UNMC To Operate Trauma Center Seven Days a Week

[jessep28]

Nebraska Medical Center to switch to 7-days-a-week trauma services

The Nebraska Medical Center will provide trauma services seven days a week, ending a longstanding arrangement to share that duty with Creighton University Medical Center.

Nebraska Medical Center administrators said the change will allow them to seek the highest level of accreditation, serve the community better and make use of staff expertise. They made the announcement Wednesday and said their plan will take effect on Aug. 1.

[bigredmed]

It will be good for Omaha to have a level 1 trauma center that is a true level 1. Currently neither CU or UNMC could get enough cases to meet the criteria for the advanced trauma certification. By condensing into 1 center, all the trauma will go to one place as the Code 3 trauma has to go to the highest level of trauma center avaiable.

This will largely end the cherry-picking in trauma care that has been going on in Omaha for a couple of decades at least. Pretty much, if you are badly injured, by current standards of emergency procedures, you will go to UNMC. (At least as I understand it.) This will make trauma care less of a economic hole for UNMC as they will get all the victims, not just the uninsured knife and gun club crowd.

[iamjacobm]

Interestingly...

http://www.ketv.com/news/trauma-service ... a/24936400

Alegent Creighton Health, which was notified of the plan Wednesday morning, said it also plans to create a full-time trauma center at its hospital at 30th and California streets.

That means, should everything go according to plan, there will be two full-time trauma centers in Omaha starting on Aug. 1.

[Ben]

This new setup may be detrimental to all involved. There is a huge cost to having full Trauma teams (surgeon, anesthesia, nurses, ORs preped and ready) available 24x7 (and all of the ancillary specialists on call). If we have 2 facilities, neither at full use, it'll be detrimental to skills of those involved, and will cost significant sums of money.

It'll be interesting to see how the coordinating body decides on who to send where if they're both open.

They currently share lots of other services - 1 helicopter, shared Trauma residency program, 1 joint Trauma coordinator. How they split this will be very political. Will they duplicate this all?

[RNcyanide]

Interestingly...

http://www.ketv.com/news/trauma-service ... a/24936400

Alegent Creighton Health, which was notified of the plan Wednesday morning, said it also plans to create a full-time trauma center at its hospital at 30th and California streets.

That means, should everything go according to plan, there will be two full-time trauma centers in Omaha starting on Aug. 1.

I thought they were going to move the trauma center to Bergan, though...

[Ben]

I thought they were going to move the trauma center to Bergan, though...

They are, but it won't be until late 2015, at the earliest, as there's a lot of prep that needs to happen first. New ED built, added ICU beds, dedicated trauma surgery suites, several sub-specialties added to the Bergan campus, etc.

If they want to continue to do Trauma at Creighton in the mean time, they'll have to certify on their own, by the Aug 1 deadline of when UNMC/Creighton are separating.

[GetUrban]

I thought they were going to move the trauma center to Bergan, though...

They are, but it won't be until late 2015, at the earliest, as there's a lot of prep that needs to happen first.  New ED built, added ICU beds, dedicated trauma surgery suites, several sub-specialties added to the Bergan campus, etc.

If they want to continue to do Trauma at Creighton in the mean time, they'll have to certify on their own, by the Aug 1 deadline of when UNMC/Creighton are separating.

What is "ED"....? Emergency Department?

Sounds like a potential big waste of money if the need doesn't exist for two trauma centers. Doctors and administrators exercising their egos, apparently.

[Coyote]

What is "ED"....?  Emergency Department?
.

Yes. That is the more typical name...

[bigredmed]

I thought they were going to move the trauma center to Bergan, though...

They are, but it won't be until late 2015, at the earliest, as there's a lot of prep that needs to happen first.  New ED built, added ICU beds, dedicated trauma surgery suites, several sub-specialties added to the Bergan campus, etc.

If they want to continue to do Trauma at Creighton in the mean time, they'll have to certify on their own, by the Aug 1 deadline of when UNMC/Creighton are separating.

What is "ED"....?  Emergency Department?

Sounds like a potential big waste of money if the need doesn't exist for two trauma centers. Doctors and administrators exercising their egos, apparently.

Nope.

