march 2012 adminreport - georgia trauma...

March 2012 Meeting Letton Auditorium, Atlanta Medical Center

Thursday, 15 March 2012 10:00 am until 1:00 pm

Call to order and Chairman’s report Dr. Dennis Ashley Quorum established Dr. Dennis Ashley Agenda review Jim Pettyjohn RTAC Reports:

RTAC IX (action required) Dr. Gage Ochsner

RTAC V Debra Kitchens RTAC VI Regina Medeiros RTAC I Randy Pierson Draft Strategic Plan (action required) Carol Pierce Georgia Committee On Trauma Excellence Report Elaine Frantz Greg Pereira EMS Subcommittee of Trauma Report Ben Hinson FY 2012 EMS Vehicle Equipment Grants (action required) Jim Pettyjohn Trauma Communications Center Update John Cannady eBroselow Program Update Linda Cole Trauma Associates of Georgia Proposal Debra Kitchens Georgia Committee on Trauma Proposal Debra Kitchens FY 2012 Budget and Expenditures Update Judy Geiger FY 2013 Commission Budget Discussion Draft Linda Cole Jim Pettyjohn Judy Geiger

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Trauma Centers and Physicians Funding Subcommittee Report Dr. Leon Haley Greg Bishop DPH OEMS, Office of Trauma Dr. Pat O’Neal

Keith Wages Renee Morgan

Law Report Alex Sponseller Old Business Dr. Dennis Ashley Next meeting and adjourn Dr. Dennis Ashley

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Jim Pettyjohn - [email protected] - 706.398.0842

ADMINISTRATIVE REPORT

September 2011

SB 489 Page 5 Bill as passed by the Senate attached Super Speeder Report February 2012: Page 6 Report attached. Significant increase in revenues collected for reinstatement fees for February 2012 ($1,103,870) over January 2012 ($355,260). Collections also increase for speeding fines for same period : February 2012 ($1,407,235) over January 2012 ($951,925). Total collections for January 2012: $1,307,185 Total collections for February 2012: $2,511,105 Total collections for FY 2012 to date: $12,029,290 (four months left in FY) AFY 2012: $15,937,214 RTAC VI: Page 9 Report Attached. Regina Medeiros to present. Draft Strategic Plan: Page 23 DRAFT Report Attached. Carol Pierce to present. January 2012 Day Two minutes approval 7 DRAFT Document Attached 07 February 2012 EMS Subcommittee of Trauma minutes Page 56 DRAFT Document Attached.

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Jim Pettyjohn - [email protected] - 706.398.0842

eBroselow program Update Page 62 Five-year Proposal attached Linda Cole to present Trauma Associates of Georgia Funding Proposal Page 63 Proposal Document attached Debra Kitchens to present Georgia Committee on Trauma Funding Proposal Page 65 Proposal Document attached Debra Kitchens to present FY 2012 Budget and Expenditures Report Page 67 Document attached Judy Geiger to present FY 2013 Commission Budget Discussion Draft Page 73 Document attached Commission and Staff discussion Alternatives of Readiness Cost Funding Levels Page 85 Discussion document attached Dr. Leon Haley with Greg Bishop to present

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12 SB 489/FA/2

S. B. 489- 1 -

Senate Bill 489

By: Senators Mullis of the 53rd, Unterman of the 45th, Albers of the 56th, Rogers of the

21st, Gooch of the 51st and others

AS PASSED SENATE

A BILL TO BE ENTITLED

AN ACT

To amend Chapter 11 of Title 31 of the Official Code of Georgia Annotated, relating to1

emergency medical services, so as to require the Georgia Trauma Care Network Commission2

to report annually to the House and Senate Committees on Health and Human Services3

documenting certain outcomes and verifying certain expenditures of funds; to provide for4

related matters; to repeal conflicting laws; and for other purposes.5

BE IT ENACTED BY THE GENERAL ASSEMBLY OF GEORGIA:6

SECTION 1.7

Chapter 11 of Title 31 of the Official Code of Georgia Annotated, relating to emergency8

medical services, is amended by revising Code Section 31-11-103, relating to the Georgia9

Trauma Trust Fund, as follows:10

"31-11-103.11

(a) There is established the Georgia Trauma Trust Fund. The executive director of the12

Georgia Trauma Care Network Commission shall serve as the trustee of the Georgia13

Trauma Trust Fund. The moneys deposited into such fund pursuant to this article may be14

expended by the executive director with the approval of the Georgia Trauma Care Network15

Commission for those purposes specified in Code Section 31-11-102.16

(b) The Georgia Trauma Care Network Commission shall report annually to the House17

Committee on Health and Human Services and the Senate Health and Human Services18

Committee. Such report shall provide an update on state-wide trauma system development19

and the impact of fund distribution on trauma patient care and outcomes."20

SECTION 2.21

All laws and parts of laws in conflict with this Act are repealed. 22

5

H://HB 160/FY 2012 Super Speeder Notices and Collections February 2012(1).xls

HB 160Super Speeder Reinstatement Total

($200 Fine) Fees Collected

FY 2010January 2010 200 0February 2010 15,200 0March 73,012 0April 2010 97,368 0May 2010 226,095 0June 2010 293,195 0

FY 2010 Total 705,070 1,331,835 2,036,905

FY 2011July 2010 482,600 292,125 774,725August 2010 637,600 253,505 891,105September 2010 695,450 274,585 970,035October 2010 794,890 354,194 1,149,084November 2010 696,250 208,000 904,250December 2010 787,700 291,530 1,079,230January 2011 847,285 306,805 1,154,090February 2011 1,135,695 774,490 1,910,185March 2011 1,019,570 623,935 1,643,505April 2011 778,250 442,465 1,220,715May 2011 907,290 439,905 1,347,195 June 2011 766,655 356,725 1,123,380

FY 2011 Total 9,549,235 4,618,264 14,167,499

FY 2012July 2011 971,355 456,445 1,427,800August 2011 920,895 390,445 1,311,340September 2011 955,200 414,480 1,369,680October 2011 903,500 501,190 1,404,690November 2011 973,600 430,035 1,403,635December 2011 883,800 410,055 1,293,855January 2012 951,925 355,260 1,307,185February 2012 1,407,235 1,103,870 2,511,105March 2012 0 0 0April 2012 0 0 0May 2012 0 0 0 June 2012 0 0 0

FY 2012 Total 7,967,510 4,061,780 12,029,290

OVERALL TOTALS 18,221,815 10,011,879 28,233,694

Department of Driver ServicesHB 160 Notice and Revenue Tracking

Month and Year

6


SUPER SPEEDER - $200 FINE

Second Notice - FYInitial Notice Suspension Amount Collection($200 Fine) ($50 Fine) Receivable Total Revenue Collected Outstanding Rate

FY 2010January 2010 142 0 28,400$ 200$ 28,200$ February 2010 1,084 0 216,800 15,200 201,600 March 2,546 0 509,200 73,012 436,188 April 2010 3,659 0 731,800 97,368 634,432 May 2010 4,746 57 952,050 226,095 725,955 June 2010 4,927 505 1,010,650 293,195 717,455

FY 2010 Total 17,104 562 3,448,900$ 705,070$ 2,743,830$ 20.4%

FY 2011July 2010 6,166 927 1,279,550 482,600 796,950 August 2010 5,863 1,536 1,249,400 637,600 611,800 September 2010 6,669 2,157 1,441,650 695,450 746,200 October 2010 5,760 1,980 1,251,000 794,890 456,110 November 2010 5,107 2,471 1,144,950 696,250 448,700 December 2010 4,301 2,688 994,600 787,700 206,900 January 2011 4,498 2,958 1,047,500 847,285 200,215 February 2011 7,111 2,256 1,535,000 1,135,695 399,305 March 2011 5,886 2,073 1,280,850 1,019,570 261,280 April 2011 5,056 1,479 1,085,150 778,250 306,900 May 2011 5,334 1,577 1,145,650 907,290 238,360 June 2011 5,390 3,367 1,246,350 766,655 479,695

FY 2011 Total 67,141 25,469 14,701,650$ 9,549,235$ 5,152,415$ 65.0%

FY 2012July 2011 6,264 2,382 1,371,900 971,355 400,545 August 2011 7,083 2,247 1,528,950 920,895 608,055 September 2011 6,725 2,322 1,461,100 955,200 505,900 October 2011 6,672 2,064 1,437,600 903,500 534,100 November 2011 5,611 2,580 1,251,200 973,600 277,600 December 2011 5,432 3,021 1,237,450 883,800 353,650 January 2012 5,759 2,640 1,283,800 951,925 331,875 February 2012 7,323 2,767 1,602,950 1,407,235 195,715 March 2012 - - April 2012 - - May 2012 - - June 2012 - -

FY 2012 Total 50,869 20,023 11,174,950$ 7,967,510$ 3,207,440$ 71.3%

OVERALL TOTALS 135,114 46,054 29,325,500 18,221,815 11,103,685 62.1%

Department of Driver ServicesHB 160 Notice and Revenue Tracking

Month and Year

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HB 160, PART I - REINSTATEMENT FEESFY

Combined No. Amount CollectionNotices Receivable Total Revenue Collected Outstanding Rate

FY 2010July 2009 21,743 -$ -$ August 2009 15,489 - - September 2009 14,435 - - October 2009 12,585 - - November 2009 11,538 - - December 2009 16,697 - - January 2010 16,152 - - February 2010 13,481 - - March 2010 17,882 - - April 2010 14,764 - - May 2010 15,558 - - June 2010 16,846 - -

FY 2010 Total - 187,170 15,988,315$ 1,331,835$ 14,656,480$ 8.3%Average 15,598

FY 2011July 2010 17,940 1,604,035 292,125 1,311,910 August 2010 22,614 1,951,045 253,505 1,697,540 September 2010 16,314 1,535,960 274,585 1,261,375 October 2010 19,805 1,725,135 354,194 1,370,941 November 2010 17,032 1,573,985 208,000 1,365,985 December 2010 17,270 1,525,570 291,530 1,234,040 January 2011 12,649 1,196,620 306,805 889,815 February 2011 13,270 1,332,835 774,490 558,345 March 2011 16,119 1,612,015 623,935 988,080 April 2011 13,667 1,325,830 442,465 883,365 May 2011 16,119 1,526,300 439,905 1,086,395 June 2011 15,753 1,511,050 356,725 1,154,325

FY 2011 Total - 198,552 18,420,380$ 4,618,264$ 13,802,116$ 25.1%

FY 2012July 2011 16,131 1,469,530 456,445 1,013,085 August 2011 19,288 1,775,010 390,445 1,384,565 September 2011 18,457 1,678,330 414,480 1,263,850 October 2011 16,530 1,521,305 501,190 1,020,115 November 2011 14,318 1,375,720 430,035 945,685 December 2011 13,575 1,347,635 410,055 937,580 January 2012 14,767 1,412,265 355,260 1,057,005 February 2012 13,540 1,362,850 1,103,870 258,980 March 2012 - - - April 2012 - - - May 2012 - - - June 2012 - - -

FY 2012 Total - 126,606 11,942,645$ 4,061,780$ 7,880,865$ 34.0%

OVERALL TOTALS 512,328 46,351,340 10,011,879 36,339,461 21.6%

Month and Year

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REGION V I TRAUMA ADV ISORY COMMITTEE

COMMISSION UPDATE MARCH 2012

Despite great efforts trauma remains the third leading cause of death overall and the leading cause of death for those ages 1 – 44 yrs. In Georgia, the death rate from trauma remains higher than the national average. The Georgia Trauma Care Network Commission (GTCNC) found these statistics unacceptable and embarked on a mission to decrease the death rate from trauma and ensure the right patient gets to the right hospital at the right time. Only thirty percent of trauma injuries in Georgia are treated at a designated trauma centers. The National Study on the Cost of Outcomes of Trauma (NSCOT) identified a 25% reduction in mortality for severely injured patients who receive care at a Level I trauma center. The commission designated Region VI as one of two regions tasked with piloting a framework for the development of a Regionalized Trauma Plan with to goal of getting the right patient to the right hospital at the right time. The Region VI RTAC plan was approved by the commission on September 15, 2011. A 16 member committee was appointed by the Chair of the Region VI EMS Council to take on the task of implementing and testing the regional trauma plan. To date this group has been active in developing a strategy for success. Some restructuring has taken place within the committee; an updated membership list is attached to this document. The Region VI RTAC utilizes the Public Health Model developed by the HRSA as the basis for operationalizing the regional trauma plan.

There are three main components of this model: Assessment, Policy Development and Assurance Assessment

• Identification of injury problems • Assessment of system resources: infrastructure, process and performance • Benchmarks for measurement of change

Policy Development • Lead Agency Identification: State office of EMS&T/GTCNC • Identification of role in policy development • Enabling legislation: SB60 • Trauma System Plan • Management information system: Registry and TCC • Benchmarks

Assurance • Enforcement and Regulation • Patient destination and hospital care • EMS systems and assurance • Training and Education • Evaluation and Performance Improvement

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SUBCOMMITTEE DESCRIPTIONS AND ASSIGNMENTS

Because the task at hand was large and there was a strong desire to keep the trauma stakeholders engaged in the process, RTAC subcommittees were created. These subcommittees are chaired by members of the RTAC however subcommittee membership was open to any trauma stakeholder interested in participating. Each subcommittee was required to ensure their membership was multidisciplinary.

Education Committee – The education committee is responsible for education of all health care providers participating in trauma care within Region VI. Their first task is the development and implementation of a comprehensive plan to educate EMS providers and hospitals regarding the operationalization of the plan, the CDC field triage criteria and the TCC.

Following the primary education related to the plan the Education Subcommittee will coordinate efforts related to trauma education including but not limited to ITLS, PHTLS, ATLS, TNCC and ATCN. The Education Subcommittee will also develop and implement educational programs related to issues identified in the PI committee.

Performance Improvement Committee – The PI committee will develop a matrix for measuring process and outcomes for trauma care delivered within Region VI. The PI committee will also develop a system by which providers within region VI can submit issues for review. Data from the TCC will also be reviewed by this committee and recommendations for improvement will be reported to full committee for a vote.

TCC Committee – This committee will function as the primary POC and liaison between Region VI RTAC and the TCC. The members of this committee will make recommendations regarding TCC use and will be the POC for TCC members to report issues identified related to communication and use of the system. This committee will assist with the education and implementation of the TCC dashboards and provide any ongoing support to hospital and provides related to the TCC as needed.

Guidelines Committee – This committee is responsible for the development and implementation of guidelines for the care and treatment of trauma victims within Region VI. Some examples of the guidelines they will develop include guidelines for use of the TCC, transport from the field to designated and NDPH as well as interfacility transfer. They will also develop guidelines related to education and performance improvement in conjunction with their respective committees.

Regional Trauma Resource Committee – This committee is be responsible for the evaluation of existing resources within Region VI related to trauma care and will make recommendations based on their finding for additional designated trauma centers.

Attached to this document is a list of subcommittees, their membership and the goals/objectives and timeline for completion.

10

REGION V I TRAUMA ADV ISORY COMMITTEE

COMMISSION UPDATE MARCH 2012

Despite great efforts trauma remains the third leading cause of death overall and the leading cause of death for those ages 1 – 44 yrs. In Georgia, the death rate from trauma remains higher than the national average. The Georgia Trauma Care Network Commission (GTCNC) found these statistics unacceptable and embarked on a mission to decrease the death rate from trauma and ensure the right patient gets to the right hospital at the right time. Only thirty percent of trauma injuries in Georgia are treated at a designated trauma centers. The National Study on the Cost of Outcomes of Trauma (NSCOT) identified a 25% reduction in mortality for severely injured patients who receive care at a Level I trauma center. The commission designated Region VI as one of two regions tasked with piloting a framework for the development of a Regionalized Trauma Plan with to goal of getting the right patient to the right hospital at the right time. The Region VI RTAC plan was approved by the commission on September 15, 2011. A 16 member committee was appointed by the Chair of the Region VI EMS Council to take on the task of implementing and testing the regional trauma plan. To date this group has been active in developing a strategy for success. Some restructuring has taken place within the committee; an updated membership list is attached to this document. The Region VI RTAC utilizes the Public Health Model developed by the HRSA as the basis for operationalizing the regional trauma plan.

There are three main components of this model: Assessment, Policy Development and Assurance Assessment

• Identification of injury problems • Assessment of system resources: infrastructure, process and performance • Benchmarks for measurement of change

Policy Development • Lead Agency Identification: State office of EMS&T/GTCNC • Identification of role in policy development • Enabling legislation: SB60 • Trauma System Plan • Management information system: Registry and TCC • Benchmarks

Assurance • Enforcement and Regulation • Patient destination and hospital care • EMS systems and assurance • Training and Education • Evaluation and Performance Improvement

11

SUBCOMMITTEE DESCRIPTIONS AND ASSIGNMENTS

Because the task at hand was large and there was a strong desire to keep the trauma stakeholders engaged in the process, RTAC subcommittees were created. These subcommittees are chaired by members of the RTAC however subcommittee membership was open to any trauma stakeholder interested in participating. Each subcommittee was required to ensure their membership was multidisciplinary.

Education Committee – The education committee is responsible for education of all health care providers participating in trauma care within Region VI. Their first task is the development and implementation of a comprehensive plan to educate EMS providers and hospitals regarding the operationalization of the plan, the CDC field triage criteria and the TCC.

Following the primary education related to the plan the Education Subcommittee will coordinate efforts related to trauma education including but not limited to ITLS, PHTLS, ATLS, TNCC and ATCN. The Education Subcommittee will also develop and implement educational programs related to issues identified in the PI committee.

Performance Improvement Committee – The PI committee will develop a matrix for measuring process and outcomes for trauma care delivered within Region VI. The PI committee will also develop a system by which providers within region VI can submit issues for review. Data from the TCC will also be reviewed by this committee and recommendations for improvement will be reported to full committee for a vote.

TCC Committee – This committee will function as the primary POC and liaison between Region VI RTAC and the TCC. The members of this committee will make recommendations regarding TCC use and will be the POC for TCC members to report issues identified related to communication and use of the system. This committee will assist with the education and implementation of the TCC dashboards and provide any ongoing support to hospital and provides related to the TCC as needed.

Guidelines Committee – This committee is responsible for the development and implementation of guidelines for the care and treatment of trauma victims within Region VI. Some examples of the guidelines they will develop include guidelines for use of the TCC, transport from the field to designated and NDPH as well as interfacility transfer. They will also develop guidelines related to education and performance improvement in conjunction with their respective committees.

Regional Trauma Resource Committee – This committee is be responsible for the evaluation of existing resources within Region VI related to trauma care and will make recommendations based on their finding for additional designated trauma centers.

Attached to this document is a list of subcommittees, their membership and the goals/objectives and timeline for completion.

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RTAC REGION VI EDUCATION WORKGROUP (2 .2012)

Primary Goals with short term timeline. In conjunction with the TCC workgroup, ensure that participating ED’s are educated on TCC website and procedures

• See TCC update for details on status Education for EMS Personnel

• Three train the trainer classes have been held around the region. Materials have been sent via email to each trainer. In addition, training materials have been posted to the GTCNC website for download.

• Ongoing training for EMS related to the Regional Trauma Plan, the TCC, Field Triage Criteria and Reporting is currently underway. To date Emmanuel, Jenkins and Warren EMS services have completed training and are calling into the TCC. Data is being collected by the TCC and the Level I trauma center in the region.

Education for Hospital Personnel A gap in education was identified, local hospital ED staff were not originally included in the training plan. A comprehensive training package is being developed and will be implemented for hospital ED staff related to the Regional Plan, TCC, Field Triage Criteria, Re-‐triage, and Stabilization and Transport. Incorporated into that package will also be education and training on the e-‐Broselow System. Secondary Goals with long range timeline:

• Assess ongoing education needs of the region and implement programs to address needs • Research resource availability for ITLS, PHTLS, TNCC, ATCN, ENPC, EPC, ABLS, ATLS • Develop and implement ongoing prevention and community outreach program

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RTAC REGION VI PERFORMANCE IMPROVEMENT WORKGROUP TIME LINE

October – December: Identify one performance improvement question from each section identified in the framework that is relevant and measureable January – March: Develop a plan and tool to measure the identified questions April – June: Collect data (sources of data will be TCC, registry, PCR, and possible the uniform discharge data set to capture data from NDPH) July – September: Finalize data collection, report results, plan for next phase of PI expansion. Goal is to have full PI program in place within five years. At five year mark will repeat BIS assessment to measure change in regional results.

