Support for the Trauma System in Oklahoma How we got therehere 20032005

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Support for the Trauma System in OklahomaHow we
got there/here 2003-2005

• Roxie M. Albrecht, MD, FACS
• Medical Director, Trauma Surgical Critical Care
• OU Medical Center

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Senate Bill 1554

• Trauma Care Assistance Revolving Fund
• Reimburse for uncompensated care
• Hospitals
• Prehospital provider services
• Physicians at Medicare rates
• Medicaid Matching for Trauma Fund

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Past Trauma Fund Distributions
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Funding Initiatives
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Current Trauma Fund

• Collections
• July 04 July 05 14,465,423.00
• June 05 1,409,623 July 05 1,737101
• Eligible Physician participants
• Tier A
• Emergency Medicine, Neurosurgery, General
  Surgery, Maxillo-facial surgery, Orthopaedic
  surgery, Anesthesiology and Trauma intensivists.
• Tier B
• Areas not identified in A
• Funds will be distributed pending excess from
  Tier A allocation

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Trauma Fund Physician Reimbursement

• Qualifying Cases
• ICD-9 code of 800.0-959.9
• Limited to contacts within 30 days of injury
• Accompanied by one or more
• Admission for at least 48 hours
• Transfer from a lower facility for major trauma
• Activation of the trauma team
• Admission to an ICU
• Admission directly to the OR for head, chest,
  abdomen, or vascular system
• Declaration of DOA
• Declaration of dead in ED or hospital
• PLUS
• AIS of gt 3
• ISS of gt 9
• Probability of Survival lt 0.90

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Trauma Fund

• The first claim period for submission of Trauma
  provider uncompensated care will be July 1, 2004
  to December 31, 2004. 
• www.health.ok.gov/program/injury/trauma/tfund.html
   
• Reporting is due into OSDH by October 31. 

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Senate Bill 1554

• Establish the Oklahoma Trauma Systems Improvement
  and Development Advisory Council
• Makes recommendations to the DOH regarding the
  trauma system
• 18 members
• 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

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Senate Bill 1554

• Rulemaking authority for the OSDH to regulate the
  trauma system
• Every hospital (including medical staff) must
  participate in a regional system of providing
  24-hour emergency hospital care
• Reciprocal Transfer Agreements

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Senate Bill 1554

• Established 8 regional trauma boards
• must develop a trauma system within the region
  based on State approved guidelines

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Oklahoma County

• Priority I and Priority II call schedule
• - Baptist
• - OUMC (Mercy will take single system
  neurological trauma)
• - Southwest
• - Mercy/Edmond (Edmond is primary hospital for
  Orthopedics)
• - Deaconess (OUMC will take single system
  neurological trauma)
• - OUMC (Mercy will take single system
  neurological trauma)
• - Midwest City

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Oklahoma County System

• When on call, each hospital will provide
  orthopedics, neurosurgery, general surgery,
  facial trauma, and anesthesia.or arrange
  coverage through hospital transfer agreements.
• 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.
• 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.
• It is understood that the other hospitals may
  have to provide back-up coverage for a designated
  hospital.

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Senate Bill 1554

• Trauma Transfer and Referral Centers
• Each County and contiguous communities with gt
  300, 000 persons
• Direct ambulance patients to facilities with
  clinical capacity and capability
• EMSystem
• Internet based computer application
• Real time access to regional and statewide
  information on hospital ED divert and air
  transport status

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Regional Transfer Centers

• Based at EMSA
• OKC 888-658-7262
• Tulsa 866-778-7262

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Senate Bill 1554

• Appointed State/Regional PI Committees and a
  Medical Audit committee
• Protection from discovery
• PI indicators have been established
• Medical Audit Committee functional
• Developing referral form and phone number
• Currently call Patrice Greenawalt or Dr. Tim
  Cathey at the Department of Health Trauma
  Division

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Crisis

• November 5, 2003
• OU Medical Center to close Level 1 Trauma Center
  on December 31, 2003

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OUMC Only State Level I/II

• Financial Losses
• 35-39 million/year Emergency Care
• 9 million over 3 years - Trauma
• Increase Uncompensated care
• Insurance Status of patients
• Inability to place in rehabilitation
• Increases Length of Stay
• Limits bed capacity
• Limited State Funding

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Percent Uninsured
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Oklahoma Medicaid Population
OHCA 2003
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Major Trauma by Primary Payor Oklahoma,
2001-2003
N 7245 1/1/01 6/30/03
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Oklahoma City Metropolitan Area
John Sacra,MD, Medical Director EMSA
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EMS Triage/TransportJan July 2003

• OKC Metro Area - OUMC received
• 84 of the major trauma
• 86 of the serious injured trauma