A basic concept:

Medicine is full of things that are cool, often very important to society, but don't get paid for. Trauma is a classic example of this. For most places, this is a huge cost center that is not easily balanced against either revenue centers or philanthropy centers. If you get the wrong case-mix, your losses get to be extreme. Trauma could easily push an entire hospital to insolvency. The staff needs and the physical plant needs are seriously expensive, so without taking steps to get patients in that have insurance, you go broke even if you don't have gang-bangers to deal with. Add the knife and gun clubs, and the cost of security added to the costs of personnel and you bleed money faster. The burn rate of trauma losses would easily destroy any hospital in Omaha if the case-mix tilts to the knife and gun club. Amplify the direct costs by the downstream losses due to bad reputation and you get to a point where the costs cant be recouped and the rest of the hospital can't compete in other areas because people don't want to go to a place where they have to deal with the violence and the morons from the knife and gun clubs. So you can't build up OB or Plastics, or other areas where you could make some money. These lost-opportunity costs grease your skids into insolvency.

What happens is that CHI has bought a bunch of the hospitals in Omaha that don't have a lot of medicaid exposure and Creighton. CU is a HUGE blackhole for money. The physical plant is problematic and the location is over exposed to very expensive patients with crappy coverage (medicaid, if you are lucky). They are moving all the services from CU that can be salvaged to Bergan. This has UNMC in a pickle. If Bergan were to go to a level 1 trauma center (which is not likely, but not impossible), then all the trauma that exists in west Omaha (land of insurance and people who get into accidents, but don't bring their homies to shoot it out in the ED parking lot) would go there. All the rest would get dumped on UNMC. Guess what happens next?

By moving the level 1 designation, UNMC gets better control over their trauma services and downstream referrals to support services (like PT/OT, plastics, etc). They get some insurance that they will not be left holding the bag for all the expensive patients. Besides CU's plan only works if they are a full service hospital and they are not now, and will be even less so once CHI finishes their relocation plans (this is a requirement of the accreditation body).

This was defense on the part of UNMC against CHI. Had they not done that, CHI would have carved out all the financially viable services out of Creighton and left a "clinic" behind. UNMC would be bombed by the high cost patients derived from the various knife and gun clubs. No ego involved, just financial security and advancement of the ED training program at UNMC.

[GetUrban]

Thanks for the insight. It will be interesting to see how it all shakes out.

[jessep28]

The Omaha Fire Department will implement a new trauma patient transport procedure to basically mirror the old Odd/Even trauma center rotation. I'm curious if this was to help keep insured trauma patients from out west flowing into UNMC after Alegent Creighton moves their trauma center to Bergan.

Omaha Fire Department to begin new trauma-patient system

The Omaha Fire Department said Monday night that it planned to implement a new system to transport trauma-care patients to Omaha hospitals, starting in a little more than two weeks.

The new procedure will operate on an odd-even rotation between the Nebraska Medical Center and Creighton University Medical Center for adult patients. Those patients who are in stable condition may choose either trauma center for emergency care, the fire department said. Nonstable patients will be taken to the designated trauma center of the day based on the odd-even system.

[blueblood]

Some random questions

1. UNMC had a full page add in the OWH Sunday. Not sure if this was a one time event or not. Why? Does anyone really think about which ER to visit when they have some sort of accident? Don't you normally just go to the closest one or where ever the ambulance takes you?

2. Is UNMC state funded? Thus can they spend more and afford more loss?

3. The OWH has written many stories on the changes and tried to compare all Omaha hospitals. I was shocked to see CU med center overall rated higher than UNMC. I realize there were limitations but still. Was also shocked to see CU med center ER saw more patients than UNMC by I think about a 10-20% number. Not that I would ever want to go to either place but anyone else surprised by that?

[bigredmed]

Some random questions

1. UNMC had a full page add in the OWH Sunday. Not sure if this was a one time event or not. Why?  Does anyone really think about which ER to visit when they have some sort of accident? Don't you normally just go to the closest one or where ever the ambulance takes you?  

2. Is UNMC state funded? Thus can they spend more and afford more loss?

3. The OWH has written many stories on the changes and tried to compare all Omaha hospitals. I was shocked to see CU med center overall rated higher than UNMC.  I realize there were limitations but still. Was also shocked to see CU med center ER saw more patients than UNMC by I think about a 10-20% number. Not that I would ever want to go to either place but anyone else surprised by that?

