Traumatic trauma fees loom for ER patients

By Christopher Wolfington

Emergency room visits are not cheap. They are staffed 24/7 with professionals who must be able to handle anything, from a broken arm to a head contusion to sharp chest pain. If they don’t do their jobs quickly, effectively, and efficiently, people can die. So, if you need to go to the ER, that expensive bill exists because the ER is expensive to operate. 

But there is another expense that doesn’t always make sense for patients, costs tens of thousands of dollars and can be totally unavoidable: trauma fees.

In a fascinating report for Vox, Jenny Gold, Sarah Kliff, and the Kaiser Health News staff explain the phenomena of trauma fees in length. The National Uniform Billing Committee first approved trauma response fees in 2002. Its initial philosophy was simple. By charging trauma fees to those who those who specifically utilized trauma services for injuries “above and beyond a regular emergency department,” hospitals could subsidize the extremely expensive trauma centers and keep them operating.

Unfortunately, as is often the case in the convoluted American health care industry, what should be a simple fee structure can cause mountains of havoc for everyone involved.

Trauma fees do not automatically activate, as most ER visits do not require trauma teams. Rather, medics in the field activate trauma teams by informing the hospital that they will be necessary. Trauma fees then activate if those teams perform 30 or more minutes of critical care on the patient.  

While this sounds straightforward, it can often be a nightmare in practice. Trauma teams are called at the discretion of the medical professional in the field, and sometimes opinions differ on what is considered to be traumatic. Then, there’s the issue of “overtriage,” where the medics err on the side of caution in calling for trauma teams. The American College of Surgeons deems that acceptable, and it does save lives. 

Of course, unnecessary caution would not be a big deal if it didn’t present such a big risk for significantly overcharging patients for services they did not receive. While hospitals are supposed to downgrade a visit from ‘traumatic’ to ‘standard ER,’ if traumatic patient care is not rendered above 30 minutes, many hospitals do not do so.

And that is how you get the case of Sam Hausen, whose $26,998 ER bill was mainly comprised of a $22,550 trauma response fee despite receiving only “ibuprofen, two staples, and a saline injection.” That is how you get the case of Park Jeong-whan, whose parents were charged a $15,666 trauma activation fee when they took him to a hospital after he fell from his crib. It was just a scare; Jeong-whan was fine, and no trauma services were rendered.

It is a delicate balance, paying for things that are not cheap and doing right by the patient. But by charging families with life-changing bills they can’t pay for services they didn’t use, hospitals are indeed doing harm.