RTAC REGION VI PERFORMANCE IMPROVEMENT WORKGROUP GOALS AND OBJECTIVES

The Performance Improvement Workgroup will use the public health model as a framework Goal: To develop a matrix for measuring process and outcomes for trauma care delivered within Region VI. Assessment: Determine if all EMS providers are using the same triage decision making scheme to determine destination. Based on findings -‐ implement new tool, educate and measure difference.

• Training has taken place regarding the new CDC field triage criteria. A new revamp of the hospital response guideline has taken place. The new guideline will be shared with EMS to help increase awareness and understanding of the use of PAMCo and how it impact team activation. Over and Under triage will be monitored using the Cribari Modified Grid.

Policy Development: Pre/post implementation of plan measure, develop questionnaire for all participating hospitals looking at attitude toward regionalization plan and implementation. Develop and implement training on plan. Do post implementation questionnaire. Measure difference.

• Pre-‐Questionnaire and Post-‐Questionnaire has been developed. Pre-‐Questionnaire will be distributed to EMS during the training sessions related to the TCC and the regionalization plan. Post-‐Questionnaires will be distributed 3 – 6 months following implementation.

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Assurance: Patient destination – develop methodology and tool for measuring time from injury identification to definitive care. Time from 911 call to hospital care. To begin data collection after tool and methodology are confirmed.

• Utilizing the registry a benchmark will be identified that measure the average time from scene to arrival at the trauma center. Prospective data will be collected that will include this benchmark to identify impact of TCC and plan on time.

This first year will be a test year. Look at feasibility of measuring performance utilizing the model and framework proposed.

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1

RTAC Resource Committee Report Updated 02/15/12

Committee Members

Pam Tucker, Chairperson Peggy Barmore Jim Cruickshank

Elliott Price Harry Wingate

Region VI RTAC 2012 Meeting Dates Richmond County Board of Health

1916 North Leg – Building D Augusta, GA 30907

February 15, 2012 – 3:00 p.m.

April 25, 2012 – 3:30 p.m. July 25, 2012 – 3:30 p.m.

October 24, 2012 – 3:30 p.m.

Proposed Resource Workgroup Meeting Dates

Met on Tuesday, January 24, 2012 @ 11:45 a.m. Tuesday, April 17, 2012 Tuesday, July 17, 2012

Tuesday, October 23, 2012

Goals & Objectives

I. Evaluate existing trauma care resources within Region VI a) Mine accessible data to develop a list of existing resources b) Assign committee contact responsibilities to verify or update data

II. Make recommendations for additional designated trauma centers a) Optimize the utilization of existing limited resources b) Formulate plan and policies

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2

Timeline

October – December 2011: Hold first workgroup meeting and determine action steps to accomplish the overall goals and objectives; set up future meeting schedule and member roles.

January – March 2012: Designate research responsibilities to workgroup members to verify or update existing data; maintain a central database of all information collected and complete mapping.

April – June 2012: Conduct a comprehensive review of all data collected to identify gaps in service areas.

July - September 2012: Formulate a plan with associated policies, including recommendations for possible additional hospitals to become designated trauma centers within Region VI.

Workgroup Action Steps – January –March 2012

• Coordinate with Dr. Wingate’s schedule to hold a meeting before next RTAC Meeting (February 1, 2012 @ 3:30 p.m.) – Completed

• Obtain a list of all hospitals and addresses in Region VI (Aiken & Edgefield) – (Received list of hospitals and addresses on 12/05/11.) - Completed

• Request information from EMS Council regarding vehicle crashes with injuries and what hospital the injured were transported to. – State advised on 01/06/12 that the information we requested is not complete, accurate or reliable in the GEMSIS database, so they could not provide the data we requested.

• Coordinate with Columbia County GIS to map all hospitals and crash/injury transports once information is received. – Completed; see above regarding crash/injury info

• Assemble existing information on current hospital capabilities; Dr. Wingate and Rene Hopkins – what databases exist for this information and how all hospital trauma treatment levels. - Ongoing

• Develop a chart showing existing trauma treatment levels at Region VI hospitals and add to map. – Completed

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3

Workgroup Action Steps for April – June 2012 (from Jan 24th Meeting)

• Determine if the questionnaires sent to hospitals by Regina have service inventory. – Regina provided the form (copy attached) to Pam on 01/25/12, but it does not provide info needed.

• The “Service Inventory” information will be requested from the various hospital administrations. – Pam sent letters on behalf of the Resource Committee to all participating hospitals on 01/30/12 *Received Service Inventory Information from University Hospital, Trinity Hospital and Jefferson County…as of 02/15/12

• Requests for information will not include Screven and Jenkins at this time since they are not currently participating in RTAC. – Ongoing process

• Tripp Wingate will provide information about training conducted at hospitals regarding their becoming (at least) Level IV Trauma Centers. Pam will distribute to committee members when received. – Pam forwarded info sent by Dr. Wingate to all Committee members on 01/26/12

• Add all of the EMS services in Region VI to the map. – EMS station locations for entire region was sent to GIS to add to map. We should have the updated map within a few days.

• Add Washington County Regional Medical Center to the map – Completed – updated map attached.

• Obtain baseline date for morbidity and mortality rates. – Joy Miller (Director of Epidemiology for East Central Health District) providing the state public health Website (OASIS) that will need to be mined for this data.

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4

Levels of Definitive Trauma Care Facilities

LEVEL I A Level I Trauma Center is a comprehensive regional resource that is a tertiary care facility central to the trauma system. A Level I Trauma Center is capable of providing total care for every aspect of injury – from prevention through rehabilitation.

Key elements of a Level I Trauma Center include 24-hour in-house coverage by general surgeons, and prompt availability of care in specialties such as orthopedic surgery, neurosurgery, anesthesiology, emergency medicine, radiology, internal medicine and critical care. Other capabilities include cardiac, hand, pediatric, microvascular surgery and hemodialysis. The Level I Trauma Center provides leadership in prevention, public education and continuing education of the trauma team members. The Level I Trauma Center is committed to continued improvement through a comprehensive quality assessment program and an organized research effort to help direct new innovations in trauma care.

LEVEL II A Level II Trauma Center is able to initiate definitive care for all injured patients.

Key elements of a Level II Trauma Center include 24-hour immediate coverage by general surgeons, as well as coverage by the specialties of orthopedic surgery, neurosurgery, anesthesiology, emergency medicine, radiology and critical care. Tertiary care needs such as cardiac surgery, hemodialysis and microvascular surgery may be referred to a Level I Trauma Center. The Level II Trauma Center is committed to trauma prevention and to continuing education of the trauma team members. The Level II Trauma Center is dedicated to continued improvement in trauma care through a comprehensive quality assessment program.

LEVEL III A Level III Trauma Center has demonstrated an ability to provide prompt assessment, resuscitation, stabilization of injured patients and emergency operations.

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5

Key elements of a Level III Trauma Center include 24-hour immediate coverage by emergency medicine physicians and the prompt availability of general surgeons and anesthesiologists. The Level III program is dedicated to continued improvement in trauma care through a comprehensive quality assessment program. The Level III Trauma Center has developed transfer agreements for patients requiring more comprehensive care at a Level I or Level II Trauma Center. A Level III Trauma Center is committed to the continued education of the nursing and allied health personnel or the trauma team. It must be involved with prevention and must have an active outreach program for its referring communities. The Level III Trauma Center is also dedicated to improving trauma care through a comprehensive quality assessment program.

LEVEL IV A Level IV Trauma Center has demonstrated an ability to provide advanced trauma life support (ATLS) prior to transfer of patients to a higher level trauma center.

Key elements of a Level IV Trauma Center include basic emergency department facilities to implement ATLS protocols and 24-hour laboratory coverage. Transfer to higher level trauma centers follows the guidelines outlined in formal transfer agreements. The Level IV center is committed to continued improvement of these trauma care activities through a formal quality assessment program. The Level IV center should be involved in prevention, outreach and education within its community.

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TCC Workgroup Goals I. In collaboration with the TCC staff we will ensure that the dedicated personal computers are placed in

the participating hospital with the requisite software loaded and enabled. Assist TCC personnel in the implementation as needed.

II. In collaboration with the TCC ensure that appropriate training is made available to the hospital personnel utilizing the TCC monitoring system.

GHSU – Dedicated monitor in use, training complete, receiving calls and transfers Burke Medical Center – Computer in place, training complete Doctor’s Hospital – Computer in place, training complete Emanuel Med. Center – Computer in place, training complete Jefferson Hospital – Computer in place, training complete Trinity Hospital – Computer in place, training complete University Hospital – Computer in place, training complete McDuffie Regional – Have computer, training in process Wills Memorial – Have computer, training in process Aiken Regional – Requested to participate with TCC, demonstration pending Jenkins Co. Hospital – Not participating Screven Hospital – Not participating .

III. Encourage the TCC to establish a call list for assistance that includes who to call for specific issues. Complete

IV. Ensure that participating hospitals utilize the TCC when transferring patients to appropriate designated trauma centers. Ongoing.

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Jefferson Hospital

Jenkins County Hospital

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Screven Memorial Hospital

Trinity HospitalUniversity Hospital

Wills Memorial HospitalTrauma Level IV

Emanuel Medical CenterTrauma Level IV

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GTC Annual Meeting ·∙ Day One·∙ January 2012 ·∙ Page 1

Meeting Report

Georgia Trauma Commission Annual Workshop Thursday, 26 January 2012

Intended Meeting Result: To advance the vision for a comprehensive trauma system in Georgia by identifying actions and metrics for 2012-2015. Participants: Dr. Dennis Ashley, Chair GTC, Medical Center of Central Georgia; Dr. Robert Cowles, member GTC, Cowles Clinic; Dr. Leon Haley, vice-Chair GTC, Grady Hospital; Linda Coles, Secretary/Treasurer GTC, Childrens Health Care of Atlanta; Elaine Frantz, member GTC Memorial Hospital; Ben Hinson, member GTC, Mid Georgia Ambulance; Dr. Fred Mullins, member GTC, Joseph M Still Burn Center; Bill Moore, member GTC, Atlanta Medical Center; Courtney Terwilliger, GAEMS; Keith Wages, OEMS&T; Lee Oliver, MCCG; Gina Solomon ,Gwinnett Medical Center; Laura Garlow, WellStar Kennestone Hospital; Fran Lewis, Grady Hospital; Alex Sponseller, Attorney General; Russ McGee, OEMS&T Region 5 EMS; Lawanna Mercer-Cobb, OEMS&T Region 6 EMS; Renee Morgan, OEMS&T; Dr. Pat O’Neal, DPH; Judy Geiger, staff GTC; Michelle Martin, staff GTC; John Cannady, staff GTC; Lauren Noethen, GTC; and Jim Pettyjohn, GTC. Background: To prepare for the strategic planning discussion, three documents were provided to participants. These documents included: 1) A Comprehensive Trauma System for Georgia, 2011-14 Strategic Plan Summary, draft; 2) The State of Trauma, Chairman’s Annual Report, January 2012 and 3) Summary Accomplishments and Gaps Update: American College of Surgeons Trauma System Consultation Recommendations for Georgia: January 2009 (ACS) and Our Emerging Vision: A New Public Service for Georgians, February 2009. The ACS and Our Emerging Vision Summary document summarized the recommendations from the 2009 ACS consultation visit and Emerging Vision objectives, 2009-2014, the adopted strategic plan by the Georgia Trauma Commission (GTC), in to “like” or similar sections. Georgia Trauma Commission staff and Office of Emergency Medical Services and Trauma (OEMS&T) staff provided feedback on what had been accomplished and what remaining gaps need to be addressed. Ten of the eighteen priorities in the ACS Report were proposed for discussion based on the pre-meeting feedback and input provided by the GTC Committee of Officers, Governor’s EMS Representative on the GTC, GTC staff and OEMS&T staff, and information in the State of Trauma Chairman’s Annual Report, January 2012. The ten priorities selected addressed the most immediate concerns expressed and thus became top priorities for meeting discussion and guidance for work in the upcoming 2012 to 2015 timeframe. The remaining priorities don’t “go away”, they will remain in the summary document for reference. The ten ACS priorities selected include: Indicators as a Tool for System Assessment; Statutory Authority and Administrative Rules; System Leadership; Lead Agency and Human Resources Within the Lead Agency; Trauma System Plan; System Integration; Financing; Emergency Medical Services; Definitive Care Facilities; System-Wide Evaluation and Quality Assurance. Coalition Building and Community Support was added as another important priority for discussion, totaling eleven ACS priorities. Participants reviewed the summary information for the eleven selected ACS priorities, discussed the information and identified actions based on criteria. Actions were defined as proposed activities or movement needed to address the identified need. The following criteria were proposed and accepted as a basis for selecting actions: 1) Does the action support role clarification among trauma system leaders and organizations?

2) Does the action promote collaboration and partnership? 3) Does the action promote optimal outcomes for the seriously injured? 4) Does the action provide evidence for a return on investment?

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The 2012-2015 Georgia Trauma System Strategic Plan draft included within this document is proposed based on the discussion and actions identified by meeting participants. Timeframe and metrics were added post-meeting and should be considered draft at this stage. The timeframes for actions have been defined as:

Year 1: Near term, 01 July 2012 – 30 June 2013 Year 2: Intermediate, 01 July 2012 – 30 June 2014 Year 3: Long term, 01 July 2012 – 30 June 2015

Once the Strategic Plan draft has been reviewed and feedback provided, budget impact will be added. Once approved by the GTC, the new 2012-2015 Georgia Trauma System Strategic Plan will replace Our Emerging Vision: A New Public Service for Georgians, February 2009 as the Georgia Trauma Commission’s strategic plan. This new plan will begin July 2012.

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Summary: Goals and Objectives, 2012-2015 by Related ACS Priorities ACS Priority: (Relates to Goal A) Indicators for System Assessment

Goal A: Assess the trauma system and develop plans for improvement. Objective 1A: Complete the Benchmarks, Indicators and Scoring (BIS) assessment by all ten EMS Regions as part of their trauma system regionalization activities within Year 2. Objective 2A: Complete a statewide Benchmarks, Indicators and Scoring (BIS) assessment by trauma system stakeholders within Year 3.

ACS Priorities: (Relates to Goals B, C and D) Statutory Authority and Administrative Rules System Leadership (relates to System Integration) Lead Agency and Human Resources within the Lead Agency Definitive Care Trauma System Plan

Goal B: Clarify and delineate trauma system leadership roles. Objective B1: Implement recommendations that assures essential system development tasks are addressed, effective collaboration and coordination of trauma system stakeholders occurs and is the best use of Georgia’s trauma system resources within Year 2. Objective B2: Georgia Trauma Commission to promulgate trauma system rules and regulations to define and describe Georgia Trauma System components and subsystems within Year 3.

Goal C: Expand the number of designated trauma centers to achieve access to a Level I, II, or III within one hour for all Georgians within Year 3

Objective C1: Develop criteria to determine the number of trauma centers needed to address the trauma care needs in Georgia within Year 1. Objective C2: Increase GTC members understanding of trauma center designation, associated recommendations and statewide gaps as determined by trauma center designation and re-designation process and results of trauma system surveys within Year 1.

Goal D: Develop trauma system regionalization in Georgia.

Objective D1: Establish Regional Trauma Advisory Committees (RTAC) in each EMS Region to support trauma and emergency care and system building within Year 2. Objective D2: Implement the Georgia Trauma Communications Center statewide to provide information to EMS and participating hospitals resulting in the transport or transfer of seriously injured patients quickly and to the most appropriate facility ready to provide care as measured by a reduction in time from injury to definitive care from _____to ____within Year 1.

ACS Priority: (Relates to Goal E) Financing and Coalition Building and Community Support

Goal E: Increase trauma system funding. Objective E1: Develop a Georgia Trauma Foundation to advocate and raise funds for the Georgia Trauma System within Year1. Objective E2: Implement a campaign to create permanent and adequate trauma system funding of $______within Year 3.

ACS Priority: (Relates to Goal F) EMS

Goal F: Strengthen Emergency Medical Services in rural areas. Objective F1: Increase County Commissioner understanding about trauma care and system requirements through presentations, conversations and interactions within Year 2. Objective F2: Increase efficiencies in the EMS system within Year 2.

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ACS Priority: (Relates to Goal G) System-wide Evaluation and Quality Assurance

Goal G: System-wide Evaluation and Quality Assurance Objective G1: Establish system-wide metrics to evaluate system performance and implement improvements in the Georgia trauma system within Year 2. Objective G2: Increase the # (or increase the %) of EMS providers providing quality data to the OEMS&T from ________to _________within Year 2.

ACS Priority: (Relates to Goal H) Research

Goal H: Conduct trauma system and care outcomes research Objective H1: Initiate two trauma system research projects within Year 2.

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2012-2015 Georgia Trauma System Strategic Plan

ACS Priority: Indicators for System Assessment Participant Discussion: The value of a Benchmarks, Indicators and Scoring (BIS) assessment was discussed. The BIS is a self-assessment tool* included in the 2006 HRSA Model Trauma System Planning and Evaluation document. The BIS has 113 indicators or measures to quantify a trauma system’s effectiveness. Upon completion of the assessment, the trauma system receives a quantitative score. Stakeholders from all parts of the trauma system learn how their program relates to other parts of the trauma system. With this data, trauma system stakeholders establish a plan for improvement, which addresses the gaps identified from the assessment.

* 2006 Health Resources and Service Administration (HRSA) Model Trauma System Planning and Evaluation document, from US Department of Health and Human Services

Goal A: Assess the trauma system and develop plans for improvement.

Objective 1A: Complete the Benchmarks, Indicators and Scoring (BIS) assessment by all ten EMS Regions as part of their trauma system regionalization activities within Year 2. Actions Key Players Timeframe Budget Impact Metric or Measure of Success 1) Develop a standard

implementation process for the BIS assessment and present to GTC for approval.

GTC, OEMS&T, RTAC V, VI, IX Leadership

Year 1 Implementation process developed and process includes the full range of trauma system stakeholders

2) Require the completion of a BIS assessment as the system-planning tool for all RTACs going forward.

GTC Year 1 BIS assessments completed utilizing the standard implementation process A completed BIS assessment is a requirement for RTAC funding

3) Funding for RTACs is based on the plan developed to address needs identified in the BIS assessment.

GTC Year 3 Region plans developed Funding addresses identified needs

Objective 2A: Complete a statewide Benchmarks, Indicators and Scoring (BIS) assessment by trauma system stakeholders within Year 3.

Actions Key Players Timeframe Budget Impact Metric or Measure of Success 1) Complete a state BIS assessment. GTC,

OEMS&T, All RTAC Leads

Year 3 State BIS assessment completed

2) Funding priorities based on the plan developed to address needs identified in the BIS assessment.

GTC Year 3 State plan developed Funding addresses identified needs

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ACS Priorities: Statutory Authority and Administrative Rules System Leadership (relates to System Integration) Lead Agency and Human Resources within the Lead Agency Definitive Care Trauma System Plan

Participant Discussion: The statute language in Senate Bill 60 gives responsibilities for trauma system design, development and funding to the GTC. Funding provides stability for the trauma system and supports expansion. Designation of trauma centers in Georgia Code gives the Department of Public Health the statutory authority to designate trauma centers and specialty care centers. The designation is done through OEMS&T who has expertise and a thirty-year history with trauma care. There is no GTC authority related to trauma center designation. The funding provided by GTC is an incentive for hospitals to seek designation. A hospital could become a state designated center through the American College of Surgeons (ACS) verification and bypass the state designation process. Participants discussed that GTC benefits extend beyond funding. GTC drives readiness requirements for funding such as: participation in Trauma Quality Improvement Program (TQIP); participation on the Trauma Medical Director’s call; and ensures trauma registry reporting to OEMS&T. The language of “lead agency” utilized by ACS is challenging because currently there is not a single agency with responsibilities for the trauma system. GTC has the funding and is developing the system and OEMST is responsible for designation of trauma centers. Concerns were expressed that OEMS&T is understaffed due to underfunding. Each regional trauma system will operate according to the Regional Trauma System Plan developed by the region’s Regional Trauma Advisory Committee (RTAC). RTACs provide the infrastructure to improve trauma care through better alignment with all the participants providing trauma care and identification about what system improvements are needed. The Plan organizes existing and identifies additional resources needed to provide a comprehensive trauma care system to care for trauma patients from the moment of injury through rehabilitation. A yearlong pilot project in Regions V, VI and IX is currently being implemented. The purposes of the pilot project were to test the Framework as a guide for trauma system regionalization and plan development; and to operationalize the Trauma Communications Center. The Trauma Communications Center opened in January 2012.

