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HCA trauma centers under fire in Florida


By Beth Kutscher
Posted: March 14, 2014 - 6:00 pm ET
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A yearlong investigation of HCA-operated trauma centers in Florida found that the company charges the highest rates, on average, of any trauma facility in the state, according to the Tampa Bay Times.

The newspaper's investigation comes as more than a dozen lawsuits have been filed in Florida to prevent HCA from operating trauma centers at three facilities: Blake Medical Center in Bradenton; Regional Medical Center-Bayonet Point in Hudson; and Ocala (Fla.) Regional Medical Center, according to news reports.

Both houses of Florida's Legislature are advancing their own versions of a bill that would codify how many trauma centers should be allowed across the state. The house bill, which passed a state house subcommittee Tuesday, would allow any level 1 or 2 trauma center to continue operating if it has done so for at least 12 consecutive months, and submits to a site visit by the American College of Surgeons Committee on Trauma.

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The Senate version sets a number for how many trauma centers Florida can have in 18 defined service areas. Both bills, if passed, would allow HCA's trauma centers to keep operating. Florida's Republican governor, Rick Scott, is the founder and former CEO of Columbia/HCA.

The Tampa Bay Times reported that HCA's actions are driving up prices across the state, as other hospitals rush to keep pace. Florida Blue, the largest insurer in the state, said it has negotiated rates with HCA that are twice what it pays other trauma centers.

The Times' investigation comes as HCA has been lobbying for legislation that would protect its place in the market, with competitors fighting against its trauma care expansion. And it also highlights growing concern about the growth of trauma centers and special trauma fees charged by hospitals, which are a kind of cover charge for all kinds of patients admitted to a hospital's trauma center.

“The issue is developing in many areas of the country,” said Greg Bishop, president and founder of Bishop & Associates, a California-based consulting firm for trauma centers and founder of the Trauma Resource Network and the Trauma Center Association of America. “There's a lot of hoopla about this, but it's simply an industry that hasn't had to deal with too many trauma centers before—and now it's about to.”

Four of the five most expensive trauma centers in Florida are owned by HCA, with not-for-profit Tampa General Hospital also making the list, according to the Tampa Bay Times report. HCA's “trauma response” fee is as high as $33,000, four times higher than the state average of $6,754, the newspaper found.

HCA West Florida issued a lengthy response to the story, posted on its website, in which it took issue with using charges as a stand-in for how much patients pay. Its hospitals are paid less than $300 per uninsured trauma patient, the statement said.

HCA also noted that its hospitals provide 20% of the total uncompensated care in Florida, yet receive only 4.7% of Low Income Pool funding from the state. And its for-profit status means it paid $236 million in Florida taxes last year, it said.

“While we don't know how others set their charges, we generally establish response charges based on the costs associated with assembling a trauma team when a patient needs these highly specialized services,” HCA said, adding that its trauma centers have an above-average survival rate of 96.8%.

HCA has led the movement to develop trauma centers but it's not the only hospital operator in the race. Bishop pointed to Denver and Detroit as two other cities facing similar issues of smaller community hospitals developing level 2 trauma centers and taking volume away from each other as well from level 1 trauma centers.

Trauma centers are attractive, Bishop said, because they help hospitals attract surgeons and create a surgical advantage. While they're expensive to build, “the real issue over time is, are you going to get value out of your trauma center?” he said. “Obviously, trauma care shouldn't be about money. But it has become about money to a large extent.”

The Florida Hospital Association could not be reached for comment.

Follow Beth Kutscher on Twitter: @MHbkutscher


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