Becoming and remaining a trauma center is an expensive proposition. Some components can pay for themselves (surgical specialists and operating rooms) but others are required yet generate no revenue. These costs must somehow be offset for a trauma center to remain viable.

How much does it actually cost? There have been two papers that deal with this topic (see references). One was published way back in 2004 and examined readiness costs averaged across 10 Florida trauma centers. They comingled data for these hospitals, which were a mix of adult, pediatric, Level I and Level II centers. They arrived at a median annual cost of readiness of $2.1 million.

A similar study was published in 2017 for Level I and Level II centers in Georgia. They were ultimately able to estimate that the annual average readiness cost for Level I centers was $6.8 million, and for Level II centers was $2.3 million.

That’s a lot of money! These hospitals tend to be larger and have specialty centers that allow them to generate enough revenue to support the non-revenue parts of the trauma program.

But what about Level III and Level IV centers? They are generally much smaller hospitals. In many more rural states they are critical access hospitals with 25 or fewer beds. They don’t have a wealth of other programs that can generate significant excess revenue.

So how much does it cost them?  A group at Mercer University in Atlanta attempted to quantify this issue. They developed a survey tool along the lines of the previous work. They sent this to all 14 Level III and Level IV trauma centers in the state, who based their numbers on 2019 data.

Here are the factoids:

• For Level III centers, the average annual readiness cost was $1.7 million
• The most expensive components for Level III centers were for clinical medical staff. This was most likely related to stipends for service / call coverage.
• For Level IV centers, the cost was only $82 thousand and primarily involved administrative costs (most likely trauma program personnel)
• Education and outreach programs are mandated for these centers but the centers actually spent only $8,000 annually. The authors believe this represented significant under-resourcing by the hospitals.

The authors concluded that there is a need for additional trauma center funding to enable Level III and IV centers to meet the requirements set forth by the American College of Surgeons.

My comments: This is a very enlightening paper on the cost of being a trauma center. Only two papers have previously explored this, and only for higher level centers. However, the devil is in the details. The nuts and bolts numbers and the assumptions made on how they fit together are key. But it does provide some enlightening information on what it costs to be a trauma center. And the disparity between the two levels is fascinating / frightening.

Here are my questions for the authors / presenters:

• What assumptions did you have to make to arrive at these numbers? Please explain the details of your model and where you think the weaknesses in it may lie.
• Why is it so much more expensive to be a Level III center? The abstract places the blame on “clinical medical staff.” Are these on-call stipends or something else?
• What would you tell wannabe Level III or IV centers looking to become a trauma center? Unfortunately, these numbers might scare some of the off.

Thanks for an intriguing and challenging paper! The discussion will be very interesting!

References: 

1. ASSESSING TRAUMA READINESS COSTS IN LEVEL III AND LEVEL IV TRAUMA CENTERS. Plenary session paper #10, AAST 2022.
2. The cost of trauma center readiness. Am J Surg 187(1):7-13, 2004.
3. What Are the Costs of Trauma Center Readiness? Defining and Standardizing Readiness Costs for Trauma Centers Statewide. Am Surg 83(9):979-990, 2017.