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May 7, 2020

CT hospitals billed $32M for trauma activation fees; lawmaker says more action needed

Photo | HBJ File Hartford Hospital, Hartford HealthCare's flagship hospital.

If you’re going to suffer a severe injury in Connecticut, it might be cheaper to do it near Hartford rather than Stamford.

A fee that qualified hospitals charge when a trauma team of emergency physicians and other providers is called into action, such as after a bad car accident or shooting, can be costly, particularly in Fairfield County, according to newly mandated disclosures that hospitals filed with the state Office of Health Strategy (OHS), after state lawmakers decided the fees should be publicly disclosed and scrutinized.

The priciest so-called “trauma activation fee” was charged by Stamford Hospital, which billed more than $17,000 per trauma discharge during the 2019 fiscal year that ended Sept. 30. That was well above the second priciest, Norwalk Hospital, which billed $7,316 per patient last fiscal year.

The lowest per-patient trauma billings were at Waterbury Hospital, which charged an average of $1,254, followed by Hartford Hospital, which charged $2,238, according to the reports.

In all, Connecticut’s 12 designated trauma center hospitals billed $32.5 million in trauma activation fees last year, related to care they provided to 7,115 patients.

The reports, which also include trauma activation policies for the 12 individual hospitals, don’t reveal the entire picture.

The fee amounts provided are derived from the hospitals’ individual “chargemasters” -- massive lists of billing codes and charges that amount to sticker prices rather than what many insurers and other payers actually end up paying for the services.

“In the vast majority of circumstances, we are paid at lower, negotiated contractual rates by insurance companies, and sometimes, if a patient is un- or underinsured, not at all,” Stamford Hospital spokeswoman Andie Jodka said in a statement. “Unfortunately, public disclosure of charges often leads to confusion given the difference between charged amounts and paid amounts. This is the first year we have been required to report on trauma activation fees, and these types of reports allow organizations such as ours the opportunity to evaluate our charges.” 

The actual trauma fee revenue paid to hospitals remains unknown, as the amounts depend on confidential contracts negotiated with payers, which can vary widely.

Nonetheless, Senate President Pro Tem Martin Looney (D-New Haven), a key advocate of the fee disclosures, said Wednesday that the chargemaster data reveal a wide range of trauma fees that he feels requires further probing and potential legislative action.

“The next step will be looking at imposing caps and regulations,” said Looney, who added that the fees are currently “completely unregulated and uncapped” and could be a previously unexamined profit center for hospitals in the state.

News reports in recent years have found that trauma fees in other parts of the country can be much higher than at Connecticut hospitals, where the fees averaged about $4,000, according to the recent disclosures to OHS.

For example, Kaiser Health News and Vox, which collected more than 1,400 emergency room bills from around the country, reported in 2018 that trauma fees are typically in the thousands of dollars, but they found one instance, in California, where the fee exceeded $50,000

The Tampa Bay Times reported in 2014 that Florida’s average trauma fee was $10,000.

Senate Minority Leader Len Fasano, a Republican who advocated for the fee disclosures last year alongside Looney, said the data in the reports provide a good starting point.

”We went fishing,” said Fasano, who has pursued numerous healthcare and insurance reforms during his 18 years in the Senate, a tenure that’s coming to an end, since he is not seeking reelection this fall. “This is how you start peeling back the onion.”

The priciest trauma fees in the state tended to be at hospitals that are considered Level II trauma centers, whose capabilities are not as comprehensive as Level 1 centers. 

Level I hospitals received trauma patients that are “presumably the most challenging and, you would think, the most expensive,” Looney said. “It’s another piece of data that leads to further questions.”

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