul></ul><ul><ul><li>Pre-Hospital Providers </li></ul></ul><ul><ul><li>Greater Oklahoma City Hospital Council </li></ul></ul><ul><ul><li>Hospital Administrators </li></ul></ul><ul><ul><li>Physicians – ED, Surgical Specialists, General surgeons </li></ul></ul><ul><li>Call Schedule Sub-Committee Meets Monthly </li></ul><ul><ul><li>10 Members + </li></ul></ul><ul><li>Call Schedule First implemented – May 2004 </li></ul>
    28. 37. Advocacy Strategies Funding <ul><li>Legislative Meetings </li></ul><ul><ul><li>Speaker of the House and representatives </li></ul></ul><ul><ul><li>Senate Pro Tempore and senators </li></ul></ul><ul><ul><li>Governor’s Director of Finance </li></ul></ul>
    29. 38. <ul><li>Data </li></ul><ul><ul><li>Definitions – </li></ul></ul><ul><ul><ul><li>Trauma System </li></ul></ul></ul><ul><ul><ul><li>Trauma center levels </li></ul></ul></ul><ul><ul><ul><li>Priority I, II, III patients </li></ul></ul></ul><ul><ul><li>Comparison to neighboring states </li></ul></ul><ul><ul><ul><li>Trauma centers, physicians, admissions </li></ul></ul></ul><ul><ul><li>Impact on other training programs/bed capacity </li></ul></ul><ul><ul><li>Cost, reimbursement and outcome data </li></ul></ul><ul><ul><li>Transfers in – types and geographic locations </li></ul></ul><ul><ul><li>Length of stay – funded v. unfunded </li></ul></ul>
    30. 39. Advocacy Strategies <ul><li>Trauma Center Tours </li></ul><ul><ul><li>Senators and Representatives </li></ul></ul><ul><ul><li>State Finance personnel </li></ul></ul><ul><li>Lobbyist – University, OHA </li></ul><ul><li>Doctor of the Day </li></ul><ul><li>State and County Medical Societies </li></ul><ul><li>ACS – Advocacy and Health Policy </li></ul>
    31. 40. SSLAC Support <ul><li>Letter </li></ul><ul><li>As a trauma care provider in Oklahoma, </li></ul><ul><li>I urge you to support a number of bills to increase funding for the Trauma Care Assistance Revolving Fund: HB 2600 – increases the Fund to provide reimbursement for uncompensated care to recognized facilities that care for trauma patients; HB 2250 – provides for increases in court fees to be deposited in the Fund; HB 2382 – increases fines on driver’s license suspensions, DUI, narcotics and child safety seat violations to be deposited in the Fund; and HB 2660 – places on the ballot a referendum for Oklahoma voters to support creation in the State Treasury of a “Special Health Care Revolving Fund” to help pay for future health care costs. </li></ul><ul><li>Monies from the Trauma Care Assistance Revolving Fund are used to reimburse recognized trauma facilities and licensed ambulance services for uncompensated trauma care. Passage of this legislation is extremely critical because hospitals across our state are suffering huge financial losses when providing emergency trauma care for uninsured patients. Should this trend continue, the viability of emergency care services at many of these institutions will be threatened - resulting in significantly reduced access to trauma care for Oklahomans across the state. </li></ul><ul><li>As more hospitals cease to provide emergency trauma care, victims of injury will have to be transported over increased distances to reach definitive trauma care, pushing the limits of the critical &quot;golden hour.&quot; Injury victims who fail to receive comprehensive treatment within the first hour suffer greater risk of death or life-long disability. </li></ul><ul><li>The legislature must not adjourn without adopting these critical bills. Please show your support for our trauma system by voting “YES” on HB 2600, HB 2250, HB 2382, and HB 2660! </li></ul><ul><li>Email </li></ul><ul><li>Contact Your State Senator to Support Trauma System Funding </li></ul><ul><li>Dear Oklahoma Surgeon: </li></ul><ul><li>The Oklahoma House of Representatives recently passed a number of bills to address funding issues for the Trauma Care Assistance Revolving Fund: HB 2600 – increases the Fund to provide reimbursement for uncompensated care to recognized facilities that care for trauma patients; HB 2250 – provides for increases in court fees to be deposited in the Fund; HB 2382 – increases fines on driver’s license suspensions, DUI, narcotics and child safety seat violations to be deposited in the Fund; and HB 2660 – places on the ballot