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Currents To Medical Center Employees: Medicaid funds comprise a significant portion of the Medical Center’s   revenues. Last fiscal year, Medicaid funds amounted to approximately $155 million or 28 percent of our overall revenues of approximately $550 million. Currently we are keeping abreast of state and federal level deliberations concerning Medicaid funding.      We receive Medicaid funds through two methods. First, “fee for services” amounted to approximately $90 million of our Medicaid dollars last fiscal year.  This is referred to as the “base program,” and it includes the state’s match funds.  In the past, the state’s match funds have been funded through non-recurring funds.  The Governor’s budget proposes these match funds be clearly earmarked so we will not have to deal with the year-to-year unknowns of funding the match dollars through non-recurring funds. There have also been proposals by legislators to pass a tobacco tax to enable recurring funding.  In any event, we are encouraged that state leaders are focused on a long-term funding solution, and we will keep you abreast with the progress in this area.    A second source of funding is the Disproportionate Share (DSH) funds. The DSH funds amounted to $65 million, or approximately 40 percent of our Medicaid dollars last fiscal year. To arrive at DSH funding for our state, the federal government matches funds contributed by the state's public hospitals.  The U. S. Department of Health and Human Services is  currently revisiting the definition of “public hospitals.” The eligibility of MUSC to participate in the DSH program has not been a question, but some other hospitals in our state may be declared ineligible to participate in the DSH funds match program. If any hospitals that are currently participating in the DSH program are declared ineligible, this would be unfortunate for our state and would adversely effect MUSC’s funding. In the event that an unfavorable decision is reached, the net result could be a reduction in overall Medical Center DSH funding this fiscal year in the range of $4 to $5 million. We will be looking at options right away to address this potential funding reduction.    Thank you very much. W. Stuart Smith Vice President for Clinical Operations and Executive Director, MUSC Medical Center   Communications meeting targets Trauma Services Pending trauma legislation in the S.C. State Legislature needs grass roots support from the state’s citizens to save the existing system from termination, MUSC Trauma Services medical director Doug Norcross, M.D., told hospital administrators and managers Tuesday.     Those gathered for the Medical Center’s weekly scheduled communi-cations meeting also learned that funding to maintain and improve the trauma system could  be another hurdle against making the system a reality, even if the legislation passes.     “I suspect that’s how it will go down,” Norcross said, explaining that public pressure likely will force funding of the costly system once the legislation, which contains no adequate funding provision, is passed.     Citing National Safety Council statistics, Norcross said that an effective regionalized trauma system is especially needed in South Carolina because of the state’s high rates of both unintentional and intentional injuries and fatalities. He said that the state’s economic loss due to motor vehicle crashes alone amounts to a staggering $2 billion, and a total of $4 billion when all accidental injury is factored.     “The longer it takes to definitively treat a severely injured patient, the higher the rates of death and disability,” Norcross said in support of a system that includes a network of Level I, II and III trauma centers to provide care appropriate to a patient’s injuries. “All hospitals cannot provide care for all patients, so patients must get to a facility that can provide the care they need as quickly as possible, even if that means bypassing a closer hospital.”     A Level I hospital provides the highest level of care and can provide care for virtually any significant injury. Level II provides care for most injuries but may need to transfer patients with the most complex injuries. Level III provides care for uncomplicated injuries and stabilizes more complicated patients for transfer to Level I or II facilities.     Norcross took special pride in demonstrating ambulance and helicopter travel with an animated slide that drew cheers and applause from the audience as vehicles bypassed a local community hospital in favor of a Level I, II, or III trauma center and an air transport flew directly to a facility with the highest level of care.     As a result of legislation passed in 1980 that designated Level I trauma centers in the state and further legislation in the 1990s that developed Level II and III centers, seriously injured patients were provided access to quality trauma care that meets national standards.     “But the trauma system is in jeopardy,” Norcross said. Poorly designed administrative structure, lack of funding, the fact that trauma patients generally are less able to pay for their care than other patients, and the hospitals’ inability to collect from legal settlements all contribute to a potential dismantling of the system.     Hospitals suffer from the burden of having to absorb a disproportionate number of patients unable to pay the cost of their care, Norcross said, and the toll on trauma surgeons is daunting.     “Physicians caring for these patients are expected to provide for a very labor intensive, and often unappreciative group of patients at all hours of the day or night,” he explained. “Rather than being rewarded for this, they are, instead, punished both financially and personally for doing so.”     In recent years, pressures on trauma centers have forced the withdrawal of hospitals from the trauma system and the termination of trauma service directors and trauma surgeons in the state. Some hospitals have decreased from Level II to Level III status. And an increased difficulty in attracting trauma surgeons to the state is a continuing problem, as is decreased activity in trauma research.     Norcross said that the pending legislation in the S.C. Legislature promises to be the state’s best hope for an effective and well run trauma system. He said that Senate Bill 713 and House Bill 4262, known as the Trauma Care Act:  Provides legal authority to a redesigned state agency to regulate the trauma system, to perform inspections and to develop standards for trauma centers and the trauma system Provides for revocation of trauma center designation  Allows the state to fine hospitals or agencies advertising themselves as trauma centers or as part of the trauma system that are not so designated by the state Mandates development and composition of a “Trauma Advisory Council” to serve as technical advisors in trauma system development and maintenance Provides for confidentiality of trauma registry data submitted to the state Provides that, unless adequately funded, the state is under no obligation to carry out their duties under the law Establishes the South Carolina Trauma Care Fund Funding sources provided in the bill, Norcross said, are inadequate, assuming the Trauma Care Act passes. But he predicts it will take public pressure to make a funded trauma system a reality.     “It’s important that we understand the scope of this problem and its impact on the state’s economy and on the health and welfare of its citizens,” Norcross said. He added that it would be helpful for people to contact their legislative representatives and make known their concern about the state’s trauma system. Announcement Carol Dobos, director, Children’s Services, introduced Deborah Browning as the interim nurse manager of the Pediatric Emergency Department.       Catalyst Online is published weekly, updated as needed and improved from time to time by the MUSC Office of Public Relations for the faculty, employees and students of the Medical University of South Carolina. Catalyst Online editor, Kim Draughn, can be reached at 792-4107 or by email, catalyst@musc.edu. Editorial copy can be submitted to Catalyst Online and to The Catalyst in print by fax, 792-6723, or by email to petersnd@musc.edu or catalyst@musc.edu. To place an ad in The Catalyst hardcopy, call Community Press at 849-1778.