HD62 - The Use and Financing of Trauma Centers in Virginia


Executive Summary:
House Joint Resolution 183 (2004) directed the Joint Legislative Audit and Review Commission (JIARC) to study the use and financing of trauma centers in Virginia, and to identify any steps that can be taken to maintain appropriate and necessary trauma services in the Commonwealth. This study was directed as a result of concerns that access to trauma centers in Virginia might be compromised, given recent experience in Virginia Beach in which the trauma center downgraded its designation level due to staffing shortages.

Assistance was provided during the course of this study by the leaders of each of the 13 designated trauma centers in Virginia as well as their administrative, financial, and clinical staff, the Virginia Hospital and Healthcare Association, and the Office of Emergency Medical Services.

Hospital administrators consistently cited physician availability as the primary issue that could jeopardize access to trauma centers. A disproportionately large number of uninsured trauma patients, rising medical liability costs, and poor quality of life have reduced the number of physicians willing to treat trauma patients. By providing financial relief for uncompensated care, the State could help to attract more physicians to trauma centers.

The financial analysis of trauma programs in Virginia revealed that uncompensated care, low reimbursement rates from public insurers, and readiness costs created a $44 million loss across Virginia trauma centers in 2003. Because this level of economic losses could result in the closure of trauma programs, the State may wish to provide financial support to trauma centers.

State support could also provide an incentive for additional hospitals to seek trauma center designation in areas that are currently underserved. An analysis of access to trauma centers found that a large number of Virginians live too far away from a trauma center to receive prompt treatment, particularly if ground transportation is used. While air medevac services enhance access to trauma care, air transportation is not always available.

Finally, an analysis of triage effectiveness in the State found that a large number of critically injured trauma patients are not treated in designated trauma centers, while many moderately injured patients receive the highest level of trauma care. A systematic analysis of triage patterns should be conducted by the Virginia Department of Health to optimize the health outcome of trauma patients.