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Support for the Trauma System in Oklahoma How we got there/here 2003 -2005 Roxie Support for the Trauma System in Oklahoma How we got there/here 2003 -2005 Roxie M. Albrecht, MD, FACS Medical Director, Trauma & Surgical Critical Care OU Medical Center

Senate Bill 1554 • Trauma Care Assistance Revolving Fund – Reimburse for uncompensated care Senate Bill 1554 • Trauma Care Assistance Revolving Fund – Reimburse for uncompensated care • • • Hospitals Prehospital provider services Physicians – at Medicare rates • Medicaid Matching for Trauma Fund

Past Trauma Fund Distributions Year Approved Total for cases Uncompensated Distribution cost (million) (Million) Past Trauma Fund Distributions Year Approved Total for cases Uncompensated Distribution cost (million) (Million) Reimbursement Ratio 2000 N/a 8. 85 2. 12 0. 24 2001 N/a 10. 7 2. 18 0. 20 2002 N/a 16. 6 3. 38 0. 20 2003 3393 27. 0 2. 51 0. 09 2004 3024 21. 5 4. 0 0. 19

Funding Initiatives House Estimated Effective Source Bill Funding Dates 2600 $ 12. 4 9/1/04 Funding Initiatives House Estimated Effective Source Bill Funding Dates 2600 $ 12. 4 9/1/04 Failure to maintain liability million ins. , reinstatement DL, drug offenses 2250 6/3/04 2042 $ 1. 8 million $400, 000 2299 unk 11/1/04 2660 $ 17 million 1/1/05 7/1/04 Open Container, Speeding, DUI General Fund Convictions – driving without a valid DL Tobacco Tax

Current Trauma Fund • Collections – July 04 – July 05 = 14, 465, Current Trauma Fund • Collections – July 04 – July 05 = 14, 465, 423. 00 • June 05 – 1, 409, 623 & July 05 – 1, 737101 • Eligible Physician participants – Tier A – • Emergency Medicine, Neurosurgery, General Surgery, Maxillo-facial surgery, Orthopaedic surgery, Anesthesiology and Trauma intensivists. – Tier B – • Areas not identified in A • Funds will be distributed pending excess from Tier A allocation

Trauma Fund – Physician Reimbursement • Qualifying Cases – ICD-9 code of 800. 0 Trauma Fund – Physician Reimbursement • Qualifying Cases – ICD-9 code of 800. 0 -959. 9 – Limited to contacts within 30 days of injury – Accompanied by one or more • • Admission for at least 48 hours Transfer from a lower facility for major trauma Activation of the trauma team Admission to an ICU Admission directly to the OR – for head, chest, abdomen, or vascular system Declaration of DOA Declaration of dead in ED or hospital PLUS – – AIS of > 3 ISS of > 9 Probability of Survival < 0. 90

Trauma Fund • The first claim period for submission of Trauma provider uncompensated care Trauma Fund • The first claim period for submission of Trauma provider uncompensated care will be July 1, 2004 to December 31, 2004. • www. health. ok. gov/program/injury/trauma /tfund. html • Reporting is due into OSDH by October 31.

Senate Bill 1554 • Establish the Oklahoma Trauma Systems Improvement and Development Advisory Council Senate Bill 1554 • Establish the Oklahoma Trauma Systems Improvement and Development Advisory Council – Makes recommendations to the DOH regarding the trauma system – 18 members • Public health, trauma registrar, rural hospital, EMT, orthopaedic surgeon, specialty hospitals (ASC), ED physician, EMS director, rehabilitation, hospital administrators (Level 1 or II, urban, rural), administrative director of pre-hospital service, trauma surgeon, general public

Senate Bill 1554 • Rulemaking authority for the OSDH to regulate the trauma system Senate Bill 1554 • Rulemaking authority for the OSDH to regulate the trauma system – Every hospital (including medical staff) must participate in a regional system of providing 24 -hour emergency hospital care – Reciprocal Transfer Agreements

Senate Bill 1554 • Established 8 regional trauma boards – must develop a trauma Senate Bill 1554 • Established 8 regional trauma boards – must develop a trauma system within the region based on State approved guidelines

