Published 5/1/2011
Hassan R. Mir, MD

Who is funding your trauma system?

Over the past few decades, trauma systems have been developed in several states and have improved patient access to timely care. The importance of trauma systems in expediting patient care and transport cannot be overstated; however, a great deal of variability exists in the funding available to support their continued development and implementation.

State funding
According to a September 2010 report by the American College of Surgeons (ACS), 42 states have established statewide trauma systems, 24 of which are funded or partially funded by the state. States use a variety of methods to collect and allocate these funds. Examples include fines and fees on moving violations, fees on motor vehicle registrations, fees on license plates, fees on driver’s license renewals, taxes on cigarette sales, fees from criminal penalties, and funds from general revenues.

This year, the ACS is tracking six state bills that address trauma funding. Updated information on these bills can be found in the advocacy section of the ACS Web portal, which has a specific section for bills related to trauma funding.

Federal funding
In 2010, the Patient Protection and Affordable Care Act (PPACA) authorized $224 million in federal funding for trauma and emergency medical services programs and activities, including the following:

  • reauthorization of the National Trauma Center Stabilization Act
  • provision of two $100 million grant programs—Trauma Care Center Grants and Trauma Service Availability Grants
  • reauthorization of the Trauma Care Systems Planning and Development Act (TCSP)
  • authorization of $24 million for grant programs under TCSP to support state development of trauma systems
  • incorporation of a new Regionalization of Emergency Care Pilot Program (RECPP)

The Trauma Care Center Grants provide operating funds that enable trauma centers to maintain their core missions. These grants also compensate trauma centers for losses from uncompensated care and provide emergency awards to centers at risk of closure.

The Trauma Service Availability Grants are intended to be channeled through the states and used for activities that address shortfalls in trauma services and improve access to and the availability of these essential lifesaving services.

In addition, half of the funding under the TCSP is designated for implementation of the RECPP to design, implement, and evaluate innovative models of regionalized emergency care systems. As with previous congressional acts that have authorized federal funding of trauma systems, the House and Senate Appropriations Committees must choose to fund the programs during the appropriations process.

The Access to America’s Orthopaedic Services Act (AAOS Act), which was originally introduced in the 111th Congress and will be reintroduced to the 112th Congress, addresses the need to educate Congress and the public on the burden of musculoskeletal diseases and conditions. One of the many provisions of the AAOS Act requires the Secretary of the Department of Health and Human Services to issue a report to Congress on the orthopaedic implications of model trauma networks, trauma rehabilitation, and integration into the community with particular attention to access to specialty care for patients with orthopaedic-related conditions, outcomes for trauma patients, and access to postacute rehabilitative services.

Orthopaedic surgeons should be involved in the implementation and improvement of trauma systems. Federal and state funding is necessary to improve the current model, and orthopaedic surgeons must advocate on behalf of the specialty and their patients to try to secure funding to ensure the success of trauma systems.

For updates on the AAOS Act and other state and federal health policy activities of the American Association of Orthopaedic Surgeons (AAOS), visit the AAOS government relations Web site at www.aaos.org/dc

Hassan R. Mir, MD, is a member of the Orthopaedic Trauma Association Public Relations Committee. He can be reached at hassan.mir@vanderbilt.edu