Tag Archives: fees

‘Trauma Centers’ Huge Fees to Treat Minor Injuries and Send Home

The care was ordinary. A hospital in Modesto, California, treated a 30-year-old man for shoulder and back pain after a car accident. He went home in less than three hours.

The bill was extraordinary. Sutter Health Memorial Medical Center charged $ 44,914 including an $ 8,928 “trauma alert” fee, billed for summoning the hospital’s top surgical specialists and usually associated with the most severely injured patients.

The case, buried in the records of a 2017 trial, is a rare example of a courtroom challenge to something billing consultants say is increasingly common at U.S. hospitals.

Tens of thousands of times a year, hospitals charge enormously expensive trauma alert fees for injuries so minor the patient is never admitted.

In Florida alone, where the number of trauma centers has exploded, hospitals charged such fees more than 13,000 times in 2019 even though the patient went home the same day, according to a KHN analysis of state data provided by Etienne Pracht, an economist at the University of South Florida. Those cases accounted for more than a quarter of all the state’s trauma team activations that year and were more than double the number of similar cases in 2014, according to an all-payer database of hospital claims kept by Florida’s Agency for Health Care Administration.

While false alarms are to be expected, such frequent charges for little if any treatment suggest some hospitals see the alerts as much as a money spigot as a clinical emergency tool, claims consultants say.

“Some hospitals are using it as a revenue generator,” Tami Rockholt, a registered nurse and medical claims consultant who appeared as an expert witness in the Sutter Health car-accident trial, said in an interview. “It’s being taken advantage of” and such cases are “way more numerous” than a few years ago, she said.

Hospitals can charge trauma activation fees when a crack squad of doctors and nurses assembles after an ambulance crew says it’s approaching with a patient who needs trauma care. The idea is that life-threatening injuries need immediate attention and that designated trauma centers should be able to recoup the cost of having a team ready — even if it never swings into action.

Those fees, which can exceed $ 50,000 per patient, are billed on top of what hospitals charge for emergency medical care.

“We do see quite a bit of non-appropriate trauma charges — more than you’d see five years ago,” said Pat Palmer, co-founder of Beacon Healthcare Costs Illuminated, which analyzes thousands of bills for insurers and patients. Recently “we saw a trauma activation fee where the patient walked into the ER” and walked out soon afterward, she said.

The portion of Florida trauma activation cases without an admission rose from 22% in 2012 to 27% last year, according to the data. At one Florida facility, Broward Health Medical Center, there were 1,285 trauma activation cases in 2019 with no admission — almost equal to the number that led to admissions.



'Trauma Centers' Huge Fees to Treat Minor Injuries and Send Home

Broward Health Medical Center in Fort Lauderdale, Florida.

“Trauma alerts are activated by EMS [first responders with emergency medical services], not hospitals, and we respond accordingly when EMS activates a trauma alert from the field,” said Jennifer Smith, a Broward Health spokesperson.

Florida regulations allow hospitals themselves to declare an “in-hospital trauma alert” for “patients not identified as a trauma alert” in the field, according to standards published by the Florida Department of Health.

At some hospitals, few patients whose cases generate trauma alerts are treated and released the same day.

At Regions Hospital, a Level I trauma center in St. Paul, Minnesota, patients who are not admitted after a trauma team alert are “very rare” — 42 of 828 cases last year, or about 5%, said Dr. Michael McGonigal, the center’s director, who blogs at “The Trauma Pro.”

“If you’re charging an activation fee for all these people who go home, ultimately that’s going to be a red flag” for Medicare and insurers, he said.

In the Sutter case in Modesto, the patient sued a driver who struck his vehicle, seeking damages from the driver and her insurer. Patient “looks good,” an emergency doctor wrote in the records, which were part of the trial evidence. He prescribed Tylenol with hydrocodone for pain.

“If someone is not going to bleed out, or their heart is not going to stop, or they’re not going to quit breathing in the next 30 minutes, they probably do not need a trauma team,” Rockholt said in her testimony.

