1. Support for the Trauma System in Oklahoma How we got there/here 2003-2005 Roxie M. Albrecht, MD, FACS Medical Director, Trauma & Surgical Critical Care OU Medical Center

2. Senate Bill 1554 Trauma Care Assistance Revolving FundTrauma Care Assistance Revolving Fund –Reimburse for uncompensated care HospitalsHospitals Prehospital provider servicesPrehospital provider services Physicians – at Medicare ratesPhysicians – at Medicare rates Medicaid Matching for Trauma FundMedicaid Matching for Trauma Fund

3. Past Trauma Fund Distributions Year Approved cases Total Uncompensated cost (million) Total for Distribution (Million) Reimbursement Ratio 2000N/a8.852.120.24 2001N/a10.72.180.20 2002N/a16.63.380.20 2003339327.02.510.09 2004302421.54.00.19

4. Funding Initiatives House Bill Estimated Funding Effective Dates Source 2600$ 12.4 million 9/1/04Failure to maintain liability ins., reinstatement DL, drug offenses 2250$ 1.8 million 6/3/04Open Container, Speeding, DUI 2042$400,0007/1/04General Fund 2299unk11/1/04Convictions – driving without a valid DL 2660$ 17 million 1/1/05Tobacco Tax

5. Current Trauma Fund CollectionsCollections –July 04 – July 05 = 14,465,423.00 June 05 – 1,409,623 & July 05 – 1,737101June 05 – 1,409,623 & July 05 – 1,737101 Eligible Physician participantsEligible Physician participants –Tier A – Emergency Medicine, Neurosurgery, General Surgery, Maxillo-facial surgery, Orthopaedic surgery, Anesthesiology and Trauma intensivists.Emergency Medicine, Neurosurgery, General Surgery, Maxillo-facial surgery, Orthopaedic surgery, Anesthesiology and Trauma intensivists. –Tier B – Areas not identified in AAreas not identified in A Funds will be distributed pending excess from Tier A allocationFunds will be distributed pending excess from Tier A allocation

6. Trauma Fund – Physician Reimbursement Qualifying CasesQualifying Cases –ICD-9 code of 800.0-959.9 –Limited to contacts within 30 days of injury –Accompanied by one or more Admission for at least 48 hoursAdmission for at least 48 hours Transfer from a lower facility for major traumaTransfer from a lower facility for major trauma Activation of the trauma teamActivation of the trauma team Admission to an ICUAdmission to an ICU Admission directly to the OR – for head, chest, abdomen, or vascular systemAdmission directly to the OR – for head, chest, abdomen, or vascular system Declaration of DOADeclaration of DOA Declaration of dead in ED or hospitalDeclaration of dead in ED or hospital PLUS –PLUS – –AIS of > 3 –ISS of > 9 –Probability of Survival < 0.90

7. Trauma Fund The first claim period for submission of Trauma provider uncompensated care will be July 1, 2004 to December 31, 2004.The first claim period for submission of Trauma provider uncompensated care will be July 1, 2004 to December 31, 2004. www.health.ok.gov/program/injury/trauma /tfund.htmlwww.health.ok.gov/program/injury/trauma /tfund.html Reporting is due into OSDH by October 31.Reporting is due into OSDH by October 31.

8. Senate Bill 1554 Establish the Oklahoma Trauma Systems Improvement and Development Advisory Council –Makes recommendations to the DOH regarding the trauma system –18 members Public health, trauma registrar, rural hospital, EMT, orthopaedic surgeon, specialty hospitals (ASC), ED physician, EMS director, rehabilitation, hospital administrators (Level 1 or II, urban, rural), administrative director of pre-hospital service, trauma surgeon, general public

9. Senate Bill 1554 Rulemaking authority for the OSDH to regulate the trauma system –Every hospital (including medical staff) must participate in a regional system of providing 24-hour emergency hospital care –Reciprocal Transfer Agreements

