Legislature(2009 - 2010)BELTZ 211
04/08/2009 01:30 PM Senate HEALTH & SOCIAL SERVICES
| Audio | Topic |
|---|---|
| Start | |
| SB66 | |
| SB168 | |
| SB169 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| *+ | SB 168 | TELECONFERENCED | |
| *+ | SB 169 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
| = | SB 66 | ||
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.]
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