Like other California hospitals with trauma center designations, Sutter Health Memorial Medical Center follows “county-designated criteria” for calling an activation, said Sutter spokesperson Liz Madison: “The goal is to remain in position to address trauma cases at all times — even in the events where a patient is determined healthy enough to be treated and released on the same day.”



'Trauma Centers' Huge Fees to Treat Minor Injuries and Send Home

Sutter Health Memorial Medical Center in Modesto, California.

Trauma centers regularly review and revise their rules for trauma team activation, said Dr. Martin Schreiber, trauma chief at Oregon Health & Science University and board chair at the Trauma Center Association of America, an industry group.

“It is not my impression that trauma centers are using activations to make money,” he said. “Activating patients unnecessarily is not considered acceptable in the trauma community.”

Hospitals began billing trauma team fees to insurers of all kinds after Medicare authorized them starting in 2008 for cases in which hospitals are notified of severe injuries before a patient arrives. Instead of leaving trauma team alerts to the paramedics, hospitals often call trauma activations themselves based on information from the field, trauma surgeons say.

Reimbursement for trauma activations is complicated. Insurers don’t always pay a hospital’s trauma fee. Under rules established by Medicare and a committee of insurers and health care providers, emergency departments must give 30 minutes of critical care after a trauma alert to be paid for activating the team. For inpatients, the trauma team fee is sometimes folded into other charges, billing consultants say.

But, on the whole, the increase in the size and frequency of trauma team activation fees, including those for non-admitted patients, has helped turn trauma operations, often formerly a financial drain, into profit centers. In recent years, hundreds of hospitals have sought trauma center designation, which is necessary to bill a trauma activation fee.

“There must have been a consultant that ran around the country and said, ‘Hey hospitals, why don’t you start charging this, because you can,'” said Marc Chapman, founder of Chapman Consulting, which challenges large hospital bills for auto insurers and other payers. “In many of those cases, the patients are never admitted.”

The national number of Level I and Level II trauma centers, able to treat the most badly hurt patients, grew from 305 in 2008 to 567 last year, according to the American College of Surgeons. Hundreds of other hospitals have Level III or Level IV trauma centers, which can treat less severe injuries and also bill for trauma team activation, although often at lower rates.



'Trauma Centers' Huge Fees to Treat Minor Injuries and Send Home

Emergency surgeons say they walk a narrow path between being too cautious and activating a team unnecessarily (known as “overtriage”) and endangering patients by failing to call a team when severe injuries are not obvious.

Often “we don’t know if patients are seriously injured in the field,” said Dr. Craig Newgard, a professor of emergency medicine at Oregon Health & Science University. “The EMS providers are using the best information they have.”

Too many badly hurt patients still don’t get the care they need from trauma centers and teams, Newgard argues.

“We’re trying to do the greatest good for the greatest number of people from a system perspective, recognizing that it’s basically impossible to get triage right every time,” he said. “You’re going to take some patients to major trauma centers who don’t really end up having serious injury. And it’s going to be a bit more expensive. But the trade-off is optimizing survival.”

At Oregon Health & Science, 24% of patients treated under trauma alerts over 12 months ending this spring were not admitted, Schreiber said.

“If this number gets much lower, you could put patients who need activation at risk if they are not activated,” he said.

On the other hand, rising numbers of trauma centers and fees boost health care costs. The charges are passed on through higher insurance premiums and expenses paid not just by health insurers but also auto insurers, who often are first in line to pay for the care of a crash victim.

Audits are uncommon and often the system is geared to paying claims with little or no scrutiny, billing specialists say. Legal challenges like the one in the Sutter case are extremely rare.

“Most of these insurers, especially auto insurance, do not look at the bill,” said Beth Morgan, CEO of Medical Bill Detectives, a consulting firm that helps insurers challenge hospital charges. “They automatically pay it.”

And trauma activation charges also can hit patients directly.

“Sometimes the insurance companies will not pay for them. So people could get stuck with that bill,” Morgan said.

