Our Services
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No One Knows Trauma Centers Better
Trauma centers are expensive, complex, and demanding hospital services, and each potential trauma center presents unique circumstances and challenges. B+A has conducted hundreds of trauma center feasibility studies over the past decades. We apply our broad and deep experience with trauma care across the nation to your hospital’s specific culture and objectives. If a trauma center is feasible, you end up with a solid plan for its success that includes a sense of partnership with your medical staff. If not, you will have a clear understanding why, as well as an idea of how you could overcome your specific challenges in the future.
Our Process Is Collaborative and Exhaustive
Assessing the feasibility of a new trauma center requires a collaborative, team-building approach. This is of particular importance with the medical staff, as they have strong feelings and often misconceptions about the impact of a trauma center on their practice and call schedule. We keep “hearts and minds” at the center of the process. We strongly believe that trauma care exemplifies the very best of healthcare, with the trauma program often setting the standard for quality in the hospital and bringing out the best in other surgical and medical departments.
The reason for our excellent track record and reputation is our approach. We explore all possibilities for determining the long-term success of building a new trauma center and often present a series of options or stages for hospital leadership to consider. Our clients know that the results are thorough and understandable, and by the end of the project there will be no surprises because leadership is informed throughout the process.
Components of the Project
The components of a typical trauma center feasibility project may include the following:
Identification and mapping of a defined trauma service area based on regional trauma system rules, distance between hospitals and other trauma centers, expected population growth, and other trauma patient referral patterns.
Analysis of the regional trauma market to determine likely volume, severity of injury, and payer mix of proposed trauma service area.
Analysis of hospital data, trauma registry data (if applicable), EMS data, and state hospital discharge data.
Evaluation of medical staff resources and creation of a plan to assure medical support for a trauma center (See also Acute Care Surger and Staff Solutions).
Assessment of the economic feasibility and sustainability of a trauma center and preparation of an easy-to-use pro forma that includes direct and indirect costs. (See also Financial Performance Assessment and Optimization).
Development of a gap analysis tool that hospitals can use to assess readiness for trauma center operations.
Strategies for maximizing the “halo effect” to enhance other services at your hospital.
Concise reports and recommendations for the feasibility of a new trauma center.
We’ve Got Your Back For The Long Term
B+A traditionally provides strong support to former clients. Our clients will tell you they feel supported by us as long as needed, rarely at added cost. We know that hospitals often need months or even years to fully digest the feasibility results and make the decision to proceed with the initiative. If circumstances change, we are equipped to reevaluate the feasibility of the trauma center endeavor.
We regularly provide ongoing advice on medical staff arrangements by specialty, recruitment of trauma surgeons, and strategies for working with the state or regional agency governing trauma, as well as other issues that arise as you develop your trauma center. We stand by our work.
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No One Knows Trauma Centers Better
When a trauma center has determined that it is feasible to build a new trauma center, B+A is equipped to facilitate the development process. We have worked with hospitals of all levels, ranging from ACS-verified Level I trauma centers to state-verified Level IV trauma centers. Our comprehensive, hands-on process can help hospitals plan for, develop, and open a new trauma center or increase its trauma center level. (See Trauma Center Upgrade.)
Establishing a new trauma center is a huge endeavor. By its very nature, trauma care is multidisciplinary and involves nearly every department of the hospital. In addition, trauma centers are expensive to operate, and each trauma center presents unique administrative, financial, and staffing challenges.
Our Process Is Collaborative and Exhaustive
As consultants, we recognize that our involvement in your hospital is temporary. As such, our approach works directly with hospital staff to help you build your trauma program. This is critical for many reasons. First, the trauma program must reflect and work within your unique hospital culture, regional trauma environment, and state regulations. Second, a trauma center must be built organically so hospital staff feel invested in the process. Third, a trauma center is sustainable only when physicians and staff take ownership of the program as “their” trauma program.
B+A can provide the structure, organization, and steady presence to start the process, but from the beginning we will work with hospital administration and staff to execute a collaborative, team-building approach. This is of particular importance with the medical staff, as they have strong feelings and often misconceptions about the impact of trauma patients on their workload and call schedule.
We keep “hearts and minds” at the center of the process and empower your administrative and clinical staff to be the visible leaders of the process. We are committed to help your people build and sustain the best possible trauma center.
Components of the Project
The components of a typical trauma center development project may include the following:
Organization of a trauma center steering committee to lead the process and ensure hospital administrators are informed at each step of the process.
