The Tampa Bay Times much-ballyhooed series on trauma care purported to be a serious investigation into the state of such care in Florida at a time when there are legitimate policy questions to debate on the subject. But disappointingly enough, the Times did little to advance that debate, even as its reporters and editors indulged in a round of premature self-congratulation over their series. Instead, the Times created a caricature of reality that relied on sensational anecdotes and an intentionally misleading interpretation of the facts.
I’ve been following this issue for years now, and so I have a basic understanding of what is going on in the delivery of trauma care in Florida. But in the interest of the kind of evenhanded journalism that the Times abandoned to produce its hyperventilating report, I have also spent the last couple of days — in between my coverage of the special election in CD 13 — doing my own investigating and consulting with experts who are closer to this issue before I decided to write.
Also, let me say up-front, yes, there are advertisers on this site who were referenced in the Times story. But there are advertisers on this site who are on the opposite side of the debate.
To have a genuine debate about the state of trauma care and charges, there is one basic concept to take into consideration at the outset. Despite what the Times suggests, there is no dispute that hospital charges, or bills, do not reflect what patients actually pay. In late February, the Wall Street Journal made this point exactly as it argued for greater transparency (or clarity) in the way hospital bills are prepared:
“With outrage growing over incomprehensible medical bills and patients facing a higher share of the costs, momentum is building for efforts to do just that. Price transparency, as it is known, is common in most industries but rare in health care, where “charges,” “prices,” “rates” and “payments” all have different meanings and bear little relation to actual costs.”
However, the Times ignored this fact and began its investigation fishing for outrageous patient billing stories by running an advertisement in its own newspaper inviting patients who were “startled” by the size of their hospital bill to share their “hospital billing story” with the Times.
The Times’ almost singular focus on trauma activation fees is misleading and fails to answer some key questions that were raised as I read through the series
But since the Times wants us to talk about activation fees, let’s get them out of the way first. My EMS friends tell me that hospitals themselves have no role in determining who is or who is not a trauma patient. EMS/First Responders evaluate patients in the field. Then, based on a set of criteria established by the State of Florida, they make the determination to activate a trauma team. Ultimately, the EMS team must transport the patient to the nearest trauma center. If patients are found not to have life-threatening injuries once they are evaluated and treated at the trauma center, the activation fee is still charged because the trauma team has provided the assessment and immediate care.
So, now that we have established the fact that it is our first responders who call trauma alerts and transport patients to the nearest hospital, let’s go through some of the other lingering, more important questions.
How much do patients really pay for trauma care? HCA West Florida has this response to the Times stories on its website. It contains a lot of relevant information that I can only assume they shared with the Times reporters who chose not to provide this point of view to their readers.
Here are a few key facts:
· Medicare and Medicaid pay a predetermined rate for trauma patients. Medicare and Medicaid do not pay trauma activation fees.
· Commercial insurers negotiate big discounts.
That doesn’t sound like they are getting rich off of trauma patients to me, but I’m no expert on hospital billing. One can only conclude that the Times decided not to include this information because it didn’t fit into the storyline they were pursuing.
The Times suggests the difference between for-profit and non-profit trauma centers is the “bloated” activation fee. If you are looking at the data with an open mind, there’s more information here to consider. Again, looking at the response piece from HCA, you can see that HCA paid $236 million in taxes last year in Florida alone. And while HCA is the largest provider of uncompensated care in Florida, treating 20 percent of the uninsured (at a cost of $700 million in 2012), they only received 4.7 percent ($53 million) of the funding from the Low Income Pool (LIP) that is set aside for treating those patients. By way of comparison, non-profits pay no taxes and receive a greater percentage of LIP funding on a per patient basis.
There has been a lengthy and heated debate going on in Florida about how to ensure we have adequate trauma care for our citizens and visitors. There have been many lawsuits filed to invalidate the state’s trauma allocation rule and shut down existing HCA trauma centers that are already serving our communities. The Department of Health has been very deliberate as it has worked to promulgate a new allocation rule – which has drawn out the process and created more division and rancor on both sides of the issue.
The unfortunate thing about the Times series is that it gives no real context for fees from a national perspective. Nor does it provide a comparison of total patient charges from one hospital to the next, presumably because such information would show that HCA’s charges are in line with other hospitals. And the series excludes any mention of public subsidies that HCA’s competitors rely on heavily. Instead, the Times chose to inject more emotion and misleading data into the discussion.
What the Times should have focused on is the fact that hospital bills are sometimes impossible to understand, unregulated and ever changing. Perhaps state or federal lawmakers should consider a transparency initiative to ensure there is a simple way to review hospital costs.
Instead, the Tampa Bay Times staff let this much larger issue fall by the wayside so it could sensationalize the issue of charges, increase readership and impact the debate going on in the Legislature to suit their own agenda.
That’s too bad. I would hope we could expect more.