Level I trauma centers are not only expensive to operate, they’re difficult to staff, which says a lot about why Tucson now has only one — at University Medical Center (UMC).
But a number of factors — including a potential $6 million loss in public support - have made even the sole remaining top level (Level I) trauma center into a fragile operation, as members of Metropolitan Pima Association learned at their monthly breakfast meeting last week at the Viscount Suite Hotel.
 The first floor of the six-story Diamond Children’s Medical Center building will house a larger trauma center at UMC. |
Dr. Peter Rhee, UMC’s recently hired medical director of trauma and critical care, and Eileen Whalen, vice president of trauma and perioperative services at UMC, said they want the entire community to understand the challenges of running a top trauma center and rally support for funding.
In conjunction with its new six-story Diamond Children’s Medical Center building, UMC plans to dedicate the first floor to emergency and trauma services. Summer 2009 is the anticipated opening date. The new facility will increase the space for the emergency department and trauma center to 43,000 square feet, from the existing 25,000 square feet, according to Whalen. The trauma center will go from four beds to seven beds in the new building.
Tucson had two Level I trauma centers until Tucson Medical Center closed its unit in 2003. At that time, the UMC unit was handling about 2,200 cases per year. As the sole Level I center now, that figure is up to about 5,000 cases per year and has remained constant over the past few years, Whalen said.
Level I trauma centers are the only facilities that have entire teams of medical specialists on call seven days a week, 24 hours a day, to handle emergency cases such as shooting, automobile accidents and other life-threatening situations.
Not only is Tucson’s sole Level I trauma center the busiest in Arizona (there are six more in the Phoenix area), but it also has length of stay and mortality rates that are well below the norm, Whalen said. But because of the nature of what is required of a trauma center surgeon, the positions are not only difficult to fill, but expensive to fill, according to Dr. Rhee.
"We need 10 trauma surgeons and right now we have two," Dr. Rhee said. "Trauma is not a fun thing — not all doctors want to be up at 2 a.m. and most choose not to be in trauma."
Dr. Rhee said he is interested in recruiting only trauma surgeons who are "top-notch leaders" and are willing to abandon private practice and be employees of the trauma center. Currently he must pay private surgeons a premium when the trauma center needs them.
"I don’t want guys who need the job — I want guys who are experts and leaders. Recruiting is a tough process," Rhee said.
But the real challenge is funding the operation. Dr. Rhee said UMC collects just 31 percent of its charges, making it necessary for the rest to be made up from other funding. Asked why such a low percentage of charges is collected, Dr. Rhee said 31 percent is actually higher than in many communities, where about 25 percent is the norm.
"There are so many games with shifting costs and with bureaucracy and billing, and people don’t pay their bills," Dr. Rhee said.
UMC’s trauma center is also receiving about $2 million a year from a federal source that pays for emergency services to undocumented immigrants through the Emergency Medical Treatment and Labor Act (EMTALA). Whalen said that is slated to be discontinued after September, at the end of this fiscal year but the hospital industry is lobbying for the federal government to keep the $250 million in next fiscal year’s budget.
UMC receives another $4 million a year in Indian casino gaming funds but this, too, is in jeopardy. Although the amount was approved by voters, lawmakers have introduced legislation (HCR 2044) that would allow the diversion of the money to help cover state budget deficits.
"Physicians don’t want to come here if they think funding to support the trauma center is in jeopardy," Rhee said.
Tucson Mayor Bob Walkup has created a task force to explore solutions for the trauma center’s funding problem.
If no solution is found, there is always the threat that Tucson could lose its last remaining Level I trauma center. The next nearest center is in Phoenix.
Dr. John Porter, medical director of UMC’s trauma center, has said that patients treated within the first hour after a traumatic injury can triple their chances of survival. A helicopter ride to Phoenix could take up much of that hour.
Contact reporter Ed Egger at eegger@azbiz.com or (520) 295-4238.
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