3 On Your Side Investigates: Preferential Treatment

Updated: Sep. 11, 2019 at 11:20 PM CDT
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JACKSON, Miss. (WLBT) - Two central Mississippi hospitals spend millions each year to keep from having to treat the Magnolia State’s most critical trauma patients, 3 On Your Side and Mississippi Today have learned as part of an ongoing series on emergency care services across the state.

Those non-participation fees from Baptist Medical Center and St. Dominic Hospital, both based in Jackson, add up to more than $26 million paid to the Mississippi State Department of Health, according to public records obtained through our collaboration with Mississippi Today.

3 On Your Side Investigates: Preferential Treatment
3 On Your Side Investigates: Preferential Treatment(WLBT)

“Every hospital that participates in the Medicaid and Medicare service programs has to take care of trauma. It has to take care of injuries and others that come to their facility," said Jim Craig, who serves as the director of health protection for the Mississippi Department of Health. "Everyone has an obligation.”

It’s a system called “Play or Pay," which comes from the requirement that hospitals either participate in the state’s trauma care system or pay a fee to cover the cost of others providing that care instead.

Mississippi was the first state in the nation to adopt the system in 2008.

Each year, the Mississippi Department of Health assesses hospitals, looks at their staffing, their specialties, and designates them one of four levels on the trauma care ladder, which corresponds to how quickly they can address patients with life-threatening conditions.

“Not every hospital, not every physician is going to want to do trauma work," said executive director Norman Miller, who heads up the state’s central Mississippi trauma region.

Most of the state’s hospitals are Level IV, meaning they’re supposed to stabilize and transfer trauma patients to hospitals with higher levels of care. When used, those hospitals become a stopgap of sorts to keep patients alive long enough to send them somewhere better.

“If they have critically injured patients, they transfer them to the appropriate level of care," Craig said.

This graphic illustrates the most significant differences between the state's trauma care...
This graphic illustrates the most significant differences between the state's trauma care designations. Original source of information: Mississippi State Department of Health(WLBT)

Level III hospitals must have 24/7 surgical capabilities and orthopedic options but can’t offer neurological services.

That’s reserved for levels I and II.

Only Level I can provide the best care -- including surgical residency and more around-the-clock resources.

The University of Mississippi Medical Center serves as the state’s only Level I hospital.

Why do these designations matter?

Each year state health officials reviewed both Baptist Medical Center and St. Dominic Hospital, those hospitals were designated as a Level II based on their abilities.

And each year, those hospitals have opted out of most of that trauma care responsibility, sending checks for nearly $1.5 million apiece so the state can designate them a Level IV, the same as any community hospital with an emergency room.

3 On Your Side Investigates: Preferential Treatment
3 On Your Side Investigates: Preferential Treatment(WLBT)

“If you have a 24/7/365 emergency room, and there are some support services, lab, radiology, etc., you would qualify as a level four trauma center," Miller said.

Those millions pour into the state’s trauma fund, comprised of around $20 to 25 million a year, according to Craig.

“The fund goes to pay for the designated trauma care centers, the hospitals that participate in the system, the surgeons that participate in the system, and for EMS to get patients to the right hospital the first time," Craig said.

Trauma-related injuries are the leading cause of death for ages 1 to 44, Craig said, and most trauma-related injuries come from motor vehicle accidents.

Because of that, lawmakers began taking a portion of the money spent on car tags, traffic violations and all-terrain vehicle sales ten years ago, and transferred it to the trauma fund.

Much of that ended in 2016 with Senate Bill 2362, which swept the extra trauma money from fines and tickets to Mississippi’s general fund.

Recently, lawmakers have set a cap at $28 million that MSDH can spend on trauma-related costs.

“The 2007 trauma care task force said that we needed $40 million to operate a trauma system. We have done it with far less than that and we have still been successful. I think that’s the dedication of the people involved in it," Miller said.

Craig said financial constraints are likely the reason why those hospitals choose a lower trauma level, paying the non-participation fee instead of having to pay more for 24-hour physicians and uncompensated trauma care.

He also believes the trauma system that’s relied on that extra $3 million a year for the last decade now depends on it.

“It is part of our funding fomula right now to have that revenue to be able to take care of trauma patients in Mississippi," Craig said. “It would need to come from there or from another source.”

When asked if Baptist and St. Dominic’s lack of participation helps or hurts the overall trauma system, Craig alluded to the former.

“The system is designed right now for them not participating,” Craig said.

While the Level IV designation means neither hospital will receive patients from emergency medical technicians, those hospitals cannot turn patients away if they show up voluntarily, Miller said.

In cases where hospitals cannot provide that level of care, though, that patient will be transferred to a facility that can.

Neither Baptist nor St. Dominic’s agreed to on-camera interviews for our investigation, releasing statements instead.

“To avoid duplication of trauma services, St. Dominic Hospital defers to UMMC, which is already well equipped to handle these cases,” said Andy North, St. Dominic’s director of marketing and communications. “It is more cost-effective and provides better patient outcomes for St. Dominic’s to support the state’s trauma fund through payment of the fee.”

Baptist spokesperson Ayoka Pond said the company is committed to doing its part to provide the best emergency care to everyone who needs it.

“Our priority is to serve the people of this community, and we believe our approach to providing emergency care does just that,” Pond said via e-mail Wednesday. “We have more than 64,000 visits to our emergency room every year, and we’re very proud of the care our team provides.”

Pond also mentioned the company has sister hospitals in Carthage, Kosciusko and Yazoo City, rural areas that “enhance access to critical emergency services in these areas.”

While Pond did not directly address why Baptist chooses not to participate in the state’s trauma care network, she did say that Baptist believes it is important to support it nonetheless through the fee.

“Our yearly contribution to the fund ensures that Mississippians have access to trauma care in accordance with the State Trauma System guidelines,” Pond said. “In addition to that, Mississippi Baptist Medical Center routinely cares for trauma patients.”

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