SB 168-TRAUMA CARE CENTERS/FUND 2:42:09 PM CHAIR DAVIS announced consideration of SB 168. TOM OBERMEYER, staff to Senator Davis, sponsor of SB 168, read the sponsor statement. It is about state certification and designation of trauma centers, creating the uncompensated trauma care fund to offset uncompensated trauma care provided at certified and designated trauma centers and providing for an effective date. SB 168 addresses the urgent need for a comprehensive statewide trauma center system coordinating and integrating the efforts of emergency medical services, public safety agencies, air medical services and health care facilities to insure that patients receive the most efficient and effective care from time of injury through rehabilitation. Trauma care systems have been shown to reduce death from injury by as much as 25 percent and are recognized as an integral part of the state's EMS and disaster response system. Only eight states have fully functioning systems and 15 states have no system. Trauma is any life threatening occurrence either accidental or intentional that causes injuries. The leading causes of trauma are motor vehicle accidents, falls and assaults; trauma is the leading cause of death among Americans under 44 years of age. A trauma center is a hospital, clinic or other certified entity equipped to provide comprehensive emergency medical services to patients suffering traumatic injuries. They were established by the medical establishment in response to traumatic injuries that often require complex and multi-disciplinary treatment including surgery in order to give the victim the best possible chance for survival and recovery. 2:43:57 PM Section 1 in SB 168 adds subsection (c) to emergency medical services to address the state certification and designation of trauma centers. It creates the uncompensated trauma care fund under section 2 to offset uncompensated trauma care provided at certified and designated trauma centers and provides for an immediate effective date. The bill requires the commissioner to establish special designations in regulation of levels of 1-4 of certified trauma centers that shall be used to set compensation eligibility and the amounts under the uncompensated trauma care fund. Although current Alaska statutes revised in 1993 require certification of hospitals, clinics or other entities representative of trauma centers, they do not require or provide incentives for participation. The uncompensated trauma care fund will provide the needed incentives for hospitals for clinics and other entities to seek certification as trauma centers. Since the state's statutes and regulations in this area were enacted over 15 years ago, only 3 of 24 eligible Alaska hospitals reportedly have successfully completed the verification and certification process as trauma centers. In order to qualify as a trauma center, a hospital must meet certain criteria established by the American College of Surgeons. Trauma centers vary in their specific capacities and are identified by levels 1-4; 1 being the highest. Higher levels of trauma centers will have trauma surgeons available including those trained in such specialties as neurosurgery, orthopedic surgery, as well as highly sophisticated medical diagnostic equipment and specialized treatment units. Lower levels of trauma centers may only be able to provide initial care and stabilization of a traumatic injury and arrange for transfer of the victim to a higher level trauma care. 2:45:52 PM MR. OBERMEYER said under the Alaska trauma center system, it is anticipated that tertiary hospitals designated as higher level trauma centers will insure the availability of critical care specialists 24 hrs/day, 7 days/wk. The Alaska Native Medical Center is a level 2 trauma center; Yukon Kuskokwim and Norton Sound Regional Hospitals are level 4. It is believed that there are adequate medical resources to establish more level 2 trauma centers in Anchorage, and it is considered feasible to establish level 3 and 4 centers throughout the state. Because of long transport times trauma centers at all levels are necessary to improve patient outcomes. Level 1 trauma centers have critical care specialists in the hospital or on call at all times. The closest level 1 trauma center is Harborview Medical Center in Seattle. The operation of a trauma center is extremely expensive. Some areas are underserved by trauma centers because of this expense. For instance, Harborview is the only level 1 trauma center to serve the entire states of Washington, Idaho, Montana, and Alaska. He said that patient traffic at trauma centers can vary widely as there is no way to schedule the need for emergency services. A variety of different methods have been developed for dealing with this. Halifax Health in Daytona Beach, Florida, reportedly is employing a pod system to be provided by several different small emergency departments at different hospitals rather than one large trauma center. It is anticipated that Alaska, likewise, will have to develop a trauma center system which is best suited to its needs. It is anticipated that persons critically injured in remote areas of Alaska will be transported directly to a distant trauma center by plane and helicopter for faster and better care than if they had been transported to a closer hospital, which is not designated a trauma center. The designation, coordination and funding of a trauma center in Alaska as provided under SB 168 will save time and lives. It will also provide the financial incentives for more participation by hospitals, clinics and other certified trauma care entities which are not available under present law. He drew the committee's attention to the attachments and documents that indicate that in Alaska the leading cause of death in persons ages 1 to 44 is trauma; the average number of fatalities from trauma is 400 each year, and for every injury death, 11 people are hospitalized for trauma-related injuries. For every trauma death that occurs in the hospital, there are an estimated 3 people discharged with permanent disability. On average, more than 800 Alaskans are hospitalized annually with central nervous system injury (spinal cord or brain injuries). In 2004 motor vehicles were the leading cause of injury death (117), followed by firearm injuries (116). In 2004, the economic cost of hospital stays for trauma patients in Alaska was estimated at over $73 million; 1 in 4 of those hospital admissions were uncompensated. CHAIR DAVIS set SB 168 aside. SB 168-TRAUMA CARE CENTERS/FUND  CHAIR DAVIS returned attention to SB 168 to continue taking testimony. 