Goal B: Clarify and delineate trauma system leadership roles. Objective B1: Implement recommendations that assures essential system development tasks are addressed, effective collaboration and coordination of trauma system stakeholders occurs and is the best use of Georgia’s trauma system resources within Year 2. Actions Key Players Timeframe Budget Impact Metric or Measure of Success

1) Receive opinion from the Attorney General on a legal review of delineated roles in the statutes and codes.

Attorney General Year 1 Opinion received

2) Analyze current trauma system roles and responsibilities of all Georgia agencies (e.g. designate trauma center designation, funding, registry).

GTC, OEMS&T, other key players/agencies that have roles in the trauma system

Year 2 Roles analyzed and reported in a document

3) Identify potential operational efficiencies, opportunities for integration between all agencies involved in trauma system development (including reporting efficiencies).

GTC, OEMS&T, other key players/agencies with trauma system roles

Year 2 Efficiencies identified Reporting duplication for trauma centers eliminated

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Actions Key Players Timeframe Budget Impact Metric or Measure of Success 4) Present efficiency recommendations

to the GTC that assures essential trauma tasks are addressed and effective collaboration and coordination among trauma system agencies occurs.

GTC, OEMS&T Year 2 Recommendations developed Recommendations presented

5) Based on the recommendations, identify key positions that are needed to fulfill responsibilities.

GTC, OEMS&T Year 2 A list of needed positions is developed and prioritized

Objective B2: GTC to promulgate trauma system rules and regulations to define and describe Georgia trauma system components and subsystems within Year 3. Actions Key Players Timeframe Budget Impact Metric or Measure of Success 1) Develop a report for the trauma

system regionalization pilot project and revise the Framework.

GTC, OEMS&T, RTAC Leadership

Year 1 Report and revised Framework approved by GTC

2) Develop rules and regulations based on the analysis completed (under Objective #1).

GTC, OEMS&T Year 3 Rules and regulations developed Rules and regulations promulgated

Goal C: Expand the number of designated trauma centers to achieve access to a Level I, II, III within one hour for all Georgians within Year 3. Objective C1: Develop criteria to determine the number of trauma centers needed to address the trauma care needs in Georgia within year 1.

Actions Key Players Timeframe Budget Impact Metric or Measure of Success 1) Discuss ACS Guidelines for

Optimal Care Standards, HRSA Model Trauma System Planning and Evaluation Document for information regarding trauma center location and optimal time to definitive care.

GTC, OEMS&T Year 1 Guidelines discussed

2) Based on the review in action 1 above, identify data needed to inform the criteria. Data review to include role of Level IV designation.

GTC, OEMS&T

Year 1 Data provided, reviewed and discussed by GTC, OEMS&T and Regional Councils.

3) Develop criteria. OEMS&T

Year 1 Review occurred Recommendations discussed

4) Provide criteria to Regional Councils to use in regional planning.

GTC, OEMS&T Year 1

5) Develop funding strategies and targets based on the trauma centers placement plan to incentivize identified hospitals to become trauma centers.

GTC, OEMS&T Year 3

‘

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Objective C2: Increase GTC members understanding of trauma center designation, associated recommendations and statewide gaps as determined by trauma center review designation and re-designation process and results of trauma system surveys within Year 1.

Actions Key Players Timeframe Budget Impact Metric or Measure of Success 1) Understand the ACS Guidelines for

Optimal Care Standards and the process and timelines followed for trauma center designation and re-designation implemented by OEMS&T.

GTC Year 1 Presentation made to GTC by OEMS&T and designation process discussed GTC understand how trauma centers are designated and are confident in the process so they can explain to others GTC members attend a designation visit

2) Provide a summary report on Trauma Center designation and re-designation that maintains confidentiality and updates the GTC on trauma center status and statewide gaps.

OEMS&T Ongoing GTC understand current trauma center designation status and existing statewide gaps that impact designation

Goal D: Develop trauma system regionalization in Georgia. Objective D1: Establish Regional Trauma Advisory Committees (RTAC) in each EMS Region to support trauma and emergency care and system building within Year 2. Actions Key Players Timeframe Budget Impact Metric or Measure of Success

1) Establish a Performance Improvement Committee.

GTC, OEMS&T and RTAC reps

Year 2 Committee established

2) Establish quality assurance requirements based on the data needed for the regional trauma system and develop improvement plans as needed.

RTACs Year 2 Quality assurance requirements developed Improvement plans developed

3) Provide funding for RTAC development in remaining six regions.

GTC Year 2 Funding provided

Objective D2: Implement the Georgia Trauma Communications Center statewide to provide information to EMS and participating hospitals resulting in the transport or transfer of seriously injured patients quickly and to the most appropriate facility ready to provide care as measured by a reduction in time from injury to definitive care from _____to ____within Year 1. Actions Key Players Timeframe Budget Impact Metric or Measure of Success 1) Develop and implement the

procedures and protocols for the Georgia Trauma Communications Center to coordinate trauma patient triage, transfer and transport.

GTC, OEMS&T RTAC V, VI, IX, EMS Subcommittee, GCTE

Year 1 Statewide system operational Reduced transport times for trauma system patients. Decrease in inappropriate transfers

2) Develop a process to determine baseline data.

GTC, OEMS&T RTAC V, VI, IX, EMS Subcommittee, GCTE

Year 1 Process developed

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Actions Key Players Timeframe Budget Impact Metric or Measure of Success 3) Develop and implement pediatric

protocols to be used by the trauma communications center to make sure the needs of pediatric patients are met.

GTC Pediatric Subcommittee, OEMS&T, GCTE

Year 1 Reduced transport times for patients needing trauma care Decrease in inappropriate transfers

4) Determine baseline data. GTC, OEMS&T Regions V, VI, IX, EMS Subcommittee, GCTE

Year 1 Baseline data in hand

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ACS Priorities: Financing Coalition Building and Community Support Participant Discussion: While the funding has decreased, the trauma system infrastructure has been preserved and all existing trauma centers have maintained designation. Participants express being good stewards of the funding. Concern was expressed that the trauma system could be weakened if people don’t think it is worth participating because of the lack of funding and trauma centers not seeking designation. There is an opportunity to build on the past support received from many elected officials to increase trauma funding especially when the economy improves. There is also an opportunity to build public support for trauma system funding. The public was very supportive, with 1.2 million out of 2.5 million voters supporting the funding referendum in 2010. As a mechanism for advocacy, Arkansas developed a Foundation because they realized the biggest gap in site designation was in education. In addition, to developing a Foundation for advocacy, it could be used as the place for research and potentially provide funding for grants. Goal E: Increase trauma system funding. Objective E1: Develop a Georgia Trauma Foundation to advocate and raise funds for the Georgia Trauma System within Year 1. Actions Key Players Timeframe Budget Impact Metric or Measure of Success 1) Identify the steps needed to form a

Foundation. GTC Year 1 Action plan developed

2) Identify potential stakeholders to participate in the Foundation (e.g. Tea Party, Auto Insurance companies, Blue Cross/Blue Shield Foundation, Safe Kids of Georgia and auto manufacturers).

GTC, OEMS&T Year 1 2-3 committed stakeholders demonstrate commitment to participate in Coalition and invite others to attend

3) Enhance trauma system development through application for federal funding.

GTC, OEMS&T Ongoing Application submitted for federal funds Funding received

4) Develop mechanism for financial contribution from patients and families who have been touched the trauma system.

Trauma Foundation

Year 2 Mechanism developed Funding received

5) Seek input from the Foundation on the goals and direction of the Georgia trauma system.

GTC, OEMS&T Year 2 Input received

Objective E2: Implement a campaign to create permanent and adequate trauma system____funding of $______within Year 3. Actions Key Players Timeframe Budget Impact Metric or Measure of Success 1) Conduct a “post-mortem” review of the

work done for the 2010 referendum. Trauma Foundation

Year 1 Campaign reviewed

2) Develop a referendum campaign. Trauma Foundation

Year 2 Campaign developed

3) Implement campaign. Trauma Foundation

Year 2 Campaign implemented

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ACS Priority: EMS

Participant Discussion: There are 159 counties in Georgia and most have an EMS service. With this many EMS services or agencies, there are efficiencies that need to be considered that can improve the outcomes for trauma patients. This year, several accomplishments promoted efficiencies such as: participation in the AVLS system giving Directors information about the location of EMS units (700 EMS units participated); over 200,000 on-line EMS courses were available and utilized by over 14,000 EMS providers; and over 1000 rural first responders were reached through GTC directed training. More efficiency can be gained by developing a uniform policy about getting the right patients to the right place at the right time. The Association County Commissioners of Georgia (ACCG) is a key stakeholder to include in the discussion about a uniform policy. Regionalization, through the creation of RTACs, builds on existing EMS Regions promotes efficiencies and creates an infrastructure to have important conversations about utilization of resources including mutual aid and inter hospital transfer. Goal F: Strengthen Emergency Medical Services in rural areas. Objective F1: Increase County Commissioner understanding about trauma care and system requirements through presentations, conversations and interactions within Year 2.

Actions Key Players Timeframe Budget Impact Metric or Measure of Success 1) Participate in disaster planning,

exercises and drills to build relationships with county stakeholders.

GTC, other stakeholders

Year 1 # of events attended by stakeholders

2) Make trauma system presentations at County Commission and Association County Commissioners of Georgia meetings.

GTC, other stakeholders

Ongoing # of presentations

Objective F2: Increase efficiencies in the EMS system within Year 2. Actions Key Players Timeframe Budget Impact Metric or Measure of Success

1) Develop a pilot for multi-county system for EMS transport.

GAEMS , OEMS&T, RTAC

Year 2 Pilot implemented and results reviewed

2) Develop a uniform policy with County Commissioners and EMS Directors regarding patient transport.

GAEMS, OEMS&T

Year 3 ACCG participates in policy development

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ACS Priority: System-wide Evaluation and Quality Assurance

Participant Discussion: Georgia has a single trauma registry, which provides data to measure system performance. Level 1 and 2 Trauma Centers are beginning to participate in the Trauma Quality Improvement Program (TQIP). Participants discussed the importance of establishing system-wide metrics to evaluate performance and to make improvements in Georgia trauma care standards. Participants agreed that one of the system wide indicators should be the time from first medical contact to definitive care. Pre hospital reports provide important data required for system evaluation; however, pre hospital reports are not always completed or follow quality measures. Participants discussed that EMS providers need to be held to the same standard as trauma centers on quality reporting. If reports are not submitted, funding is not received. The group agreed that thresholds for EMS data reporting need to be developed and enforced. These thresholds may change over time as improvements occur. The implementation of this with EMS provides a good example of the regulatory side (OEMS&T) requiring data submittal and then the funding side (GTC) providing funds if the regulatory requirements are met. OEMS&T has begun analysis using trauma registry and hospital discharge data regarding patients treated in non trauma centers including pediatric patients. Other information important for system-wide evaluation is understanding when a patient is initially transported to a community hospital by EMS and then transferred out to a trauma center; how much time is taken before definitive care is received? Goal G: System-wide Evaluation and Quality Assurance

Objective G1: Establish system-wide metrics to evaluate system performance and implement improvements in the Georgia Trauma System within Year 2. Actions Key Players Timeframe Budget Impact Metric or Measure of Success 1) Hire a Trauma

System Compliance and Improvement within GTC staff.

GTC Year 1 Position filled

2) Establish an Evaluation Committee to identify and monitor system wide performance measures.

GTC, OEMS&T, RTAC representatives, state epidemiologist,

Year 1 Diverse group of stakeholders represented on Evaluation Committee System wide performance measures are agreed upon

3) Review existing trauma data and recommend system-wide performance measures and identify baseline.

GTC, Trauma Medical Director’s Subcommittee and Invited National Trauma Consultants

Year 1 System wide performance measures identified Baseline established The list of performance measures are written and share with the public

4) Compare data on patients treated in a trauma center and patients not treated in a trauma center based on Injury Severity Score (ISS).

Public Health Epidemiologist, Bishop and Associates

Year 1 Data received and reviewed

5) Compare data on pediatric patients treated in a trauma center and pediatric patients not treated in a trauma center based on Injury Severity Score (ISS).

OEMS&T Epidemiologist, Bishop and Associates

Year 2 Data received and reviewed

6) Assure alignment between regional quality requirements and the system wide performance measures identified.

Evaluation Committee

Year 2 Regional quality measures provide data for the system wide quality measures

7) Complete individual case analysis of patients transferred to a trauma center from another hospital and location of the scene of the accident. Note: These cases will be used to illustrate key points about time to definitive care, communication protocols etc…)

OEMS&T Year 2 Cases identified Cased used to illustrate the importance of system wide communication

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Objective G2: Increase the # (or increase the %) of EMS providers providing quality data to the OEMS&T from ________to _________within Year 2.

Actions Key Players Timeframe Budget Impact Metric or Measure of Success 1) Identify the number of EMS

providers currently providing required report data (e.g. review EMS trip reports and other system reports)

OEMS&T Year 1 Baseline measure identified (e.g. currently how many EMS providers are providing quality data) Objective written with agreement upon measures for improvement

2) Provide education to EMS providers about the value and the use of the data they provide.

OEMS&T, GAEMS GTC, RTAC

Ongoing # of providers receiving education

3) Establish thresholds for EMS data to receive funding from GTC.

OEMS&T, GTC, RTAC representatives

Year 1 EMS data received and meets quality standards Process developed to terminate funding if quality data not received

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ACS Priority: Research Participant Discussion: The group discussed the importance of researching mutual trauma system topics of interest. The information would be used to make improvements in the trauma system and for publication. The formation of a Research Committee will be discussed by the Medical Director Subcommittee. Research committee members would include trauma center representatives and other interested stakeholders. The Committee could be part of the newly forming Trauma Foundation. Goal H: Conduct trauma system and care outcomes research. Objective H1: Initiate two trauma system research projects within Year 2. Actions Key Players Timeframe Budget Impact Metric or Measure of Success 1) Establish a Georgia Trauma

System Research Committee (see Coalition Building above) that is located in the Trauma Foundation.

Trauma System representatives

Year 1 Committee established

2) Develop a research agenda that utilizes trauma registry data.

Georgia Trauma System Research Committee

Year 2 Trauma registry data used Existing system resources are utilized (statisticians, epidemiologist)

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Georgia Trauma Care Network Commission 05 & 06 January 2011 Workshop Page 1

ANNUAL WORKSHOP

MEETING MINUTES

Thursday – Friday, January 26 & 27, 2012 Day One Scheduled: 08:00 am until 05:00 pm

Stuenkel Conference Center Floyd Medical Center

304 Turner McCall Boulevard Rome, Georgia 30165

DAY ONE: 26 January 2012

COMMISSION MEMBERS PRESENT COMMISSION MEMBERS ABSENT Dr. Dennis Ashley Linda Cole, RN Ben Hinson Dr. Leon Haley Bill Moore Dr. Fred Mullins Dr. Robert Cowles Kurt Stuenkel Elaine Frantz, RN

STAFF MEMBERS SIGNING IN REPRESENTING

Jim Pettyjohn, Executive Director Lauren Noethen, Administration Judy Geiger, Business Operations Officer John Cannady, TCC Coordinator Michelle Martin, TCC Operations Assistant

Georgia Trauma Care Network Commission Georgia Trauma Care Network Commission Georgia Trauma Care Network Commission Georgia Trauma Care Network Commission Georgia Trauma Care Network Commission

OTHERS SIGNING IN REPRESENTING

Alex Sponseller Lawanna Mercer-Cobb Gina Solomon Keith Wages Russ McGee Renee Morgan Lee Oliver Laura Garlow Fran Lewis Pat O’Neal Susan Bennett Lee Oliver

Assistant Attorney General GPT Hamilton Medical Center OEMS Region 5 OEMS/T OEMS/T MCCG Wellstar Kennestone Hospital Grady DPH/OEMS/T JMS Burn Centers, Inc. MCG

37


Quorum established Dr. Dennis Ashley established quorum. Staff Performance Review Ms. Linda Cole stated that she has completed the evaluation on Mr. Jim Pettyjohn and it was sent out to the Commission members for comments. Ms. Cole has received those comments back and will hand them over to Dr. Ashley. Dr. Ashley will set up and appointment with Mr. Pettyjohn to discuss the evaluation personally. Dr. Ashley asks that Mr. Jim Pettyjohn and Ms. Lauren Noethen step out of the room so the Commission members can discuss the comments that were received by Ms. Cole. MOTION GTCNC 2012-26-01: I move that the open meeting of the Georgia Trauma Commission be closed to the public for the scheduled Staff Performance Review.

