Wide Price Variations in Hospital Trauma [ER] Fees

Question How do trauma team activation fees in the US vary by region and hospital characteristic?

Findings In this cross-sectional study of 523 trauma centers in the US, the median tier 1 trauma activation fee was $9500, and fees ranged widely from $1000 to $61 734. Trauma activation fees were higher in the West and in for-profit hospitals.

Meaning These findings suggest that some patients who sustain serious traumatic injuries will incur disproportionately high trauma activation fees depending on the trauma center to which they are brought and that standardization of trauma activation fees is warranted.

Overall, the median (IQR) tier 1 trauma activation fee was $9500 ($5601-$17 805), and the mean (SD) tier 1 trauma activation fee was $13 349 ($11 034); these fees ranged from $1000 to $61 734. Median (IQR) trauma activation fees were highest in the West ($18 099 [$10 741-$$27 607]), especially in California, where the median (IQR) activation fee was $24 057 ($15 979-$33 618). Trauma activation fees were also higher at for-profit hospitals, most of which were owned by the HCA Healthcare system, which had 43 trauma centers and a median (IQR) tier 1 trauma activation fee of $29 999 ($20 196-$37 589).

Traumatic injuries are a major contributor to total US health care spending.

Trauma activation fees were first approved in 2002 after it was argued that the high cost of running trauma centers threatened to shut down many essential trauma centers.[6](Trauma Team Activation Fees by US Region and Hospital Ownership) While a trauma activation fee may be justified, popular media articles have decried the large amounts charged for trauma activation for, in some cases, very minor injuries.

I certainly agree that a trauma activation is necessary as ERs are open 24/7 and are ready to spring into action. But some facilities are gougers.

Table #1 at the link has a list of the top 10 states with most trauma centers.
Table #4 at the link has a list of the 15 hospital systems with at least 5 trauma centers.
As stated in the piece HCA has the highest activation fee followed closely by TENET & Provident [a church controlled system].

Given that patients are unlikely to be able to assess prices in a timely manner after a serious injury, standardization of trauma activation fees should be pursued.

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Fortunately, once you turn age 65 and qualify for Medicare (and if you avoid Medicare Advantage), you don’t have to worry about this stuff.

Traditional Medicare has very strong protections against price gouging, and if a hospital attempts to charge you a higher fee, they have to warn you in writing in advance with the exact amount they will charge you.

MLN909183 - Advance Beneficiary Notice of Non-coverage Tutorial (cms.gov)

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And how exactly do you do that with a trauma patient who may not even be conscious?

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In somewhat related news, ER staff, employed by a PE group, not the hospital, went on strike a couple days ago, over short staffing.

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They can’t. They have to treat you at the standard Medicare reimbursement if it’s a hospital that accepts Medicare, which almost every US hospital does.

That’s the beauty of not having a $30 million/year health insurance CEO between you and your doctor or hospital.

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