Trauma Center Designation battle in Sacramento gets ugly - Updated

There once was an urban legend that Trauma Center designation does not pay, in fact, was a big money drain on a Hospital. That’s not true in Sacramento as two hospitals, each affiliated with large chains, go nuclear on each other battling for designation as Sacramento Counties 3rd Level II Trauma Center. Whether trauma pays or is a drain on a hospital boils down to the old real estate saying, location, location, location. If you serve an poor inner city crowd with a high percentage of penetrating trauma your going to loose money. If you have a better payer mix and are located in the burbs or along a commuter corridor then there is big money to be made. Basically, blunt trauma pays, penetrating does not. The two hospitals, Methodist, a member of CHW, and Kaiser South Sacramento, a part of the Kaiser family of hospitals. are right across the street from one another. They are located at the South end of town along the commuter corridor into Sacramento and also in proximity of some of Sacramento’s knife and gun club neighborhoods.

In October of 2006 Sacramento County issued an RFP for a South County Level II Trauma Center. Methodist and Kaiser applied. There was lots of publicity, visits by the American College of Surgeons (ACS), full page newspaper adds by both sides, letter writing campaigns, and lots of buzz. The competition gradually turned bitter with both hospitals questioning openly in the media the others ability to provide the service as well as their motivations. An interesting cast of characters began to line up, mostly on the side of Methodist hospital. Those pulling for Methodist included UC Davis Medical Center, Sacramento’s Level I trauma center, as well as several Insurances companies (Blue Shield and HealthNet) who claim that Methodist would be better since they have contracts with them and Kaiser does not.

In April the ACS gave their nod to Kaiser. That was followed by the same recommendation from Sacramento County staff. The decision was quickly protested by Methodist and things got even uglier. The County hired a EMS - Trauma consultant, the Abaris Group, to review the entire process. The consultant came to the same conclusion that Kaiser was substantially better prepared at nearly all levels and in fact appeared ready to move to implement a Trauma facility before the 2010 date called for in the RFP. One would think that would be the end of it but Methodist and friends battle on with a final decision to be announced by the Sacramento County Board of Supervisors in late November.

One would wonder what is motivating the players here. With Kaiser its simple. They have approximately half of the working insured in the Sacramento area (the people who drive to work every day) and an overall market share of about 35 percent. They have no Trauma facility so whenever one of their members gets caught by the wide net of the Trauma System, mostly as the result of blunt motor vehicle Trauma, ambulances transport them to a trauma facility and Kaiser pays full price. Not only that, their patients are virtual hostages of these facilities who will not transfer them to a Kaiser facility until they have been stabilized (that’s code for captured most of the available charges) because it would be sending patients to a lower level of care, ie non trauma center. Kaiser is hemorrhaging dollars mostly to UC Davis Medical Center that charges some of the highest rates in the nation for Trauma care. Kaiser seems to be willing to take their share of the knife and gun club to stop the financial bleeding . UCDMC is supporting Methodist so the Kaiser cash machine keeps paying off, even if they have to share a little with a CHW facility, better than loosing the full boat.

Methodist wants in on the action and is being a little more sneaky, in my opinion. They seem to be making their case based on who is supporting them and making the public claim that Kaiser would abandon the uninsured rather than making the investment in their facility and staff to be competitive. That’s almost funny as CHW does not have the greatest reputation for taking care of the uninsured. The main ED at Methodist has only an 8 beds plus a number more in their fast Track. The Hospital is old and they do not have a reputation for treating their ED staff well. It shows as turnover is high and most ED Nurses are Travelers. They claim that they will have their facility remodeled and ready by 2010. Kaiser by contrast has a relatively modern, much larger ED and stable staff. The cat snuck out of the bag a little more when Methodist announced the purchase of land further south in a nice area for a new hospital site. Conveniently out of range of the knife and gun club but still in the heart of the commuter crowd. Nah, Methodist would not take their Trauma designation and run to the burbs would they? Medical redlining, not Methodist. Methodist further had the curtain pulled back on them when it was revealed in the media 2 days ago that they had not passed their April JACHO accreditation visit having received only conditional accreditation. That never surfaced during any of the discussions and testimony over who would be best equipped to get the Trauma Center nod.

The whole thing reminds me of my dog I had as a kid. He challenged almost any dog, no matter how big from a distance or when I was standing by as backup but he would turn tail and run when it was obvious his opponent was superior. I think its time for Methodist to learn that lesson. Stay tuned for updates.

Update: December 11
Kaiser gets the nod 3-2 from Sacramento County Board of Supervisors. The competition got real ugly in the final stretch with an aggressive media campaign and letters from one of the Sisters of Mercy that got placed on car windshields at churches throughout the area. Note to Methodist: People judge you by the company you keep. The endorsement of large insurance companies and the Academic Medical Center with an obvious conflict of interest was a bad stratagy.