Trauma activation charges 60% higher at for-profit hospitals

Trauma activation fees range from $40 to $29,000 by payer

This latest study adds to the conversation by quantifying the variation in trauma activation fees.

Using data from the federal Hospital Price Transparency rule and the Turquoise Health database for Level I-III trauma centers, the researchers found significant variation based both on clinical need and for-profit status.

In total, 38% of the U.S. trauma centers included in the databases reported any type of trauma activation fee. The minimum fee charged was $40, which was the charge for a Medicaid contract. The highest fees were $28,356 for self-pay patients and $28,893 for commercial contracts.

Naturally, Level I trauma centers, which deliver higher-acuity trauma care, charged higher trauma activation charges than their Level III peers. Additionally, activation charges were higher when there was a full team trauma activation, regardless of the trauma center's level.

This all makes sense, the researchers said, because Level I trauma centers need more resources to handle more clinically complex cases and it will be more resource-intensive to activate an entire trauma team than part of the team.

But the researchers also flagged variation that was not based on clinical need.

Overall, investor-owned, for-profit hospitals charged trauma activation charges that were 60% higher than for their nonprofit, public counterparts.

And as noted above, trauma activation charges varied by payer status. The researchers said this might not be consistent with the fees' intended design, because the resources a trauma center must set in place should be the same regardless of a trauma patient's insurance coverage type.

"Neither payer type nor hospital ownership has any bearing on the resources needed for trauma readiness, and thus the variation in trauma activation fees by these factors also calls for greater transparency," the researchers asserted.

Self-pay, or uninsured, patients saw significantly higher trauma activation charges than those covered by Medicare and Medicaid, despite the fact that these patients will incur much higher out-of-pocket costs. This could deepen inequities, the researchers said.

The downstream consequences of misusing trauma activation fees might be nefarious, the researchers suggested. In particular, the group pointed out a "proliferation of trauma centers in areas without demonstrated population-level need for more trauma care." These centers, which are usually Level II and for-profit, could end up being detrimental to the community.

"Unnecessary trauma center proliferation in areas that already have sufficient population-level access to timely trauma care may harm the already fragile financial viability of existing trauma centers by siphoning off an already limited pool of state- or county-based funds dedicated to trauma systems and disrupting the payer mix in mature trauma systems by reducing the proportion of commercially insured patients for any given trauma center," the team said.

What's more, adding in more trauma centers adds little clinical value, the team said. When there are already mature trauma centers in a community, adding other trauma centers into the mix does little to improve clinical outcomes or patient access, the researchers said, pointing to previous research.

And for patients, the unchecked variation in trauma activation charges could be financially ruinous.

Around a fifth of self-pay patients can be charged trauma activation charges topping $10,000, often leading to considerable medical debt, poor credit scores and eventual delayed or forgone care down the line.

Hospital Price Transparency rule and misuse monitoring

The researchers pointed out that this study was made possible by federal policymaking through the Hospital Price Transparency rule.

"Before the federal rule, exploring price variation across hospital services nationwide, including trauma activation fees, was difficult," they said. "These findings thus can inform future policies that seek to protect trauma centers from financial insolvency while also reducing the potential misuse of trauma activation fees."

For one thing, better state regulation of price transparency could compel trauma centers to post their trauma activation charges. Currently, only 38% of trauma centers report their fees.

Better policy-backed accountability structures compelling hospitals to use activation fees for their intended purpose is also critical, the researchers said. That, plus monitoring for the potential misuse of trauma activation charges, will be essential for protecting patients from the financial implications of these fees.

Sara Heath has covered news related to patient engagement and health equity since 2015.