A Descriptive Review of the Mississippi Trauma Care Systems Fund
Executive Summary
Introduction
In response to a legislative request, the PEER Committee reviewed the revenues, distributions, and expenditures of the Mississippi Trauma Care Systems Fund.
The Legislature created the state’s trauma care system to “reduce the death and disability resulting from traumatic injury.” Participants in the state’s trauma care system are the Department of Health, the department’s Trauma Care Advisory Committee, the seven trauma care regions and their boards of directors, hospitals that have qualified as trauma centers, a burn center, and emergency medical services providers. State law requires the Department of Health to develop the Trauma Care System Plan, which guides the system, and to develop regulations for the system. Data for the system is maintained in a statewide trauma registry.
MISS. CODE ANN. Section 41-59-5 (1972) requires every Mississippi licensed acute care facility to participate in the statewide trauma care system. Facilities are designated as Level I-IV trauma centers based on specific criteria, including the services each facility offers.1 As of September 24, 2012, seventy-eight in-state hospitals, one in-state burn center, and two out-of-state hospitals were participating in the Mississippi trauma care system.2
All facilities in the trauma care system, except Level I trauma centers, are required by regulation and the Trauma Care System Plan to have transfer agreements in place with higher-level facilities to expedite and facilitate the transfer of patients in need of a higher level of care. Transfer agreements are also in place for specialty care patients such as burn and pediatric patients.
Any hospital that chooses not to participate in the trauma care system or that participates at a level lower than the level at which it is capable of participating, as determined by the Department of Health, must pay a non-participation fee as required by the Mississippi Trauma Care System Regulations.
Sources of Revenues for the Trauma Care Systems Fund
The Legislature established the Mississippi Trauma Care Systems Fund for use by the Department of Health in the administration and implementation of a comprehensive state trauma care plan. The fund receives revenues from assessments and fees related to vehicles, penalties assessed against hospitals that choose not to participate in the state’s trauma care system, and interest on the investment of the fund.
From FY 2009 through FY 2012, the Trauma Care Systems Fund received approximately $101 million in revenues, including:
Distribution of Money from the Trauma Care Systems Fund
From 1998 to 2008, the Department of Health used the Trauma Care Systems Fund to cover administrative expenses of the state trauma system, with the remaining balance distributed to participating trauma centers based on their provision of uncompensated care to patients. Beginning in FY 2010, the department continued to use the fund to cover administrative expenses of the system, but distributed the remaining balance in a formulated manner based on each hospital’s specific designation as a trauma center.
Initially, the Department of Health distributed funds to hospitals that voluntarily participated in the state’s trauma care system on the basis of their provision of uncompensated care to trauma patients. In its 2007 session, the Legislature created a Trauma Care Task Force to determine adequate funding requirements for the system. In 2008, the task force recommended a different method for distributing monies from the Trauma Care Systems Fund to trauma care regions, trauma centers, and emergency medical services providers.
Since FY 2010, the Department of Health has distributed monies in the Trauma Care Systems Fund to hospitals in a formulated manner based on each hospital’s designated trauma center level and the populations served by the emergency medical services providers in each trauma care region. (See pages 19 through 24 of the report for a description of the fund distribution method.)
During FY 2010 through FY 2012, the department distributed approximately $74 million from the fund to emergency medical services providers, trauma centers, and the Joseph M. Still Memorial Burn Center at Crossgates River Oaks Hospital in Brandon.
Allowable Expenditures from Trauma Care Systems Fund Distributions
Board of Health regulations specify the types of expenditures that emergency medical services providers and trauma centers may make from their Trauma Care Systems Fund distributions.
Departmental regulations allow emergency medical services providers to expend their distributions primarily on employee compensation, training, and equipment related to trauma care. The regulations require Level I-III trauma centers and the burn center to expend 30% of their distributions on physicians’ compensation, while the remaining 70% may be expended on other staff compensation, training, commodities, and equipment. All expenditures for Level I-III trauma centers must be related to the care of trauma patients.
Each Level IV trauma center receives an annual stipend and educational grant for its participation in the state’s trauma care system. Such funds are intended to assist the Level IV trauma centers in covering administrative costs associated with entering data in the trauma registry and other trauma-related activities.
In FY 2010 through FY 20123, emergency medical services providers and trauma centers expended approximately $50.6 million from the Trauma Care Systems Fund. The Department of Health has not yet audited these expenditures and has not required the burn center to provide expenditure information regarding its FY 2012 distribution.
Monitoring of Trauma Care System Performance
After establishing performance measures for the trauma care system, the Department of Health utilizes state, regional, and hospital-based committees to monitor and evaluate the performance of the state’s trauma care system.
State law charges the Department of Health with developing and administering trauma regulations that include, in part, “trauma care system evaluation and management.” In order to monitor the effectiveness of the system, the department has established a performance improvement program. The goals of the department’s performance improvement program are to:
The Department of Health utilizes performance improvement committees at the state, regional, and hospital levels to monitor the performance of the state’s trauma care system.
Since 2000, the number of Mississippi’s trauma-related deaths has remained fairly constant (a 14% increase), even though trauma-related injuries have risen significantly (a 196% increase). While factors such as motorcycle and bicycle helmet laws, seatbelt laws, and improved medical knowledge and technology have arguably played a role in controlling the number of trauma deaths, the percentage increase in trauma-related deaths from 2000 to 2010 in relation to the percentage increase in trauma-related injuries seems to indicate that the system has been effective in providing trauma care and reducing the number of deaths from trauma-related injuries.
Recommendations
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1Level I trauma centers have the greatest amount of clinical services to handle trauma cases on a twenty-four-hour per day, seven-day per week basis; Level IV trauma centers have only basic emergency medicine services.
2University of South Alabama Hospital in Mobile, AL, and the Regional Medical Center at Memphis in Memphis, TN, provide Level I care for transferred patients.
3Expenditures for FY 2012 include only expenditures for the first of two fund distributions—i. e., they do not represent a full year of expenditures.