MOTION BY: Dr. Fred Mullins SECOND BY: Dr. Robert Cowles The open meeting of the Georgia Trauma Commission was closed to the public at 8:15 a.m., pursuant to the provisions of Chapter 14 of Title 50 of the Official Code of Georgia Annotated (Chapter 14 of Title 50 of the Official Code of Georgia attached to the meeting minutes). MOTION GTCNC 2012-26-02: I move that the closed meeting of the Georgia Trauma Commission be opened to the public. MOTION BY: Dr. Leon Haley SECOND BY: Mr. Ben Hinson The closed meeting of the Georgia Trauma Commission was opened to the public at 9:05 a.m. CALL TO ORDER Dr. Dennis Ashley, Chair, called the scheduled Annual Workshop meeting of the Georgia Trauma Care Network Commission to order at 9:35. Dr. Ashley stated that just to be official the Commission meeting is back in open session now. We were closed this morning for the staff evaluations. We will now move into the Strategic Planning part of the meeting. WELCOME, INTRODUCTIONS AND CHAIRMAN’S REPORT Dr. Dennis Ashley thanks Mr. Kurt Stuenkel for allowing the Commission to use his facility. Dr. Dennis Ashley introduces Ms. Carol Pierce who is a Public Health Consultant. Dr. Ashley stated that last year the Commission did Strategic Planning and this year we are going to facilitate so that the Commission can have an organized discussion and come up with goals. We are going to discuss where we are now and what goals are reasonable. Dr. Ashley turns the meeting over to Ms. Carol Pierce who will guide us through this discussion. Strategic Planning

Courtney Terwilliger GAEMS

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Ms. Carol Pierce stated that she is a nurse by background and has spent about ten years in the private sector working with the healthcare system in New Mexico as a Clinician in the urgent care field, another decade working in public health, another decade helping organizations realize their visions and what they want to accomplish. Ms. Pierce stated that she is a neutral facilitator that is here to help move things forward and she has a passion for public health, in prevention and with helping populations in states have the healthiest people they can. Ms. Pierce thanks everyone for the opportunity to create a robust conversation and stated that at the end of the day what she wants to accomplish is to advance the vision for a comprehensive trauma system in Georgia. (A COMPREHENSIVE TRAUMA SYSTEM FOR GEORGIA 2011-14 Strategic Plan Summary included in the Annual Workshop binder) and (The State of Trauma: Chairman’s’ Annual Report January 2012 Public Service for Georgians February 2009 included in the Annual Workshop binder.) Ms. Pierce stated that based on the feedback she received from folks that reviewed the Summary document, (SUMMARY ACCOMPLISHMENTS AND GAPS UPDATE AMERICAN COLLEGE OF SURGEONS TRAUMA SYSTEM CONSULTATION RECOMMENDATIONS FOR GEORGIA: January 2009 & Our Emerging Vision: A new Public Service for Georgians February 2009 included in the Annual Workshop binder) and given what the ACS says in terms of what are priorities are to move a system forward, Ms. Pierce picked ten priority areas to discuss today. From the Trauma System Assessment (1) Indicators as a Tool for System Assessment. From Trauma System Policy Development (2) Statutory Authority and Administrative Rules, (3) System Leadership, (4) Lead Agency and Human Resources Within the Lead Agency, (5) Trauma System Plan, and (6) Financing. From Trauma System Assurance (7) Emergency Medical Services, (8) Definitive Care Facilities, (9) System-Wide Evaluation and Quality Assurance (10) Research. Ms. Pierce stated that those that were left off were not left off because they were not important, or shouldn’t be included, but we had to start somewhere. Ms. Pierce also recommended, Proposed Criteria for Actions, (1) Does the action support role clarification among trauma system leaders and organizations?, (2) Does the action promote collaboration and partnership?, (3) Does the action promote optimal outcomes for the seriously injured?, (4) Does the action provide evidence for a return on investment. Dr. Ashley stated that if he understanding the process correctly this will be the rules of engagement and the scorecard as we discuss each item. Then we will assign each point of discussion some kind of quality based on the four scoring systems. Ms. Pierce describes the process she is proposing for the discussion: 1. Ms. Pierce will pause for a few minutes to give folks a chance to review the information contained in each priority area 1-10, 2. Pause and give people a chance to review the successes, 3. Give folks a chance to ask for clarification about the gaps and recommendations, 4. Add other gaps and recommendations. 5. Recommend an action using the criteria, which goes back to Dr. Dennis Ashley’s clarification. Ms. Pierce stated that she would write up this meeting and work with Mr. Pettyjohn to make sure that everything is captured. Ms. Pierce will be presenting the results to the Commission at the March meeting. Dr. Ashley stated that the meeting today was just the beginning. He has learned from previous experiences that things can get pushed to the side. This presentation will be put into a message format where it can be reviewed. We will then start assigning projects and moving forward. Next meeting: Tomorrow January 27, 2012 at 10:00 am Meeting Adjourned: 5:50 pm

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ANNUAL WORKSHOP

MEETING MINUTES

Thursday – Friday, January 26 & 27, 2012 Day Two Scheduled 08:00 am until 4:00 pm

Stuenkel Conference Center Floyd Medical Center

304 Turner McCall Boulevard Rome, Georgia 30165 DAY TW0: 27 January 2012 COMMISSION MEMBERS PRESENT COMMISSION MEMBERS ABSENT Dr. Dennis Ashley Linda Cole, RN Ben Hinson Dr. Leon Haley Bill Moore Dr. Fred Mullins Dr. Robert Cowles Kurt Stuenkel Ms. Elaine Frantz

STAFF MEMBERS SIGNING IN REPRESENTING

Jim Pettyjohn, Executive Director Lauren Noethen, Administration Judy Geiger, Business Operations Officer John Cannady, TCC Coordinator Michelle Martin, TCC Operations Assistant

Georgia Trauma Care Network Commission Georgia Trauma Care Network Commission Georgia Trauma Care Network Commission Georgia Trauma Care Network Commission Georgia Trauma Care Network Commission

Quorum established Dr. Dennis Ashley establishes quorum.

OTHERS SIGNING IN REPRESENTING Laura Garlow Fran Lewis Rana Bayakley Linda Capewell Danlin Luo Jim Sargent Scott Sherrill Scott Maxwell

Wellstar Kennestone Hospital Grady GDPH GDPH GDPH North Fulton Hospital GTRI Doctors Hospital

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APPROVAL OF THE MINUTES OF THE 17 November 2011 MEETING The draft minutes of the 17 November 2011 meeting were distributed to the Commission prior to the meeting via electronic means. MOTION GTCNC 2012-27-01: I move that the minutes of the 17 November 2011 meeting of the Georgia Trauma Care Network Commission distributed and presented here today to be approved.

MOTION BY: Ms. Linda Cole SECOND BY: Mr. Bill Moore DISCUSSION: None Motion has been copied below: ACTION: Approved The motion PASSED with no objections, nor abstentions. (Approved

minutes will be posted to www.gtcnc.org FY 2012 Budget Discussion Ms. Judy Geiger goes over the Georgia Trauma Commission Proposed FY 2012 Amended Budget document. (Proposed FY 2012 Amended Budget pages 52-64 included in the Workshop binder). Ms. Geiger started with page 52 the Trauma General Fund Allocations, which is an overview of the Commissions budget from day one. The Commission started off with 20 million. In the original legislation there was 2.5 million ARRA funding (American Recovery and Reinvestment Act) and we discovered we could not use that and it was immediately removed from the budget. That left us with 17.6 million. In August the governor requested that each state agency propose a 2% reduction, which was $353,000. That left us with 17.3 million. In January the governor came out with his proposed amended 2012 budget and instead of giving us a 2% cut, he directly tied our budget to revenue collections, which reduced our budget by 1.7 million, which amounts to about a 10% cut. The Trauma Commission had already approved the August 2% reductions, so we went from that and did a hard budget review, of which the whole staff participated in. We took expenditures from 12/31 and projected out what we expected to spend for the next six months, until June 30th, which is the end of the state fiscal year. We added those two amounts together and that became the new proposed budget. Ms. Geiger stated that under Commission Operations budget on page 53 you will see that the employer’s share of health insurance increased from 27.63% to 34% effective January 1st and that is basically why the budget increased in this case, because we have to cover salaries and fringe benefits. The Department of Community Health negotiates the rates in the State Benefit Plan and every state agency ends up getting hit with this. Ms. Geiger stated page 54 is Trauma Communications Center Operations, the Commission was able to take a considerable amount more out of that budget. There were some things that were paid through contracts that were extended through June 30th. GTRI had enough funding to carry them through FY 2012, and that helped us a great deal. Ms. Geiger stated page 55, is System Development, Access and Accountability at the beginning of the year we had projected spending an additional $100,000, but they have enough money left over from their FY 2011 funding, and that was a huge savings. We do not project any additional costs on contracts in that budget, so we took that amount out.

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Mr. Ben Hinson wanted to know if money was left over because the cost of the ambulances was lower than anticipated? Ms. Geiger stated it is because they had not completed all the deliverables in the contract, and the $100,000 was an estimate at the beginning of the year as to what their needs would be. Mr. Jim Pettyjohn stated that in August we did not have the strong leadership at the TCC that we have now and it was anticipated that we might need to lean on GTRI for some additional work. We do not need to do that now. Mr. Scott Sherrill continues to work with us based on funding from the FY 2011 contract, of which we were able to extend and so we should be fine throughout the remainder of the year. Ms. Geiger moves onto EMS Allocations page 56. Ms. Geiger stated that the EMS Subcommittee would still need to review their total budget and come up with the line items and approve them. We basically took the August budget and gave you a handout that was not included in the book, to show you a comparison of where we started in the August 2011 Approved budget and then where we ended up, and the changes in the January proposed (Comparison of Approved August Budget with 2% Reduction & Proposed January Budget EMS attached to the minutes). Mr. Bill Moore wants to know if we have allotted the EMS Vehicle Replacement dollars yet and if that money must be spent by June 30th. Mr. Pettyjohn stated that we have to award the grants by June 30, 2012. The application process took place and was closed December 2011. The Scoring Committee, which includes Mr. Keith Wages, Lauren Noethen and myself, will meet and do the final scoring. The subcommittee chair will submit recommendations to the full Trauma Commission for consideration during the March 15, 2012 Trauma Commission meeting. Ms. Geiger moves onto Office of EMS and Trauma Allocations page 57, and stated that we do not recommend any additional cuts other than the 2%, which still puts them at the 3% mandate of the budget. Mr. Hinson makes a clarification that the mandate is 2%, and it is funded up to 3%. Ms. Geiger moves onto Trauma Center Physician Allocation page 58, which shows the 20%, and 80% split on the stakeholders funding. This shows the breakout of the 75% that goes to the hospitals, and the 25% that goes to the physicians, in both readiness payments and uninsured patient care payments. Ms. Geiger stated that on page 59 you will find the Trauma Center Readiness and Performance Based Payments for each of the Trauma Centers, and page 60 reflects the adjusted numbers from the audit that GHI did. Mr. Pettyjohn stated that the red numbers on page 60 in the ISS buckets reflect the results of the audit. Ms. Geiger stated that on page 61 is the Trauma Fund Trauma Center Allocations for Readiness, Performance Based and Uninsured Patient payments, and the breakdown of what each center receives. On Page 62 you will find the Trauma Registry Fund, and the details behind that. Then page 63 kind of summarizes everything. The total for each center in the right hand column is the amended contract amounts for each of the centers. Ms. Geiger stated that it is important to note that we did not cut any of the regionalization funding’s that go to the pilot program. Ms. Geiger stated that page 64 is basically the details of the deliverables for each of the trauma center’s contracts. Where you see the X that is a deliverable in the contract. Mr. Moore wants to know what regionalization funding’s are. Mr. Pettyjohn explains what the Regionalization funding’s are that go to the pilot program, stating that last year in 2011 MCG, and MCCG both received $75,000 in their Readiness and Uncompensated Care contract which was a carved out deliverable for them to do work with their EMS regions to develop the RTAC. This

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year they received $20,000 dollars a piece in sustainment funding. Also this year EMS region 9 through Savannah received $75,000 dollars for that as well. That $75,000, and 20/20 remained uncut. Ms. Cole stated that even though there was a 10% cut because of the cuts that were made in Operations, there was only a 5% cut to the stakeholders. Ms. Geiger stated that was made possible by realized savings in other budget categories. Ms. Geiger explains the AVLS process stating that the rollout in the equipment of AVLS is handled through GTRI and GEMA and FEMA funding. Right now GTRI is also paying for the airtime for those devices. When we started evaluating taking on the charges that GTRI was paying TCC as far as phone lines, and computer lines, we decided to bring that all in house. When we did that we also wanted to evaluate what costs there would be in taking on the AVLS airtime charges, verses what the cost would be to continue the contract with GTRI. We found that GTRI charges 13.6% overhead on those airtime charges, so it would be an effective savings to bring that in house and pay those bills directly instead of going through the contract. Our contract was extended until June 31, but we have already transferred those accounts and payed the first bill starting in January. We will continue to pay those AVLS charges through June. That was already included in our 2012 budget from the very beginning, so it is no additional dollars. The budget was estimated at $50, 000, and it is going to cost us $51,000. So we are covered for 2012. Mr. Pettyjohn stated that we are going to submit next years budget depending on what the Commission decides to do on paying AVLS, to bring this totally in house. It is just a matter of paying the air fees as well as well as the In Motion service contract and having telephone access to providers who have questions. Unless there are additional funds found somewhere else to buy additional units we think we can handle this part without any additional staff. We could realize these savings by not contracting with GTRI, just to pay air card time. Mr. Hinson stated when the system was being built they needed their help to manage it. Now that we are stable and GEMA and FEMA is funding the additional units and we are just paying for the maintenance, he thinks it can be brought in house. If in the next budget we find out there is no more FEMA or GEMA money and we want to buy some more units, we may have to revisit someone helping us to do the install and rollout. Right now I think it will be a savings in this part of our budget. Ms. Geiger stated that page 125 is a projection for future years if every ambulance in Georgia receives an AVLS unit this would be the yearly cost of airtime. It is a comparison of effective savings of almost $100,000 by bringing that billing in house and paying the bills directly instead of going through contract. Mr. Pettyjohn stated that if this budget were approved he would need to go back and start amending contracts with the hospitals. Ms. Cole wants to know if it will be on the amended budget and not the AVLS budget. Mr. Pettyjohn stated not on the AVLS, that the Commission would go back to that at the March Commission meeting when we start talking about 2013 funding. MOTION GTCNC 2012-27-02: I make the motion to approve the budget as presented. MOTION BY: Ms. Linda Cole SECOND BY: Ms. Elaine Frantz DISCUSSION: None Motion has been copied below:

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ACTION: The motion PASSED with no objections, nor abstentions. (Approved

minutes will be posted to www.gtcnc.org EMS Subcommittee Update and Discussion Mr. Ben Hinson stated that the EMS Subcommittee met on January 4th in Atlanta. GAEMS is doing an outstanding job of getting first responder classes accomplished across the state, but we realized that not as many people signed up for the class as we had allocated dollars for. The discussion was to redirect some of that money to start an education course provided by Georgia Southern that teaches people specific extrications and also to fund some positions in EMS leadership training. The money was redirected there. This was done on January, 04 2012 and then we learned about the governor’s additional cuts on January, 10, 2012 and that is about another $192,000 dollars out of our bucket. Mr. Hinson asks that the Commission would allow the EMS Subcommittee to use the budget that is allocated to EMS to basically accomplish what the EMS Subcommittee asks for, which is to help with the class at Georgia Southern. The extrication school would allow us the flexibility to figure out how to make the amount of money we have now work to do that. Mr. Hinson stated that as soon as the EMS Subcommittee meets again we would be able to move forward. Dr. Robert Cowles wants to know if we have metrics that show that First Responders really help. Mr. Hinson stated that he does not have absolute metrics, but he can tell you antidotal that they make a huge difference in very rural counties. GAEMS actually contracts with the people to do the course, they are pretty stringent and we are not wasting money. Dr. Cowles stated that his experience is the opposite that the First Responders slow everything up dramatically. They take to long to access the situation. Dr. Cowles stated that before the Commission spends an incredible amount of money on First Responders class’s metrics need to be attached to show if we are getting our moneys worth. Mr. Bill Moore wants to know if the First Responders pass some sort of test and is there competency checklists. Mr. Hinson stated that there is evidence that we have trained them properly and we are following national standards. He thinks Dr. Cowles is asking is if there are metrics that prove that care improves. Mr. Hinson stated the EMS Subcommittee would work to get that budget done and report back at the March meeting. We may have to move forward with getting those contracts done, but we will stay within our budget. Trauma Center Audit Report and Discussion GH&I Mr. Pettyjohn introduces Jessica Story and Paul Lundy who are with Gifford, Hillegass & Ingwersen the Commissions audit firm here for the second year to report on the procedures they performed for us. Mr. Paul Lundy stated that he is passing out their report, which is still in draft form and he will walk the Commission through the findings from their work. (GH&I Uncompensated Care audits draft report included in the Workshop binder page 70-114) Mr. Pettyjohn mentions that the draft report was provided to the Commission and was posted to the Trauma Commission website on Tuesday.

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Mr. Lundy stated that the were engaged last year for the first time to go out and perform procedures at each of the trauma centers looking specifically at uncompensated claims being submitted for reimbursement and making sure that those claims met the criteria of Senate Bill 60. Mr. Lundy stated that most of the work contains a sampling of the claims. We started with the list that is first compiled by the trauma centers and then submitted to Bishop & Associates, the Commissions consulting firm. Then based on that initial data that they submitted we selected samples. We also were making sure the claims had been properly bedded, properly documented and the results of our work indicated it was an appropriate claim. When you look at all this information that is what the first round of our procedures were focused on. Mr. Lundy stated that they did find some exceptions and they are identified in our report. Based on those exceptions and working with Mr. Pettyjohn and his group, we got back to each of the trauma centers and asked the ones that had exceptions to go back through their material again, look at it and submit a new list of numbers. We have summarized some of those results in our report. Mr. Lundy stated that they also went through the claims to verify the ISS score that was assigned to it. Based on that work we documented that all together and that was the first round of results. We reviewed that information with Mr. Pettyjohn and then based on that we sent the information back to the trauma centers. Ms. Jessica Story stated in summary of their findings all the criteria that did not qualify was listed out and they bullet pointed the specific trauma centers who had an exception with that criteria. The criteria with the most widespread exception range was that the patient did have medical coverage, either through Workman’s Compensation, automobile insurance or some other third party, including a settlement or judgment. Ms. Story stated that the second way we summarized this information was by individual ISS scores. We began with the original data that was submitted to us, and then we performed our procedures and worked from that data. Those were the cases that they identified that did meet the criteria. The difference number one is the exceptions that we found in our test work. After we performed our test work we came back with additional procedures and asked the trauma centers to go through their lists and scrub their original data to see if there were any other exceptions. The revised list is the information that the trauma centers provided back to them in that second round of testing. The difference two is the combination of the results from their test work and also the results from the trauma centers rescrubbing their data. Mr. Lundy stated that another situation that they encountered this year was whether or not the trauma center had received any sort of reimbursements. There was a hospital that was actually selling their receivables that they were unable to collect and they were getting paid. So under the letter of the law they were paid something for this claim and so we treated it as an exception. From a business perspective that is probably a wise decision for them to actually try to sell and get something out of the receivables, but it immediately disqualifies them. Mr. Hinson wants to know if the payments for the uncompensated care were made prior to the audit being done. Mr. Pettyjohn stated that the hospitals have not been paid. The budget you approved this morning had those numbers factored in. Mr. Lundy stated they performed a new procedure this year. They were engaged to gain an understanding of the process that each trauma center goes through for funding physicians with their portion of Readiness and Uncompensated Care dollars. Based on that process, and our documentation, we have a couple of recommendations. For the Readiness we recommend that those locations continue that process that they already have implemented. As far as funding physicians for uncompensated care we would recommend the trauma centers analyze the list of trauma patients before sending the list to the individual physicians as outlined in the Commissions contract, which is taken from Senate Bill 60. There is one criterion the physicians should scrub themselves and that is if they receive a patient payment of 10% or more, because that could be different from the physicians side verses the hospital side. Dr. Ashley wants to know what scrubbing the list means.

