TCAA Board Members and members blanketed Capitol Hill on June 28 during the association's annual Lobby Day, meeting with more than 70 Congressional offices to promote TCAA's advocacy messages. During these meetings, TCAA members educated legislators and their staff about trauma care, the value of receiving care for a traumatic injury at a trauma center, and the growing concern that the federal government has not made necessary investments in trauma, leaving a fragile trauma system to falter. TCAA members conveyed to members of Congress that the combination of market pressures and reduced reimbursement, as well as a growing shortage of on-call specialists, may result in a "perfect storm" of closures, with 30 percent of the nation's trauma centers having already closed between 1990 and 2005.
In order to prevent more closures, TCAA advocates offered short-term, intermediate and long-term solutions, including: providing funding for the Public Health Service Act trauma and regionalization of emergency care programs, fixing current reimbursement problems associated with the trauma activation fee, and allowing trauma centers to model and test long-term alternative trauma payment models that would incentivize high quality outcomes and cost-effectiveness of care while providing a more stable and predictable funding mechanism for trauma centers and specialist physicians.
During the Lobby Day, TCAA leadership (Board Chair Dan Gross, Board Members Mary Hillfiker, MD and John Osborn, and TCAA members Steven Briggs, MD and William Marshall, MD) also had the opportunity to meet with the Chief Medical Officer at the Centers for Medicare and Medicaid Services (CMS), Dr. Patrick Conway, as well as Dr. Rick Gilfillan, Acting Director of the Center for Medicare and Medicaid Innovation (CMMI), to discuss the unique considerations of trauma centers as they assess delivery system redesign opportunities, integration with accountable care organizations (ACOs) and payment reform initiatives. TCAA was pleased to be joined at this meeting by representatives of the American College of Emergency Physicians (ACEP), the American Association of Orthopaedic Surgeons (AAOS), the American College of Surgeons (ACS) and the American Association of Neurological Surgeons (AANS) at this meeting - all active partners in the ad hoc trauma/EMS coalition that TCAA helps coordinate in Washington, DC.
During the CMS meeting, TCAA also had the chance to speak with Marc Hartstein, Deputy Director of the Hospital and Ambulatory Payment Group at CMS about the trauma activation fee, which Medicare and some commercial payers recognize and pay for. TCAA explained that trauma centers are finding that the code's value is limited in that it requires pre-notification by EMS or a transferring hospital and currently applies only to outpatients, leaving significant uncompensated readiness and activation costs unreimbursed. TCAA is in the process of working on a follow-up meeting to discuss this issue at further length with CMS and will keep the membership apprised of any developments.
Following the lobby day, TCAA convened a half-day Advocacy Summit with representatives from its partners at the American Association for the Surgery of Trauma (AAST), the Eastern Association for the Surgery of Trauma (EAST), and the Society of Trauma Nurses (STN). (The American Trauma Society was also invited, but unable to attend.) Ronald Stewart, MD, Jeffrey Salomone, MD, Christine Eme, and Juliet Geiger joined TCAA Board Chair, Dan Gross, and Board Members Mary Hillfiker, MD and John Osborn to learn about the organizations' individual federal advocacy agendas and to discuss ways in which the organizations could continue to collaborate on areas of mutual interest.
In addition, the group met with HHS Assistant Secretary for Preparedness and Response (ASPR) Nicole Lurie, MD and senior officials on her team. Representatives from ACEP and AANS also joined us for the meeting at ASPR. During the meeting the group lobbied for funding of the trauma programs authorized under the Public Health Service Act, and urged the Administration to use some of its discretionary dollars to fund the programs in this fiscal year, as well as prioritize funding for these programs in the Administration’s next federal budget proposal. Dr. Lurie's team, including Gregg Lord (Director of the Emergency Care Coordination Center at ASPR) and Dave Marcozzi, MD (Director of the Hospital Preparedness Program), also discussed the Administration's evolving effort to enhance coordination of emergency care throughout the Department, as well as their efforts to transform the Hospital Preparedness Program.
TCAA is pleased to be able to work with so many members and partners in support of a common agenda and will continue to highlight opportunities to lobby Congress and the Administration on the issues of importance to the TCAA membership. If you were unable to participate in TCAA's Lobby Day, TCAA urges you to utilize the messages contained in the documents posted on the TCAA home page at www.traumafoundation.org to contact your legislators and communicate the TCAA message. Your advocacy makes all the difference!