10. Senate Bill 1554 Established 8 regional trauma boards – must develop a trauma system within the region based on State approved guidelines

12. Oklahoma County Priority I and Priority II call schedulePriority I and Priority II call schedule - Baptist - OUMC (Mercy will take single system neurological trauma) - Southwest - Mercy/Edmond (Edmond is primary hospital for Orthopedics) - Deaconess (OUMC will take single system neurological trauma) - OUMC (Mercy will take single system neurological trauma) - Midwest City

13. Oklahoma County System When “on call”, each hospital will provide orthopedics, neurosurgery, general surgery, facial trauma, and anesthesia….or arrange coverage through hospital transfer agreements.When “on call”, each hospital will provide orthopedics, neurosurgery, general surgery, facial trauma, and anesthesia….or arrange coverage through hospital transfer agreements. This schedule is for unassigned, Priority 2 patients with single-system injury, or at risk for injury but currently stable, picked up by EMSA in its service area or transported into the metropolitan area from other regions of the State.This schedule is for unassigned, Priority 2 patients with single-system injury, or at risk for injury but currently stable, picked up by EMSA in its service area or transported into the metropolitan area from other regions of the State. Each hospital will provide care for the patients who arrive in their ED even on the nights they are not the designated hospital….or will arrange transfer.Each hospital will provide care for the patients who arrive in their ED even on the nights they are not the designated hospital….or will arrange transfer. It is understood that the other hospitals may have to provide back-up coverage for a designated hospital.It is understood that the other hospitals may have to provide back-up coverage for a designated hospital.

14. Senate Bill 1554 Trauma Transfer and Referral Centers –Each County and contiguous communities with > 300, 000 persons –Direct ambulance patients to facilities with clinical capacity and capability EMSystem® –Internet based computer application –Real time access to regional and statewide information on hospital ED divert and air transport status

16. Regional Transfer Centers Based at EMSA –Based at EMSA – –OKC888-658-7262 –Tulsa866-778-7262

17. Senate Bill 1554 Appointed State/Regional PI Committees and a Medical Audit committee –Protection from discovery PI indicators have been establishedPI indicators have been established Medical Audit Committee functionalMedical Audit Committee functional –Developing referral form and phone number –Currently call Patrice Greenawalt or Dr. Tim Cathey at the Department of Health – Trauma Division

18. Crisis November 5, 2003 OU Medical Center to close Level 1 Trauma Center on December 31, 2003

19. OUMC – Only State Level I/II OUMC – Only State Level I/II Financial LossesFinancial Losses –$35-39 million/year – Emergency Care –$9 million over 3 years - Trauma Increase Uncompensated careIncrease Uncompensated care Insurance Status of patientsInsurance Status of patients –Inability to place in rehabilitation Increases Length of StayIncreases Length of Stay –Limits bed capacity Limited State FundingLimited State Funding

20. Percent Uninsured State % Uninsured Texas23.5 New Mexico 20.7 California19.5 Louisiana19.3 Oklahoma18.3 Arizona17.9 Florida17.5 Georgia16.6 U.S. Average 14.6

21. Oklahoma Medicaid Population OHCA 2003

22. Major Trauma by Primary Payor Oklahoma, 2001-2003* N = 7245 *1/1/01 – 6/30/03

24. Oklahoma City Metropolitan Area John Sacra,MD, Medical Director EMSA

25. EMS Triage/Transport Jan – July 2003 OKC Metro Area - OUMC receivedOKC Metro Area - OUMC received 84 % of the major trauma84 % of the major trauma 86 % of the serious injured trauma86 % of the serious injured trauma