>>Trauma is broken down to non-life threatening and life threatening. The NLT trauma goes to your hospital of choice IF it is a hospital that can handle it. If you want to go to X place, but they don't do trauma, the EMT's will take you to the receiving level 1 trauma center. If you have level 1 trauma, you go to the receiving level 1 trauma center, regardless of your location.

>>UNMC receives state funds to run the school, not the hospital. The hospital has not received funds from the state for a very long time (since the 70's or even earlier.) The medical school and the other schools are supported in part by NU. The legislature will fund things separately (like cancer research) as well. None of that money goes to patient care. Basically, UNMC's hospital is a private venture.

>>CU sees more ED patients for two reasons. 1. In the old system, it was 4 days CU and 3 days UNMC per week. UNMC took Friday and Sunday as trauma days, and one other day per week. Thus, CU received more level 1 trauma. 2. CU is close to North Omaha and downtown, so they get more of the "ED as clinic of convenience" patients.

Hope this helps.

[blueblood]

Thanks.

1. So if one was to go to the Woman's hospital ER, they then transport to UNMC but if I go to Bergan I end up at CU? In other words is it affiliated hospital transport?

2. What is the short answer to how getting the trauma 1 ER business translates into cash? Do the two hospitals release info in regards to financials? They are both willing to spend an enormous amount of money to get the ER business. Assume with construction, salaries, upkeep, and non payers they both must lose boatloads of money. How does that compare to say the Lakeside ER? Do ER visits then translate into other hospital division winners? Thus does Ortho make money due to ERs? Without the ER would it not? Or is this about prestige?

3. Are the specific hospitals(ortho specific center at 144th and Center) killing the old style one size fits all hospitals? Is it growing?

4. Lets assume Obamacare succeeds. Does it make a everyone a paying customer at some point and thus an ER could make some serious cash?

5. Predictions on where we stand in 5-10 years. Nonbinding answer of course, just a guess.

[bigredmed]

Thanks.

1. So if one was to go to the Woman's hospital ER, they then transport to UNMC but if I go to Bergan I end up at CU? In other words is it affiliated hospital transport?

2. What is the short answer to how getting the trauma 1 ER business translates into cash? Do the two hospitals release info in regards to financials?  They are both willing to spend an enormous amount of money to get the ER business. Assume with construction, salaries, upkeep, and non payers they both must lose boatloads of money. How does that compare to say the Lakeside ER? Do ER visits then translate into other hospital division winners?  Thus does Ortho make money due to ERs? Without the ER would it not? Or is this about prestige?

3. Are the specific hospitals(ortho specific center at 144th and Center) killing the old style one size fits all hospitals? Is it growing?

4. Lets assume Obamacare succeeds. Does it make a everyone a paying customer at some point and thus an ER could make some serious cash?

5. Predictions on where we stand in 5-10 years. Nonbinding answer of course, just a guess.

1. You would go to the higher level place on call. You would go from Women's to Methodist or to a level 1 center.

2. If you are getting well insured ortho cases from the burbs, you get the fees from the ED, the clinic, the OR, the hospital, and the rehab. If you are part of an accountable care organization, you get these fees instead of paying someone outside of network. Trauma is required for surgery, ortho, neurosurg,prnd ED residents. If you have it, you don't have to send your people elsewhere.

3. The specialty hospitals eat into the teaching hospitals by taking profitable simple cases and leaving the uninsured and the super complicated underpaid cases to the general hospitals. The hit on these by ACA is that there are now restrictions on the building of new ones and payment to them is decreased.

If everyone paid their bills, the ED would make money. Obamacare is just putting more people on medicaid. That program is notorious for underpayment. How long could you stay in business if you received 15% of your fee?

In 15 years, CHI will either be broke or will control healthcare in Nebraska.

[Ben]

Predictions:

Short term:
Alegent/Creighton rebranding to further tie them to the other CHI Nebraska facilities, to give one unified system look and feel throughout the state. Could be renaming St E's, NHI, Good Sam, St Francis to Alegent, but more likely some new name that's not from any of them.

Mid term:
Methodist Health System gets purchased by one of the big national chains, as it becomes the "guy left out" in the Omaha hospital battle (CHI vs Nebraska Med Center system). Or maybe it affiliates closer with Nebraska Med Center.