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Mr. Lundy stated they narrow down the list of trauma registry patients to only those that meet the definition for uncompensated care. Dr. Cowles stated that it is critical that we readdress the ten-dollar car tag fee to increase funding to the Commission. Ms. Frantz wants to know what the next step would be to get Amendment #2 which provided for a $10.00 car tag fee back on the ballot in November. Ms. Cole’s concern is if the tag fee went back to the legislature and we got it back on the ballot the Commission would be no better off than we were before. We need to get the coalitions together, because we do not want to fail twice. Dr. Cowles agrees with Ms. Cole and stated that the Commission needs time to get the legislatures lined up get everybody onboard, get the right PR groups together, and spokespeople. Dr. Ashley agrees and thinks that we need to start a coalition now, and then start working on reintroducing Amendment #2 back to the legislature. Mr. Lundy stated that they met with the EMS Subcommittee earlier this month and presented their report to on procedures that were performed this year explicitly on the EMS service companies that were receiving funding from the FY 2010 EMS Uncompensated Care Program (CY 2008 claims). We interviewed 20 of the 44 EMS companies. Our goal was to understand the general process and procedures that they go through submitting their claims. We did not test individual claims, we were interviewing and understanding the process and documenting that. From that work our recommendations were: 1. EMS companies standardize the process of submitting claims for uncompensated care funding and that all EMS service companies have a written policy and follow that policy so that each case is handled in a consistent manner, 2. that they all develop written standardized policies concerning collection procedures and 3. that all locations consider implementing a second review before the list is submitted to the Commission. MOTION GTCNC 2012-27-03: I move to accept the Gifford, Hillegass & Ingwersen Audit report in draft form. MOTION BY: Dr. Leon Haley SECOND BY: Mr. Bill Moore DISCUSSION: None Motion has been copied below: ACTION: The motion PASSED with no objections, nor abstentions. (Approved

minutes will be posted to www.gtcnc.org Burn Center Report and Georgia Trauma Foundation Concepts Mr. Greg Bishop stated that he is going to be talking about the Burn Center Assessment (Georgia Burn Center Assessment January 27, 2012 PowerPoint attached to the meeting minutes). The core goal was to do an objective economic assessment of the burn centers and compare that to the economic assessment that we did with the trauma centers, so we can to define burn centers relative need for state funding. Mr. Bishop stated that Doctors Hospital in Augusta is a very good addition to the system in Georgia. They are the

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largest burn center in the country and have been around for 30 years. They have a major initiative in terms of outreach, education and prevention. Grady Memorial Hospital is the other burn center and is in Atlanta. They have a very strong program as well and are strengthening over time. Mr. Greg Bishop stated that the bottom line is that we have the burn centers, their report of the percent of those numbers in terms of their total costs and them we have that compared with per patient to the trauma centers. Mr. Bishop stated that if you look at the various comparisons and their revenue and take out the total cost, the burn centers show a 28% surplus and the trauma centers show a 16% loss. Mr. Bishop stated that clearly the burn centers were profitable in 2009 and the trauma centers were not. The difference here is that the trauma centers have substantially more in terms of readiness costs, which is 17% of there total cost verses 7% for the burn centers. The other issue is that on the revenue the burn centers get 28% surplus on those costs and the trauma centers are losing 16% on the revenue right from the get go. Mr. Bishop stated that he would take the Medicaid and the Medicare surplus for the burn centers at 13-15% and just call it a wash, if you look at the overall payer mix. Which leaves us the difference being the reimbursement on the insured patient, which the burn centers do very well on compared to the trauma centers. Dr. Dennis Ashley wants to know what Mr. Bishop means when he says that Medicare, and Medicaid are awash. Mr. Bishop stated that going back to the payer mix discussion, because the burn centers have 9% fewer insured patients and more Medicare and Medicaid funded patients and because Medicare and Medicaid pays them at a higher rate on the same dollar of costs, it is somewhat comparable. The point he was trying to make is that the payer mix does not make a big difference. The big difference is the readiness costs and the amount of revenue the burn centers are receiving on the insured patient. Ms. Elaine Frantz wants to know what the comparison at first collection rate is in general when comparing Level 1 and Level 2 to burn centers? Mr. Bishop stated that we never deal with collection rates anymore because the charges are so out of whack. We do a cost recovery rate. The differences between the two are trauma centers are around 140% cost on the insured patient and burn centers are above 200%. Mr. Bill Moore wants to know how you can estimate the patient treatment cost? Mr. Bishop stated that patient treatment costs are the fully allocated costs that they report to us and that is both direct and indirect. Mr. Bishop stated that because of the cost center issue we took the readiness costs out of the patient treatment costs because we felt they were double counted. We also looked at the trauma center costs in that regard. There are some trauma centers reporting fairly high costs that indicate that they have cost centers and are including that overhead. So we reduced the patient treatment costs for the trauma centers by 25% of that 44 million. We took 11 million out of the trauma center patient treatment cost so we could have an apple-to-apple comparison. Dr. Fred Mullins asks Mr. Leon Haley how Grady determines a burn patient and if they put them into the trauma category. Dr. Leon Haley stated that they would go into the trauma registry if they have a significant traumatic injury, but if they are just a straight burn then that is a separate entry. Ms. Fran Lewis stated that if they have any traumatic injury than they go into the trauma registry. Dr. Fred Mullins stated that large portions of burns have traumatic injuries. Mr. Bishop stated that when they first started this process they separated the Grady Burn from the trauma, not necessarily the patients that were injured and needed the trauma center themselves. We made it a point to not include them.

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Dr. Ashley wants to know if there is a list that Commission can look at that shows funding of burn centers by the states. Mr. Bishop replied, ”Any state that funds their trauma centers where the burn center is part of the center then those are typically included in the allocations of funding by that state.” The independent burn centers are typically not in terms of that application. Mr. Bishop stated that he would be happy to provide Dr. Ashley a list of burn centers funding by states. Mr. Bishop stated that his report would be going to the Committee next where issues will be addressed and then brought back to the Commission at some point. Dr. Haley stated that it would go to the Trauma Center and Physician Funding Subcommittee so they can review Mr. Bishop’s conclusions and then it will come back to the Trauma Commission to make a full recommendation as to how the Commission will fund the burn centers. Mr. Bill Moore wants to know, since Mr. Bishop mentioned that the burn centers have been effective in lobbing and getting sort of add-on or enhanced Medicaid payments, if he is able to identify what that enhanced portion is. Mr. Bishop stated that it is 13% from the same dollar of costs. We ask how much cost did you have with Medicaid patients and how much revenue. Then we compare that cost recovery rate. The burn centers receives 13% more on Medicaid revenue over the cost to that of trauma centers. Dr. Mullins asked, ”So for every dollar they get an extra 13%? Mr. Bishop replied, ” Yes, for every dollar of patient cost they get an extra 13%”. Dr. Ashley stated that there was legislation to give trauma centers an increase or percentage on Medicaid, in other words if you are a trauma center you would receive a percentage more than a non-trauma center. That legislation fell through, but needs to be revisited. Dr. Mullins stated that burn patient’s absorb a tremendous amount of resources. A burn patient can be in the hospital for weeks and sometimes months. There is no funding of those patients 99 out of 100 times, but they have to be taken care of. Mr. Bishop stated that this survey has been done annually over the last four years and as we continue we will continue to address that issue. Ms. Rana Bayakly wants to know where Mr. Bishop obtained the figure of 11,000-trauma center burn cases. Did he get that number from the hospital discharge or did he survey the trauma centers asking them how many burn cases they had. Mr. Bishop stated that he did not ask the trauma centers how many burn patients they had, we asked them how many trauma center patients they had. We survey that and they report that to us. This information is in the trauma registry and it is coming from there and that is how we get the 11,000 for trauma centers and we ask the burn centers the same thing. Dr. Mullins asks, “Is that 11,000 burn patients?” Mr. Bishop replies, “No, that is 1,200 burn patients.” Ms. Bayakly replies, “I understand now, there are 11,000 trauma patients.” Mr. Bishop was also asked to look at the issue of Trauma Foundations and he has included that in his PowerPoint presentation. Mr. Bishop also included a list of items from the GTCNC Strategic Plan that consists of functions that could contribute to or be carried out by a Trauma Foundation. The basic approach would be

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to define what the Commissions needs are. It would be a contractual relationship between the Commission and a Trauma Foundation in terms of doing things for the Commission on an annual contract basis. Mr. Bishop mentions that Dr. Ashley went to Arkansas where they are developing a new Trauma Foundation and asks Dr. Ashley if he has any insights on that. Dr. Dennis Ashley stated that it is very similar in a sense that they have a Trauma Foundation with their own board and their Commission puts money into that. They can also approve other money from corporations or private citizens and that is tax deductible. The money is used for education and research. They report back to the Commission from what their strategic plan was for the year of the Commission. Education was one big issue where the Commission would decide what educational courses they wanted to keep or change and it is the Foundations job to set up the web site with those courses so that students can register online. They have their plan and will be very organized once it is instituted. Dr. Mullins stated that Joseph M. Still Burn Center has a Burn Foundation and in it they have over 300 publications and post a meeting every quarter where people from all over the world commune and talk about burn care. It presents at every national and international meeting on burn care and really ties everything together. State Vision on Trauma System in Georgia Dr. Pat O’Neal stated there is a need for more outreach and involvement of the larger group of stakeholders in the community. We urged looking at some of the existing coalitions and giving consideration to joining those instead of creating new ones. Dr. O’Neal stated that the greatest advocates for trauma system in the state of Georgia are those individuals with the Trauma Coordinator group. Dr. O’Neal believes that the Commission would be well advised to establish a much more integral relationship with that group to assist in getting into the coalition business a more definitively. Dr. O’Neal stated that each of the Commission members have fulltime jobs and may not have time to participate in coalitions, but the trauma coordinators do have the opportunity to participate. We have 14 Regional Coordinating Hospitals throughout the state and many of them are trauma centers. Each of the Regional Coordinating Hospitals has an existing coalition and it is the very same membership that is needed to advance the trauma system. Dr. Ashley asks, ”What is a Regional Coordinating Hospital?” Dr. O’Neal replied, ”In response to a request from Public Health the Georgia Hospital Association did a fantastic job of organizing hospitals into 14 regions through-out the state with each of the regions having a Regional Coordinating Hospital surrounded by several satellite hospitals.” There are mutual aid agreements that facilitate the hospitals supporting each other during disasters and crises. This network of hospitals has functioned exceedingly well. Each of the Regional Coordinating Hospitals has a coalition of members, which assist in emergency/disaster planning. It would be helpful for the Trauma Coordinators to join the coalitions at their closest Regional Coordinating Hospital, which in many cases is in their own trauma center. Dr. O’Neal thinks that the Trauma Commission could do a really good job of jumping into the coalition approach real quickly with the help of the Trauma Coordinators and that would get the dialogue out there to the community. In terms of getting funding Dr. O’Neal thinks there is little chance that we will get any additional funding this year from the legislature, but that does not mean that we shouldn’t start to get the message out. It is going to be a 1-½ year process at least to get to where we need to be with the public and the legislature to obtain the necessary funding. That coalition piece needs to start right away and this is just one place that it can be done. Dr. O’Neal stated that the data piece is also critical. We need to be able to go to the legislature and show them the numbers. We need to be able to show that we have improved outcomes for trauma care in Georgia. For the metrics Dr. O’Neal stated that he should not stop with the interval from injury to acceptance because there are too many ways to fake that. He would go from the time of the injury until the patient arrives at definitive care. Dr. O’Neal stated that he had asked his associate Dr. Linda Capewell from the CDC to look at trauma data in the hospital discharge database and she will be addressing that shortly with the Commission.

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Hospital Discharge Data/Trauma Data Set Dr. Linda Capewell, VMD, MPH, CDC Preventive Medicine Fellow presents a PowerPoint on the evaluation of the Trauma System in Georgia (Copes of this PowerPoint are available by Ms. Rana Bayakly email address [email protected]). Dr. Capewell stated her outline is the methodology direction she took to abstract common data from the Georgia Hospital discharge database of 2009. Her first step was to identify those areas in need of trauma care coverage and place new trauma centers in those needed areas. Dr. Capewell also will be comparing the differences in outcome between patients in a non-designated trauma center verses designated. Dr. Ashley stated that he thinks he understands what Dr. Capewell is doing but he needs to see the bottom line. Dr. Ashley thinks that the two groups are not comparable based on ISS scores and asks Mr. Bishop if there is a way to take the data base and the discharge data and assign an ISS score so that you can see if the two groups that you are talking about are exactly the same. Mr. Greg Bishop stated that there is, but it is not exact. Dr. Ashley stated that as you go through this analysis it is key that you put in ISS scoring for patients when comparing trauma center to non-trauma center patients. Mr. Moore stated especially when you start comparing mortalities. Dr. Ashley stated if you base your study just on taking out some ICD-9 codes, the groups might be totally asymmetrical. The ISS score is very sophisticated and gives you a way of knowing just how sick a patient is, through computer software and multiple papers where it well written out. Dr. Ashley is not saying that it is easy. He thinks that Dr. Capewell is off to a good start, but as we walk down this road with outcomes the Commission we will have to ask those questions. Ms. Bayakly stated that they would follow up on that idea and see if they can do the ISS scores. Dr. Capewell stated that her next steps would be to compare outcomes between those two groups and to give a representation of how many patients are going to the different hospitals. This will be in her next presentation. Dr. Ashley stated that if he understanding Dr. Capewell’s study correctly, it is about transporting patients and showing that the further a patient is away from a trauma center the worse the outcome. That study is all good, but when you are comparing directly a trauma center verses a non-trauma center based on the methodology that he has seen today and the way you are doing it, there is no scientific validity compared to what is in the literature. Dr. Ashley stated that if we are going to go down that route to answer that one question, for example, does a ruptured spleen in a non-trauma center have the same survival as a ruptured spleen in a trauma center, that there is a way to do that, it is very expensive, labor intensive and it has already been proven at a national level. Do we want to invest that much time into a question that has already been answered, and if we do it better be done the right way. Dr. Ashley believes that is separate to the question that Dr. Capewell is answering, but is just focused on that one question and wants to make sure we do not go down the wrong path. Planned Trauma Data Use During CY 2012 Ms. Rana Bayakly, stated that their goals for the 2012 calendar year are related to the ACS Consultation Visit Report from 2009 and the research project that the Commission is currently involved with, also the Trauma Data Enhancement which we will be starting soon and some of the activity we are doing with the data use for injury control and prevention programs. To just concentrate on the research projects we are going to be presenting the data at the Admission Trauma Society in April 12-13 in Savannah and if you are there please drop by. We are doing training with the Emory Center for Injury Control and how to use various injury data

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sets, including the trauma registry data. This way we can encourage academic research. From the presentation we did in September, we came up with two projects and the author on those two projects is Dr. Anitha Mathews, who is funded from the Emory Center for Injury Control for Pediatric Research. This project is titled Analysis of Children Traffic Motor Vehicle Collision Outcomes Based On Designation and Distance in Demographics. Dr. Matthew is also applying for the other project, which concentrates on adults. The purpose of engaging in these types of research is to enhance our data, such as adding the address of the injury and the time between the transportation from injury to definitive care. We will be able to do some of the outcome that the Commission has expressed interest in looking at. We will also be starting a pilot sometime in February linking the emergency EMS database with the trauma registry database. We have picked a couple of hospitals to work with. If we are successful with those two hospitals then we can learn from that and expand it to the rest of the trauma centers. Ms. Bayakly stated that she has been working with injury control and the prevention program of the state and she will be participating in the Advisory Committee and hopefully will be able to present the data that will be useful. Trauma Communications Center Update Mr. John Cannady stated that the TCC began staffing 24/7 on December 19th in order to allow for additional training and shift acclimation. In addition, we wanted to be sure that the hospitals became familiar and comfortable with updating their status on a 24/7 basis. We made ourselves available to receive calls on 1/1/12. Regions 5 and 6 have decided to “phase in” their training and utilization of the TCC with the Region 5 deadline to complete training by 1/31 and the Region 6 deadline by 3/1. We have taken four calls to date. We have and will continue to perform review and PI on these calls to find areas of strengths and weaknesses. We recognize that the TCC is there to provide a service to EMS and hospitals. We have used this service-based approach as we move forward and will continue to keep high levels of service as a top priority. We rely on feedback from EMS and hospital providers in order to ensure that we are providing the highest level of service possible. As we recognize the importance of coalition building and working with all stakeholders I want to point out the work of the RTAC’s in bringing all the various stakeholders together. With the cooperation of Russ and Lawanna from OEMS, I feel that both Region 5 and Region 6 have done a great job of garnering cooperation throughout each region. Mr. Cannady thanks Mr. Scott Sherrill for his assistance and hard work with the TCC as well Mr. Kirk Pennywitt for his work with the AVLS program and GTVC at the TCC. AVLS Update Mr. Kirk Pennywitt stated that he is going to be presenting a review of the Automatic Vehicle Location System program and all the numbers and figures he will be giving you are up to date as of two days ago (PowerPoint presentation Georgia EMS AVLS Program Update 27 January 2012 attached to the meeting minutes). Mr. Pennywitt stated that they publish a quarterly newsletter, and newsletter number 4 was just approved yesterday (Onboard Newsletter number 4 January 2012 attached to the meeting minutes). Ms. Linda Cole asks, ” What UASI stands for ” ? (UASI area ambulances mentioned on slide 20 of the PowerPoint attached to the minutes). Mr. Pennywitt replies, ”UASI stands for Urban Area Security Initiative.” There are certain cities within the Unites States that are designated as potentially high-risk terrorist targets. Atlanta is one of those areas and so it gets special federal dollars for security initiatives that are related to their uniqueness. Ms. Cole wants to know if Atlanta is the only city within Georgia that is UASI. Mr. Penneywitt stated that Metro Atlanta is the only city in Georgia, including 6 counties in that area. Mr. Penneywitt stated that the Georgia EMS AVLS Program is the only program in the Unites States to tie so many individual EMS agencies into a single integrated system. There are other systems in the country that are actually larger and have more vehicles, such as LA Metro, all of their buses, taxi cabs, fire and police have units in their vehicles and that is more than 750, but they are all under the jurisdiction of a single

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agency. Mr. Pennywitt stated that ours are under the jurisdiction of 85 agencies and so there is no other program that has such a disparate collection of different agencies unified in a single system. eBroselow Discussion Mr. Peter Lazar presents a PowerPoint presentation on the Artemis Initiative that we have done with the Georgia Trauma Commission in the state of Georgia (eBroselow Georgia Artemis Initiative PowerPoint attached to the meeting minutes). This is a system to prevent dosing errors particularly in children and acute situations. This is built on Dr. Jim Broselows and Lutins work over the last decade and also the pediatric pharmacy adversary group which is a which is a 700 member non-profit group based in Memphis Tennessee. Together they have created this library of approved standardized dosing which really had not been created before. Tools were also created as a way to administer the drugs in a way that prevents errors. Mr. Lazar stated that there were some speed bumps and we found that there needed to be a few structural adjustments on how we do things and they all have to do with the slowness of how long it takes to implement. Mr. Lazar is convinced that it is not inherit in the Artemis itself, because they have rolled out to even larger sets of hospitals. One of the challenges that they have had is that it was set up as a one year contract and hospitals were not sure about future payments and how much they would it be, if they would be tied into it and whether the cost would be absorbent in the future. The proposed solution is to make the next version of this contract multi-year, so the hospital would know what expectations were for at least five years. There also is not really a formal structure and so the potential solution was to put this under a Trauma Subcommittee and actually have eBroselow representation and provide a report at least four times a year. We also found that the institutions were completely swamped with there meaningful use EMR rollouts and the solutions to that is naturally that is going to flush out and more people will be available to do other things. Mr. Lazer stated that eBroselow is introducing some additional exciting features (eBroselow Phase 2-Additional Features slide 5 Artemis Initiative PowerPoint attached to the meeting minutes). eBroselow’s proposal on how they will do this(eBroselow Phase 2-Proposal slide 6 Artemis Initiative PowerPoint attached to the meeting minutes). Dr. Fred Mullins wants to know if the $3,750 is per year? Mr. Lazar stated that it is per hospital per year for years 2-5. Ms. Elaine Frantz wants to know if that $3,750 is per hospital regardless of the size, or if that is an average Mr. Lazar replied that it is an average, they can come back, make it flexible and change it around. Dr. Ashley wants to know if Georgia is the first state to do the EMS application. Mr. Lazar replied that Georgia was the first state, but Colorado did something similar. Ms. Elaine Frantz wants to know if the adult dosing is available now. Mr. Lazar replied that they have it in a test environment and they will show it to the Commission in their PowerPoint presentation today. Ms. Frantz wants to know if there is ability in the system to customize it. Mr. Lazar replied that there is. Dr. Broselow stated that they are willing to take on the liability and there is nothing in the system that says use this has a guide, it is just really up to you, we are just giving you background. We are willing to stand behind our standards. We never say it is the only way to do it, but we do say it is a good way to do it.