Identification of key stakeholders to serve on development committees, particularly in the areas of medical staff development and trauma center operations.
Execution of a sequential and orderly process for ensuring all departments participate and have a role in building trauma center protocols and practices.
Facilitation of stakeholder meetings to ensure that hospital and medical staff receive regular updates on trauma center development and have opportunities to ask questions and provide feedback throughout the process.
Assistance with attracting, identifying, vetting, and recruiting trauma program leadership, including the Trauma Medical Director and Trauma Program Manager.
Collaboration with the trauma system or regional governing body to ensure the hospital meets appropriate standards and timelines for designation.
Creation of a marketing and communication strategy to ensure internal and external audiences (including EMS and referral facilities) are informed about the new trauma center.
Development of an injury prevention initiative to address common trauma mechanisms in the region.
Establishing an educational plan that ensures all physicians, nurses, and ancillary staff receive appropriate trauma education and orientation.
Preparation of a budget to track and optimize trauma center development costs.
Collaboration with the hospital financial department or hospital/system staff to optimize managed care carve-outs and cost recovery rates.
Assistance with development of a trauma registry that complies with the National Trauma Data Standard and county/state data requirements.
Identification of strategies for maximizing the “halo effect,” including the development of a Trauma and Acute Care Surgery service or Surgical Center of Excellence. (See Acute Care Surgery and Staff Solutions)
Support for the ongoing trauma center development process.
We’ve Got Your Back For The Long Term
New issues are bound to arise as a trauma center begins operation. B+A traditionally provides strong support to former clients. Our clients will tell you they feel supported by us as long as needed, rarely at an added cost.
We regularly provide ongoing advice on medical staff arrangements by specialty, recruitment of trauma surgeons, and strategies for working with the state or regional agency governing trauma, as well as other issues that arise as you open your trauma center. We stand by our work.
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No One Knows Trauma Centers Better
When a trauma center has determined that it is feasible to increase to a higher level of trauma care, B+A is equipped to facilitate the upgrade process. We have worked with hospitals of all sizes that have increased their trauma center designation level (most commonly Level III to Level II or Level II to Level I) and even some that have decreased their trauma level (Level II to Level III). Our comprehensive and hands-on process can help hospitals plan for, develop, and operate a new level of trauma center.
Increasing the level of a trauma center can have huge impact on hospital costs, medical staff needs, facility requirements, and nursing services. While the trauma center already knows how to be a trauma center, increasing to a higher level of trauma center can pose new administrative, financial, staff, and marketing challenges. B+A has been involved with several trauma center upgrades occurring across the nation over the past decades.
Our Process Is Collaborative and Exhaustive
As consultants, we recognize that our involvement in your hospital is temporary. As such, our approach works directly with hospital staff to help them increase the level or quality of the new trauma center program. This is critical for many reasons. First, the trauma center must reflect and work within your unique hospital culture, regional trauma environment, and state regulations. Second, a trauma center must be improved organically so hospital staff feel invested in the process. Third, a higher-level trauma center is sustainable only when physicians and staff take ownership of the program as “their” trauma program.
B+A can provide the structure and organization to start the process, but from the beginning we will work with hospital administration, trauma program leaders, and hospital staff to execute a collaborative, team-building approach. This is of particular importance with the medical staff, as they have strong feelings and often misconceptions about the impact of trauma patients on their workload and call schedule.
We keep “hearts and minds” at the center of the process and empower your administrative and clinical staff to be the visible leaders of the process. We are committed to help your people provide the best possible trauma care.
Components of the Project
The components of a typical trauma center upgrade differ by trauma level but may include the following:
Organization of a trauma center steering committee to lead the process and ensure hospital administrators are informed at each step of the process.
Identification of key stakeholders to serve on development committees, particularly in the areas of medical staff development and trauma center operations.
Execution of a sequential and orderly process for ensuring all departments understand the new requirements and have a role in building trauma center protocols and practices.
Facilitation of stakeholder meetings to ensure that hospital staff receive regular updates on the trauma center upgrade and have opportunities to ask questions and provide feedback throughout the process.
When necessary, assist with attracting, identifying, vetting, and recruiting new trauma program leadership, including the Trauma Medical Director and Trauma Program Manager.
Collaboration with the trauma system governing body to ensure the hospital meets new standards for designation.
Creation of a marketing and communication strategy to ensure internal and external audiences (including EMS and referral facilities) are informed about the higher-level trauma center.
