Testimony Submitted by TMA and Texas College of Emergency Physicians
House Committee on Appropriations
Testimony on the Texas Trauma System
July 13, 2016
On behalf of the Texas Medical Association and the Texas College of Emergency Physicians, thank you for the opportunity to provide input on the state’s trauma system. A strong trauma system is vital to the overall health of the state. Trauma is the leading cause of death for Texans under 44 years of age as a result of more than 117,000 trauma incidents in Texas each year. These include motor vehicle crashes, falls, assaults, and firearm injuries. Automobile crashes are the leading cause of traumatic injury in Texas for children and adults, and Texas leads the nation in the number of individuals driving under the influence of alcohol or drugs. But thanks to a strong trauma system in the state, the fatality rate is a full percentage point lower than the national average. To maintain Texas’ low trauma mortality, trauma funding must be preserved.
Further, Texas’ trauma system is critical to the state’s efforts to reduce injury and violence among children and adults. Hospitals receiving trauma funding are required to lead local initiatives to reduce the prevalence of trauma, such as initiatives to reduce child abuse and domestic violence, improve child passenger safety, and decrease falls among older Texans. These programs not only save lives but also have the potential to reduce health care costs by decreasing emergency department usage.
Critical to the success of a strong trauma system is appropriate funding levels. A major source of funding for uncompensated care is the Driver Responsibility Program (DRP). DRP is the leading source of state funding for the Texas trauma system, contributing $75-$80 million per year. The program targets repeat offenders and unsafe drivers, such as those who drive under the influence of alcohol or drugs, and penalizes those bad drivers with surcharges. These surcharges go into the Account 5111, the Designated Trauma Facility and Emergency Medical Services Account, and the General Revenue account. The funds derived from the surcharges are used to offset the cost of more than $300 million in uncompensated trauma care each year.
DRP was designed to support existing trauma centers and offer incentives for other hospitals to become trauma-designated. While many of the state’s larger cities have Level I or Level II trauma centers that serve the city’s population, many rural areas do not have any designated trauma centers. This program has encouraged many smaller and rural hospitals to achieve Level III or Level IV trauma designation. Since the program began, an additional 77 Texas hospitals have become designated trauma centers. These additional trauma centers ensure trauma care access to citizens across the state.
We are fully cognizant that the current structure of the program has the potential to cause hardship for low-income drivers who have accrued penalties. We believe reforms are necessary and support a robust stakeholder process to address any proposed reforms. However, eliminating statewide funding would undermine a trauma system on which all Texans depend and shift the financial burden for trauma care to local taxpayers and the privately insured. If DRP is abolished or reformed, it must be replaced with alternative funding at comparable funding levels. To do otherwise would put the state’s trauma system in jeopardy.
In addition, in 2011 the corpus of the Permanent Tobacco Fund for EMS and Trauma Care was shifted to provide funding for the Cancer Prevention and Research Institute of Texas. While we certainly understand the importance of cancer research, the emergency medical services (EMS) and trauma system in the state cannot bear any more funding cuts. We strongly urge legislators to find and maintain a permanent and stable source of funding for the EMS and trauma system.
Thank you for the opportunity to provide input on trauma care and funding in the state. We look forward to working with state lawmakers to find ways to maintain Texas’ strong trauma system.
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