a referendum for Oklahoma voters to support creation in the State Treasury of a “Special Health Care Revolving Fund” to help pay for future health care costs. </li></ul><ul><li>These bills now await action by the Oklahoma Senate. Please take a moment to advocate on behalf of them by clicking on </li></ul><ul><li>the following link – – and sending a letter you may easily personalize to your state senator asking them to vote for this legislation. </li></ul><ul><li>Thank you for your help in advocating for: HB 2250; HB 2382; HB 2600; and HB 2660. We must do all we can to preserve our state’s trauma system, and your efforts will greatly help in this endeavor. </li></ul><ul><li>Roxie Albrecht, MD, FACS </li></ul><ul><li>State Chair, Oklahoma COT </li></ul>
    32. 41. Advocacy Strategies <ul><li>Education Material </li></ul><ul><ul><li>Trauma System </li></ul></ul><ul><ul><li>Trauma Center </li></ul></ul><ul><ul><li>How to contact your senator/representative </li></ul></ul><ul><li>Media </li></ul><ul><li>Patient/Family Testimonials </li></ul>
    33. 43. <ul><li>Letters to the Editor </li></ul><ul><ul><li>Chair of University Hospital Authority and Trust, Patients families, employees and families, TMD, CMO </li></ul></ul><ul><li>CHANCE MEETINGS </li></ul>
    34. 44. November Vote – Tobacco Tax <ul><li>Oklahoma Hospital Association </li></ul><ul><ul><li>Solicitations for funding </li></ul></ul><ul><ul><ul><li>Hospitals, Universities </li></ul></ul></ul><ul><ul><ul><li>Foundations, Individuals </li></ul></ul></ul><ul><ul><li>Flyers, buttons, billboards, radio ads </li></ul></ul><ul><ul><li>Presentations </li></ul></ul><ul><ul><ul><li>Rotary, Junior league, professional society meetings </li></ul></ul></ul>
    35. 45. <ul><li>Media </li></ul><ul><li>Trauma Survivor Picnic – week before vote </li></ul><ul><ul><li>Speaker of the House </li></ul></ul><ul><ul><li>Governor </li></ul></ul><ul><ul><li>Patient/Family Testimonials </li></ul></ul><ul><ul><li>Trauma Center Personnel </li></ul></ul>
    36. 46. ACS Advocacy and Health Care Policy Division <ul><li>Dear Oklahoma Surgeons: </li></ul><ul><li>I’m writing to you today in my capacity as the state chair of the Oklahoma Committee on Trauma (COT). Earlier this year, a number of bills passed our state’s legislature to increase funding for our trauma system, and I asked you at that time to write your legislators in support of them. One of these trauma funding initiatives included an increase in the tobacco tax that will be going before the voters on November 2. State Question (SQ) 713, the Oklahoma Health Initiative, will increase the excise tax on cigarettes by 80 cents. Other tobacco products such as chewing tobacco and cigars will see an increase, too. </li></ul><ul><li>Some of the revenues generated from the increased tobacco tax are allocated to the trauma care assistance fund. In fact, if the voters approve SQ 713, $17 million will be made available to the trauma system. Combined with the $13 million already allocated through the state budget, we would have $30 million for our trauma system, with one-third of that potentially eligible for federal matching funds. </li></ul><ul><li>As you can see, it is critical to our state’s trauma system that SQ 713 be passed. I encourage you to support SQ 713, and to talk to your patients and your physician colleagues about supporting it as well. I’ve attached a two-page handout that provides greater detail on the impact this tax will have, not only in increased revenues for health care programs but also reduced use of tobacco by our patients. </li></ul><ul><li>If you have any questions about this ballot initiative, please feel free to drop me a line at [email_address] . I would be glad to speak with you. </li></ul><ul><li>Thank you for your support for and involvement in this important trauma funding advocacy effort. </li></ul><ul><li>Sincerely, </li></ul><ul><li>Roxie M. Albrecht, MD, FACS </li></ul><ul><li>Chair, Oklahoma Committee on Trauma </li></ul>
    37. 47. 2005 Trauma System <ul><li>Still Developing </li></ul><ul><ul><li>Awaiting further ‘rural’ regional plans </li></ul></ul><ul><li>Funded </li></ul><ul><ul><li>Projected 14-20 million </li></ul></ul><ul><li>Fragile </li></ul><ul><ul><li>Specialty Surgical Coverage </li></ul></ul>