Trauma centers convey a 25% reduction in mortality for seriously injured patients. The American College of Surgeons Committee on Trauma recognizes the importance of appropriate and sustained financing of trauma centers.
While trauma centers and state or regional systems are recognized as public goods, they are variably supported by state and local funding. The costs for continuous trauma service availability, day and night, are significant, up to $10 million annually; most are fixed costs, independent of patient volume and incurred regardless of actual trauma team activation. Trauma activation fees are assessed by many trauma centers to maintain the resources required for continuous trauma patient readiness. Requirements outlined in the American College of Surgeons Optimal Resources for Care of the Injured Patient include trauma-specific clinician and program staffing, equipment and supplies, and patient care units. Absent trauma activation fees, many trauma centers would not receive sufficient reimbursement from payers to sustain capabilities for care of patients with time critical injuries.
Across states, trauma activation fees have variable importance for trauma program sustainment, depending on payer mix, availability of state funding, and institutional support. Activation fees apply when patients meet activation criteria in the pre-hospital setting and arrive at a trauma center. Trauma team activation may be full or partial based on the trauma center’s evidence- based activation guidelines, which conform to state-defined designation/verification requirements. The purpose of trauma team activation criteria is to identify severely injured patients rapidly in order to expedite comprehensive injury care. While often predicting severe injuries, not all patients meeting activation criteria have serious injuries.
There is wide variation in the amounts charged for activation fees, as well as how they are reimbursed across payers. There is also a lack of transparency in what is charged by hospitals and how fees are used for readiness. Trauma activation fees may not be managed optimally in all circumstances: (1) revenue from trauma activation fees might exceed readiness costs without attribution to the trauma center; (2) fees might place an undue burden on under- and uninsured patients with high out-of- pocket costs; and (3) trust in trauma centers may be compromised by the perception of high fees for trauma team activation.
The ACS asserts that trauma activation fees are necessary for the viability of trauma centers to ensure optimal care for patients. Absent reimbursement for such fees, alternate funding would be needed to sustain trauma centers and their missions.
The ACS affirms the following considerations for accountable and transparent trauma activation fees:
- Trauma activation fees should be considered “trauma patient readiness fees” that reflect the contingent costs of immediate resource availability at all times for all trauma patients.
- Trauma activation fees must only apply to designated/verified trauma centers.
- Trauma activation fees must be used to defray the costs of trauma center readiness for injured patient care.
- Trauma activation fees should be public and transparent.
- Trauma team activation must be based on evidence-based activation guidelines, which are reevaluated regularly for effectiveness.
- Trauma medical directors and program managers should be included in developing activation fees, determining their allocation, and reassessing their appropriateness.
- Public and private payers should be responsible for reimbursement of trauma activation fees appropriate for trauma patient readiness costs and without patient charge.
Further, the ACS advocates for a system of public and private sector financial support for trauma centers and systems.