The 2 Trauma Center experiment fails miserably when neither facility sees enough patients to qualify for level 1 certification (hard to maintain competency if you don't see enough cases), and they eventually form some sort of cooperative agreement similar to the past relationship. This isn't very far fetched, as Omaha would be the smallest city in the country with 2 level 1 trauma centers.

Even futher out: I could see one of the 2 area medical schools closing, with Creighton losing this battle. Creighton is already losing some of the control of its program with it moving westward, away from campus, to Bergan. Heck the new "academic medical center" aka enlarged Bergan, may not even bear the Creighton name once their done with the rebranding. Once again, not all that far fetched, as Omaha is currently the smallest city in the country with 2 full service medical schools.

[iamjacobm]

To the last point and this is pure rumor mongering here. I have heard UNMC has had to turn away tons of applicants this year already and Creighton's applications are down from years past. Could be a one year blip, but it seems like UNMC has been on a steady rise the past decade that might really be paying off now.

[MSizlack]

As someone who deals with most of the hospitals in the area, this is what I know. TNMC sees about 52k patients a yr and CUMC about 23k. Even though CUMC had 1 more trauma day a week, TNMC saw close to 200 more trauma pts last yr. TNMC out ranks all other hospitals in the area in many areas. As bigredmed pointed out Unmc and TNMC are not the same entity. Unmc is the education side and TNMC is the hospital side. However these 2 along with the Bellevue Med center will all come under one board in the very near future. This is why they are changing the name of the system.
Of course hospitals would like to transfer pts within their own systems. But many don't have specialty services or if they do, require an even higher level of care and thus go to TNMC. Serious pediatric trauma goes to TNMC. Children's has trauma designation but they currently do not accept seriously injured pts directly. That might change 3-5 yrs down the road as they higher more pedi surgeons. CUMC will take pedi trauma pts over a certain age, stabilize them , then transfer them out.
For TNMC to become a level one trauma hospital is not a big issue. Why? They have been operating as one for many yrs. They have hired more surgeons and added staff to some specialty areas, but that's just to bulk up. Many people would be surprised to see how many trauma pts get transferred out of Cumc. For quite a few yrs now they have functioned as a level 2 trauma service at best. Alegent/chi will be spending $10s of millions to take trauma to Bergan and try to build it up. The state recently evaluated TNMC for level 1 status. CUMC does this in Oct. Next yr TNMC will have the ACS (American college of surgeons) do their evaluation . This is the national standard and the most prestigious one.
ERs make money as does trauma. Everyone sees the lead story on the news about the lastest shooting or stabbing . Most of these pt don't have insurance and their care can cost $100s of thousands of dollars. But the vast majority of traumas are car and motorcycle accidents, farm injuries, falls at home, etc, and most of these are insured patients.
TNMC will continue to be the premier hospital in the region. With its broad focus on education, research, cancer, transplant, and pt care it will continue to be so. Children's has made a very strong effort over the last 5 yrs to grow their name and services and have become THE pediatric hospital in the area. (This had not been the case as each hospital had a pedi unit. Now only they and TNMC does). Methodist does well and controls the labor and delivery market with their West location.
CHI will have a quality trauma program at Bergan and will operate a decent med/health care school to create a pipeline of employees for their hospitals all across the states.
I've spent time in their St . Anthony hospitals in denver, mercy in Des Moines and idaho. Good hospitals, average care. And I've seen what is done in hospitals like university of Iowa, university of Colorado med center and here at TNMC, and have been absolutely amazed at what these systems can do.

[iamjacobm]

Creighton loses their trauma designation.

[BRoss]

Creighton loses their trauma designation.

CHI Creighton Loses Trauma Center Approval

Chief Medical Officer Joseph Acierno cited failure to meet four standards during a recent visit:

• Clinical Capabilities, General Surgery
• Clincal Qualifications, Neurosurgery
• Clinical Capabilities, Orthopedic Surgery
• Emergency Department, RN-TNCC Verified or Equivalent

DHHS is giving CHI Creighton an opportunity to appeal the decision.

[MSizlack]

CHI and its "Imagin-ary better health" is really showing its true colors to the public. If only all the other stuff behind the scenes were public, more people would be changing care to Nebraska Medicine and Methodist.

[Greg S]

I'm already in the UNMC camp. Talked to my Doctor who is affiliated with Methodist and he stated no one should be supporting CHI in tis.

