Inequities in Emergency care and the ACA

Report
TRAUMA CENTERS
BY GABE SIEGEL
SHORT ANECDOTE
Example: US Congressman Bobby Rush’s son was shot and killed on the
same block as a Hospital, yet he was driven 10.3 miles to the nearest
trauma center.
STATE OF EMERGENCY MEDICINE
EMTALA and the ACA
Insurance ≠ Access: shortage of Primary Care
physicians
ACA increases demand for resources
Poor reimbursements, uncompensated care,
and utilization issues
Importance of Trauma centers and systems
Under the ACA: $224 million in grants for
Trauma Centers
TRAUMA
Trauma-mostly severe and critical injuries.
Trauma is predictable
Injury is the leading cause of death for individuals
from ages 1 to 44
Accounts for approximately 170,000 deaths each
year and over 400 deaths per day
35 million people are treated annually for trauma -one hospitalization every 15 minutes.
QUICK FACT
For every $3.51 the federal government spends
on HIV research and $1.65 for cancer, trauma
gets 10 cents. And this is true despite the fact
that someone dies from a traumatic injury
every three minutes in the United States.
Compared to every 9.5 minutes someone is
infected with HIV/AIDS in the U.S.
DEFINING THE PROBLEM
25 % of Trauma Centers have closed in the U.S
Disproportionately burdens vulnerable populations
46 million Americans lack access to a trauma
center.
“Trauma Deserts”
Access to a trauma center reduces risk of death by
25%
The interests, individuals, ideas, institutions
TRAUMA SYSTEM COMPONENTS
911 Access
Pre-Hospital Providers
Hospital EDs
Trauma Centers
Rehabilitation Centers
Trauma Registry and Injury Prevention
TRAUMA CENTER LEVELS
Level 1- 24/7 emergency care capable of
providing care for any injury. Leader as a
research institution.
Level 2- 24/7 essential care.
Level 3- 24/7 emergency physicians, key
services, prompt availability of surgery staff,
and transfer agreements.
Level 4- 24/7 physician coverage. Transfer
agreements.
TRADE OFF PARALLELOGRAM
Cost
Quality
Equity
Access
POLICY PROPOSAL
Recognizing trauma systems as a public good
National Trauma System
Linking funds to Trauma center availability
Increased and new modes of funding for EMS and Trauma
Centers
Changing reimbursement
Activation Fee
Alternative payment model that incentives quality outcomes
and cost-effective care
Stopping “defensive medicine”
OUTCOMES AND OBSTACLES
Funding
Public and professional support and policy lightening
Lowering mortality rates
Maintain and improve cost, quality, access, and
equity
Prevention of Trauma Center closures
Reducing “trauma deserts”
Preparation for a major terrorist attack or disaster
TRAUMA MAP
http://www.traumamaps.org/Trauma.aspx

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