Identifying new educational requirements for physicians, nurses, and ancillary staff.
Preparation of a budget to project and track new or incremental trauma costs.
Collaboration with hospital financial department and hospital or system staff to optimize managed care carve-outs and cost recovery rates. (See Financial Performance Assessment and Optimization)
Assistance with required improvements in the trauma registry to comply with the National Trauma Data Standard and county/state data requirements.
Identification of strategies for maximizing the “halo effect,” including the development of a Trauma and Acute Care Surgery service or Surgical Center of Excellence. (See Acute Care Surgery and Staff Solutions)
Support for the ongoing trauma center upgrade process.
Trauma Research Program
One of the distinguishing characteristics of a Level I trauma program is the production of scholarly activity in the form of peer-reviewed publications. B+A can assist trauma centers in building, improving, and maintaining the research infrastructure and productivity for adult and pediatric trauma programs. This can be part of a Level II trauma center initiative to become a Level I trauma center or a response to a research deficiency in an existing Level I trauma program.
Trauma research requires a long-term engagement by a core team of individuals at the trauma center, including trauma surgeons, trauma nurses, residents and medical students, and hospital research support staff. A trauma center must be continuously initiating research projects and generating research publications, as each research study will take a minimum of 12-months to move from study design through publication.
As consultants, we recognize that our involvement is not permanent. B+A can provide the structure and organization to start the research process, but our approach ultimately works directly with hospital staff to build the infrastructure for a sustainable research program. This involves the development of a research culture led by the trauma program. We have first-hand experience in watching how the quality of trauma care is escalated when trauma surgeons and other staff grow in their research involvement and begin applying research findings to their clinical practice.
We will work with your study site to identify the essential components that must be in place for a successful research program, which could include access to an IRB to review study protocols, dedicated research staff at the hospital to manage projects internally and to learn how to sustain the research program, library access to published research articles, involvement of at least one trauma surgeon in research, access to state and hospital trauma data, and commitment from the state for hosting a resident research paper competition.
The components of a typical trauma research program development project may include the following:
Organization of a core trauma research group to lead the process and troubleshoot institutional barriers for research.
Identification of physicians, staff, or hospital partners with experience, training, or current engagement in research (including any staff needing to conduct research as part of their training or degree program).
Assistance in identifying hospital staff with the knowledge and capability to perform statistical analysis. In the absence of such staff, we will assist in the hiring or contracting of personnel for this skillset.
Assistance in writing IRB protocols and launching new research studies.
Facilitating ongoing conversations with research teams to identify research ideas and determine which ideas are feasible as research studies.
Execution of a sequential and orderly timeline for starting, conducting, and publishing the required number of research publications.
Preparation of a budget to cover research costs related to staffing, contracting, and publication fees.
Application of experience in research and publishing to curb research ideas that may not be publishable and to recognize study design flaws that must be resolved to ensure publication of the paper.
Support to the study team to write, edit, or revise paper manuscripts (*specific terms apply to preserve integrity and transparency in the research and publication process).
Training and mentoring trauma physicians and staff in the research and writing process.
Involvement in initial ACS verification or remediation of research deficiency of Level I trauma centers.
Trauma Center Downgrade
In some circumstances, a trauma center will choose to operate at a lower level, most commonly a Level II trauma center moving to a Level III trauma center. B+A can help hospitals manage this process, including internal and external communication, assessment of volume and financial losses, and identification of strategies to optimize new trauma center operations.
We’ve Got Your Back For The Long Term
New issues are bound to arise as a trauma center begins operating at a higher or lower level. B+A traditionally provides strong support to former clients. Our clients will tell you they feel supported by us if needed, rarely at an added cost.
We regularly provide ongoing advice on medical staff arrangements by specialty, recruitment of trauma surgeons, and strategies for working with the state or regional agency governing trauma, as well as other issues that arise as you manage your trauma center. We stand by our work.
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We Know Trauma Center Financing
Trauma finance is a crucial aspect of sustaining and enhancing trauma care. It involves securing funding for trauma centers, managing costs, and optimizing resource allocation to ensure high-quality patient care. B+A is a known leader in trauma financing and optimization. We apply our state-of-the-art approach to trauma center financing to work through known complexities, including: managed care contract carve-outs, trauma activation fees for trauma patients, a focus on cost management using national/state trauma center benchmarks, and a reporting method that assures an ongoing focus on key financial factors unique to trauma care.