26. Funding Oklahoma Trauma Fund –Support $1 per license tag$1 per license tag –Distribution 2002 - $ 3 million2003 - $ 2.5 million2002 - $ 3 million2003 - $ 2.5 million Pre-Hospital services & Acute care facilitiesPre-Hospital services & Acute care facilities –Submissions - Uncompensated Care 2002 – $16 million total - $6 million from OUMC2002 – $16 million total - $6 million from OUMC 2003 – $ 25 million total - $ 13 million from OUMC2003 – $ 25 million total - $ 13 million from OUMC No provisionNo provision –Physician – reimbursement/stipends –Long term care providers

27. Crisis Announced Press Conference – November 5, 2003 –Level 1 Closure – December 31, 2003 Unless improvements the state of the trauma system and funding –Potential for increased fatalities from trauma

28. Governor Appointed Emergency Task Force Secretary of Health, Senator, Representative Physicians – Trauma Centers, ED, Specialty hospitals, Acute Care Hospitals Board of Health Members Hospital Administrators – Urban and Rural Pre-Hospital Providers Payor Representatives

29. Task Force Recommendations to DOH Department of Health – Emergency RulesDepartment of Health – Emergency Rules –Hospital Licensure Hospital/Physicians Participate in Regional System DevelopmentHospital/Physicians Participate in Regional System Development –Triage/Transport Revisions –Central Dispatch/Transfer Center –Reciprocal Transfer Agreements –New Trauma Systems Improvement and Development Task Force/Regional Advisory Boards –Funding

30. OCMS Ad Hoc Committee Proposed County-Wide Call ScheduleProposed County-Wide Call Schedule Priority II Patients within OK CountyPriority II Patients within OK County Initial Meeting AttendeesInitial Meeting Attendees OMSAOMSA Governor’s OfficeGovernor’s Office DOHDOH Pre-Hospital ProvidersPre-Hospital Providers Greater Oklahoma City Hospital CouncilGreater Oklahoma City Hospital Council Hospital AdministratorsHospital Administrators Physicians – ED, Surgical Specialists, General surgeonsPhysicians – ED, Surgical Specialists, General surgeons Call Schedule Sub-Committee Meets MonthlyCall Schedule Sub-Committee Meets Monthly 10 Members +10 Members + Call Schedule First implemented – May 2004Call Schedule First implemented – May 2004

37. Advocacy Strategies Funding Legislative Meetings –Speaker of the House and representatives –Senate Pro Tempore and senators –Governor’s Director of Finance

38. Data –Definitions – Trauma System Trauma center levels Priority I, II, III patients –Comparison to neighboring states Trauma centers, physicians, admissions –Impact on other training programs/bed capacity –Cost, reimbursement and outcome data –Transfers in – types and geographic locations –Length of stay – funded v. unfunded

39. Advocacy Strategies Trauma Center Tours –Senators and Representatives –State Finance personnel Lobbyist – University, OHA Doctor of the Day State and County Medical Societies ACS – Advocacy and Health Policy