Greg

[GRANDPASMUCKER]

I'm already in the UNMC camp. Talked to my Doctor who is affiliated with Methodist and he stated no one should be supporting CHI in tis.

Greg

The dispute between CHI and Blue Cross is not over yet but yeah it was over before it even started. Where Blue Cross got off or still gets off thinking they were going to tell CHI what to charge and how to do it simply defies reason. Of course Blue Cross is right that CHI is sticking it to us but they are fools to think they had more power or clout with the sheeple then CHI. People love their Drs. Many women think Drs are gods. People don't love their insurance company or worship it like it was a god! Blue Cross had no right to impose this doomed campaign on their policy holders. I just cant believe Blue Cross actually thought they had a chance of taking on CHI.

[MSizlack]

What's really funny is what you are saying about people loving their doctor and not their insurance company is EXACTLY what CHI was putting out to their employees early on in this dispute. But what CHI found out is that people love their money even more. So when those people who had BCBS saw what they would be paying for out of network care, guess what those people did? They found new doctors, not new insurance. I know 2 internal med and 2 family med MDs that have seen their practice dry up by 60% or more. One left CHI because she cant pay the bills with the volume the practice has fallen to. The MDs I know at Methodist and Ne Med have had the polar opposite problem. So many new patients that they have been racing to find more staff and extending hrs in clinic. And to further illustrate how much people would rather keep their money than their MD, since the dispute began, I personally know 4 couples who are having their 2nd or 3rd child, who left their prior OB MD at Bergan or Lakeside. Each of them said how much they loved their OB doc. And each of these couples changed care to Women Methodist when they found out it would cost $1500-2500 more as out of network with CHI. And in just the last 8 weeks, each couple couldn't be happier with their new OB MD and even if the dispute is resolved, they won't go back. This is what is going to hurt CHI for many years to come is those pts who left their CHI MD and won't be going back. Even CHI is estimating that 25-40% of those who left won't return. That's HUGE numbers!!!
But let's go back to what this post is about, and that's trauma. CUMC has been deficient in services for the last 3-4 yrs and the loss of their level one designation should have happened back then. This has NOTHING to do with the dispute with BCBS. CHI inherited this problem when the bought alegent and when Ne Med went 24/7 it just highlighted all the deficIencies. They just never were able to fix them and now it has bit them in the |expletive|.

[MSizlack]

Also, BCBS never told CHI what to charge. They only told them how much they were going to reimburse.

[Coyote]

+1 internets.

[Greg S]

I'm already in the UNMC camp.  Talked to my Doctor who is affiliated with Methodist and he stated no one should be supporting CHI in tis.

Greg

The dispute between CHI and Blue Cross is not over yet but yeah it was over before it even started. Where Blue Cross got off or still gets off thinking they were going to tell CHI what to charge and how to do it simply defies reason. Of course Blue Cross is right that CHI is sticking it to us but they are fools to think they had more power or clout with the sheeple then CHI. People love their Drs. Many women think Drs are gods. People don't love their insurance company or worship it like it was a god! Blue Cross had no right to impose this doomed campaign on their policy holders. I just cant believe Blue Cross actually thought they had a chance of taking on CHI.

No way CHI hospitals should be more expensive than ones such at UNMC/Nebraska Medical Center or Methodist/Children's. Totally agree with Blue Cross on this.

Greg

[RNcyanide]

I have no pity on CHI.

Speaking of Creighton, I have class with someone who is a pharmtech at Bergan Mercy and has worked occasionally at Creighton. He said that other factors in the state's decision to revoke their Level I trauma certification was due to the lack of things like Pixsys Machines (or other brand) for their medications, and not having bags of fluids in their crash carts (which are critical when the patient is losing blood and needs to be resuscitated).

Personally, I feel like since they are going to close Creighton, CHI has basically wrote the whole facility off as not being worthy of any investment. Which is sad, because in the end, they are writing off any patients that are being treated there.

