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Compensation rates received by level I, II, and III centers are 28.3%, 18.1%, and 3.1%, respectively, of their Medicaid volume and standard dollar amount (SDA) (RULE §355.8052). 9 Account 5111 dispersals for UC occur in the form of a trauma add-on.
#TRAUMA CENTER LEVELS HOUSTON DRIVER#
In Texas, financial support to cover UC historically came from the Driver Responsibility Program and state traffic fines (Account 5111). As of 2020, no programs have been identified as revenue stream replacements for Account 5111. The DRP was later repealed in September 2019. Due to insufficient revenue, additional revenue streams were incorporated into the DRP in 2015. The DRP was the primary source of state revenue for the Designated Trauma Facility and Emergency Medical Services Account (5111). After the enactment of the Affordable Care Act, Texas opted for the 1115 Medicaid waiver and started the Driver Responsibility Program (DRP). Texas management of uncompensated care since 2010. 8 This estimate does not take into account undocumented residents in Texas. 7 Currently, approximately 5.3 million Texans are uninsured, making Texas the state with the highest rate of uninsured individuals (21.8%) in the USA. In 2015, the Texas Medical Association estimated 4.3 million adult residents lacked insurance coverage, representing a 75% increase over the national average. Texas is 1 of 19 states that chose not to expand Medicaid program coverage to low-income adults as provided under the ACA ( figure 1). 6 Consistent expansion of the uninsured population has increased the cost of providing UC. The AHA calculates UC by adding a hospital’s bad debt and the financial assistance it provides for services for which hospitals neither received, nor expect to receive, payment due to the patient’s inability to pay.
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The American Hospital Association (AHA) defines uncompensated care (UC) as the overall measure of hospital care provided for which no payment was received from the patient or insurer. Previous studies have suggested that there is a correlation between inadequate reimbursement and patient transfer practices. Trauma-related healthcare costs and trauma-specific administrative expenses threaten to overwhelm institutions treating large numbers of uninsured, severely injured patients.
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3 In the USA, trauma-related healthcare expenditures are second only to those related to cardiovascular disease. 2 Given the low reimbursement rates for patients without insurance, trauma centers are often considered the most financially vulnerable healthcare entities. National estimates suggest one in five trauma patients lacks health insurance. Unfortunately, by 2017 the number of individuals without insurance coverage started to rise again. As a result, the number of uninsured patients nationwide decreased. In 2014, the Affordable Care Act (ACA) expanded coverage to nearly 20 million of previously uninsured Americans through the expansion of Medicaid and the establishment of the Health Insurance Marketplace. In 2013, an estimated 44 million Americans lacked health insurance coverage. Gaps in the public insurance system and the lack of affordable private coverage have left millions of Americans without health insurance.