For the past 20 years, MetroHealth Medical Center has been the sole provider of Level 1 adult trauma care for the metropolitan Cleveland area's 2 million residents.
Located on the city's west side, Cuyahoga County-owned MetroHealth operates one of the busiest trauma centers in the country. Its specialized facility and highly trained clinical staff handle more than 3,000 sudden and serious injuries a year, including gunshots, stabbings, falls and motor-vehicle accidents. “Emergencies come first here,” said Dr. Jeffrey Claridge, director of the trauma division at MetroHealth.
But his center is about to face some stiff competition. Next month, Case Western Reserve's University Hospitals (UH), anchored by its massive 1,032-bed tertiary-care hospital on the city's east side, will open the region's second Level 1 trauma center. Its rationale: The largely African-American eastern side of Cleveland has been underserved for years because of the distance to reach MetroHealth.
“When we first started to look at the delivery of adult trauma care, we really looked at it from a public health need,” said Dr. Michael Anderson, UH's chief medical officer. “Cleveland is often thought of as east side and west side, so for those patients on the east side of town, rapid access to trauma care was sorely lacking.”
Such scenarios are playing out in a number of metro areas across the country. More urban hospitals are looking to open trauma-care centers or elevate the designation of an existing facility to Level 2 or Level 1. Experts say the designation upgrade not only steps up the medical services they can provide, but generates substantially higher facility fees from both government and private payers.
Since 2012, 117 Level 1 and Level 2 trauma centers have opened in the U.S., bringing the total of such facilities to more than 520, according to the American Trauma Society. “You have a surge of openings in trauma-care centers right now that has replaced probably the main problem that we have had for decades, (which was) not enough,” said Greg Bishop, president and founder of Bishop and Associates, a healthcare research consulting firm that specializes in trauma-center development and management.
Some say the growth in trauma centers reflects an increase in trauma cases and local population booms. But the financial incentives for trauma-center expansion have clearly been a factor, as a greater share of trauma-care patients are now covered by public and private insurance. If the expansions lead to overcapacity, it could be detrimental for patient care and the bottom lines of those hospitals.