Trauma Readiness Costs Defined

Trauma readiness costs are the financial expenses that exist because a hospital is a trauma center and has obligations for readiness and capability. These are the fixed costs that go beyond the normal costs of running a hospital or costs otherwise recovered through indirect costs, direct cost accounting (e.g. nursing staff, lab tests, bed charges), and professional fees.

The easiest way to think about trauma readiness costs is to ask the question: What expenses or staffing would go away if our hospital stopped being a trauma center? For example, a hospital may only use the MRI machine during weekly business hours, but a trauma center must be able to staff and conduct an emergent MRI scan within 2 hours at all times of day and on all days. That means it costs money for a team must be ready to come in and perform the MRI and that the machine must be in a location that is easily accessible for a critically ill patient.

Types of Trauma Readiness Costs

Trauma Program Administration

This includes the staffing costs associated with running a trauma program. Most commonly this is the salary, benefits, and professional education expenses for the trauma program manager, performance improvement (PI) coordinator(s), registrar(s), injury prevention coordinator(s), and administrative support. Most of these staffing requirements are dictated by the American College of Surgeons and are volume-based, meaning that as trauma volumes go up, staffing requirements also increase to ensure there are enough people to do the work. Many of these costs are recovered through hospital indirect cost accounting.

Departmental Readiness

This includes the costs associated with having hospital resources available 24/7, such as blood bank, the OR, and radiology. These departments must have in-house staff able to respond to trauma patients at all hours of the day, including the overnight when there may be few or no patients. If a patient is seen, the hospital and physician can apply direct charges and professional fees for services rendered; but if no patients are seen, fully staffed departments may sit idle.

Medical Staff Coverage

This is the largest (most expensive) component of trauma readiness costs. It includes the costs of having 20+ surgical and medical specialties available 24/7. Most frequently this is accomplished through higher contracted salaries or supplemental pay to take call at night.

Verification, Registry, and Education

Trauma programs have other requirements for verification, including: the costs of hosting or offering internal and external education for staff and providers in the community; the costs and equipment needed for outreach and injury prevention efforts; software and hardware costs for the trauma registry; and the costs of American College of Surgeons verification and Trauma Quality Improvement Program (TQIP) participation.

Why Trauma Readiness Costs Are Complicated

It is critically important for trauma leaders to understand trauma readiness costs.

First, these costs often aren’t fully reimbursed by insurance because they’re not tied to a specific patient encounter.

Second, hospitals must pay them regardless of patient volume. Generally speaking, the costs will remain static whether the trauma center sees 1 or 10 patients in a day.

Third, trauma readiness costs vary wildly by trauma center level and region of the country.

• In a paper published in the Journal of Trauma and Acute Care Surgery in 2019, Ashley et al. found that the average Level I trauma center had $10 million in trauma readiness costs annually. They reported that Level II trauma centers averaged $4.9 million annually, but results were published prior to the release of the ACS 2022 standards that increased many requirements to be comparable to Level I trauma centers.

• Atkins et al. (2019) reported that Level III trauma centers averaged $1.7 million per year and level IV trauma centers averaged $81,600 per year.

• These studies are currently being replicated in Georgia and results are forthcoming.

The Bottom Line

Trauma readiness costs allow hospitals to maintain 24/7 staffing, specialized equipment, and rapid-response systems. It is a significant ongoing investment beyond routine care. Knowing these costs helps leaders budget effectively, justify resources, and ensure their hospital can deliver timely, lifesaving treatment when emergencies happen.