News, Patient Care, Trauma

Trauma Care: Course for 09 Session Studied

ATLANTA — Reeling from defeat in the Atlanta Legislature, advocates of state aid for trauma care are calculating the lessons learned and crafting strategies for next year.

Many are scratching their heads and adding up what went wrong with the effort to provide long-term state aid for trauma care hospitals.

When the Legislature convened in January, funding for trauma center hospitals glided in with the governor’s support, almost universal appeal among lawmakers and high public approval. A University of Georgia poll showed two out of three Georgians surveyed would pay $25 a year or more to support trauma care statewide.

Then, the consensus broke down over how to raise the cash and how to spend it.

Pretty quickly, the debate in some quarters shifted from aiding cash-strapped hospitals that specialize in medical care for traumatic injuries to more politically divisive issues defined in terms of tax increases and entitlements.

The favored plan would have added a $10 fee to car registrations and generated $74 million a year for the 15 hospitals in the state that handle the most serious injuries. Many of these hospitals are strapped for cash. Providing trauma care is an expensive proposition, requiring advanced medical equipment and keeping specialists and surgeons on call.

Advocates say the defeat, on the last day, when the House and Senate leadership couldn’t reach a compromise, helped clarify the obstacles.

One obstacle may have been Grady Memorial Hospital, metro Atlanta’s only top-level trauma center and its premier provider of health care for the poor. Grady loses $40 million a year providing trauma services, but it brought to the debate a host of divisive issues that may have muddied the outlook for trauma funding.

With the lessons learned, advocates say, the strategy for next year is shaping up to focus on things such as raising public awareness and stressing that hospitals across the state need the money, not just one urban Atlanta medical center.

Georgia State Universityis planning several forums on trauma care, starting next month, as part of a series on important state policy issues.

State research provides ammunition for the argument: Georgia’s death rate for trauma victims is 20 percent higher than the national average. Meeting the average would save 700 lives a year.

In wide swaths of Georgia, people are far from a hospital with a trauma center, said Kevin Bloye, spokesman for the Georgia Hospital Association.

Hospital officials, some lawmakers and other advocates say they will press to assure that next year the trauma care issue is considered on its own merits.

“It’s important enough to stand on its own,” said Dr. Arthur Kellermann, associate dean for health policy at the Emory University School of Medicine.

This past session, House Speaker Glenn Richardson linked trauma care funding to a more controversial proposal to cut ad valorem taxes on cars. Trauma care essentially went down with the tax-cut plan.

Supporters of that approach saw a natural link, because many trauma cases involve auto accidents. Some lawmakers also saw an appealing give-and-take balance in removing the tax on cars while adding a tag fee for trauma care.

The House bill ran into trouble in the Senate, where Lt. Gov. Casey Cagle and Senate leaders uncoupled the tax and the fee, while adding spending restrictions.

Some trauma funding advocates blame Cagle and Richardson for the failure to adopt a plan, saying they turned the debate into an ego battle. “Cagle and Richardson had a greater commitment to further their political goals,” said Sen. Vincent Fort (D-Atlanta).

Dueling tax plans alone didn’t kill trauma funding.

Some lawmakers said the $10 tag fee would create an entitlement, because much of the money would pay the hospital bills of the poor and uninsured.

“I’m not interested in creating an entitlement program in Georgia,” Cagle said at the time, explaining the Senate’s changes.

Advocates respond that traumatic injuries don’t discriminate between rich and poor and that access to fast, expert care is important to everyone.

“I guess it is an entitlement program,” said Pete Correll, head of Grady’s new nonprofit board. “We all feel entitled to get an ambulance that will deliver us to a hospital, and there will be somebody there to care for us.”

In the final days of the session, the Senate addressed the “entitlement” concern by declaring that no money from the tag fee could pay for uncompensated care at hospitals. The Senate bill stipulated that funds pay only for “readiness costs,” such as equipment and keeping specialists on call.

Uncompensated care serves poor and uninsured people who cannot pay their bills, and it is a major reason some hospitals are suffering financially. Kellermann said trauma patients are disproportionately uninsured or underinsured: manual laborers hurt on the job or young people driving with little insurance or victims of violence.

Sen. Eric Johnson (R-Savannah) said, “If the state is going to get into trauma funding, we’re not going to get into paying for everybody who walks into an emergency room.”

Johnson, the Senate president pro tem, said the Senate wanted to make sure the money did not provide government subsidies for hospital operations, but was used to upgrade the trauma care in the state.

“If you want popular support,” he said, “people have to think it’s going to make sure there is a trauma system for their child if they’re in an auto accident. They don’t want to be paying fees for uncompensated care for anyone who comes into an emergency room with the sniffles.”

Advocates say talk of entitlement tainted the issue by implying that providing more money for emergency care is akin to a social welfare program.

Then there is the Grady factor. Grady clearly influenced the fate of the trauma care plan, but there’s debate on whether it was good or bad for the issue. Some said Grady’s financial crisis, fueled in part by providing trauma care to uninsured people, helped highlight the problem. Others say the politics of Grady became a distraction, obscuring the statewide problem.

“I think [the political controversy over Grady] did not necessarily help — it may have hurt,” Sen. David Adelman said. “‘ Uncompensated care’ has become code for Grady.”

As advocates start to lobby the issue for next year’s legislative session, there’s disagreement on whether trauma care funding will fare better or worse.

Grady is getting on its feet, financially, and so it is expected to play a lesser role.

Next year is not an election year for state lawmakers, so some may be less apt to oppose the $10 tag fee, which for some smacks of a new tax. Then again, the economy may be worse off, making state budgets even tighter. Though legislators didn’t provide long-term funding, they did approve a one-shot allocation of $58 million. The state Trauma Commission is expected to divvy up the money at its meeting Thursday.

Hospital officials and others say a long-term funding source still is essential.

“We don’t let people bleed to death,” Emory’s Kellermann said. “We take care of them. … It’s a moral entitlement.”

THE STORY SO FAR

* Previously: The state Legislature failed to provide long-term state aid for hospitals that specialize in trauma care.

* The Latest: Trauma care advocates are licking their wounds and mapping out a strategy for the next push.

* What’s Next: The issue is expected to rise again in next year’s legislative session.

OPTIONS FOR FUNDING TRAUMA CARE

1. Impose a $10 fee on the annual car registration.

* Proposed by House Speaker Glenn Richardson.

* Projected to raise $74 million a year.

2. Divert the .25 mill property tax levy the state already collects.

* The measure was a proposed compromise between the state House and Senate.

* Projected to raise $90 million annually.

3. Increase fines on “super speeders,” found guilty of driving at speeds well in excess of the limit.

* Proposed a year ago by Gov. Sonny Perdue.

* Projected to raise $25 million a year.