JACKSONVILLE, Fla. – The News4JAX I-TEAM has found patients can be charged up to $34,000 in fees for just being brought to a trauma center after a traumatic injury, and data shows the rate of trauma alerts, which trigger these fees, is growing faster than Florida population, elderly population, and violent crime rate.
John Farra and his partner Ruth Ann Robinette were rushed to the trauma center at UF Health in July after a t-bone crash flipped their truck multiple times.
“Once she hit us, it was over with,” Farra said. “I don’t remember nothing.”
Paramedics alerted a trauma team to stand by.
“Just as soon as we came to, the ambulance was already there,” Farra said.
Robinette received X-rays, scans, muscle relaxers and acetaminophen. Farra received X-rays and scans, as well, plus staples in his head and stitches in his arm. Their injuries were not catastrophic, but their bills were.
The couple reached out to the I-TEAM after getting their bills:
More than $47,000 in charges for Robinette, and Farra, who does not have health insurance, got a bill costing about $150 more. Both bills came with liens.
“You get a wake up call whenever you get hit by somebody, and then they go charging you these kind of outrageous prices,” Farra said.
The I-TEAM reviewed their bills and found the biggest single charges were for about $11,000 trauma alert fees, which cover the cost of having surgeons, nurses, and equipment standing by ready to assist in the most critical cases.
The I-TEAM dug deeper and found there’s a huge disparity in the trauma alert fees hospital charge.
“That activation fee isn’t regulated, and it can be whatever the hospital wants it to be,” said Dr. Nicholas Namias, who is the chief of trauma at the University of Miami Jacksonville Memorial Hospital Ryder Trauma Center.
Namias said the cost to run a trauma center in Florida shouldn’t vary much because they all have to meet the same standards.
Studies show for-profit hospitals charge the most. While non-profit UF Health Jacksonville charges about $11,000 to activate its trauma team, for-profit Orange Park Medical Center charges about $35,000 and for-profit Memorial Hospital charges $27,000 just for being taken through the doors of their trauma centers.
But trauma patients don’t get to choose where they go, and data shows the number of patients charged for trauma alerts is rising faster than Florida’s population, even as violent crime is trending downward.
“Motor vehicle crashes , falls from heights, gun shot wounds, stabbing…those are what trauma centers are really meant for,” Namias said.
Now, falls make up a significant portion of trauma calls.
In 2021, data reported to Florida’s EMS Tracking and Reporting system shows “slipping, tripping, stumbling and falls” accounted for more trauma alerts than any other designation.
“Falls from standing are a serious thing, but I don’t think they all require trauma centers,” Namias said.
Trauma alerts are triggered by paramedics. Leon County EMS deputy chief of clinical affairs Mac Kemp said they follow strict criteria, and the patient is always the priority.
“You’d rather have the team there ready just in case they needed it than not have the team there,” Kemp said.
Trauma centers used to be seen as money losers, but with the advent of trauma alert fees 20 years ago, they were able to become sources of revenue.
As more trauma centers have opened in Florida, data shows more trauma alerts are being triggered.
“Instead of splitting the pie, the pie has just expanded,” Namias said.
Public data analyzed by healthcare economist Etienne Pracht, who is a professor at the University of South Florida, shows the number of people who received trauma charges and were released the same day, like Farra and Robinette, nearly doubled from 2015 to 2020.
“If we look at trauma services as kind of a public health concern, then we want to find other sources of steady funding for those hospitals,” Pracht said. “If on the other hand, we want to look at it as a revenue generating service, then we should get used to the system as it is now with these kind of large trauma fees.”
There are four hospitals with trauma centers in northeast Florida.
Data from Florida’s Agency for Health Care Administration shows non-profit UF Health Jacksonville lost money overall in 2020, while for-profit hospitals with trauma centers owned by HCA Healthcare raked in big bucks. According to AHCA data, HCA-owned Orange Park Medical Center made $57 million in profit in 2020, and HCA-owned Memorial Hospital made $96 million.
While many factors go into turning a profit, the data shows that these hospitals reported increased profits after building their trauma centers.
AHCA records show Memorial Hospital’s profits grew by about 40% from 2017, when a trauma center was opened in May, to 2018, going from $38.6 million dollars in profit to $64 million. AHCA records show Orange Park Medical Center’s profits jumped by a third from 2016, when they opened a trauma center in May, to 2017.
Both systems have continued to see a rise in profit year after year.
A spokesperson said over the past five years both Orange Park Medical Center and Memorial Hospital have added new services and greatly expanded their footprints, saying “Trauma care is a part of that, but certainly not the only part.” However, they declined to point to specific examples in the years where their profits jumped after opening trauma centers.
“By definition it has to be money-making, or the for-profits wouldn’t be in it,” Namias said.
Robinette and Farra worried about losing everything when they got their bills. Their dream of buying land in the country and making a home there seemed suddenly out of reach.
“Putting a lien against people before anything’s ever done…that’s horrifying really,” Farra said.
Bills that hit him out of nowhere left financial uncertainty long after staples and stitches were removed.
“How would you like to wake up and see a bill for $47,000 not knowing how you was going to pay it?” Farra said.
Farra and Robinette were relieved to find their bills had been paid in full when they went to pick them up earlier this year to share with the I-TEAM. They were covered at least partially by auto insurance. While that was good news for them, there is a concern that unnecessary trauma alerts may increase insurance costs for everyone.
UF Health hasn’t commented other than to say trauma alerts are called by paramedics at the scene of an incident, as per state regulations.
A spokesperson for Memorial Hospital Orange Park Medical Center said the fees they charge are used to cover the costs of running the trauma center and that the fee is waived for the uninsured and patients with insurance won’t be charged out of pocket for them.
In 2016, UF Health tried to block the opening of Orange Park Medical Center’s trauma center, with the CEO saying it would drive up healthcare costs and would result in a majority of uninsured patients going to UF Health with insured patients going to OPMC. At the time, OPMC’s CEO told News4JAX the new trauma center was saving lives.