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Funding

• Oklahoma Trauma Fund
• Support
• 1 per license tag
• Distribution
• 2002 - 3 million 2003 - 2.5 million
• Pre-Hospital services Acute care facilities
• Submissions - Uncompensated Care
• 2002 16 million total - 6 million from OUMC
• 2003 25 million total - 13 million from
  OUMC
• No provision
• Physician reimbursement/stipends
• Long term care providers

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• Crisis Announced
• Press Conference November 5, 2003
• Level 1 Closure December 31, 2003
• Unless improvements the state of the trauma
  system and funding
• Potential for increased fatalities from trauma

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Governor AppointedEmergency Task Force

• Secretary of Health, Senator, Representative
• Physicians Trauma Centers, ED, Specialty
  hospitals, Acute Care Hospitals
• Board of Health Members
• Hospital Administrators Urban and Rural
• Pre-Hospital Providers
• Payor Representatives

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Task Force Recommendations to DOH

• Department of Health Emergency Rules
• Hospital Licensure
• Hospital/Physicians Participate in Regional
  System Development
• Triage/Transport Revisions
• Central Dispatch/Transfer Center
• Reciprocal Transfer Agreements
• New Trauma Systems Improvement and Development
  Task Force/Regional Advisory Boards
• Funding

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OCMS Ad Hoc Committee

• Proposed County-Wide Call Schedule
• Priority II Patients within OK County
• Initial Meeting Attendees
• OMSA
• Governors Office
• DOH
• Pre-Hospital Providers
• Greater Oklahoma City Hospital Council
• Hospital Administrators
• Physicians ED, Surgical Specialists, General
  surgeons
• Call Schedule Sub-Committee Meets Monthly
• 10 Members
• Call Schedule First implemented May 2004

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Advocacy StrategiesFunding

• Legislative Meetings
• Speaker of the House and representatives
• Senate Pro Tempore and senators
• Governors Director of Finance

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• Data
• Definitions
• Trauma System
• Trauma center levels
• Priority I, II, III patients
• Comparison to neighboring states
• Trauma centers, physicians, admissions
• Impact on other training programs/bed capacity
• Cost, reimbursement and outcome data
• Transfers in types and geographic locations
• Length of stay funded v. unfunded

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Advocacy Strategies

• Trauma Center Tours
• Senators and Representatives
• State Finance personnel
• Lobbyist University, OHA
• Doctor of the Day
• State and County Medical Societies
• ACS Advocacy and Health Policy

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SSLAC Support

• Letter
• As a trauma care provider in Oklahoma,
• 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 drivers 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.
• 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.
• 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 "golden hour." Injury victims who fail
  to receive comprehensive treatment within the
  first hour suffer greater risk of death or
  life-long disability.
• 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!

• Email
• Contact Your State Senator to Support Trauma
  System Funding
• Dear Oklahoma Surgeon
• 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 drivers 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.
• These bills now await action by the Oklahoma
  Senate. Please take a moment to advocate on
  behalf of them by clicking on
• the following link http//capwiz.com/sslac/mail
  /oneclick_compose/?alertid5522761 and sending
  a letter you may easily personalize to your state
  senator asking them to vote for this legislation.
• 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 states trauma system,
  and your efforts will greatly help in this
  endeavor.
• Roxie Albrecht, MD, FACS
• State Chair, Oklahoma COT

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Advocacy Strategies

• Education Material
• Trauma System
• Trauma Center
• How to contact your senator/representative
• Media
• Patient/Family Testimonials

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• Letters to the Editor
• Chair of University Hospital Authority and Trust,
  Patients families, employees and families, TMD,
  CMO
• CHANCE MEETINGS

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November Vote Tobacco Tax

• Oklahoma Hospital Association
• Solicitations for funding
• Hospitals, Universities
• Foundations, Individuals
• Flyers, buttons, billboards, radio ads
• Presentations
• Rotary, Junior league, professional society
  meetings

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• Media
• Trauma Survivor Picnic week before vote
• Speaker of the House
• Governor
• Patient/Family Testimonials
• Trauma Center Personnel

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ACS Advocacy and Health Care Policy Division

• Dear Oklahoma Surgeons
• Im 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 states 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.
• 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.
• As you can see, it is critical to our states
  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. Ive 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.
• If you have any questions about this ballot
  initiative, please feel free to drop me a line at
  roxie-albrecht_at_ouhsc.edu. I would be glad to
  speak with you.
• Thank you for your support for and involvement in
  this important trauma funding advocacy effort.
• Sincerely,
• Roxie M. Albrecht, MD, FACS
• Chair, Oklahoma Committee on Trauma

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2005 Trauma System

• Still Developing
• Awaiting further rural regional plans
• Funded
• Projected 14-20 million
• Fragile
• Specialty Surgical Coverage