A few years ago, Zuckerberg San Francisco General Hospital charged a $ 15,666 trauma response fee to the family of a toddler who had fallen off a hotel bed. He was fine. Treatment was a bottle of formula and a nap. The hospital waived the fee after KHN and Vox wrote about it.

Trauma alert fatigue can add up to a nonfinancial cost for the trauma team itself, McGonigal said.

“Every time that pager goes off, you’re peeling a lot of people away from their jobs only to see [patients] go home an hour or two later,” he said.

“Some trauma centers are running into problems because they run themselves ragged. And there is probably unneeded expense in all the resources that are needed to evaluate and manage those patients.”

Read more
This post originally posted here Medscape Medical News

Curve (CRV) sees 150% rebound as DeFi bottoms and ETH gas fees drop

DeFi tokens and protocols took a heavy hit on May 19 as Bitcoin price dropped to $ 30,000 and while BTC has entered what some analysts describe as a ‘compression’ phase, the total value locked in DeFi and the value many of the sector’s tokens have yet to rebound to the levels seen before the market crash.

Curve DAO token (CRV) stands among the few DeFi tokens that have seen a strong recovery over the past two weeks due to reduced Ethereum gas fees, the launch of Convex Finance and the DeFi sector beginning to find a bottom. 

Curve (CRV) sees 150% rebound as DeFi bottoms and ETH gas fees drop
CRV/USDT 4-hour chart. Source: TradingView

Data from Cointelegraph Markets Pro and TradingView shows that CRV has increased 55% since June 1, rallying from a low of $ 1.76 on June 1 to an intraday high at $ 2.76 on June 3 alongside a 250% increase in 24-hour trading volume.

Convex Finance launch attracts CRV holders

One source of the sudden rise in price and momentum for CRV is Convex Finance (CVX), an optimizer for the Curve Protocol that enables swaps of similar assets like stablecoin to stablecoin transactions.

Since it’s official launch on May 17, the Convex protocol has rapidly gained a substantial user base thanks to yields as high as 52.16% and some analysts have suggested that the protocol is challenging  Yearn.finance for CRV-related deposits.

Data from Defi Llama shows that in the two and a half weeks since the launch of Convex Finance, the total value locked (TVL) on the protocol has surpassed $ 2.3 billion with stakers on the protocol earning $ 4.3 million in total revenue.

Curve (CRV) sees 150% rebound as DeFi bottoms and ETH gas fees drop
Total value locked on Convex. Source: Defi Llama

Both Convex Finance and Yearn.finance rely heavily on CRV for the operation of their platforms and the increased activity has resulted in a decline in the circulating supply of CRV. This may have helped to boost CR price as investors clamor to stake tokens for the highest return possible.

Curve Finance and the wider DeFi ecosystem could also be benefitting from the sharp decline in gas fees on the Ethereum (ETH) network, which had previously priced out many retail traders from performing the simple approval and confirmation transactions required to stake and claim earnings from DeFi protocols.

Curve (CRV) sees 150% rebound as DeFi bottoms and ETH gas fees drop
Average Ethereum gas fee. Source: Etherscan

Lower fees have allowed a wider range of users to re-engage with their favorite DeFi protocols, and Curve has been a significant beneficiary of this development.

The VORTECS™ indicator flashed before the breakout 

VORTECS™ data from Cointelegraph Markets Pro began to detect a bullish outlook for CRV on May 31, prior to the recent price rise.

The VORTECS™ Score, exclusive to Cointelegraph, is an algorithmic comparison of historic and current market conditions derived from a combination of data points including market sentiment, trading volume, recent price movements and Twitter activity.

Curve (CRV) sees 150% rebound as DeFi bottoms and ETH gas fees drop
VORTECS™ Score (green) vs. CRV price. Source: Cointelegraph Markets Pro

As seen in the chart above, the VORTECS™ Score for CRV registered bullish readings throughout the past week with a high of 77 coming late in the day on May 31. This was roughly 15 hours before the price rallied 55% over the next 48 hours days.

The views and opinions expressed here are solely those of the author and do not necessarily reflect the views of Cointelegraph.com. Every investment and trading move involves risk, you should conduct your own research when making a decision.