What Can Payers Do When Hospitals Overuse Trauma Codes?

The growth in hospital trauma center designations has coincided with increases in improper “trauma alert” coding and billing, leading to astronomical bills for patients and payers. This finding, reported in an investigation by Kaiser Health News (KHN), means payers will have to step up their scrutiny of emergency claims, experts say.

Trauma centers are special designations given to hospitals that can provide the highest standard of care in cases of severe, time-sensitive injuries. They employ a specially trained, highly experienced team of doctors and nurses who can scramble to attend to a severely wounded patient in minutes. Traditionally, these teams were stationed in one of several local hospitals and activated when EMTs requested they be ready as soon as the ambulance arrived at the emergency room door.

However, growth in the number of high-level trauma centers has boomed in recent years. According to the American College of Surgeons, the number of Level I and II trauma centers — the highest designations — grew from 305 in 2008 to 567 in 2020. Yet the volume of emergency room visits has been fairly stable, according to federal data. So why have so many hospitals sought high-level trauma center designations?

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Peter Johnson

Peter Johnson

Peter has worked as a journalist since 2011 and has covered health care since 2020. At AIS Health, Peter covers trends in finance, business and policy that affect the health insurance and pharma sectors. For Health Plan Weekly, he covers all aspects of the U.S. health insurance sector, including employer-sponsored insurance, Medicaid managed care, Medicare Advantage and the Affordable Care Act individual marketplaces. In Radar on Drug Benefits, Peter covers the operations of (and conflicts between) pharmacy benefit managers and pharmaceutical manufacturers, with a particular focus on pricing dynamics and market access. Before joining AIS Health, Peter covered transportation, public safety and local government for various outlets in Seattle, his hometown and current place of residence. He graduated with a B.A. from Colby College.

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