Trauma Feasibility Project

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W E L C O M E
Presented by Bill BullardSenior Consultant Pam
TurnerSenior Consultant The Abaris GroupWalnut
Creek, CA www.abarisgroup.com
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Project Overview

• Review how Montgomery County trauma patients
  currently receive care
• Estimate the volume of trauma cases in Montgomery
  County
• Calculate the appropriate number and type of
  trauma centers necessary to support the needs of
  Montgomery County residents
• Determine the necessary capabilities to become a
  trauma center
• Identify funding opportunities to support trauma
  care
• Develop revenue and cost model for potential
  trauma center

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Project Research

• Interview key stakeholders
• Montgomery County Hospital District
• South Montgomery Woodlands Chamber of Commerce
• Memorial Hermann- The Woodlands
• Conroe Regional Medical Center
• St. Lukes Community Medical Center
• Air Medical Providers
• EMS Providers
• South East Texas Trauma Regional Advisory Council
  (SETTRAC)
• Concerned Citizens
• Determine current hospital capabilities and
  interest for trauma center designation
• Gather community input on the need for a trauma
  system
• Collate available data for the volume and
  severity of current trauma cases
• Project the future trauma needs

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County DemographicsPopulation

• Ranked 27th fastest growing county in the nation
  for 2005 (US Census Bureau)
• The 400,000 residents are spread over 1,100
  square miles
• Population is projected to reach 500,000 within
  the next 5 years
• One Level IV trauma center in the county

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County DemographicsMotor Vehicle Fatality Rate

• Higher than the Texas average per 1,000
  population
• Stated during interview process as highest of any
  suburban/urban county in the state

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EMS and ED Volumes

• Significant growth annually both for Emergency
  Medical Services (EMS) transports and each
  hospitals Emergency Department (ED) visits
• Expect continued increase due to projected
  population growth

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EMS Statistics

• Single provider for Montgomery County through the
  Hospital District
• 15 to 22 ambulances scheduled based on daily call
  volume
• Minimum of one EMT and one paramedic on each
  ambulance
• 37,000 calls for ambulance service to 9-1-1 last
  year
• 60 percent of calls are transported to a hospital
• 40-80 minute ground transport time to Level I
  trauma centers in Houston
• Average hospital off-load time is 35 minutes, 50
  longer than nationally
• Advanced skill sets
• Pericardiocentesis
• IO fluid infusion
• Crycothyrotomy
• Rapid Sequence Intubation (RSI)
• Combi-tubes
• CPR Rescue Pods

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Air Ambulance Statistics

• Two providers for Montgomery County
• PHI Air Medical
• Memorial Hermann Life Flight
• 25 to 35 trauma transports per month
• Most transports from 9-1-1 scenes
• Destination is typically Memorial Hermann Level I
  Trauma Center helipad
• The three larger hospitals in Montgomery County
  have helipads however, mostly used to transport
  patients out

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Hospital Demographics

• Memorial Hermann The Woodlands
• Level IV trauma center, moving towards Level III
• 27 percent of EMS volume
• One of ten hospitals in Memorial Hermann hospital
  system
• Joint Commission credentialed Primary Stroke
  Center
• Conroe Regional Medical Center
• Level III trauma center until 2005
• 55 percent of EMS volume
• Past county hospital
• Accredited Chest Pain Center
• St. Lukes Community Medical Center
• Built in 2003 as a cardiac care center for the
  community
• 18 percent of EMS volume
• System hospital with free-standing emergency
  departments

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Trauma Volumeusing Historical Data

• 941 estimated trauma patients in 2007

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Trauma Volumeusing Utilization Rate

• 957 estimated trauma patients for 2007 based on
  trauma utilization rate of 2.35 cases per 1,000
  people

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Trauma Centers Needed

• 941 - 957 trauma cases in 2007
• 1,200 trauma cases are necessary for a Level II
  trauma center to be clinically and financially
  viable
• A Level III trauma center requires only 600 cases
  to be viable
• Some of the trauma cases will be too severe for a
  Level III and require transport to the Level I
  trauma centers in Houston

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Injury Severity

• Injury Severity Score (ISS) numerically defines
  the acuity of trauma patients, with a higher
  number representing greater injuries
• A Level III trauma center has the resources to
  triage and care for trauma patients with ISS
  scores from 0-15
• Based on five years of trauma experience, this
  represents 70.0 of the total trauma volume

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Severity Adjusted Volume

• 689 Level III appropriate trauma cases are
  projected for 2008 using most conservative state
  population growth rate

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Trauma Centers Needed

• 2008 1 Level III trauma center
• 2013 1 Level II trauma center
• 2031 1 Level II and 1 Level III
• Note Assumes sustained population growth

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Shared Trauma Center

• American College of Surgeons (ACS) would expect
  either hospital to deliver the same level of
  trauma care to walk-in patients even if not its
  week as the trauma center

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Trauma Center Funding

• Texas trauma funds available to trauma centers of
  any level
• 47 million distributed last year
• MH-The Woodlands received 42,000
• Disproportionate funds are available to trauma
  centers to offset the cost of uncompensated care
  regardless of designated trauma center level
• 1.46 billion shared to 210 trauma centers during
  last fiscal year
• MH-The Woodlands received 1.2 million

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Trauma Center RevenuePayor Mix
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Trauma Center RevenueGross Charges

• Existing trauma center charges provided by MH-The
  Woodlands
• 5 percent increase estimated for 2008

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Trauma Center RevenueNet Revenue
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Trauma Center CostsPhysician On-Call Stipends

• Physician on-call stipends represent a
  significant expense to trauma centers

• Trauma centers pay 43 percent higher stipends to
  ensure on-call coverage

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Trauma Center CostsNew Operating Expenses
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Trauma Center CostsTotal Operating Expenses

• Note Memorial Hermann The Woodlands has fewer
  new trauma center expenses as an existing Level
  IV trauma center

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Trauma Center Net Income
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Major Recommendations

• Sufficient trauma patients exist to justify one
  Level III trauma center today
• By 2013, expected population growth will require
  the Level III trauma center to upgrade to a Level
  II with trauma neurosurgery capability
• By 2031, Montgomery County will likely benefit
  from both a Level II and a Level III trauma
  center based on the expected increase in trauma
  cases
• The designated trauma center should strongly
  consider the addition of trauma specific charges
  to offset the new trauma center expenses

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Next Steps

• Adopt the recommendations from the feasibility
  report
• Develop Request For Proposal (RFP) process to
  designate most appropriate hospital
• Establish a county-wide trauma system with air
  and ground EMS trauma protocols
• The Chamber of Commerce and Hospital District
  should partner with the designated trauma center
  to promote injury prevention and other trauma
  system enhancements consider a prevention
  steering committee

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Online Resources
Questions?

• abarisgroup.com
• facs.org

The Abaris Group 700 Ygnacio Valley Road, Suite
270 Walnut Creek, CA 94596 888.EMS.0911 pturner_at_ab
arisgroup.com bbullard_at_abarisgroup.com