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Lawmakers eye solutions to trauma crisis

August 18, 2002|by BOB MAGINNIS

When Del. Michael Busch says he's passionate about the Maryland shock trauma system, he's not just paying lip service to all the citizens concerned about its future. The Anne Arundel County Democrat knows firsthand what a life-saver shock trauma can be.

"I'm a guy who lost four family members this year, but a little girl was saved," Busch said.

In an accident that drew national attention, Busch's brother-in-law, his wife, and two sons were killed, but a 7-year-old niece was saved after she was flown to Christiana Hospital in New Castle County, Delaware. A trauma surgeon there who was trained in the Maryland system was able to relieve the brain swelling that might otherwise have killed her.

The experience has redoubled Busch's determination to find an answer for statewide system being strained for two key reasons - overworked surgeons and dwindling reimbursement. As a member of the Maryland General Assembly's shock trauma task force, Busch feels he might have an answer.

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Lawmakers felt they had a partial fix two years ago when they increased the fee for license tag renewal and dedicated the money to the Maryland Shock Trauma Center in Baltimore, with the idea that part of the cash would go to reimburse physicians.

As it turned out, Busch said, all the funds went for capital equipment, putting a strain on physicians who've watched as Medicare/Medicaid reimbursements have fallen, insurance companies have gotten more difficult to deal with, and the number of people with no insurance or inadequate coverage is increasing. And then there's malpractice insurance, which is also getting more expensive.

As much as one-third of the care given at the University of Maryland and Johns Hopkins trauma centers is uncompensated, Busch said. For smaller centers, this is a problem, he said, because when insurance and the government were more generous, doctors were willing and more financially able to do the pro bono work.

Now, said Busch, it's getting more difficult to attract physicians who want to do the work - or getting those already doing it to stay. But he's got an idea.

"Because the vast majority of trauma cases are automobile or motorcycle-related, one of the solutions you might consider is to put a $1 or $2 assessment on every auto insurance policy," he said.

Given the number of drivers in the state, a $2 per-policy charge would raise $8 million, he said, which could be dictated to physician reimbursement.

Busch said there would have to be some controls on what would be reimbursed, and some accountability, but he felt his proposal could work and that citizens would accept it.

"As a driver and a father and a husband, I want a good trauma unit and I'm willing to pay for it," he said.

But $8 million might not be enough to fix what ails the trauma system, according to Del. John F. Wood Jr. A Democrat who represents parts of Charles and St. Mary's counties, he's co-chair of the task force. No solution has been agreed on yet, he said.

"We are looking at everything and would not rule out anything," he said, adding that he feels the state will have to come up with $20 million in new money.

That amount of cash is necessary, Wood said, because it's not just Hagerstown that's having problems.

"It's a Hagerstown problem today, but of about seven or eight in the state, about half of them are saying they have the same problems. But at this time no other centers are saying that they have to shut down," Wood said.

The group hopes to get a solution worked out by the end of the year and in the meantime, "we're asking the hospitals and the doctors to work with us," he said.

Other solutions are being studied under HB 805, a bill passed last session by Del. John Donoghue, D-Hagerstown. The study will look at different methods of payment and reimbursement.

"We'll also look at the possibility of having an uncompensated care fund," Donoghue said.

The trauma task force will meet next Wednesday in Annapolis. In attendance will be John Ashworth, executive vice president of the University of Maryland Medical System and director of the Baltimore Shock Trauma Center.

Hagerstown is a vital hub and the system needs a center there, whether it's a Level II or Level III Center, Ashworth said. Level II centers require trauma surgeons to be on site, while in Level III they must be within 30 minutes of the hospital.

Hagerstown's problems aren't unique to the system and trauma surgeons all over are suffering from falling rates of reimbursement. Ashworth said something must be done to get more cash into the system.

Asked why Hagerstown seems to have a more severe version of the "virus" that's affecting centers all over the state, Ashworth had this to say:

"A lot of this is the personality of the organization and the personality of the community. In Hagerstown there has been some stridence. I hear all the stories, but who can say who has done what to who?"

What those I've talked to on this issue are saying is that there needs to be a short-term compromise while a long-term solution is sought. Next Wednesday's meeting should provide an indication of whether it will be easy or difficult to make that deal.

Bob Maginnis is editorial page editor of The Herald-Mail newspapers.

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