Payments
Department of Health trauma pass-through – hospitals
Trauma Care Pass-through – Levels I and II
We disburse these pass-through funds each year to Level I and II designated trauma services. The pass-through grants subsidizes undercompensated trauma care costs. We base the pass-through on a hospital's proportionate share of undercompensated trauma care. We use figures for bad debt, charity care and total patient revenue to calculate this pass-through. This information is taken from the most recent, complete calendar year of hospital patient data. The sum of the Injury Severity Scores (ISS) is extracted from our Trauma Registry for the same period. This includes cases that meet both the trauma registry inclusion criteria and one of the following criteria:
- Adult trauma patients with an ISS of 13 or greater.
- Pediatric trauma patients, under 15 years of age, with an Injury Severity Score of nine or greater.
- All trauma patients received in transfer regardless of Injury Severity Score.
Figure 1 shows how this pass-through is calculated:
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Sum of ISS x ((bad debt + charity care)/ total patient revenue) = N1 ((N1 / NT) x total $ available for pass-through) = trauma service pass-through amount |
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| Figure 1 - Levels I – II Trauma Care Pass-through Calculation |
Trauma Care Pass-through – Levels III, IV, and V
We disburse these pass-through funds each year to Level III-V designated trauma services. The pass-through subsidizes undercompensated trauma care costs. We base the pass-through calculation on designation level and trauma patient volume. The level bases are a ratio of: 10 for Level III to 5, for Level IV to 2.5 for Level V. Volume data includes charges for trauma patients with a primary payer of Medicaid, self-pay, or charity care.
Figure 2 shows how this pass-through is calculated:
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total charges for trauma patients with primary payer of Medicaid, charity care or self-pay = N1 Sum of all trauma services N1s = NT ((N1 / NT) x total $ available for volume portion of pass-through) = Volume Volume + Level Base = trauma service pass-through amount |
| Figure 2 - Levels III – V Trauma Care Pass-through Calculation |
Hospital Participation Pass-through – Levels I-V
We disburse these pass-through funds each year to all designated trauma services for both general and pediatric designations. The pass-through is to help offset the costs of participating in the trauma system. We use three criteria to calculate this pass-through:
- Designation level, with weight given to higher levels.
- Trauma patient volume, with weight given to higher volumes.
- Location, with weight given to rural services.
The total pass-through funds available are divided among the criteria: 65 percent for level, 17.5 percent for volume and 17.5 percent for location. Each service is grouped by volume. The tables below show the volume group levels:
Acute Volume
| Acute Volume | High | Medium | Low |
|
I |
1000+ | 500-999 | 0-499 |
| II | 500+ | 200-499 | 0-199 |
| III | 400+ | 100-399 | 0-99 |
| IV | 200+ | 30-99 | 0-29 |
| V | 50+ | 25-49 | 0-24 |
Pediatric Volume
| Pediatric Volume | High | Medium | Low |
| I-P | 150+ | 75-149 | 0-74 |
| II-P | 60+ | 30-59 | 0-29 |
| III-P | 40+ | 20-39 | 0-19 |
We base location on the most current population data from the Office of Financial Management.
Hospital Rehabilitation Participation Pass-through – Levels I and II
We disburse these pass-through funds each year to Level I and II designated trauma rehabilitation services for both general and pediatric designations. The pass-through is to help offset the costs of participating in the trauma system. We base the amount of the pass-through on level of designation only. Of the total pass-through funds available, 60 percent is for Level I services the remaining 40 percent is for Level II services. These amounts are then divided by the number of levels to give the individual pass-through amount.
Department of Health trauma pass-through – Prehospital
Medical Program Director Pass-through
We disburse these pass-through funds each year to all current medical program directors. The pass-through is to help offset their costs. Medical program directors provide medical oversight for emergency medical services and trauma prehospital personnel.
Prehospital Participation Pass-through
We distribute these pass-through funds each year to all trauma-verified prehospital agencies. The pass-through is to help offset the costs of participating in the trauma system. These costs can include equipment, training, supplies, and staffing. The individual pass-through amount is the total amount of funding divided by the number of active trauma verified credentials in December. We email pass-through applications and instructions to trauma verified agencies in January each year. We use the state medical licensing system to determine agencies with active verified credentials and for contact data.
Health Care Authority trauma supplemental Medicaid payments
Supplemental Hospital Trauma Care Medicaid Distributions – Levels I, II, and III
The Health Care Authority (HCA) supports hospitals through supplemental Medicaid distributions for Levels I, II, and III. These payments apply to trauma cases that meet or exceed the injury severity score of 13 for adults and nine for children less than 15 years of age, and to cases received in transfer. The agency makes five supplemental hospital distributions for each state fiscal year (the “service year”). The supplemental payment each hospital receives is based on each participating hospital's percentage share of all eligible trauma claims for the service year to date. Beginning in state fiscal year 2014, hospital distribution calculations will include both fee-for-service claims and managed care encounter data.
Increased Physician Trauma Care Medicaid Payments
The Health Care Authority (HCA) supports clinical providers through increased physician payments. HCA's payments apply to trauma cases that meet or exceed the Injury Severity Score of 13 for adults and nine for children less than 15 years of age, and to cases received in transfer. Physicians and other clinical providers receive increased payments for trauma services on a claim-specific basis. Claims for professional services are reviewed at the line item level; some procedures (e.g., laboratory) aren't eligible for increased payment. For an eligible procedure, the payment amount is the HCA's maximum allowable fee multiplied by the enhancement percentage.
Injury Severity Score (ISS)
The Injury Severity Score is used to describe patients with multiple injuries. The abbreviated injury scale is used to score the severity of a patient's injuries. The abbreviated injury scale is used to classify each injury by body region on a scale from 1 to 6 – the higher the number the more severe the injury. The abbreviated injury scale is used to calculate the injury severity score. The sum of the squares of the highest abbreviated injury scale scores, in the top three most severely injured body regions, gives the injury severity score.