Dimensions Healthcare System

By Patrice Dickens
Daily Record Business Writer

Physicians Support Busch's Health Care Reimbursement Bill as First Step

In preparation for upcoming hearings on his House Bill 1, House Speaker Michael E. Busch, D-Anne Arundel, is already gathering all the support he can find.

The bill, aimed at reimbursing trauma physicians for uncompensated and underpaid services, recently got the support of the Maryland Health Care Commission. Many of the state's trauma physicians and organizations seem to support the bill as well.

But James P. Hamill, president and chief executive office of Washington County Health System, yesterday said the bill has good intentions but does little to address the concerns of Level 2 and Level 3 trauma centers, like the Level 3 trauma facility that his system operates in Hagerstown.

According to Hamill, the primary concern of Level 2 and Level 3 trauma facilities is on-call pay for physicians.

Level 3 trauma facilities allow trauma surgeons to be on call, but able to be at the facility within 30 minutes, as opposed to Level 2 requirements that surgeons be in the hospital at all times.

Last June, a dispute over pay for on-call physicians for the Hagerstown trauma facility led to the trauma center temporarily closing. The facility, originally a Level 2, reopened last October as a Level 3.

The doctors said they were losing money by agreeing to work at the center because they were unable to see patients or schedule procedures while on call.

Hospitals across the country are closing their trauma programs for several reasons, among them rising levels of uninsured or underinsured patients and a decrease in reimbursement rates. Closures also are attributed to significant increases in malpractice premiums and long work weeks.

"The trauma system is in real danger right now," said Dr. Thomas Scalea, physician-in-chief at the R Adams Cowley Shock Trauma Center in Baltimore.

All over the country trauma centers are closing, and in those cases there have been poor outcomes, Scalea said.

For example, last June Brandywine Hospital in Pennsylvania suspended trauma care for its Level 2 trauma center because of the shortage of trauma surgeons to staff its center. In July, the only Level 1 trauma center in Las Vegas closed its doors, leaving millions of people without emergency medical care services.

"I don't think the people of Maryland want to learn that way ... when some kid dies, that the threat is real." Scalea said.

According to Scalea, 40 percent of the patients treated at the facility are either uninsured or have medical assistance, which leaves hospitals underpaid for their services.

Richard S. Kennedy, chief operating officer of Prince George's Hospital Center and vice president of the Maryland Trauma Centers Network, also said part of the problem is that the money hospitals get from the state supports hospital functions but not trauma physician salaries.

As a result, the trauma facilities in the state have to subsidize physicians to participate in their trauma program.

For example, Prince George's Hospital Center, with a Level 2 facility, pays $3 million a year to subsidize on call trauma physician, Kennedy said.

According to Kennedy, that money is not reimbursed by the Health Services Cost Review Commission.

Kennedy said he thinks "House Bill I is a great first step in addressing the issues around physician availability and reimbursement in trauma care."

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