40. SSLAC Support Letter As a trauma care provider in Oklahoma, I urge you to support a number of bills to increase funding for the Trauma Care Assistance Revolving Fund: HB 2600 – increases the Fund to provide reimbursement for uncompensated care to recognized facilities that care for trauma patients; HB 2250 – provides for increases in court fees to be deposited in the Fund; HB 2382 – increases fines on driver’s license suspensions, DUI, narcotics and child safety seat violations to be deposited in the Fund; and HB 2660 – places on the ballot a referendum for Oklahoma voters to support creation in the State Treasury of a “Special Health Care Revolving Fund” to help pay for future health care costs. Monies from the Trauma Care Assistance Revolving Fund are used to reimburse recognized trauma facilities and licensed ambulance services for uncompensated trauma care. Passage of this legislation is extremely critical because hospitals across our state are suffering huge financial losses when providing emergency trauma care for uninsured patients. Should this trend continue, the viability of emergency care services at many of these institutions will be threatened - resulting in significantly reduced access to trauma care for Oklahomans across the state. As more hospitals cease to provide emergency trauma care, victims of injury will have to be transported over increased distances to reach definitive trauma care, pushing the limits of the critical "golden hour." Injury victims who fail to receive comprehensive treatment within the first hour suffer greater risk of death or life- long disability. The legislature must not adjourn without adopting these critical bills. Please show your support for our trauma system by voting “YES” on HB 2600, HB 2250, HB 2382, and HB 2660! EmailEmail Contact Your State Senator to Support Trauma System Funding Dear Oklahoma Surgeon: The Oklahoma House of Representatives recently passed a number of bills to address funding issues for the Trauma Care Assistance Revolving Fund: HB 2600 – increases the Fund to provide reimbursement for uncompensated care to recognized facilities that care for trauma patients; HB 2250 – provides for increases in court fees to be deposited in the Fund; HB 2382 – increases fines on driver’s license suspensions, DUI, narcotics and child safety seat violations to be deposited in the Fund; and HB 2660 – places on the ballot a referendum for Oklahoma voters to support creation in the State Treasury of a “Special Health Care Revolving Fund” to help pay for future health care costs. These bills now await action by the Oklahoma Senate. Please take a moment to advocate on behalf of them by clicking on the following link – http://capwiz.com/sslac/mail/onecl ick_compose/?alertid=5522761 – and sending a letter you may easily personalize to your state senator asking them to vote for this legislation. Thank you for your help in advocating for: HB 2250; HB 2382; HB 2600; and HB 2660. We must do all we can to preserve our state’s trauma system, and your efforts will greatly help in this endeavor. Roxie Albrecht, MD, FACS State Chair, Oklahoma COT

41. Advocacy Strategies Education Material –Trauma System –Trauma Center –How to contact your senator/representative Media Patient/Family Testimonials

43. Letters to the Editor –Chair of University Hospital Authority and Trust, Patients families, employees and families, TMD, CMO CHANCE MEETINGS

44. November Vote – Tobacco Tax Oklahoma Hospital Association –Solicitations for funding Hospitals, Universities Foundations, Individuals –Flyers, buttons, billboards, radio ads –Presentations Rotary, Junior league, professional society meetings

45. Media Trauma Survivor Picnic – week before vote –Speaker of the House –Governor –Patient/Family Testimonials –Trauma Center Personnel

46. ACS Advocacy and Health Care Policy Division Dear Oklahoma Surgeons: I’m writing to you today in my capacity as the state chair of the Oklahoma Committee on Trauma (COT). Earlier this year, a number of bills passed our state’s legislature to increase funding for our trauma system, and I asked you at that time to write your legislators in support of them. One of these trauma funding initiatives included an increase in the tobacco tax that will be going before the voters on November 2. State Question (SQ) 713, the Oklahoma Health Initiative, will increase the excise tax on cigarettes by 80 cents. Other tobacco products such as chewing tobacco and cigars will see an increase, too. Some of the revenues generated from the increased tobacco tax are allocated to the trauma care assistance fund. In fact, if the voters approve SQ 713, $17 million will be made available to the trauma system. Combined with the $13 million already allocated through the state budget, we would have $30 million for our trauma system, with one-third of that potentially eligible for federal matching funds. As you can see, it is critical to our state’s trauma system that SQ 713 be passed. I encourage you to support SQ 713, and to talk to your patients and your physician colleagues about supporting it as well. I’ve attached a two-page handout that provides greater detail on the impact this tax will have, not only in increased revenues for health care programs but also reduced use of tobacco by our patients. If you have any questions about this ballot initiative, please feel free to drop me a line at roxie-albrecht@ouhsc.edu. I would be glad to speak with you. roxie-albrecht@ouhsc.edu. Thank you for your support for and involvement in this important trauma funding advocacy effort. Sincerely, Roxie M. Albrecht, MD, FACS Chair, Oklahoma Committee on Trauma

47. 2005 Trauma System Still DevelopingStill Developing –Awaiting further ‘rural’ regional plans FundedFunded –Projected 14-20 million FragileFragile –Specialty Surgical Coverage