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News Section: Opinion

Trauma Center Fee Gouging is the Latest Health Care for Profit Scandal

Published Sunday, March 30, 2014 12:10 am

A recent investigative report by the St. Pete Times exposed the nonsensical structuring of “fees” at “state-designated trauma centers.” One after another, the article detailed utterly larcenous incidents of hospitals gouging patients to the tune of tens of thousands of dollars, sometimes without even providing more than a cursory look. What does it say about our country when this sort of unconscionable fleecing of the sick and injured has become commonplace in America's health care system?

The piece details one man who was charged just under $33,000 only to be told the hospital didn't have the right specialist for the job and would have to transfer him; a child who was brought in on a precautionary basis after a possible sports injury and charged nearly five grand in such fees despite no record of actual treatment; a teenager who was brought in for a superficial wound on his forehead and was sent home in less than two hours, but not only had to deal with almost seven grand in ER bills, but another $21,721 for his trauma fee; and on and on …

Over the course of one-year, the paper analyzed over 10 million patient billing records and found many such stories, while reporting that just since 2010, these trauma centers have charged Florida patients more than a half-billion dollars! Of course, not all of it is collected, but as they are often paid a percentage of such fees by insurance companies, raising the rate means more profits, while strapping the uninsured with bills that are almost certain to send them to collections and possibly even bankruptcy.

Hospitals won the ability to charge such fees from the National Uniform Billing Committee in 2002, arguing that they should have a means to recover the high costs of maintaining state-of-the-art trauma facilities, filled with ultra high-tech equipment and staffed by on-call specialists trained to respond to various catastrophes that a typical ER might not be suited for – think extreme falls, horrific car or boating accidents, etc. Ideally, they are sub-sections of emergency rooms, dedicated to such rare occurrences. Given how unlikely such admittances are, it is understandable that there would be a mechanism to make providing such treatments cost-effective.

However, as the investigation uncovered, hospitals that receive the special “trauma center” status from the state, routinely levy the fee on very typical patients who require nothing more than traditional ER or even walk-in clinic type care. A south Florida cyclist was charged a $12,500 fee when he came in for road rash after turning over his bicycle!

Governor Scott's old company, Hospital Corporation of America, was found to be by far the most egregious biller, charging an average fee of $28,000 per patient at the six centers they have opened across the state (HCA is lobbying to open even more). Most hospitals defended their sky-high fees, though one actually reduced theirs once the paper started asking questions, admitting that it had no relevance to its actual costs.

Identifying “trauma centers” is supposed to be a way to provide better critical care, in which first responders, who have a patient in need of very serious and highly-specialized emergency care can take them to the nearest hospital that is properly equipped to handle such a case and billing for those patients can be modified to reflect the cost of having that trauma team available and mobilizing it. However, hospitals who receive the designation too often seem to view it as a license to print money, as well as permission to charge everyone who walks in the door an inflated cover charge, like some trendy night club on South Beach.

The United States is the only developed nation in the world that profits off the sickness, disease and physical tragedies of its citizens, which is itself a shameful designation, but this practice puts us in a whole new category. The state needs to come up with a reasonable set of rules regarding how and when such hospitals can assess these fees, and then come up with a system of accountability to ensure it is followed.

Dennis Maley's column appears every Thursday and Sunday in The Bradenton Times. He can be reached at Click here to visit his column archive. Click here to go to his bio page. You can also follow Dennis on Facebook.

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I agree with Nancy Dean's comments. Venture capitalists are investing in all facets of health care, and their interest is not in your health.
Posted by Christina Amato on March 30, 2014

The observations gleaned from my 50+ years of association with the health care industry, convince me that hospital care is best delivered by non-profit institutions. Some believe that the first duty of a for profit institution is to its stock holders rather than to the patients they serve. My observations support the supposition that patient welfare is not the foremost concern of for-profit hospitals. Most recently seeking forgiveness rather than permission to establish trauma centers suggests a willingness to take expedient actions rather than acting within governmental laws, rules and/or regulations set-up to protect patient safety. Even worse than gouging the public is the real possibility of patient injury or death when seeking back room methods of achieving goals become institutionalized.
Posted by Nancy R Dean, RN, EdD on March 30, 2014

it seems that the health industry is just as greedy as ever & it has nothing to do with "obamacare", just old fashioned greed.We will keep being gouged as long as the politicians are in the pockets of special interests & until the voters wake up & wise up to start throwing out these useless representatives of the people & start electing those who will serve all the people ,"but don't count on it"
Posted by William E.Moore on March 30, 2014

Outrageous gouging for gouging's sake. Not unlike going to a hospital for an out-patient procedure instead of a clinic. What the public needs to know which hospitals claim to have trauma centers and stay away from them. These places are like grass covered snake pits. The innocent public has no idea what they are in for once they walk in the door with a scraped knee.
Posted by Henry Kuhlman on March 30, 2014

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