Spokanes two biggest hospitals, already straining under the yoke of higher malpractice-insurance premiums, have been hit with another unforeseen cost: The state earlier this year stopped paying them a customary bonus for treating severely injured Medicaid patients.


The so-called trauma-enhancement payments were designed to boost reimbursement received by Sacred Heart, Deaconess, and certain other medical centers for providing care to trauma patients who are covered by Medicaid, a state- and federally-funded health insurance program for low-income and disabled residents.


The enhanced payment takes into consideration that the cost of our providing trauma services is well above the normal cost (of care) since we have to have teams of people that are on call and ready to arrive here within 20 minutes, says Michael Wilson, president of Sacred Heart.


Certain hospitals throughout the state had been eligible to receive those payments since 1996, and the Legislature created a dedicated trauma fund to cover them in 1998, says Janet Griffith, director of emergency medical services and trauma for the state Department of Health.


Earlier this year, however, that fund ran dry due to a higher-than-expected number of claims, Griffith says. At just about the same time, the state emptied the funds $6.1 million reserve to help balance its budget.


Those sort of colliding trains meant that we needed to suspend the enhanced payments, she says, adding that the bonuses were suspended beginning in April.


Wilson says Sacred Heart will lose $3.6 million this year due to the suspension, which includes $2.6 million in payments due for care this year as well as claims that were billed from previous years that werent paid before the suspension.


Deaconess expects to lose $1.8 million from the suspension, says hospital spokeswoman Janice Marich.


Sacred Heart and Deaconess are the only two hospitals in the Inland Northwest area that are affected because they share all of what are called Level II trauma care cases for this region.


Not all emergency-room visits rise to the level of trauma thats eligible for the payments. For the purposes of the trauma fund, injuries are scored based on severity and number, and only care for patients whose scores rise above a certain level is eligible for reimbursement, Griffith says.


Both Wilson and Marich say theres not much the hospitals can do to counter the suspension except to tighten their belts even further.


That, they say, is a difficult proposition when hospitals also are dealing with sharply higher malpractice-insurance premiums, falling reimbursements from insurers and government programs, and general economic malaise.


Theres no question that hospitals will be impacted by this, says Wilson, who also is chairman-elect of the Washington State Hospital Association.


Says Marich, Whenever you have a $1.8 million unanticipated loss on top of the other financial challenges that the health-care industry is having, its significant.


Griffith says trauma payments will be suspended through the rest of the current biennium, which ends next June 31. At that time, Well be able to lift (the suspension), she says.


The trauma fund exhausted its about $24 million biennial budget well before the end of the first year of the biennium because of a large volume of catch-up claims submitted during that period by hospitals and doctors, Griffith says. Awareness of the trauma fund hadnt been great during its first four years in existence, but rules allow health-care providers to file claims for services rendered as far as three years back, and as awareness grew, many of them did so, she explains.


At the beginning of this biennium, suddenly DSHS (the state Department of Social and Health Services) received back bills and rebillings that were absolutely legitimate billings for trauma, but they came in after our previous biennium funds were used and our appropriation did not cover the needs, she says. DSHS handles billings for doctors and hospitals, while the Department of Health handles payments to ambulance companies and other health-care providers.


The trauma fund receives monies through a $4 administrative fee on the purchase or lease of a car and a $5 per-infraction surcharge on traffic tickets. The federal government also contributes to the fund, Griffith says.