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Ms. Linda Cole stated at Children’s they had been utilizing the Ibex documentation record in the ED for years and had always documented live, we did not have paper in the trauma room, or resuscitation room. We made the move to EPIC July 13th of last year. Because our documentation was taking so much longer on EPIC in the trauma room and resuscitation rooms we had to go back to paper, which was very painful. Ms. Cole stated that Children’s is looking at using eBroselow to be their documentation tool in the Trauma room and resuscitation room. Dr. Broselow stated that they are very interested as a company in trying to fill that niche and are trying to develop something that works like paper, but is better and faster. We want the information up front and in real time so you have the information that you need. Our goal is to look at the system over the next year or two and add some ability to do standard orders off it, at least trauma orders like chest x-ray, blood and cross match. This would give you the option to do acute care off of something like a touch screen and enter the orders. Ms. Cole stated that we started off this year with the 50 hospitals and we received feedbacks that the hospitals liked the product, but there was concern they would put time and energy into implementation for only a year of usage. Part of that is they do not understand or have not experienced what this system can do for them and the value it brings, or they would probably purchase it. I would like to propose we agree to a five-year agreement. The next fiscal year would be paid out of dollars we have already allocated and we would commit to funding the Broselow system for the remaining 4 years. Next year would be basically what we have already paid to get us through the next fiscal year and we would commit to paying for those 50 hospitals for the next four years. What we would really like to do over those five years is gather data. Submission of data would be one of the rules of participation to have the system funded through the Trauma Commission. The data would be utilized to determine if it has made a difference in those hospitals, has care improved and have we decreased medication errors. Ms. Cole is hoping Ms. Elaine Frantz, Ms. Debra Kitchens and Regina Medeiros will help with this study. Ms. Kitchens had already started some pre-implementation surveys in anticipation of this taking place. In addition by working with the Children’s Miracle Network, Children’s is facilitating the installation in 16 hospitals in the North Georgia area. The same rules of participation regarding data collection are being utilized. Ms. Cole stated that we really do not have to make this decision until the Commission creates their next budget. Even though no dollars need be designated in the Commissions next budget we are making the agreement that we will fund it for the following five years. Mr. Bill Moore wants to know how many hospitals is it in now. Ms. Cole stated that we are getting ready to put it into 50 hospitals. Right now it is in Children’s and all the Level 1’s and Level 2 trauma centers. Dr. Broselow wants to point out that what was bought initially was just for kids and did not include adults, scanning, or recording applications and the price we are giving now per hospital per year is less than you paid originally. eBroselow’s goal is to keep adding features, not price. What we want to do is keep adding value and be successful as a company because everybody uses it. We want this to become the standard way to get very rapid information for medications. Ms. Cole stated EMS would be another area to continue to work with and develop. Dr. Broselow stated there is a raw opportunity to study that within Georgia. We have already obtained a connection with EMS and they downloaded our basic apps. The idea that we would develop a pre-hospital system and this would be the first geographical area where we have put it all together from critical care, to basic transport, to flight nurses to tertiary care. Ms. Cole stated that today was just for information only. When the Commission meets in March and we start talking about the budget we will review this again. Dr. Broselow stated that they have worked with Hospital Corporation of America, starting with 52 of their hospitals and are now expanding it to four other divisions. There are many hospitals there in all different

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circumstances that have used eBroselow for almost two years. That may be a way that the Commission could get some additional information on users. Commission Subcommittees Discussion Mr. Pettyjohn stated that the current GTCNC Subcommittees list is on pages 148-150 of the Workshop binder. This document was prepared to reflect those committees past and currant. As you can see there were several over the last 3-4 years. Dr. Leon Haley’s Trauma Center and Physician Funding Subcommittee is still active. The Trauma Center Capital Grants Subcommittee has morphed into the EMS Vehicle Replacement Grant Subcommittee, which is the staff working with Mr. Keith Wages from the Office of EMS. They review the applications and come up with a list and recommendations for awards. Then based on the number of dollars available that subcommittee makes a recommendation to the full subcommittee to award that number of grants. Then there is the Government Affaires Subcommittee that Mr. Ben Hinson led, it had some activity prior to Amendment #2. Dr. Ashley recommends that Ms. Linda Cole, Dr. Leon Haley, Mr. Pettyjohn and he take another look at this subcommittee list and come up with a new list of committees that are needed. Then open it up to the Commission and find out who is interested in being on those committees. He would also like to get together with Mr. John Cannady and compile some information that they gathered from attending the Arkansas meeting and present it to the Commission at the March meeting. He thinks they had some good infrastructure in forming their trauma foundation. Ms. Linda Cole stated that the Committee that she thinks the Commission really needs is the Coalition Foundation Subcommittee. Mr. Pettyjohn asks Dr. Ashley to remember, as Dr. O’ Neal mentioned, the trauma coordinators as a coalition. We should remain close to them and recognize them as an official subcommittee of the Commission. Dr. Ashley stated that he thought we had incorporated the trauma coordinators into the Commission because they are a standard subcommittee with a direct access to the Commission’s recommendations. Dr. Ashley believes the coordinators are tied into Commission just about at the highest level they can be and he agrees the coordinators need to be there and they are. Ms. Elaine Frantz stated that she believes Dr. Ashley will be seeing a positive change in the GTCE based on what happened at the last meeting. They are actually providing some focus and guidance and their alignment of bylaws are very close in alignment to the Trauma Commission as a subcommittee. Dr. Ashley stated there are several committees that need to be maintained that have non-commission members on them, as outreach and focus and they are Georgia Committee on Trauma Excellence, the Trauma Medical Directors Subcommittee, of which he is the Chair and the EMS Subcommittee on Trauma. We are reaching out and we do have the arms going out there to touch all stakeholders, which is what we need to be doing. 2012 Commission Meeting Schedule and Workshop Wrap-Up Mr. Jim Pettyjohn stated that through various conversations with Commission members we came up with the idea of a schedule for 2012, and 2013(Proposed Trauma Commission meeting schedule for 2012 into 2013 included in Workshop binder ). Mr. Pettyjohn’s feels that this would give the Commission presence across the state and the opportunity for folks and other stakeholders to attend and see the Trauma Commission’s work. Dr. Ashley sees two issues here, change our meeting schedule from every other month to a semi-quarterly schedule and rotating the meetings to include Savannah and Augusta Georgia. Ms. Cole thinks that if we get the subcommittees formed and functioning, the new meeting schedule makes sense, but if we do not and the Commission goes three months without a meeting we might lose

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momentum. If we do decide to travel to Savannah and Augusta we need to reach out to those constituents in that RTAC and let them know about that meeting. Mr. Bill Moore thinks that we should at least try having the meetings somewhere besides Atlanta and Macon. He has never been to Savannah and recommends having the Savannah meeting on a Friday to allow time for travel. Dr. Ashley stated that moving the Savannah meeting from a Thursday to a Friday is fine with him. Mr. Pettyjohn stated the Savannah Commission meeting will be on Friday, May 18th and all meetings will be from 10-1 pm. Old business: None New business: Mr. Bill Moore stated that AMC did a Trauma Symposium, it was a lot of work and the attendance was good, but he feels that it could be better if it was a combined effort with the trauma centers in the town where it all falls together. Mr. Moore wants to know if the Trauma Commission would like to organize a statewide Trauma Symposium. We have a lot talented physicians and EMS personnel and we could do something great and hopefully get better attendance. It would be a lot of work to organize, but he wants the Commission members to think about it. Dr. Ashley stated that he has been conferring with Dr. Chris Dente the Georgia COT Chair from Grady about having a Committee on Trauma. We used to have one but it fell by the wayside. Dr. Ashley stated that his goal is bring the trauma coordinators and medical directors from all the trauma centers together and have a meeting once a year and make that meeting a requirement as part of the Performance Based payment, in other words one of the deliverables. Dr. Ashley thinks that we need to push for that at the Commission level. This would really get our trauma centers all together, plus provide education. Dr. Dente has actually been working on doing that and was planning to try and hold the first joint meeting in 2013 to include, EMS trauma coordinators and the medical directors. NEXT MEETING: March 15, 2012 Atlanta, Georgia Meeting Adjourned: 2:20

Minutes crafted by Lauren Noethen

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Georgia Trauma Commission: EMS Subcommittee on Trauma Meeting Minutes: 07 February 2012 Page 1

EMS SUBCOMMITTEE ON TRAUMA

MEETING MINUTES

Tuesday, February 07, 2012 Scheduled: 10:00 am until 12:00 p.m.

Letton Auditorium Atlanta Medical Center

Atlanta, Georgia

CALL TO ORDER Mr. Ben Hinson called the February monthly meeting of the EMS Subcommittee on Trauma to order at the Letton Auditorium, Atlanta Medical Center, Atlanta, Georgia, at 10:05 a.m.

SUBCOMMITTEE MEMBERS PRESENT SUBCOMMITTEE MEMBERS ABSENT Ben Hinson, Chair Subcommittee & GA Trauma Commission Member Randy Pierson – Region One Chad Black – Region Two Richard Lee – Region Four Lee Oliver – Region Five Blake Thompson – Region Six Huey Atkins – Region Ten Courtney Terwilliger – EMSAC Keith Wages-SOEMS Dr. Leon Haley-GA Trauma Commission Via tele-conference

Jimmy Carver-Region Seven Craig Grace – Region Eight David Moore – Region Nine Pete Quinones- Region Three

OTHERS SIGNING IN REPRESENTING Russ McGee Jim Pettyjohn Judy Geiger John Cannady Lawanna Mercer-Cobb

Region 5 EMS Georgia Trauma Commission Georgia Trauma Commission Georgia Trauma Commission Region 6 EMS

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Welcome and Introductions Mr. Ben Hinson welcomed all present at the meeting and recognized a quorum of the voting members were present. Approval of Minutes from January Meeting The first order of business was the approval of the minutes from the 04 January 2012 subcommittee meeting. MOTION #1 EMS Subcommittee 2012-02-07:

I make the motion to approve the minutes from the 04 January 2012 meeting as written.

MOTION BY: KEITH WAGES SECOND: LEE OLIVER ACTION: The motion PASSED with no objections, nor

abstentions.

TRAUMA COMMUNICATIONS CENTER UPDATE Mr. John Cannady reported that the TCC began taking calls on January 1, 2012. The TCC began receiving calls from EMS Region 5 on or about January 21, 2012 and since that time there have been approximately twenty-one (21) calls into the TCC with trauma patients. From the small amount of data that has been received from these calls, we have learned that just a few calls have gone according to what we expected. The TCC has received calls from EMS units that have already arrived at the hospital and EMS units while enroute to the hospital. We have had good cooperation from MCCG with the hospital calling the TCC and relaying information on patients that arrived without going through the TCC at all. Of the twenty-one (21) calls, five (5) of those calls were EMS units requesting hospital designation. Discussion: Mr. Ben Hinson asked if the TCC is expecting EMS units to give data to the TCC whether or not they are contacting the TCC. Mr. Cannady stated that they would prefer the EMS units to contact the TCC even though they did not utilize the TCC for designation. Mr. Ben Hinson stated he felt that we needed to be sensitive to the EMS field crews and the EMS Subcommittee needs to be very clear that we don’t want any additional work from the field crews to get data because they have to submit their data to the state and it is available through the state. Mr. Keith Wages and Mr. Chad Black agree with this and feel that the EMS field crews will not call the TCC if it creates more work on them. Mr. John Cannady reported that the TCC wants to be a service to the EMS community and wants to fulfill the function that the Trauma Commission has put on them to fulfill but at the same time does not want to create extra work for the EMS field crews. It is our goal that the TCC evolves into a service that is beneficial and gets the mission done. Mr. John Cannady feels that these discussions are very helpful to the TCC and appreciates any feedback from the EMS Subcommittee. Mr. Blake Thompson questioned whether or not the TCC can be contacted for the availability of the closest helicopter in the near future. Mr. John Cannady stated that the TCC does not want to get into dispatching helicopters but would be happy to provide contact information and patch the EMS crew through to them. Mr. Ben Hinson stated that his position is when you hit the button on your device stating that you need a helicopter; that some objective process needs to decide which helicopter they are

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sending and send the one who is quickest, closest, and does the best job. We don’t need to make those decisions based on marketing or anything else. EMS VEHICLE EQUIPMENT REPLACEMENT GRANTS Mr. Jim Pettyjohn reported that the FY 2010 Vehicle Replacement Grants are complete. For FY 2011, there are two (2) that have not received their final payment. In the FY 2012, fifty-four (54) applications have been received and after this meeting, Mr. Jim Pettyjohn will be meeting with Ms. Lauren Noethen and Mr. Keith Wages to begin the process of reviewing the applications and scoring them. Depending on the recommendations from the EMS Subcommittee, which the Trauma Commission has empowered them to make a decision on how much money will be distributed to the Vehicle Grant Award Program this year, a list will be developed and provided to the Subcommittee of the Trauma Commission that reviews the applications and will make recommendations to award that number during the March Trauma Commission meeting. EMS UNCOMPENSATED CARE AD HOC SUBCOMMITTEE REPORT Mr. Huey Atkins reported that the Ad Hoc subcommittee did meet and discussed the issues reported at the last EMS Subcommittee meeting from the audit report. The Ad Hoc Committee did recommend that the base rate for reimbursement be set at a $400.00 flat fee and won’t be subject to the fluctuating reimbursements from Medicare. The committee feels it is best to have a flat base rate that does not fluctuate each year. The committee is also recommending a mileage rate of $6.85 with the additional fifty percent modifier for rural counties. The second issue looked at was there was such a wide parameter of what providers considered bad debt that the committee is making the recommendation that for claims to be considered bad debt the providers have to work the claims for one (1) year for collection. There should also be one individual listed on the affidavit as the contact person for follow-up. MOTION #2 EMS Subcommittee 2012-02-07:

I make the motion to: (1) set the rate for uncompensated care reimbursement at $400.00; (2) a contact person must be identified on the Affidavit; and (3) for claims to be considered for reimbursement, the claim must have been worked for at least one year for collection.

MOTION BY: BLAKE THOMPSON SECOND: LEE OLIVER ACTION: The motion PASSED with no objections, nor

abstentions. Discussion: Mr. Lee Oliver stated that even though helicopters were not licensed in 2010 but are now, will they be eligible for reimbursement under the Uncompensated Care Program? Mr. Jim Pettyjohn replied that the requirements to be eligible for reimbursement are the provider had to be licensed in Georgia and provide the care during the timeframe that the program was open for reimbursement. Mr. Ben Hinson stated he felt that this is something that needs to be discussed with the entire Trauma Commission for future claims since the helicopters were licensed in the 2011 calendar year and since they were not licensed during the 2010 year, they would not be eligible. Mr. Jim Pettyjohn requested that the EMS Subcommittee make recommendations for audit procedures for next year. Last year was a review of the program and next year we would like actually do more case reviews. Mr. Ben Hinson agreed and we will discuss this and make a recommendation.

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FY2012 FUNDING DISCUSSION Mr. Ben Hinson reported that at the last EMS Subcommittee meeting we had just been notified of reductions and Mr. Jim Pettyjohn worked those into the budget. Then the State Budget Office came out with their reports and recommendations and we were cut again. The Trauma Commission meet February 17, 2012, and the Trauma Commission empowered the EMS Subcommittee to take the amount of money the EMS Subcommittee was allocated and determine how they thought it was best spent and begin moving forward. Mr. Courtney Terwilliger presented a hand-out with the updated figures. (Copy of handout attached as part of these minutes) Mr. Courtney Terwilliger reported that the EMS Subcommittee’s budget has been cut by $254,186.00. Mr. Courtney Terwilliger reported that when the cut was handed out, he talked with folks from GAEMS and found some issues that we would have if we tried to do the EMTB courses. In the rural areas, we have had problems with finding instructors for the First Responder classes and had to extend the contracts to allow for these to be completed. Mr. Courtney Terwilliger stated he felt that we would have the same problem with finding instructors for the EMT-B courses and recommends removing the money allotted for the EMT-B classes. Mr. Courtney Terwilliger is making the recommendation that we move the money allocated for the EMTB course to the EMS Uncompensated Care. MOTION #3 EMS Subcommittee 2012-02-07:

I make the motion to approve the amended budget as presented which will move the money allotted for the EMT-B Course to the EMS Uncompensated Care program and the caveat to only give computers to those who need it and take them back up at the end of the course for the EMS Leadership Program and let GAEMS set their parameters.

MOTION BY: COURTNEY TERWILLIGER SECOND: RICHARD LEE

Discussion: Mr. Ben Hinson stated he felt he couldn’t justify the purchase of the laptop computers for the students of the EMS Leadership Program. Mr. Courtney Terwilliger replied that the laptop purchases were put into the budget to keep all the students using the same version on their computers to be able to participate in this course. Mr. Ben Hinson stated he feels very strongly that if a person cannot get a laptop that has the required programs, then they shouldn’t be in the course. Mr. Ben Hinson stated that a pre-requisite should be sent out which outlines what is required of the students to participate. Mr. Courtney Terwilliger replied that there is a huge diversity of leadership out there and we want to bring them up to the same level. Mr. Ben Hinson again stated that he is strongly against the Trauma Commission purchasing laptop computers. Mr. Lee Oliver suggested that we purchase the laptops but do not allow the students to keep them and that way you wouldn’t be dealing with IT issues. After the course is complete, the student will have to turn the laptops in. Mr. Ben Hinson asked Mr. Jim Pettyjohn from a process standpoint how do we go about putting that money into GAEMS and giving them authority to make that decision and what do we do with the money left over if a laptop is not purchased? Mr. Jim Pettyjohn stated we would have to do an amendment to identify a use for moving the money. Mr. Ben Hinson suggested that we will evaluate the need of each student for a laptop and will only make them available for those who need them with the laptops being turned back in at the end of the course. ACTION: The motion PASSED with one objection, no abstentions.

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RETURN ON INVESTMENT DISCUSSION Mr. Ben Hinson stated that one thing that has been discussed is how the EMS Subcommittee can prove to the Trauma Commission then they can prove to the legislature that there is a good return on investment on the money they give us. It was suggested that maybe we need to look to the Trauma Commission to tell the EMS Subcommittee what they expect the EMS Subcommittee to generate as a return on investment. Mr. Ben Hinson stated that has not been answered yet but as we move down the road and get the data, we will be able to see the EMS services that used the TCC to move their patient through the system versus those who didn’t and we can show that the ones that go through the TCC get to definitive care 30-45 minutes earlier. This would be considered a huge win and the good thing is we would have a baseline to compare to that is on-going. We have yet to decide in the Trauma Commission what a win is. As we get to the return on investment discussion, there are bigger questions to get answers too. As a EMS Subcommittee, we can see that a systematic process can improve things better than a single hospital. The Trauma Commission has yet to come up with a return on investment. Mr. Jim Pettyjohn replied that everyone that receives an ambulance under the Vehicle Replacement Grant has a Return on Investment plan that they provide to the Trauma Commission with their work-plan. Mr. Ben Hinson stated that return on investment is not a financial return but a return on improvement of patient care. We need to decide what it is and define it and then say what a success is and see if we get there. Mr. Jim Pettyjohn responded that for three (3) years we have been working to identify the system in Georgia. It was identified and the Trauma Commission approved a Regionalized Trauma System (RTAC) with a plan and a common component of all the plans being the Trauma Communications Center. With plans components being EMS, Pre-Hospital, QI, Registry data and using these components to drive the performance improvement of the RTAC. We have worked and have RTAC’s going in Regions 5 and 6 with Regions 9 and 3 coming on-board to hopefully begin working with the TCC by April. We have identified one of our performance measures as being the time of injury to definitive care and have solicited the support of the Governor’s office. It took us a long time to get there but getting the right patient to the right hospital at the right time and measure that from time of injury to definitive care. We have the system being developed and we will be in place soon to get those numbers. Mr. Keith Wages responded that only the ones that call the TCC can be followed at this time. OLD BUSINESS None NEW BUSINESS Mr. Lee Oliver questioned is there a time-frame on the RTAC pilots in Regions 5 and 6 and how are the upcoming Regions going to be managed? Mr. Jim Pettyjohn responded that it needs to be managed and there will no more RTAC’s coming on as pilots. One reason for the pilots was to test the framework and the operations of the TCC and we stated only for one year. For the TCC, the pilot will continue for one year. Meeting adjourned at 12:30 p.m. Next meeting date with time and venue to be determined Crafted by Shawn Hackney

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Available EMS Budget @ 20% of available funds for stakeholders: $ 2,722,217

Staffing and Meeting Support $ 3,500

Available for distribution $ 2,718,717

% Distribution from FY 2010 funding %

EMS Uncompensated Care 27.51% $ 748,028

EMS Vehicle Equipment Replacement Grants 45.18% $ 1,228,329

First Responder Training Grants 4.34% $ 118,046

Support EMS Leadership Program 1.00% $ 27,284

Extrication Project 2.79% $ 75,981 PHTLS/ITLS 4.12% $ 111,953 24 Courses

Trauma Care Related Equipment 15.05% $ 409,096

Total 100.00% $ 2,722,217

EMS ALLOCATION

#17 Ambulance grants at $72,254 per

19 Classes

FINAL: DISTRIBUTION APPROVED BY EMS SUBCOMMITTEE ON 07 FEBRUARY 2012

Staffing and minutes development

Available for distribution

Support eight students @ marginal cost + Laptop computers

Reinstitute the Georgia Extrication School

$454/per ambulance if 900 apply

61

eBroselow, LLC (formerly known as Zolstice LLC) 2200 Kraft Drive, Suite 1200G Blacksburg, VA 24060 540-250-3261

Jim Pettyjohn Executive Director Georgia Trauma Commission 706.398.0842 February 10, 2012

Subject: Updated Follow-on to Contract # 41900-032-10100282

Dear Jim,

Thank you very much for making such generous time for Dr. Broselow and me to present during the Georgia Trauma Commission Annual Workshop on Friday. Reflecting what I presented and your recent discussion with Jim Broselow, I’d like to formally follow up with proposed terms for an Artemis “Phase 2” that we hope the Georgia Trauma Commission will consider. The terms would be as follows:

- It would be a five year commitment. We understand, however, that due to Georgia rules it might formally be a one year contract with only a Commission upfront approval for future years. The five year duration will help assure the participating hospitals that the system will be around and funded after their upfront effort to rollout and train people.