Oklahoma County • Priority I and Priority II call schedule - Baptist - OUMC Oklahoma County • Priority I and Priority II call schedule - Baptist - OUMC (Mercy will take single system neurological trauma) - Southwest - Mercy/Edmond (Edmond is primary hospital for Orthopedics) - Deaconess (OUMC will take single system neurological trauma) - OUMC (Mercy will take single system neurological trauma) - Midwest City

Oklahoma County System • • When “on call”, each hospital will provide orthopedics, neurosurgery, Oklahoma County System • • When “on call”, each hospital will provide orthopedics, neurosurgery, general surgery, facial trauma, and anesthesia…. or arrange coverage through hospital transfer agreements. This schedule is for unassigned, Priority 2 patients with single-system injury, or at risk for injury but currently stable, picked up by EMSA in its service area or transported into the metropolitan area from other regions of the State. Each hospital will provide care for the patients who arrive in their ED even on the nights they are not the designated hospital…. or will arrange transfer. It is understood that the other hospitals may have to provide back-up coverage for a designated hospital.

Senate Bill 1554 • Trauma Transfer and Referral Centers – Each County and contiguous Senate Bill 1554 • Trauma Transfer and Referral Centers – Each County and contiguous communities with > 300, 000 persons – Direct ambulance patients to facilities with clinical capacity and capability • EMSystem® – Internet based computer application – Real time access to regional and statewide information on hospital ED divert and air transport status

Regional Transfer Centers • Based at EMSA – – OKC – Tulsa 888 -658 Regional Transfer Centers • Based at EMSA – – OKC – Tulsa 888 -658 -7262 866 -778 -7262

Senate Bill 1554 • Appointed State/Regional PI Committees and a Medical Audit committee – Senate Bill 1554 • Appointed State/Regional PI Committees and a Medical Audit committee – Protection from discovery • PI indicators have been established • Medical Audit Committee functional – Developing referral form and phone number – Currently call Patrice Greenawalt or Dr. Tim Cathey at the Department of Health – Trauma Division

Crisis November 5, 2003 OU Medical Center to close Level 1 Trauma Center on Crisis November 5, 2003 OU Medical Center to close Level 1 Trauma Center on December 31, 2003

 OUMC – Only State Level I/II • Financial Losses – $35 -39 million/year OUMC – Only State Level I/II • Financial Losses – $35 -39 million/year – Emergency Care – $9 million over 3 years - Trauma • Increase Uncompensated care • Insurance Status of patients – Inability to place in rehabilitation • Increases Length of Stay – Limits bed capacity • Limited State Funding

Percent Uninsured State Texas New Mexico California % Uninsured 23. 5 20. 7 19. Percent Uninsured State Texas New Mexico California % Uninsured 23. 5 20. 7 19. 5 Louisiana Oklahoma Arizona Florida Georgia 19. 3 18. 3 17. 9 17. 5 16. 6 U. S. Average 14. 6

Oklahoma Medicaid Population OHCA 2003 Oklahoma Medicaid Population OHCA 2003

Major Trauma by Primary Payor Oklahoma, 2001 -2003* N = 7245 *1/1/01 – 6/30/03 Major Trauma by Primary Payor Oklahoma, 2001 -2003* N = 7245 *1/1/01 – 6/30/03

Oklahoma City Metropolitan Area John Sacra, MD, Medical Director EMSA Oklahoma City Metropolitan Area John Sacra, MD, Medical Director EMSA

EMS Triage/Transport Jan – July 2003 • OKC Metro Area - OUMC received • EMS Triage/Transport Jan – July 2003 • OKC Metro Area - OUMC received • 84 % of the major trauma • 86 % of the serious injured trauma

Funding Oklahoma Trauma Fund – Support • $1 per license tag – Distribution • Funding Oklahoma Trauma Fund – Support • $1 per license tag – Distribution • 2002 - $ 3 million 2003 - $ 2. 5 million • Pre-Hospital services & Acute care facilities – Submissions - Uncompensated Care • 2002 – $16 million total - $6 million from OUMC • 2003 – $ 25 million total - $ 13 million from OUMC • No provision – Physician – reimbursement/stipends – Long term care providers