2:50:46 PM DR. JAY BUTLER, Chief Medical Officer, Department of Health and Social Services (DHSS), said Alaska's trauma death rate has declined over the last 30 years thanks to prevention efforts, but it is still significant. The department took a neutral stance on SB 168. DR. BUTLER said, "A better job can be done with the medical management of trauma victims." To begin a systematic approach to improving trauma care in Alaska, the DHSS hosted the American College of Surgeons' Committee on trauma system evaluation and planning this past November. The committee noted that Alaska has no trauma system and the report included over 70 recommendations for improving trauma care and creating a statewide trauma system. Among the priority recommendations was a recommendation to require all acute care hospitals to seek trauma center designation appropriate to their capacity within the next two years to improve the quality of medical care for trauma victims and improve outcomes. DR. BUTLER said SB 168 provides an incentive for hospitals to become certified trauma centers rather than creating a mandate. It creates a fund for reimbursement of trauma care that would be provided for care to uninsured or underinsured patients. There are a number of potential sources of funds, and the department has been working to develop the sources further. However, he said because of the uncertainty involving funding, the administration is taking a neutral stance on SB 168. 2:53:07 PM SENATOR DYSON asked if the administration requested this bill. CHAIR DAVIS replied no; it was requested by others than the department. 2:54:10 PM ROD BETIT, President/CEO, Alaska State Hospital and Nursing Home Association (ASHNHA), said they support the concept of SB 168. The detailed report from the College of Surgeons prescribes a mandatory approach, which he didn't think would be well received for a variety of reasons. This is a priority that his members selected to work on in 2009, and he understands it is one of the department's priorities, too. The trauma system needs to be improved; the reasons why it hasn't happened need to be understood why it hasn't happened before. Some of those include the availability of physicians and their willingness to serve because there are very significant and time sensitive requirements around each classification level in the trauma scheme, and the costs to do that. And since there is clear evidence that if you have trauma centers, they attract more uncompensated care that has to be dealt with as well as what levels are care should be in each community. He understood that Alaska has five designated facilities, four of those are tribal. The one with the highest level designation is Alaska Native Medical Center. Those are staff model hospitals where the physicians work for those hospitals. One private facility that is certified at the lowest level is co-located in a community with one of those tribal facilities. The rest have struggled with ways to meet the conditions of certification - being private hospitals with physicians who do not work for them and having a shortage of some of the types of physicians needed and the ability to make sure the physicians will be there within the time response required. This is one issue they don't know how to solve at this point, but a group within the AHNSHA is working on it. This is a great approach to try to pull more facilities in and get them designated. Clearly, uncompensated care is one way to do that, but unless they can figure out some of the logistical problems around physician availability, they won't get as far as the committee would like with this piece of legislation. 2:57:49 PM SENATOR PASKVAN asked, if it were funded at the $5 million level, what range of hospitals would want to participate in the plan. MR. BETIT answered that since this deals with "a half a glass" and deals with uncompensated care, but not with the physician cost or availability, none said they would be willing to move forward to get the designation. It's a step in the right direction, but maybe the $5 million could be matched through some disproportionate sharing funding that Medicaid makes available that the state hasn't fully capitalized on. Maybe some of that could also go into offsetting some of the increased costs for the physician on call and recognizing that they have to have the right physicians available to be on call. He hoped to work with the department on these issues over the next few months. 2:59:09 PM MARK JOHNSON, former chief of Emergency Medical Services, said during that time that he served, he worked very hard to develop an EMS system in Alaska and made a lot of progress. One of the issues they worked on was to improve the trauma system in Alaska where they made some limited progress. In the 1990s with the use of some federal grant funds, his office co-sponsored American College of Surgeon reviews of eight different hospitals in Alaska that created reports on their strengths and weaknesses. Some hospitals have been reviewed multiple times. The report that the college came out with addressed some issues mentioned by Mr. Betit as well as going into a lot more detail on how to solve some of the problems. It's been said for many years, that trauma systems require commitment, and unless the medical community and the hospitals are willing to provide it, they aren't going to solve the problem, Mr. Johnson said, and he's been dealing with it for decades. The reality is that Alaska's hospitals are not meeting national standards in trauma care, and the public is not well served by that. Harris polls indicate that nationwide, people actually think they live in a community with a trauma system, but in fact in many places it doesn't exist. MR. JOHNSON said reducing complications and lengths of stay can produce better outcomes and more lives saved, and these can all result in downstream long term savings. One of the biggest problems in this state is on-call. Sometimes a surgeon is needed immediately, but they must be called to find somebody available. Those calls take time and that sometimes results in bad outcomes. That should be pre-planned and pre-arranged; and that's what this is about. 3:02:55 PM SENATOR DYSON said "commitment" sounds like money. MR. JOHNSON said to some extent that is true, but other things can be done that don't cost much. You look at creative solutions, and some are in this report. CHAIR DAVIS said this bill will come back next session. [SB 168 was held in committee.]