- Up to 50 hospitals throughout Georgia The GTC can pick which hospitals. We assume it will be a mixture of large and small facilities.

- Use it or lose it for participating hospitals. Licenses unused after six months into any given year would be assigned to new hospitals.

- The first year (Georgia FY 2013) will be at no cost. The second through fifth years will be $3750 per participating hospital per year.

- Following year total cost will be determined by the number of hospitals choosing to participate that year ($3750 per hospital) and again up to 50 hospitals per year.

- The features include everything in the current Artemis system with the addition of new features including but not limited to the following:

- Adult dosing - Ability to customize concentrations per facility and add per-facility notes - Barcode scanning

- Oversight by a GTC subcommittee in which eBroselow is a participant.

There are several parameters above: number of hospitals, price, number of features. We are flexible to adjust between these parameters to meet GTC’s needs. We look forward to continuing our partnership with the Georgia Trauma Commission to develop our common goal of improving acute care of patients.

Sincerely,

Peter Lazar CEO eBroselow, LLC (formerly known as Zolstice, LLC)

62

2/23/2012

To: Georgia Trauma Commission Jim Pettyjohn, Executive Director From: Debra Kitchens, Education Chair Georgia Committee for Trauma Excellence (GCTE) Trauma Associates of Georgia (TAG) Re: 2013 Budget GCTE is respectfully requesting money for the Georgia Trauma Commission to support TAG in the production of the following classes for the fiscal year 2013 (01 July 2012 through 30 June 2013): Rural Trauma Team Development Course (RTTDC) – 6 @ $3800 = $22,800 Advanced Trauma Care for Nurses (ATCN) – 2 @ $6,000 = $12,000 Trauma Care after Resuscitation (TCAR) – 2 @ $13,000 = $26,000 Emergency Nurses Pediatric Course (ENPC) – 1 @ $5,000 = $5,000 Trauma Nurse Core Course (TNCC) – 1 @ $5,000 = $5,000 Total Budget Requested -‐ $70,800 Definitions and class breakdown of the classes requested: Rural Trauma Team Development – designed for rural facilities and emphasizes a team approach to the initial assessment, resuscitation and transfer of the trauma patient in a systemized, concise manner Advanced Trauma Care for Nurses – Advanced Course designed for nurses that are working in the emergency department, intensive care unit, medical surgical floor or the operating room who wish to increase their knowledge and practical skills in managing the multiple injured trauma patients; Held in conjunction with an ATLS class. Trauma Care After Resuscitation -‐ designed to provide acute care, critical care, and perioperative nurses the foundational, evidence-‐based information and critical thinking skills necessary to care for the hospitalized trauma patient. Emergency Nurses Pediatric Course – provides core-‐level pediatric knowledge and psychomotor skills needed to care for pediatric patients in the emergency care setting. Trauma Nursing Core Course – provides core-‐level knowledge, refine skills and build a firm foundation in trauma nursing.

63

In fiscal year 2012 – TAG received $37,530.00 for the following courses: AAAM AIS scoring – held on 10/10 & 10/11/11 – 36 attended RTTDC – held 11/3/2011 @ Meadows Regional in Vidalia -‐ 25 attended RTTDC – scheduled for 4/27/2012 in Mountain Lakes, GA RTTDC – scheduled for May/June in Region 7 There are plans to ask for ASPR funding as well specifically for ENPC and TNCC courses. If that funding is obtained, the money allocated for those 2 courses would potentially be re-‐allocated to another trauma course or courses. I will plan on presenting this request along with any necessary backup information at the March 15th Trauma Commission meeting in Atlanta, GA. Respectfully Submitted, Debra Kitchens, RN, CEN, NREMT-‐P

64

3/8/2012

To: Georgia Trauma Commission Jim Pettyjohn, Executive Director From: Dr. Chris Dente, MD, FACS Associate Professor of Surgery, Emory University Associate Director of Trauma, Grady Memorial Hospital Chair, Georgia Committee on Trauma Re: 2013 Budget The Georgia Committee on Trauma (COT) is respectfully requesting money from the Georgia Trauma Commission (fiscal year 2013) to support the COT with a 1 day trauma symposium/meeting in August of 2013. The proposed meeting agenda and budget are as follows: Trauma 2013 Proposed Date: August 9, 2013 Proposed Site: Medical Center of Central Georgia, Macon, GA Proposed Program: 7:30 – 8:00 am : Continental Breakfast 8:00 – 10:30 am: Resident Paper competition (10 papers, 15 min each) 10:30 – 10:45 am: Break 10:45 – 11:00 am : Announcement of Winners from competition 11:00 – 12:00 pm: Keynote Address 12:00 – 13:00 pm: Lunch (on your own) 13:00 – 15:00 pm: Meetings of the Trauma Medical Directors and Trauma Program Managers 15:00 -‐ Adjourn Budget for the proposed program: Resident Presenter Awards (1st & 2nd Clinical, 1st & 2nd Basic Science) -‐ pd by COT Travel, Lodging and Honorarium for Keynote Speaker -‐ $3,000 Continental Breakfast/Snacks -‐ $1,000 Brochures/Mailing Fees -‐ $ 700 Meeting Space -‐ 00 Total Budget Requested from GA Trauma Commission $4,700 This meeting would be in combination with the Georgia Resident paper Competition which is supported by the Committee on Trauma and the American College of Surgeons.

65

Debra Kitchens will present this request to the Georgia Trauma Commission at the March 15th meeting in Atlanta, GA. Respectfully Submitted, Dr. Chris Dente, MD, FACS

66

Approved by General Assembly (State and Federal

Funds)20,156,896$

Federal Funds ARRA HIE Grant (sub award) $ (2,500,000)

FY 2012 State Funds Available for Commission July

2011 $ 17,656,896

Proposed 2% Reduction in August 2011 $ (353,138)

FY 2012 State Funds Available for Commission

August 2011 $ 17,303,758

Governor's Actual Amended 2012 Budget $ (1,719,682)

AFY 2012 State Funds Available for Commission

January 201215,937,214$ January Approved AFY2012

Expenditures as of

February 29, 2012Remaining Budget

Commission Operations $ 377,909 $ (245,658) $ 132,251

Trauma Communications Center $ 562,829 $ (255,446) $ 307,383

System Development, Access & Accountability $ 312,375 $ (312,375) $ -

State OEMS/T Allocation $ 489,715 $ (489,715) $ -

Trauma Registry (distributed among TCs) $ 583,303 $ (583,303) $ -

Subtotal of above $ 2,326,131 $ (1,886,497) $ 439,634

Available for Stakeholder Distribution $ 13,611,083

EMS Distribution @ 20% of available funding $ 2,722,217 $ (1,250) $ 2,720,967

Trauma Centers/Physicians Distribution @ 80% of available funding * $ 10,888,867 $ (10,888,867) $ -

TOTALS $ 15,937,214 $ (12,776,614) $ 3,160,600

Georgia Trauma Commission AFY 2012

Amended 2012 January Approved

67

Staff Salary *BenefitsJanuary Approved

AFY2012

Expenditures as of

February 29, 2012Remaining Budget Remaining Budget

Percentage Should

be at 33%

Executive Director $104,000 $51,336 $ 155,336 $ (101,829) $ 53,507 34.45%

Budget/Procurement Officer $56,062 $28,352 $ 84,414 $ (54,474) $ 29,940 35.47%

Office Coordinator/Executive Assistant $40,000 $19,139 $ 59,139 $ (38,516) $ 20,623 34.87%

Worker's Compensation and Unemployment Insurance $ 1,311 $ (1,311) $ - 0.00%

Commission Members Per Diem $ 4,305 $ (1,050) $ 3,255 75.61%

Staff Travel Expenses $ 25,649 $ (13,572) $ 12,077 47.09%

Conference call account $ 4,590 $ (3,203) $ 1,387 30.22%

Website service and support $ 4,030 $ (3,987) $ 43 1.07%

Printing/Supplies $ 7,082 $ (5,003) $ 2,079 29.36%

Atlanta Office set-up $ 2,037 $ (2,037) $ - 0.00%

Telephone/ Internet $ 4,065 $ (2,907) $ 1,158 28.49%

Electrical $ 1,657 $ (1,119) $ 538 32.47%

Shipping $ 1,567 $ (779) $ 788 50.29%

Staff Cell Telephones $ 5,638 $ (2,221) $ 3,417 60.61%

PH Consultants, LLC $ 11,650 $ (12,900) $ (1,250) -10.73%

Contingency funding $ 5,439 $ (750) $ 4,689 86.21%

$ 377,909 $ (245,658) $ 132,251 35.00%

Department of Administrative Services (DOAS) billing for Worker's Compensation at $351.96 and Unemployment Insurance at $84.96 per projected employee number at beginning of FY.


Commission Operations

Location


Rising Fawn-based

Atlanta Based

Rising Fawn-based

9 Members reimbursement for Jan.Workshop, March and May Commission Meetings at $105 per day.

Commission Staff yearly travel expenses.

Premier Global: (Includes: Commission, EMS and GCTE conference calls)

Hosting and design support based on projected need.

FedEx Office and Office Depot: Meetings and Office.

Operations

Contingency for potential overages in regular operating expenditures

TOTALS

Supplies and MOA with DPH for rent of office space in Atlanta and telephone land line service.

Trenton Telephone

Georgia Power: Commission Office

Federal Express5 Cellphones January Workshop Contract

68

Staff Salary *BenefitsJanuary Approved

AFY2012

Expenditures as of

February 29, 2012Remaining Budget

Remaining Budget

Percentage Should be

at 33%

Communications Center Coordinator $52,000 $15,225 $ 67,225 $ (40,220) $ 27,005 40.17%

***Communications Center Operations Specialist - Salary of $40,000 for 5.5 months

$18,334 $9,769 $ 28,103 $ (7,285) $ 20,818 74.08%

System Compliance and Performanance Improvement- PI Nurse based on salary of $75,000 for 4 months.(Hire Date March 1st)

$25,000 $13,320 $ 38,320 $ - $ 38,320 100.00%

Worker's Compensation and Unemployment Insurance $ 874 $ (874) $ - 0.00%

Communications Center Agents $ 229,450 $ (103,195) $ 126,255 55.03%

Staff Travel Expenses $ 14,000 $ (3,871) $ 10,129 72.35%

Verizon Airtime @ $42.50/month/unit for 200 Units- EMS Regions 5 and 6 $ 51,000 $ (15,850) $ 35,150 68.92%

In Motion Service Support Agreement @ $12.50/month/unit for 200 Units $ 30,000 $ (30,000) $ - 0.00%

Building Lease and Utilities $ 13,056 $ (13,056) $ - 0.00%

Telephone and Internet Access $ 16,675 $ (5,615) $ 11,060 66.33%

SAAB Software Enhancements $ 50,000 $ (23,900) $ 26,100 52.20%

Contingency $ 24,126 $ (11,580) $ 12,546 52.00%

$ 562,829 $ (255,446) $ 307,383 54.61%


Trauma Communications Center Operations

Location

Forsyth-based

Forsyth-based


Atlanta-based


Current expenses added to projected expenses based on staffing TCC with Agents starting October 1, 2011 and 24/7 coverage with 2 agents which began December 19, 2011.

Current software enhancement proposal is for $23,900 with additional enhancements probable before June 30, 2012.

Contingency being reduced to provide more funding for stakeholders and adjusted for DOAS billing.

Trauma Communciations Center Staff travel expenses.

AVLS (200 AVLS Unit in Regions 5 and 6)

Operations

TOTALS

Current contract with GTRI covered airtime thru 31 December 2011. (Amount shown for 6 month period 01 Jan thru 31 December))

Currently paid thru 30 June 2012

Rent and Utilities per year at GPSTC -Actual Rental Agreement

Based on billing information provided by Georgia Technology Authority and GTRI. Approximately 9 months of Service.

69

Development and Access

January

Approved

AFY2012

Expenditures as of

February 29, 2012

Remaining

Budget

Trauma System Regionalization Activities115,000$ (115,000)$ -$

National Foundation for Trauma Care 1,500$ (1,500)$ -$

Trauma Associates of Georgia (TAG) 37,530$ (37,530)$ -$

Gifford Hillegass & Ingwersen

59,545$ (64,695)$ (5,150)$

Bishop + Associates

98,800$ (98,800)$ -$

312,375$ (312,375)$ -$

** This deficit will be absorbed by the TCC Contingency Funding

RTTD courses x 3 and AAAM course

System Development, Access and Accountability



Trauma System Regionalization Activities in EMS Region 9 (Memorial Health- $75,000) Continuation funding for EMS Region 5 (MCCG $20,000) and EMS Region 6 (MCG $20,000)

Annual membership

The amount has already been accounted for in the Communications Center Budget expenditures

Audit and Accounting Services: CY 2009 Uncomp Claims audit; FY 2011 EMS Uncomp program (claims) audit; and Trauma Physician funding process review with recommendations on best practices. (Actual Cost)

Technical Services: Evaluate burn care support and financial needs, Assist CY 2010 TC Financial Survey, Reevaluate TC and physician funding methodologies to include burn centers for FY 2013 (Actual Costs)

TOTALS

Accountability

70

February Approved by EMS Subcommittee

Available EMS Budget @ 20% of available funds

for stakeholders:

January

Approved

AFY2012

Expenditures as of

February 29, 2012

Remaining

Budget

Staffing and Meeting Support $ 3,500 $ (1,250) $ 2,250

EMS Uncompensated Care $ 748,028 0 $ 748,028

EMS Vehicle Equipment Replacement Grants $ 1,228,329 0 $ 1,228,329

First Responder Training Grants $ 118,046 0 $ 118,046

Trauma Care Related Equipment $ 409,096 0 $ 409,096

Support EMS Leadership Program $ 27,284 0 $ 27,284

Extrication Project $ 75,981 0 $ 75,981

PHTLS/ITLS $ 111,953 0 $ 111,953

TOTALS $ 2,722,217 $ (1,250) $ 2,720,967


EMS Allocation


71

Amended 2012 January ApprovedJanuary

Approved

AFY2012

Expenditures as of

February 29, 2012

Remaining

Budget

Approved Total Available for OEMS/T $ 489,715 $ (489,715) $ -


Office of EMS and Trauma Allocation

72

FY 2013 State Funds Governor's Recommendation 15,937,214

FY 2013 State Funds Available for Commission July 1, 2012 thru June 30, 2013 15,937,214

Commission Per Diem* -$ 0.00% 4,725$ 0.03% 0.03%

Commission Operations 377,909$ 2.37% 416,478$ 2.61% 0.24%

Trauma Communications Center 562,829$ 3.53% 915,597$ 5.75% 2.21%

System Development, Access & Accountability 312,375$ 1.96% 470,500$ 2.95% 0.99%

State OEMS/T Allocation 489,715$ 3.07% 478,116$ 3.00% -0.07%

Trauma Registry Support** 583,303$ 3.66% -$ 0.00% -3.66%

Subtotal of above $2,326,131 14.60% 2,285,416$ 14.34% -0.26%

Available for Stakeholder Distribution 13,611,083$ 85.40% 13,651,798$ 85.66% 0.26%

EMS Distribution @ 20% of available funding 2,722,217$ 17.08% 2,730,360$ 17.13% 0.05%

Trauma Centers/Physicians Distribution @ 80% of available funding 10,888,866$ 68.32% 10,921,438$ 68.53% 0.20%

TOTALS $15,937,214 100.00% 15,937,214$ 100.00% 0.00%

Percentage of Total Proposed FY 2013

Budget

Percentage Change from AFY 2012 to Proposed FY

2013

Georgia Trauma Commission FY 2013

15 March 2012 PROPOSED

Approved AFY2012 Percentage of

Total AFY 2012 Budget

Proposed FY 2013 Budget

73


Total Staff CostsApproved AFY

2012

Percentage of Total AFY 2012

Budget


Percentage of Total


Percentage Change from AFY 2012 to Proposed

FY 2013

Staff Travel $ 25,649 0.16% $ 25,000 0.16% 0.00%

Staff Benefits $ 98,827 0.62% $ 99,042 0.62% 0.00%

Staff Salaries $ 200,062 1.26% $ 205,425 1.29% 0.03%

Worker's Compensation and Unemployment Insurance $ 1,311 0.01% $ 1,311 0.01% 0.00%

Commission Members Per Diem $ 4,305 0.03% $ - 0.00% -0.03%

Total Staff Costs $ 330,154 2.07% $ 330,778 2.08% 0.00%

Operations

Trauma Center Association of America $ - 0.00% $ 1,500 0.01% 0.01%

Atlanta Office Rent and Phone $ 2,037 0.01% $ 2,000 0.01% 0.00%

Rising Fawn Office Rent $ - 0.00% $ - 0.00% 0.00%

Conference call account $ 4,590 0.03% $ 7,800 0.05% 0.02%

Website service and support $ 4,030 0.03% $ 2,500 0.02% -0.01%

Printing/Supplies $ 7,082 0.04% $ 8,000 0.05% 0.01%

Telephone/ Internet $ 4,065 0.03% $ 4,500 0.03% 0.00%

Electrical $ 1,657 0.01% $ 1,800 0.01% 0.00%

Shipping $ 1,567 0.01% $ 1,600 0.01% 0.00%

Staff Cell Telephones $ 5,638 0.04% $ 6,000 0.04% 0.00%

Contingency funding $ 5,439 0.03% $ 50,000 0.31% 0.28%

PH Consultants, LLC $ 11,650 0.07% $ - 0.00% -0.07%

Total Operations Costs $ 47,755 0.30% $ 85,700 0.54% 0.24%

Total Commission Operations Budget: $ 377,909 2.37% $ 416,478 2.61% 0.24%

Moved this budget as a separate Budget Category for 2013, but no change in amount

Total cost of Salaries for Executive Director, Office Coordinator and Business Operations Officer.

Commission - Wide Expense.

6 Cellphones

Rising Fawn

Rent and Telephone at 2 Peachtree.

Office space for 2 Employees included in Executive Director's Salary.

Rising Fawn


Premier Global: (Includes: Commission, EMS and GCTE conference calls)

Commission Operations

Printing and Office Supplies, based on estimated need.

Total yearly costs for Commission Operations Staff.

Hosting and design support based on estimated need.

Department of Administrative Services (DOAS) billing for Worker's Compensation at $351.96 and Unemployment Insurance at $84.96 per projected employee number at beginning of FY13.

Annual membership. Formerly known as National Foundation for Trauma.

Contingency for potential overages in regular operating expenditures

Total yearly costs of Operations

Description

Total yearly cost of travel for Executive Director, Office Coordinator and Business Operations Officer.

Total cost of Employer's Share FICA/Medicare, Health Insurance, and Retirement for Executive Director, Office Coordinator, and Business Operations Officer.