 • Crisis Announced • Press Conference – November 5, 2003 – Level 1 • Crisis Announced • Press Conference – November 5, 2003 – Level 1 Closure – December 31, 2003 • Unless improvements the state of the trauma system and funding – Potential for increased fatalities from trauma

Governor Appointed Emergency Task Force • Secretary of Health, Senator, Representative • Physicians – Governor Appointed Emergency Task Force • Secretary of Health, Senator, Representative • Physicians – Trauma Centers, ED, Specialty hospitals, Acute Care Hospitals • Board of Health Members • Hospital Administrators – Urban and Rural • Pre-Hospital Providers • Payor Representatives

Task Force Recommendations to DOH • Department of Health – Emergency Rules – Hospital Task Force Recommendations to DOH • Department of Health – Emergency Rules – Hospital Licensure • Hospital/Physicians Participate in Regional System Development – – Triage/Transport Revisions Central Dispatch/Transfer Center Reciprocal Transfer Agreements New Trauma Systems Improvement and Development Task Force/Regional Advisory Boards – Funding

OCMS Ad Hoc Committee • Proposed County-Wide Call Schedule • Priority II Patients within OCMS Ad Hoc Committee • Proposed County-Wide Call Schedule • Priority II Patients within OK County • Initial Meeting Attendees • • OMSA Governor’s Office DOH Pre-Hospital Providers Greater Oklahoma City Hospital Council Hospital Administrators Physicians – ED, Surgical Specialists, General surgeons • Call Schedule Sub-Committee Meets Monthly • 10 Members + • Call Schedule First implemented – May 2004

Advocacy Strategies Funding • Legislative Meetings – Speaker of the House and representatives – Advocacy Strategies Funding • Legislative Meetings – Speaker of the House and representatives – Senate Pro Tempore and senators – Governor’s Director of Finance

 • Data – Definitions – • Trauma System • Trauma center levels • • Data – Definitions – • Trauma System • Trauma center levels • Priority I, III patients – Comparison to neighboring states • Trauma centers, physicians, admissions – Impact on other training programs/bed capacity – Cost, reimbursement and outcome data – Transfers in – types and geographic locations – Length of stay – funded v. unfunded

Advocacy Strategies • Trauma Center Tours – Senators and Representatives – State Finance personnel Advocacy Strategies • Trauma Center Tours – Senators and Representatives – State Finance personnel • • Lobbyist – University, OHA Doctor of the Day State and County Medical Societies ACS – Advocacy and Health Policy

SSLAC Support • Letter • Email • As a trauma care provider in Oklahoma, SSLAC Support • Letter • Email • As a trauma care provider in Oklahoma, • Contact Your State Senator to Support Trauma System Funding • I urge you to support a number of bills to increase funding for the Trauma Care Assistance Revolving Fund: HB 2600 – increases the Fund to provide reimbursement for uncompensated care to recognized facilities that care for trauma patients; HB 2250 – provides for increases in court fees to be deposited in the Fund; HB 2382 – increases fines on driver’s license suspensions, DUI, narcotics and child safety seat violations to be deposited in the Fund; and HB 2660 – places on the ballot a referendum for Oklahoma voters to support creation in the State Treasury of a “Special Health Care Revolving Fund” to help pay for future health care costs. Monies from the Trauma Care Assistance Revolving Fund are used to reimburse recognized trauma facilities and licensed ambulance services for uncompensated trauma care. Passage of this legislation is extremely critical because hospitals across our state are suffering huge financial losses when providing emergency trauma care for uninsured patients. Should this trend continue, the viability of emergency care services at many of these institutions will be threatened - resulting in significantly reduced access to trauma care for Oklahomans across the state. As more hospitals cease to provide emergency trauma care, victims of injury will have to be transported over increased distances to reach definitive trauma care, pushing the limits of the critical "golden hour. " Injury victims who fail to receive comprehensive treatment within the first hour suffer greater risk of death or life-long disability. The legislature must not adjourn without adopting these critical bills. Please show your support for our trauma system by voting “YES” on HB 2600, HB 2250, HB 2382, and HB 2660! • Dear Oklahoma Surgeon: • The Oklahoma House of Representatives recently passed a number of bills to address funding issues for the Trauma Care Assistance Revolving Fund: HB 2600 – increases the Fund to provide reimbursement for uncompensated care to recognized facilities that care for trauma patients; HB 2250 – provides for increases in court fees to be deposited in the Fund; HB 2382 – increases fines on driver’s license suspensions, DUI, narcotics and child safety seat violations to be deposited in the Fund; and HB 2660 – places on the ballot a referendum for Oklahoma voters to support creation in the State Treasury of a “Special Health Care Revolving Fund” to help pay for future health care costs. These bills now await action by the Oklahoma Senate. Please take a moment to advocate on behalf of them by clicking on • • • the following link – http: //capwiz. com/sslac/mail/onecl ick_compose/? alertid=5522761 – and sending a letter you may easily personalize to your state senator asking them to vote for this legislation. • • Thank you for your help in advocating for: HB 2250; HB 2382; HB 2600; and HB 2660. We must do all we can to preserve our state’s trauma system, and your efforts will greatly help in this endeavor. Roxie Albrecht, MD, FACS • State Chair, Oklahoma COT