[MSizlack]

CHI has so much riding on the CUMC trauma program, so don't think they have have written the trauma service off (the rest of the facility, they certainly have). People I know have heard that CHI investment into their trauma service will be $75M. Trauma is their growth and marketing plan. When they build and open their new trauma service building at Bergan, that will be their crown jewel (also know they are going to try to start an emergency medicine residency.) You won't see a research building, cancer center, transplant center or any other specialty building there. Trauma will be it for them. So, the loss of their designation and all the bad publicity that's coming with it is two black eyes and a kick in the nuts for them. Just like the pts that will be lost to other hospitals due to the BCBS issue, the loss of these pts IF they don't get their level one cert back will be very damaging to their system.

[Brad]

new trauma service building

Where are they building that at on the Bergan Campus?

[RNcyanide]

so don't think they have have written the trauma service off (the rest of the facility, they certainly have).

That's what I was getting at, since they are going to move the unit to Bergan. I think it's a poor decision to not get the necessary equipment for Creighton while still seeing patients just because they plan on moving soon.

[MSizlack]

Not exactly sure where they will be building. I was told "to the East of where the ER is currently".
The problems with the CUMC trauma service is not so much equipment, but services and continuity of care. There is a long list of basic and specialty services that a level one truama system is required to have both in house 24/7 and on call 24/7. They have not had some VERY basic specialty service available for some time. One of the issues they have had for years is this for example; They might have 6 oral-max-facial surgeons with in the system. But do you think any of those PRIVATE MDs wants to be taking call to cover trauma services? Heck NO!!! And dont even think about calling them in if the pt does not have insurance. At a big teaching University setting like NeMed, there are layers of each of the specialty services (Staff, fellows, residents, etc) that are aways around and available.
Another thing to ponder. The certification that Ne Med got and that CUMC did not is only the state certification. What happens next year when, lets pretend, both CUMC and Ne Med are certified as level one trauma hospitals by the state. THEN Ne Med gets the level one trauma designation from the ACS? How is that going to effect OFD, the surrounding EMS systems and all the smaller community hospitals in the region that take/send their trauma pts to Omaha. The ACS is the gold standard. CHI will not be able to apply for it until a few years after opening at BMMC. Will they be right back to where they are today?, taking/sending pts to NeMed because it is certified at a higher level? Again, the loss of the designation is a very big issue for them currently and potentially in the years to come.

[RNcyanide]

Not exactly sure where they will be building. I was told "to the East of where the ER is currently".
The problems with the CUMC trauma service is not so much equipment, but services and continuity of care. There is a long list of basic and specialty services that a level one truama system is required to have both in house 24/7 and on call 24/7. They have not had some VERY basic specialty service available for some time. One of the issues they have had for years is this for example; They might have 6 oral-max-facial surgeons with in the system. But do you think any of those PRIVATE MDs wants to be taking call to cover trauma services? Heck NO!!! And dont even think about calling them in if the pt does not have insurance. At a big teaching University setting like NeMed, there are layers of each of the specialty services (Staff, fellows, residents, etc) that are aways around and available.
Another thing to ponder. The certification that Ne Med got and that CUMC did not is only the state certification. What happens next year when, lets pretend, both CUMC and Ne Med are certified as level one trauma hospitals by the state. THEN Ne Med gets the level one trauma designation from the ACS? How is that going to effect OFD, the surrounding EMS systems and all the smaller community hospitals in the region that take/send their trauma pts to Omaha. The ACS is the gold standard. CHI will not be able to apply for it until a few years after opening at BMMC. Will they be right back to where they are today?, taking/sending pts to NeMed because it is certified at a higher level?  Again, the loss of the designation is a very big issue for them currently and potentially in the years to come.

I understand the staffing issue, that was spelled out in the article. I just thought it was rather appalling that they didn't have basic equipment and fluids available, which would have been less than drops in a bucket for them to provide.

[Coyote]

Creighton University Medical Center gets top trauma center designation from state

CHI Health said it asked for an expedited final report from the Nebraska Department of Health and Human Services, where Acierno serves as the director of the Division of Public Health.

Dr. Joseph Acierno, the state’s chief medical officer, informed Kevin Nokels, the hospital’s president, of the approval via an emailed letter late Friday afternoon.

[Coyote]

This expedited judgement for the Creighton University Medical Center was given by Joseph M. Acierno, M.D., J.D. who is the Deputy Chief Medical Officer with the Nebraska Department of Health and Human Services (DHHS)? Who received a Bachelor of Science, Doctor of Medicine and Juris Doctor degrees from Creighton University? I guess there really is no conflict of interest here?