|
Files contained on this page require you to obtain the Free
Adobe Acrobat Reader to open and view the
document. Documents posted in .pdf version on the Department of
Health Web site will be made available in an alternative format on
request to users who are unable to download or view .pdf files on the
Web. To request an alternative format, contact the Subsite
Developer.
The State Legislature
established the Trauma Care Reimbursement Fund in 1997 to help offset
the high cost of operating and maintaining a statewide trauma care
system. The Legislature
specified that the Department of Health pursue opportunities for Federal
matching funds.
Therefore,
a joint partnership was created with the Department of Social and Health
Services’ Medical Assistance Administration (DSHS/MAA) to attract
federal matching funds.
The
Washington Trauma System addresses the continuum of care for victims of
trauma including:
-
Prehospital
-
Hospital
-
Physician
-
Rehabilitation
The
Trauma Care Fund also provides funding for each category of care.
The following types of funding will be distributed in the 2007-2009
biennium.
|
Category |
Type of Funding |
Administrator |
|
Prehospital |
Participation grants
Needs grants |
DOH
DOH |
|
Hospital |
Levels 1 - 3 Increased DSHS Trauma Care
payments
Levels 1 - 2 Uncompensated Trauma Care grants
Levels 3, 4 & 5 Trauma Care grants
Participation grants |
DSHS
DOH
DOH
DOH |
|
Physicians |
Increased Medicaid Trauma Care payments |
DSHS |
|
Rehabilitation |
Participation grants |
DOH |
TRAUMA
CARE FUND COMPENSATION PROGRAM
DOH distributes
Levels 1 & 2 Uncompensated Trauma Care and Levels 3, 4 and 5 Trauma Care
grants to trauma designated services to subsidize their uncompensated or
under-compensated costs in caring for trauma patients. DSHS/MAA
distributes trauma funds to levels 1 - 3 trauma designated services and
physicians through Increased DSHS Trauma Care payments.
Uncompensated
Trauma Care grants are distributed annually to levels 1 & 2 trauma
designated hospitals to help subsidize uncompensated or
under-compensated trauma care costs.
Uncompensated Trauma Care grant figures for
bad debt, charity care, and total patient revenue are
taken from the most recent calendar year available from DOH hospital
financial reports. The sum of the Injury Severity Score (ISS) is
extracted from the Trauma Registry for the same time period for
cases that:
(a)
Meet the trauma registry inclusion criteria per chapter
246-976-420 WAC; and
(b)
Are admitted with an ISS of 13 or greater for adults, 9 or
greater for pediatric patients less than 15 years of age, or trauma
patients received in transfer regardless of the ISS.
The Uncompensated grant is based on a
hospital's proportionate share of uncompensated trauma care and is
calculated using the following formula:
|
Step 1 |
Sum of the Injury Severity Score (ISS) for
all qualifying cases |
Multiplied by |
Individual hospital’s Bad Debt plus
Charity Care divided by the hospital’s Total
Patient Revenue |
Equals |
N 1 |
|
Step 2 |
Sum of All Designated Trauma Hospitals’
N 1 |
|
|
Equals |
NT |
|
Step 3 |
N 1 |
Divided by |
NT |
Equals |
The individual hospital’s % of available fund |
Or
Sum of
ISS
*
for qualifying cases |
Bad debt + charity care = N1
Total patient revenue |
| Sum of all hospitals' N1s
= NT |
N1
------
NT |
= Each hospital's % of
available fund
|
Sample Hospital Data for Levels 1 & 2
Uncompensated Trauma Care Grant:
|
Hospital |
Sum of ISS |
Total Patient Revenue |
Charity Care |
Bad Debts |
BD+CC Ratio |
ISS * BD+CC Ratio |
% of Total |
Grant Amount
|
|
|
|
|
|
|
|
|
|
|
|
Hosp. A |
2075 |
$211,087,766 |
$2,835,320 |
$3,557,535 |
3.03% |
62.8420 |
0.68% |
$15,723 |
|
Hosp. B |
5276 |
$362,517,189 |
$3,471,252 |
$13,222,699 |
4.61% |
242.9603 |
2.61% |
$60,787 |
|
Hosp. C |
2244 |
$201,546,698 |
$1,066,002 |
$2,858,510 |
1.95% |
43.6951 |
0.47% |
$10,932 |
|
Hosp. D |
5483 |
$840,496,418 |
$16,859,991 |
$8,540,487 |
3.02% |
165.7007 |
1.78% |
$41,457 |
Trauma Care grants for levels 3, 4, & 5
trauma designated hospitals are distributed annually to help
subsidize uncompensated or under-compensated trauma care costs. The
grant calculation has two components based on trauma designation
level and volume of trauma patients meeting the Trauma Registry
inclusion criteria and
reporting either DSHS, self-pay, charity care, or none as a primary
payer.