Advocacy Strategies • Education Material – Trauma System – Trauma Center – How to Advocacy Strategies • Education Material – Trauma System – Trauma Center – How to contact your senator/representative • Media • Patient/Family Testimonials

 • Letters to the Editor – Chair of University Hospital Authority and Trust, • Letters to the Editor – Chair of University Hospital Authority and Trust, Patients families, employees and families, TMD, CMO • CHANCE MEETINGS

November Vote – Tobacco Tax • Oklahoma Hospital Association – Solicitations for funding • November Vote – Tobacco Tax • Oklahoma Hospital Association – Solicitations for funding • Hospitals, Universities • Foundations, Individuals – Flyers, buttons, billboards, radio ads – Presentations • Rotary, Junior league, professional society meetings

 • Media • Trauma Survivor Picnic – week before vote – Speaker of • Media • Trauma Survivor Picnic – week before vote – Speaker of the House – Governor – Patient/Family Testimonials – Trauma Center Personnel

ACS Advocacy and Health Care Policy Division • • • Dear Oklahoma Surgeons: I’m ACS Advocacy and Health Care Policy Division • • • Dear Oklahoma Surgeons: I’m writing to you today in my capacity as the state chair of the Oklahoma Committee on Trauma (COT). Earlier this year, a number of bills passed our state’s legislature to increase funding for our trauma system, and I asked you at that time to write your legislators in support of them. One of these trauma funding initiatives included an increase in the tobacco tax that will be going before the voters on November 2. State Question (SQ) 713, the Oklahoma Health Initiative, will increase the excise tax on cigarettes by 80 cents. Other tobacco products such as chewing tobacco and cigars will see an increase, too. Some of the revenues generated from the increased tobacco tax are allocated to the trauma care assistance fund. In fact, if the voters approve SQ 713, $17 million will be made available to the trauma system. Combined with the $13 million already allocated through the state budget, we would have $30 million for our trauma system, with one-third of that potentially eligible for federal matching funds. As you can see, it is critical to our state’s trauma system that SQ 713 be passed. I encourage you to support SQ 713, and to talk to your patients and your physician colleagues about supporting it as well. I’ve attached a two-page handout that provides greater detail on the impact this tax will have, not only in increased revenues for health care programs but also reduced use of tobacco by our patients. If you have any questions about this ballot initiative, please feel free to drop me a line at [email protected] edu. I would be glad to speak with you. Thank you for your support for and involvement in this important trauma funding advocacy effort. Sincerely, Roxie M. Albrecht, MD, FACS Chair, Oklahoma Committee on Trauma

2005 Trauma System • Still Developing – Awaiting further ‘rural’ regional plans • Funded 2005 Trauma System • Still Developing – Awaiting further ‘rural’ regional plans • Funded – Projected 14 -20 million • Fragile – Specialty Surgical Coverage