California Trauma System Summit II

Improving Trauma Care through State Trauma System Development

September 21, 2009

Measure B – Support for Trauma Services

Cathy Chidester, DirectorLos Angeles County,

Emergency Medical Services AgencyTrauma Summit

LOS ANGELES COUNTY

4,082 Square Miles Population > 10 Million 73 9-1-1 Receiving Centers 13 Trauma Centers 30 Public EMS 9-1-1 Providers 19,500 Trauma Patients Annually

GOVERNANCE

Board of Supervisors (BOS) - 5 Members Department of Health Services -

EMS Agency - 2002 Virginia Price Hastings, Director

EMS Commission – 17 Members Various constituent groups – 12 Members

Appointed by the BOS – 5 Members

WHY OUR TRAUMA SYSTEM WAS VERGING ON COLLAPSE:

Increase in Trauma Patient Volumes Poor Payor Mix Drastic Cuts in Proposition 99 Tobacco

Tax Funds

INCREASE IN TRAUMA PATIENT VOLUMES:

YEAR TRAUMA PATIENT VOLUME

1992 12,718

1993 12,423

1994 12,151

1995 12,619

1996 12,596

1997 14,303

1998 15,252

1999 15,653

2000 16,912

2001 18,837

2002 19,196

PRIVATE TRAUMA CENTERS PAYOR MIX:

Medi-Cal15%

Medicare5%

Group11%

Worker's Comp5%

CASH32%

O ther *5%

HMO27%

County Funds Paid 71% of CASH

In Collection 15% of CASH

Self Pay1%

Charity Write-O ff14% of CASH

Fiscal Year 1997/98 (n = 6,745)

COUNTY TRAUMA CENTERS PAYOR MIX:

Worker's Comp1%

Medicare3%

Group9%

Medi-Cal32% CASH

38%

O ther *7%

HMO9%

County Funds Paid 52 o CASH In Collection

14% of CASH

Self Pay2%

Charity Write-O ff35% of CASH

Fiscal Year 1997/98 (n = 7,293)

DRASTIC CUTS IN TOBACCO TAX FUNDS:

1990/91

PHYSICIAN SERVICES

$7,711,000

HOSPITAL SERVICES

$9,209,000

2000/01 $596,000 $1,075,000

2001/02 $394,000 $998,000

Declined by 88%, while the indigent population for Los Angeles County steadily increased.

AS IF THAT WASN’T ENOUGH

Not only was LA facing the collapse of our Trauma System due to the Increase in Trauma Patient Volumes, Poor Payor Mix, and Drastic Cuts in Proposition 99 Tobacco Tax Funds

In addition, the County’s entire Medical Delivery System was verging on collapse due to the loss of Federal Medicaid "waiver" funding in two years.

BOARD OF SUPERVISORS HEARING JULY 30, 2002

Hearing to consider adoption of a resolution calling for voter approved special assessment

Supervisor Yaroslavsky “In less than 3 yrs, the County’s Section 1115 Medicaid Waiver will expire. In FY 05/06, we anticipate that the County will face a deficit of $710 million in the DHS budget…

“The projected decline in health funding will hurt County residents in many ways, but none so widespread as in the impact on trauma centers, EMS, and bioterrorism response.”

Board resolution providing for and giving notice of a special tax election

“While the County continues to press the State and Federal governments for relief, it should attempt to help itself by authorizing the raising of local revenues …”

“A charge of only 3 cents per sq foot of structural improvements…would raise approximately $168 million a year.”

“Preservation of Trauma Centers and EMS, Bioterrorism Response measure before the voters, does not come close to solving the County’s health funding crisis. However, it would go a long way toward the preservation of the most critically needed services provided by the County”

PURPOSE of MEASURE B

To avoid the life-threatening shutdown of Los Angeles County's trauma network,

To maintain and expand the trauma network Countywide, while ensuring more timely response to critical and urgent medical emergencies, and

To respond effectively to biological and chemical terrorism.

MEASURE B: November 5, 2002, Special Tax Election

Would Authorize the County of Los Angeles to levy a 3 cents per sq. ft. special tax on structural improvements to provide funding for the Countywide System of Trauma Centers, Emergency Medical Services and Bioterrorism Response.

Would require a 2/3 majority approval for passage from the voters.

Supervisors in favor of the measure 3:2

CAMPAIGN

Short time frame Educate Voters (history of passing Prop 13) Utilized Labor Union (SEIU) Board of Supervisor’s Support Retained Political Consultant –

Dakota Communication

CAMPAIGN (continued) Tenet Healthcare Hospital Association Endorsement by LA Times and Daily News EMS providers Free news coverage from local media Funding through Labor Union and coalition

of supporters

PROS versus CONS

Argument in Favor of Measure BPreservation of our most critically needed services!

Rebuttal to Argument for Measure BStop your taxes from rising out of control!

Virginia Price Hastings, Director, EMS Agency

Michael Metro, Chief, Paramedic Services, LA Co Fire

League of Women VotersStephen J. Ryan, MD, Dean, Keck

School of Medicine of USC

Michael D. Antonovich, Supervisor Triso Del Junco, MD, Chief

Medical Staff, ELA Star Community Hospital

Gary G. Hill, Chairman, Board of Directors, Antelope Valley Hospital

Jon Coupal, President, Howard Jarvis Taxpayers Association

TIMING IS EVERYTHING!

November 3, 2002

(Approximately 190 vehicles were involved. Roughly forty people were hospitalized, nine reportedly in critical condition.)

VIRGINIA TRIUMPHS!

MEASURE B WAS PASSED BY THE

VOTERS ON NOVEMBER 5, 2002

AT AN UNBELIEVABLE RATE OF 73%

MEASURE B FUNDS FY 2007/08

County Hospitals - County Departments - Trauma Hospitals / physicians -Grand Total -

140 million

9.8 million

44.6 million

197 million

DOWNFALLS OF MEASURE B

The passage of Measure B was no easy task Measure B has not resulted in a complete fixNot meeting expectations of:

EMS Providers All hospitals Underserved areas

REALITY OF MEASURE B

Saved our Trauma System Protects the emergency departments Makes a significant difference for

bio-terrorism preparedness

CREATIVE FUNDING

Thank you for listening to

Los Angeles County’s

creative solution to improving our

Trauma System funding.