Improving Mississippi’s Trauma Care System: Opportunities and Limitations
Executive Summary
Introduction
In January of this year, the PEER Committee released the report A Descriptive Review of the Mississippi Trauma Care Systems Fund (PEER Report #568). In that report, PEER described how the Trauma Care Systems Fund receives and distributes its funding.
Subsequent to that report’s release, the Committee conducted additional field work regarding the statewide trauma care system to determine what opportunities exist for improvement, as well as the limiting factors. This report is intended to be a companion piece to Report #568.
Background
A traumatic injury requires surgical and other medical specialists to consult, observe, or perform surgery in order to optimize recovery. A trauma system is an organized, coordinated effort within a defined geographic area that is designed to provide a continuum of intensive medical services beginning with a traumatic injury and continuing through hospital discharge.
As discussed in PEER Report #568, 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, Level II, Level III, or Level IV trauma centers based on specific criteria, including the services each facility offers, defined in Mississippi Trauma Care System Regulations.
As of February 5, 2013, seventy-nine in-state hospitals, one in-state burn center, and three out-of-state hospitals were participating in the Mississippi trauma care system.1 A trauma system also involves, at varying degrees, the coordination of trauma care delivery among trauma centers and prehospital providers with state and local governments and other healthcare resources. Other participants in the Mississippi trauma care system include:
Conclusions
Has the Mississippi Trauma Care System accomplished what it was created to accomplish?
The Legislature created the state’s trauma care system to “reduce death and disability resulting from traumatic injury.” Between 2000 and 2010, the ratio of trauma deaths versus traumatic injuries in Mississippi improved from 5.1% to 2.0%. While many factors have arguably played a role in controlling the number of trauma deaths, the Mississippi Trauma Care System has played a role by slowing the decline in the number of trauma centers and by improving the prehospital methods for routing a trauma patient to the most appropriate trauma center.
Who developed the previous and current methods for distributing the Trauma Care Systems Fund and why?
The Mississippi Trauma Advisory Committee (MTAC), with support from Department of Health staff, developed both the previous and current methods for distributing the Trauma Care Systems Fund. Instead of reimbursing hospitals and physicians for uncompensated trauma care costs based on claims submitted, as was the case under the previous distribution method, the current method distributes funds based on the trauma center’s designation and the number and severity of trauma patients treated. The current method also includes EMS providers in the funds distribution and has expanded the pool of physicians eligible to receive funds.
How does the Department of Health spend its portion of the Trauma Care Systems Fund to support the operations of the Mississippi Trauma Care System?
Because the state’s trauma care system is designed to “reduce the death and disability resulting from traumatic injury,” it is important that the state’s trauma centers and emergency medical services providers receive the majority of available funds. Therefore, the Department of Health’s portion of the Trauma Care Systems Fund for administrative expenses must be kept to a reasonable limit while ensuring adequate support of the trauma care system. The department spent approximately $2.9 million from the fund for administration during FY 2010 through FY 2012, including approximately $1.1 million in salaries and fringe benefits for departmental employees and contract workers assigned in whole or in part to the trauma care system.
What are the opportunities and limitations of Mississippi’s trauma care system and the current method of distributing the Trauma Care Systems Fund?
While the Mississippi Trauma Care System has opportunities for improvement in its design, external environmental factors pose significant fiscal and logistical challenges and system design limits options for developing or upgrading trauma centers, including:
Further, while the current level of funding provides flexibility to the trauma centers to target trauma needs, the current level is not sufficient to cover trauma centers’ uncompensated trauma care costs or to improve trauma center designation and does not specifically provide for the “golden hour”2 of trauma care.
Recommendations
1 University of South Alabama Hospital in Mobile, AL, and the Regional Medical Center at Memphis in Memphis, TN, provide Level I care for transferred patients. Le Bonheur Children’s Hospital in Memphis, TN, is a tertiary pediatric trauma center.
2 The golden hour is the first sixty minutes after a traumatic injury. It is widely believed that a serious injury victim who reaches an emergency room within those sixty minutes has a greater chance of survival if he or she receives definitive trauma care within the first hour. However, less than thirty percent of the continental United States is within one hour of a Level I or Level II trauma center.