This was moved to the Accountability Budget in System Development, Access & Accountability Budget for FY 2013

74


Staff Approved AFY 2012


Budget


Percentage of Total Proposed FY 2013 Budget


2013

Staff Travel $ 14,000 0.09% $ 30,000 0.19% 0.10%

Staff Benefits $ 38,314 0.24% $ 81,460 0.51% 0.27%

Staff Salaries $ 95,334 0.60% $ 170,900 1.07% 0.47%

Worker's Compensation and Unemployment Insurance $ 874 0.01% $ 1,312 0.01% 0.00%

Trauma Communications Center Agents $ 229,450 1.44% $ 310,000 1.95% 0.51%

Total Staff Costs $ 377,972 2.37% $ 593,672 3.73% 1.35%

Capital Expenditures

Hospital CPUs and monitors $ - 0.00% $ 75,000 0.47% 0.47%

TCC Operations

AVLS Verizon Airtime $ 51,000 0.32% $ - 0.00% -0.32%

In Motion Technologies, Inc. $ 30,000 0.19% $ - 0.00% -0.19%

TCC Office Supplies/Printing $ - 0.00% $ 5,000 0.03% 0.03%

Building Lease and Utilities $ 13,056 0.08% $ 14,362 0.09% 0.01%

Georgia Technology Authority $ 12,860 0.08% $ 16,000 0.10% 0.02%

AT&T Cellular and Internet Accounts $ 3,250 0.02% $ 6,500 0.04% 0.02%

SouthernLINC Accounts $ 565 0.00% $ 1,130 0.01% 0.00%

Saab Software licensing fees $ - 0.00% $ 47,120 0.30% 0.30%

Saab technical support costs $ - 0.00% $ 31,813 0.20% 0.20%

Saab Software Enhancements $ 50,000 0.31% $ 100,000 0.63% 0.31%

Georgia Technology Research Institute $ - 0.00% $ 25,000 0.16% 0.16%

Contingency Funding $ 24,126 0.15% $ - 0.00% -0.15%

Total TCC Operations $ 184,857 1.16% $ 246,925 1.39% 0.23%

Total TCC Budget $ 562,829 3.53% $ 915,597 5.75% 2.21%

Trauma Communications Center Office Supplies and Printing

Description

Total Yearly Staff Costs for TCC.

Budget moved to the EMS Distribtion Budget

Budget moved to the EMS Distribtion Budget

Total yearly cost of travel for TCC Manager, TCC Operations Specialist, and Performance and Complaince Improvement Nurse.

Total cost of Employer's Share FICA/Medicare, Health Insurance, and Retirement for TCC Manager, TCC Operations Specialist, and Performance and Complaince Improvement Nurse.

Total cost of Salaries for TCC Manager, TCC Operations Specialist, and Compliance and Performance Improvement Nurse.

This contract will be for Technical Support at TCC.


Rent and Utilities per year at GPSTC -Actual Rental Agreement

Trauma Communications Center (TCC)

Projected expenses based on staffing TCC with Agents via Temporary Services Contract for 24/7 coverage with 2 agents each shift.

Projected expenses for reimbursement of computers for TCC Particpating Hospitals' in 4 Regions.


SAAB software licensing fee (year 2)

Total yearly TCC Operations

Possible Enhancements of Paratus SAAB System.

Eight AT&T Land Lines at $2,000 and 6Megs circuit and Managed Router at $14,000.

Technical support fees (year 2)

No Contingency Funding for 2013 Budget.

MiFi Accounts for internet service (6 MiFi's used for back up) and 8 Cell Lines at the TCC for EMT's to call in at no charge for Mobile to Mobile.

2 Cell lines with push-to-talk capability

75


Development and AccessApproved AFY 2012

Percentage of Total AFY

2012 Budget


Percentage of Total Proposed FY

2013 Budget

Percentage Change from AFY 2012 to Proposed

FY 2013

Trauma System Regionalization Activities $ 115,000 0.72% $ 245,000 1.54% 0.82%

National Foundation for Trauma Care $ 1,500 0.01% $ - 0.00% -0.01%

Georgia Committee on Trauma $ - 0.00% $ 4,700 0.03% 0.03%

Trauma Associates of Georgia (TAG) $ 37,530 0.24% $ 70,800 0.44% 0.21%

Total Development and Access $ 154,030 0.97% $ 320,500 2.01% 1.04%

Bishop and Associates $ 98,800 0.62% $ 25,000 0.16% -0.46%

Gifford, Hillegass & Ingwersen $ 59,545 0.37% $ 80,000 0.50% 0.13%

PH Consultants, LLC $ - 0.00% $ 20,000 0.13% 0.13%

Total Accountability $ 158,345 0.99% $ 125,000 0.78% -0.21%

Contingency Funding $ - 0.00% $ 25,000 0.16% 0.16%

Total System Development, Access and Accountability Budget $312,375 1.96% $470,500 2.95% 0.99%

System Development, Access and AccountabilityGeorgia Trauma Commission FY 2013

Trauma Clinical Education for Nurses.

Trauma System Regionalization Activities (RTACS) in 4 Regions ( 3X $75,000 and 1X $20,000 Sustainment Region 9)

Accountability

CY2010 Readiness Costs Assessment and Georgia Trauma Foundation Business Plan

Auditing of Hospital and EMS Uncompensated Care and sending surveys to TC's.

Framework and Pilot Project Report. Revisit in January 2013 Workshop to evaluate progress.

Description

Total yearly Development and Access.

Total yearly Accountability

Contingency funding for either Development and Access or Accountability budgets.

Budget moved to Commission Operations.

2013 Trauma Conference Support

76

AVLS Projection BY 2013

Phase 1 Description Costs

In Motion Technology, Inc. $30,000.00Service Charge per unit is $12.50 a month for200 units. 12 months cost.

Verizon AVLS Airtime is $42.50 per unit a month for $102,000.00200 units. 12 Month Cost

Phase 1 Total 2013 Commission Costs $132,000.00


In Motion Technology, Inc. $27,500.00Service Charge per unit is $12.50 a month for200 units. 11 months cost - to begin August 2012.

Verizon AVLS Airtime is $42.50 per unit a month for $93,500.00200 units. 11 months cost - to begin August 2012.



In Motion Technology, Inc. $15,000.00Service Charge per unit is $12.50 a month for150 units. 8 months cost - to begin November 2012.

Verizon AVLS Airtime is $42.50 per unit a month for $51,000.00150 units. 8 months cost - to begin November 2012.



Announced 2011, deployment of 150-250 systems in April, 2012Would not begin paying until April 2013, if GEMA continues to pay 1 year service

In Motion Technology, Inc. $9,375.00Service Charge per unit is $12.50 a month for250 units. 3 months cost -to begin April 2013.

Verizon AVLS Airtime is $42.50 per unit a month for $31,875.00250 units. 3 months cost -to begin April 2013.


2013 Overall Phases 1-‐4 $360,250.00

77

Available EMS Budget @ 20% of available funds for stakeholders:

Approved AFY 2012


Budget




2013

Total Allocation $ 2,722,217 17.08% $ 2,730,360 17.13% 0.05%

Staffing and Meeting Support $ 3,500 0.02% $ 3,500 0.02% 0.00%

AVLS Support - Verizon Airtime and In Motion Technology, Inc. Maintenance

$ - 0.00% $ 360,250 2.26% 2.26%

Remaining Budget Available for Distribution $ 2,718,717 17.06% $ 2,366,610 14.85% -2.21%


EMS Allocation15 March 2012 PROPOSED

78


Approved AFY 2012


Budget



Percentage Change from AFY 2012 to Proposed FY 2013

Available for OEMS/T 489,715$ 3.07% 478,116$ 3.00% -0.07%


Office of EMS and Trauma Allocation

79

GEORGIA TRAUMA COMMISSION FY 2013 BUDGETTRAUMA CENTER/PHYSICIAN ALLOCATION 15 March 2012 PROPOSED

Amount

Trauma Center Readiness Payments3 $4,368,575 80%Performance Based Payment4 $1,092,144 20%

Sub Total Readiness Payments $5,460,719 100%

Uninsured Patient Care Payments5 $5,460,719

Total Trauma Center Allocation6 $10,921,438

Hospital/Physician Fund Division7 75% Hospital 25% Physician TotalTrauma Center Readiness Payments % $4,095,539 $1,365,180 $5,460,719Uncompensated Care Payments $4,095,539 $1,365,180 $5,460,719

Total $8,191,079 $2,730,360 $10,921,438Total $10,921,438

Notes:3Trauma Center readiness payments are described on page 2.

5Uncompensated Care payments are described on page 3.

6Amount allocated to Trauma Centers by the Trauma Commission

4A performance based payment (PBP) program will reward trauma centers that meet defined standards. For 2013, 20% of trauma center funding will be set aside for PBP.

7Payments for readiness and Uncompensated Care received by Trauma Centers are to be proportionally distributed between the hospital and trauma physicians on a 75%/25% basis.

80

GEORGIA TRAUMA COMMISSION FY 2013 BUDGETTRAUMA CENTER READINESS & PERFORMANCE BASED PAYMENTS 15 March 2012 PROPOSED

Trauma Center Funding Level % of Fund

Readiness Payments1

Potential PBP Payments2

Total Readiness Payments

Level IV 5%Lower Oconee 5% 0.41% $17,831 $4,458 $22,289

Morgan 5% 0.41% $17,831 $4,458 $22,289Wills 5% 0.41% $17,831 $4,458 $22,289

Level III 10%Taylor 10% 0.82% $35,662 $8,915 $44,577Walton 10% 0.82% $35,662 $8,915 $44,577

Level II 60%Athens 60% 4.90% $213,971 $53,493 $267,464

Archbold 60% 4.90% $213,971 $53,493 $267,464Columbus 60% 4.90% $213,971 $53,493 $267,464

Floyd 60% 4.90% $213,971 $53,493 $267,464Gwinett 60% 4.90% $213,971 $53,493 $267,464Hamilton 60% 4.90% $213,971 $53,493 $267,464

Kennestone 60% 4.90% $213,971 $53,493 $267,464North Fulton 60% 4.90% $213,971 $53,493 $267,464Scottish Rite 60% 4.90% $213,971 $53,493 $267,464

Level I 100%AMC 100% 8.16% $356,618 $89,155 $445,773

Egleston 100% 8.16% $356,618 $89,155 $445,773Grady 100% 8.16% $356,618 $89,155 $445,773MCCG 100% 8.16% $356,618 $89,155 $445,773MCG 100% 8.16% $356,618 $89,155 $445,773

Memorial 100% 8.16% $356,618 $89,155 $445,773Burn Center3 50%Doctors Hospital (JMSBC) 50% 4.08% $178,309 $44,577 $222,886

Totals 1225% 100.00% $4,368,575 $1,092,144 $5,460,719

Notes:1Level II trauma center received 60% of the payments for Level I trauma centers. Level III trauma centers receive 10%, Level IV trauma centers receive 5%, and burn centers 50%.2Performance Based Payments (PBP), if fully earned, will be distributed to trauma centers based upon the readiness payment formula.3 The GTCNC survey of burn center 2009 readiness costs indicated they were 81% of Level II trauma center 2008 readiness costs, so the fnding level for burn centers was set at 50% compared to 60% for Level II trauma centers.

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GEORGIA TRAUMA COMMISSION FY 2013 BUDGETTRAUMA CENTER UNCOMPENSATED CARE CLAIMS PAYMENTS15 March 2012 PROPOSED

Cost Norm Based Allocation of Funds2

Trauma Center ISS 0-8

ISS 9-15

ISS 16-24

ISS >24 Total

Severity Adjusted

Cost Norms

Total Based Upon Cost

NormsLevel IV

Lower Oconee 0Morgan 0

Wills 0Level III

Taylor 0Walton 1 0 0 1 2 $19,606 $39,212 0.15% $7,953.75

Level IIAthens 0 3 1 0 4 $12,728 $50,910 0.19% $10,326.56

Archbold 28 20 4 5 57 $10,601 $604,265 2.24% $122,568.86Columbus 19 27 12 3 61 $11,786 $718,976 2.67% $145,836.79

Floyd 11 17 7 2 37 $11,905 $440,485 1.64% $89,347.79Gwinnett 31 56 10 9 106 $11,783 $1,249,010 4.64% $253,348.66Hamilton 10 9 1 1 21 $9,528 $200,093 0.74% $40,586.78

Kennestone 0 North Fulton 23 18 12 6 59 $12,678 $748,027 2.78% $151,729.48Scottish Rite 18 8 2 0 28 $7,767 $217,482 0.81% $44,113.96

Level IAtlanta 153 109 36 17 315 $12,392 $3,903,564 14.50% $791,797.29

Egleston 17 4 3 0 24 $9,586 $230,054 0.85% $46,664.06Grady 318 228 69 63 678 $13,466 $9,129,660 33.91% $1,851,856.41MCCG 42 64 34 8 145 $15,250 $2,211,200 8.21% $448,518.88MCG 77 95 40 15 227 $14,341 $3,255,406 12.09% $660,325.19

Memorial 91 115 52 16 274 $14,318 $3,923,025 14.57% $795,744.75Total 838 770 282 145 2,035 $26,921,369 100.00% $5,460,719.20

Notes: Patient Treatment Cost Norms3

ISS Community Academic

0-8 $5,267 $6,373

9-15 $10,428 $12,61816-24 $19,626 $23,747

>24 $33,945 $41,073

Self Pay Patients Meeting SB 60 Requirements1 in CY 2009

Allocation Based On % of Norm Cost Total

1Trauma Centers report number of uncompensated care claims meeting SB 60 requirements and by patient's Injury Severity Score (ISS) category in a yearly survey. This draft budget uses CY 2009 data. Distribution will change based on CY 2010 survey results. Survey to begin 01 March 2012.

2Allocation is based upon the number and severity of patients meeting SB 60 requirements times cost norms. This derives a percent of total costs which is then applied to the total amount available.

3To develop a fair and consistent approach to estimating costs, national trauma center patient treatment cost norms by injury severity were used, for both community and academic hospitals.

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GEORGIA TRAUMA COMMISSION FY 2013 BUDGETTRAUMA FUND TRAUMA CENTER ALLOCATIONS 15 March 2012 PROPOSED

Trauma Center Readiness Payment

Potential P4P Payments2


Uncompensated Care Payment

Subject to change with CY 2010 data

Total %

Level IVLower Oconee $17,831 $4,458 $22,289 $0 $22,289 0.2%

Morgan $17,831 $4,458 $22,289 $0 $22,289 0.2%Wills $17,831 $4,458 $22,289 $0 $22,289 0.2%

Level III $0 $0Taylor $35,662 $8,915 $44,577 $0 $44,577 0.4%Walton $35,662 $8,915 $44,577 $7,954 $52,531 0.5%

Level II $0Athens $213,971 $53,493 $267,464 $10,327 $277,790 2.5%

Archbold $213,971 $53,493 $267,464 $122,569 $390,033 3.6%Columbus $213,971 $53,493 $267,464 $145,837 $413,301 3.8%

Floyd $213,971 $53,493 $267,464 $89,348 $356,812 3.3%Gwinnett $213,971 $53,493 $267,464 $253,349 $520,812 4.8%Hamilton $213,971 $53,493 $267,464 $40,587 $308,051 2.8%

Kennestone $213,971 $53,493 $267,464 $0 $267,464 2.4%North Fulton $213,971 $53,493 $267,464 $151,729 $419,193 3.8%Scottish Rite $213,971 $53,493 $267,464 $44,114 $311,578 2.9%

Level I $0 $0Atlanta $356,618 $89,155 $445,773 $791,797 $1,237,570 11.3%

Egleston $356,618 $89,155 $445,773 $46,664 $492,437 4.5%Grady $356,618 $89,155 $445,773 $1,851,856 $2,297,629 21.0%MCCG $356,618 $89,155 $445,773 $448,519 $894,292 8.2%MCG $356,618 $89,155 $445,773 $660,325 $1,106,098 10.1%

Memorial $356,618 $89,155 $445,773 $795,745 $1,241,518 11.4%Burn Center

Doctors Hospital (JMSBC) $178,309 $44,577 $222,886 $0 $222,886 2.0%Total 4,368,575 1,092,144 5,460,719 $5,460,719 $10,921,438 100.0%

Lower Oconee, Wills and Kennestone were not designated in CY 2010. Morgan and Taylor CY 2010 Uncompensated Care claim data will be determined in upcoming uncompensated care claims survey.

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GEORGIA TRAUMA COMMISSION FY 2013 BUDGETTRAUMA FUND TRAUMA CENTER ALLOCATIONS 15 March 2012 PROPOSED

Trauma Center Readiness Payment

Potential P4P Payments2


Uncompensated Care Payment

Subject to change with CY 2010 data

Total From Trauma Fund

% of Trauma Fund

Regionalization (Yet to be

determined)

Total for Each Center

Level IVLower Oconee $17,831 $4,458 $22,289 $0 $22,289 0.2% $22,289

Morgan $17,831 $4,458 $22,289 $0 $22,289 0.2% $22,289Wills $17,831 $4,458 $22,289 $0 $22,289 0.2% $22,289

Level III $0 $0Taylor $35,662 $8,915 $44,577 $0 $44,577 0.4% $44,577Walton $35,662 $8,915 $44,577 $7,954 $52,531 0.5% $52,531

Level II $0Athens $213,971 $53,493 $267,464 $10,327 $277,790 2.5% $277,790

Archbold $213,971 $53,493 $267,464 $122,569 $390,033 3.6% $390,033Columbus $213,971 $53,493 $267,464 $145,837 $413,301 3.8% $413,301

Floyd $213,971 $53,493 $267,464 $89,348 $356,812 3.3% $356,812Gwinnett $213,971 $53,493 $267,464 $253,349 $520,812 4.8% $520,812Hamilton $213,971 $53,493 $267,464 $40,587 $308,051 2.8% $308,051

Kennestone $213,971 $53,493 $267,464 $0 $267,464 2.4% $267,464North Fulton $213,971 $53,493 $267,464 $151,729 $419,193 3.8% $419,193Scottish Rite $213,971 $53,493 $267,464 $44,114 $311,578 2.9% $311,578

Level I $0 $0Atlanta $356,618 $89,155 $445,773 $791,797 $1,237,570 11.3% $1,237,570

Egleston $356,618 $89,155 $445,773 $46,664 $492,437 4.5% $492,437Grady $356,618 $89,155 $445,773 $1,851,856 $2,297,629 21.0% $2,297,629MCCG $356,618 $89,155 $445,773 $448,519 $894,292 8.2% $894,292MCG $356,618 $89,155 $445,773 $660,325 $1,106,098 10.1% $1,106,098

Memorial $356,618 $89,155 $445,773 $795,745 $1,241,518 11.4% $1,241,518Burn Center

Doctors Hospital (JMSBC) $178,309 $44,577 $222,886 $0 $222,886 2.0% $222,886Total 4,368,575 1,092,144 5,460,719 $5,460,719 $10,921,438 100.0% $10,921,438

Lower Oconee, Wills and Kennestone were not designated in CY 2010. Morgan and Taylor CY 2010 Uncompensated Care claim data will be determined in upcoming uncompensated care claims survey.

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BISHOP+ASSOCIATES

March 9, 2012 To: Georgia Trauma Commission From: Greg Bishop, Bishop+Associates Re: Alternatives of Readiness Cost Funding Levels The GTCNC funds trauma centers with a funding level (%) tied to each trauma center level. In the initial year of funding, Level I trauma centers received $2.5 million in readiness funding, and Level II trauma centers received $1.5 million. This meant Level II’s received 60% of the 100% Level I’s received, and these proportions have been maintained in subsequent budgets. Level III & IV trauma centers were added later at 10% and 5% respectively (see column at right in table). In the table below, the average amount of readiness costs for Level I and II trauma centers from CY 2006 readiness cost data are indicated along with a percentage comparison (Level II readiness costs were 50% of Level I’s). Trauma Center readiness costs from CY 2008 are also indicated along with the actual average and % in relation to the Level I average (A), and in relation to the Level II average (B). Atlanta Medical Center was included as a Level I as it has been designated as such.

The recent survey of 2009 burn center readiness costs indicated they averaged 81% of 2008 Level II trauma center readiness costs (in red), and so the burn center readiness fund allocation level is proposed at 50% compared to 60% for Level II’s. This analysis indicates that the trauma center funding levels are not consistent with actual costs (i.e., Level II trauma centers receive 60% of Level I readiness funds but only incur 31% of Level I readiness costs). This issue can be addressed subsequent to an updated survey of trauma and burn center readiness costs this year. Recommendation Conduct readiness cost analysis for trauma centers for CY 2010 and transition funding level over three years to reflect trauma and burn center investment in readiness.

Level Readiness Costs 2006

% of L1

Readiness Costs 2008

A: % of LI

B: % of L2

Funding Level

Level I $5,466,241 100% *$5,403,496 100% 324% 100% Level II $2,713,275 50% 1,665,631 31% 100% 60% Level III 95,316 2% 6% 10% Level IV 52,003 1% 3% 5% Burn Centers (2009) $1,351,119 25% 81% *50%

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march 2012 adminreport - georgia trauma...

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