Trauma Care Grants
for Levels 3, 4, & 5 are calculated using the following formula:
|
Base: |
+
|
Volume Component: |
|
Level 3 = $10,000
Level 4 = $5,000
Level 5 = $2,500
|
|
%
of qualifying trauma patient volume *
remaining funding after base amount
|
Sample Hospital
Data Calculation for Levels 3, 4, & 5 Trauma Care Grants:
|
Hospital |
Base |
% of Trauma Patient Volume |
Volume Component |
Base + Trauma Patient Volume % Grant Amount |
|
| |
| |
| |
|
Level 3 |
|
|
|
|
|
|
Hospital A |
$10,000 |
5.319% |
$50,530 |
$60,530 |
|
|
Level 4 |
|
|
|
|
|
|
Hospital B |
$5,000 |
0.196% |
$1,860 |
$6,860 |
|
|
Hospital C |
$5,000 |
1.268% |
$12,042 |
$17,042 |
|
|
Level 5 |
|
|
|
|
|
|
Hospital D |
$2,500 |
0.204% |
$1,933 |
$4,433 |
|
DSHS/MAA makes
supplemental payments to levels 1, 2, and 3 designated trauma
services and physicians for care provided to DSHS trauma patients
with an ISS of 13 or greater for adults, 9 or greater for pediatric
clients (under 15 years of age), and for transferred trauma patients
when the ISS is less than 13 (or 9 for pediatric clients) for
receiving facilities.
Please contact the DSHS/MAA Trauma Care Fund representative, Ayuni
Wimpee, for additional information at
wimpeah@dshs.wa.gov or (360) 725-1835.
Additional
DSHS/MAA Trauma Care Fund information can also be accessed through
their website at:
http://fortress.wa.gov/dshs/maa/hrates/state_plan/indextrauma.html
TRAUMA CARE FUND
HOSPITAL PARTICIPATION
GRANTS (DOH)
DOH
distributes Hospital and Rehabilitation Participation grants to help
offset the costs of participating in the Washington State Trauma
System. These costs can include, among other things: equipment,
training, supplies, and staffing. Payments are made once each state
fiscal year (July 1 – June 30). These payments are usually offered
prior to December of the calendar year.
-
Hospital Participation grants are offered to all
Washington State trauma designated services for both
general and pediatric designations. The amounts of these payments
differ depending on three variables:
-
Level of designation – 1, 2, 3, 4, or 5 – emphasis given to
higher levels
-
Volume of trauma patients – emphasis given to higher volumes
-
Geographic status (rural, suburban, urban) – emphasis given
to rural services
TRAUMA CARE FUND
PREHOSPITAL
GRANTS (DOH)
Participation
Grant Letter, A-19 and Survey form
INJURY
MEASUREMENT METHODS
·
Abbreviated
Injury Scale (AIS)
·
The AIS was developed to provide researchers with a simple
numerical method for ranking injuries
·
AIS scores range from 1 (minor) through 6 (currently
untreatable)
·
AIS scores ³
3 are considered serious and life-threatening
·
The AIS scores injuries, not consequences of injuries
·
Developed by the Association for the Advancement of
Automotive Medicine
·
Injury
Severity Score (ISS)
The ISS is a
summary severity score for anatomic injuries.
·
It is based upon the AIS severity scores for six body
regions:
1.
Head and neck
2.
Face
3.
Chest
4.
Abdominal and pelvic contents
5.
Extremities and pelvic girdle
6.
External
·
The ISS takes values from 1 to 75.
·
Generally, the higher the score, the more serious are the
patient’s injuries.
·
Any patient with an AIS 6 injury is assigned an ISS value
of 75.
·
Otherwise, the ISS is computed by identifying the highest
AIS code in each of the six body regions, and adding the squares of the
highest three.
The
ISS is most easily calculated using the Collector trauma registry
software. Every designated
trauma care facility has a copy of the Collector software.
Contact the facility’s Trauma Coordinator for more information.
In collector, the ISS can be calculated by using injury
descriptors or ICD9 codes. Injury
descriptors tend to produce a more accurate ISS than ICD9 codes.
The more detailed the descriptor, the more accurate the ISS.
ISS
EXAMPLE
For
example, suppose a patient has six injuries distributed as follows:
| Region |
Number of Injuries |
AIS Severity Codes |
| 1 |
2 |
5&4 |
| 2 |
- |
- |
| 3 |
1 |
2 |
| 4 |
2 |
3&2 |
| 5 |
- |
- |
| 6 |
1 |
4 |
-
The
three highest values from three different regions are 5 (from
region 1), 3 (from region 4) and 4 (from region 6)
-
Thus
the ISS is: (5x5) + (3x3) + (4x4) = 25 + 9 + 16 = 50
-
Since
its introduction, the ISS has been the preferred method for
combining AIS codes into a summary measure of anatomic injury
severity.
|
