An 8-month-old baby fell 3 feet and hit his head on a carpeted floor in a San Francisco hotel room. He was crying and the parents, who were from South Korea, called an ambulance. By the time the child arrived at the hospital he was obviously fine. After a bottle, a nap, and a few hours in the hospital, he was discharged.
The hospital sent a bill 2 years later, which included a charge of $15,666 for a trauma activation.
A trauma activation involves paging a number of hospital staff to go to the emergency department as quickly as possible. Those paged may include an attending surgeon, two or three surgical residents, an anesthesiologist or anesthesia resident, a respiratory therapist, a critical care nurse, and operating room nurse, and x-ray technician, a chaplain, and various others.
The trauma team assesses the patient and if serious injuries are present, expeditiously diagnoses and treats the problem. But in cases like the one described above, the team quickly disperses and returns to their usual duties.
The story above was one of several recounted in an article on Vox.com. The authors found a huge variation in the fees for trauma activation ranging from $1,112 in one hospital to a high of $50,659 at another.
This is not a new issue. In 2014, I blogged about a Tampa Bay Times story on trauma activation fees in Florida which at the time averaged over $10,000 with a maximum of $33,000. That article said hospital administrators admitted the charges were based on what other hospitals were charging and were unrelated to the resources used.
A different California hospital’s trauma activation fee was $22,550 for a young man injured in a minor motorcycle crash. He suffered a cut on his head that required two staples and received some IV fluid and ibuprofen. No x-rays, scans, or bloodwork were done.
I can understand hospitals charging a fee for trauma activations to help recover some of the costs of having a trauma service. The staff may require some special training. Managing the service, collecting data, and other incidentals may increase costs.
However, nearly all of the personnel involved in a trauma activation are already in the hospital and receive their salaries whether trauma activations occur or not. In the above examples, I would guess most members of the team spent 0 to 5 minutes at the patient’s bedside.
Despite attempts to do so, bills like those mentioned in the Tampa Bay Times and Vox stories are impossible to defend. The Vox piece quoted a hospital spokesperson: “Trauma team activation does not mean every patient will consult with and/or be cared for by a trauma surgeon. The activation engages a team of medical professionals. Which professional assesses and cares for a trauma patient depends on the needs and injury/illness of the patient.”
That statement hardly justifies the bill which admittedly is not resource-based.
The American College of Surgeons told Vox that to avoid missing a seriously injured patient a 25-35% over triage rate is acceptable. I agree with that, but it doesn’t mean a five-figure trauma activation fee is warranted for a patient with a cut on his head requiring two staples.
Imagine going into a shoe store and trying on four pairs of shoes. The salesperson, paid by the store owner, has gone to the back and retrieved them one at a time. But you decide not to buy anything. Should you be billed for the salesperson’s services?
Or at a car dealership, you test drive a car with the salesperson as a passenger. You determine the car is not what you had in mind. Should you have to pay for that experience?
Skeptical Scalpel is a retired surgeon and was a surgical department chairman and residency program director for many years. He is board-certified in general surgery and a surgical sub-specialty and has re-certified in both several times. For the last 8 years, he has been blogging at SkepticalScalpel.blogspot.com and tweeting as @SkepticScalpel. His blog has had more than 3,000,000 page views, and he has over 18,000 followers on Twitter.
Perhaps you could explain the double trauma activation fee I was charged after being transported to a trauma center after a vehicular accident with a shattered distal forearm. I am a veteran and should have gone to the VA where my particular care category means my care does not even have a co-pay, but after the police officer on scene forced me off of the cell phone of someone who stopped to help (I was trying to get the local tow company on the line) and called the ambulance and tow company contracted to the city, and then ordered me to allow the EMTs to examine me when they arrived (they were just doing their job, no beef with them) which included pulling off my gauntlet-style gloves and so removed the support for the injury I told them was there, the good Samaritan who stopped was afraid to either give me a lift to the VA about 6 miles down the road or let me call a cab on her phone and I had to accept the ambulance ride. After we were under way I found they could not legally take me to the VA, they had to take me to the county designated trauma center, AND they had no power to pass on the information that I had broken bones in my distal forearm but otherwise was uninjured. I am also a doctor and a surgeon, although my civilian work was on nonhuman animals, and I do understand that I could have missed signs of some injury, however, getting two separate bills for close to 5K aeach plus two more for around 400 each for having my arm radiographed, splinted without manipulation, re-radiographed, and receiving one injection of a painkiller seems quite excessive. The charges were explained to me as being mostly trauma team activation and trauma equipment activation, with the further information that none of it had had to be used but I had to pay for the activation.
I wish I could explain it. You should challenge it and ask for an itemized bill. If you have insurance, the company may be will to help you. The EMTs are most certainly empowered to pass on information to the ED staff whoever told you they are not is mistaken. I hope you can get this resolved. Good luck.
I used to take in house-call for trauma. I was full-time salaried and it was part of my job. I didn’t get extra pay for it. I understand that hospitals may have to pay for surgeons to take call. If a trauma center has to pad its income with inflated charges for bogus activations, maybe it isn’t seeing enough real patients and shouldn’t be a trauma center.
I can only assume u dont take in-house call for trauma. Hospitals have to pay staff to take call. No physician for trauma takes call for free. What about cost of care for those who cant pay for their trauma care