Trauma centers springing up as profits rise

— -- ORANGE PARK, Fla. -- When Orange Park Medical Center won preliminary state approval in November 2011 to open the first new trauma center in northeast Florida in almost 30 years, its executives said the decision would save lives.

But that's not how its competitor 18 miles away saw the move by Orange Park Medical and its parent, HCA Holdings, the nation's largest for-profit hospital chain.

"We believe HCA is responding not to a market need, but instead is exploiting the system to increase their revenues," said Jim Burkhart, CEO of non-profit Shands Jacksonville Medical Center, which had operated the region's lone trauma center since 1983. "Adding new trauma centers will only increase costs for hospitals, taxpayers and consumers."

Such disputes are becoming more common as hospitals across the country add trauma centers at a record pace, spurred in part by the lure of greater profits. More than 200 trauma centers have opened since 2009 in more than 20 states, and another 75 hospitals are seeking approvals, according to data collected by Kaiser Health News from state health agencies.

States with the greatest number of new centers include Texas, Alabama, Arizona and California. The growth reverses more than a decade of closures in the 1990s and early 2000s.

Leading the trend is Nashville-based HCA, according to state data. Since 2009, it has added or is planning to add about 20 trauma centers, including almost a dozen in Texas and Florida, as part of an expansion of its emergency room business. Another for-profit hospital chain, Community Health Systems, added seven trauma centers in the past three years.

Some non-profits, including Kaiser Permanente and Dignity Health, a large Catholic health system, have also competed with hospitals in Sacramento, Solano, Ventura and San Luis Obispo counties in California to offer trauma services.

How many is enough?

Trauma injuries, usually from car accidents, gun-and-knife violence or falls, are the leading cause of death for people under 45. Those treated at trauma centers have a 25% higher survival rate compared with those seen in hospitals without those services, according to a 2006 New England Journal of Medicine study.

The highest-level centers (known as level 1 and level 2) have specially trained staff and surgeons either on call or at the hospital 24 hours a day. Many also have their own operating rooms and diagnostic equipment. Lower-level trauma centers (known as level 3, 4 or 5), which account for most of the new centers, typically stabilize a patient and arrange for their transfers to a higher-level unit.

The American College of Surgeons, which verifies the quality of some trauma centers, generally recommends having one or two high-level trauma centers for every 1 million people. But that can vary based on factors such as the distance to the next high-level trauma center, the presence of high-injury industries such as mining or logging, and local speed limits.

While experts say some parts of the country, especially rural areas, need trauma services, they caution that too many higher-level facilities in one area can result in higher costs and reduced quality.