To maintain a viable trauma program, all trauma center costs must be covered by revenue on an ongoing basis. Such costs include “readiness costs” that accrue by virtue of having a trauma program and meeting strict requirements for that program. These costs largely fall into three areas: trauma center administrative staff, medical staffing and call costs, and stand-by resources (e.g., 24/7 operating room, blood bank, radiology). Over the years, our clients have told us our consultation fee readily pays for itself as we help your hospital find hidden value and recommend steps to enhance the long-term sustainability of your trauma center.
Components of the Project
The components of a typical financial assessment project may include the following:
Analysis of the trauma market to understand your hospital’s trauma volumes, severity of injury, and payer mix.
Review of current trauma center financial performance in terms of expenses, revenue, and reimbursement.
Assessment and projection of trauma center incremental/total patient revenue by payer class.
Assistance in navigating complex reimbursement systems, including payor contracting and Medicare/Medicaid policies, to ensure trauma centers receive appropriate compensation for services provided.
Gap analysis for state and national trauma center standards, along with appropriate cost estimates for trauma “readiness costs,” including program support, trauma medical staff support, 24/7 department availability, and capital/facilities.
Preparation of an easy-to-use pro forma and financial plan for the trauma center that can be modified by your team as circumstances and costs change.
Assessment of a potential “halo effect” on the hospital that can compensate for the additional costs associated with the trauma center.
Optimizing the Trauma Center Bottom Line
The financial burden of uninsured patients is unfortunately a major challenge in trauma care finance. On the flip side, trauma centers also can attract a relatively high volume of privately insured patients, which provides a major opportunity for financial optimization. In our work across the nation, we have found the typical trauma center can improve its bottom line by following several key financial strategies:
Appropriate implementation of trauma activation charges (68X activation, 208 ICU room, etc.).
Negotiation of managed care carve-outs for patients meeting trauma center criteria.
Effective implementation of a trauma-specific revenue cycle.
Awareness of severity-adjusted cost comparisons.
Strategies for managing expensive trauma readiness and medical staff support costs.
Partnership with the surgeon group to maximize trauma professional billing fees.
Facilitation of hospitals working with their larger hospital system to maximize and standardize trauma costs and reimbursement.
B+A will use a variety of data sources to compare your trauma center to national norms and to collaboratively define workable strategies for financial optimization. We excel at taking complex financial information and presenting it in a simple and digestible way that makes sense to hospital administrative officers and aids in hospital decision-making.
We’ve Got Your Back for the Long Term
The last few years of healthcare have been turbulent and damaging to hospital finances. As circumstances change, our financial model deliverable allows you to modify assumptions to determine how changes affect the bottom line. B+A also provides strong support to former clients. Our clients will tell you they feel supported by us if needed. We stand by our work.
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We Know State and Regional Trauma Systems
Unintentional injury is the third leading cause of death in the nation, following heart disease and cancer. As trauma centers work to reduce rates of injury morbidity and mortality, it becomes critically important for people to have timely access to high-quality trauma care when they need it. We firmly believe that provision of trauma care is an important public health initiative. Despite the growth of trauma care over the past few decades, disparities in trauma access still exist for many populations and in many regions of the country.
B+A has assessed state trauma systems in Arizona, California, Georgia, New Mexico, Oklahoma, South Carolina, and Texas, as well as dozens of county and regional trauma systems. Our assessment focuses on t evaluation of current trauma capacity, EMS transport patterns, and the financial performance of the current trauma centers, as well as projections of future population growth in the region and identification of geographic gaps in trauma system coverage. If the assessment results indicate that the trauma system is strong, B+A can offer strategies to enhance the system to make it even stronger. If the results indicate current or projected gaps, B+A will work with trauma system leaders to explore options to close those gaps.
Our Process is Collaborative and Exhaustive
For trauma system assessments, our approach is to work directly with as many stakeholders as possible, including trauma system leaders, EMS agencies, existing trauma centers, area hospitals, local governments, area residents, and other groups deemed important to the initiative. B+A can provide the structure, organization, and steady presence to oversee the process and engage stakeholders, with particular attention on engaging groups with strong negative feelings or misconceptions about the future of the trauma system. The final recommendations should be of no surprise to stakeholders because they have opportunities to receive and provide input throughout the process.
B+A’s unique expertise on state and regional trauma system performance grows with each project. Our experience and credibility enable collaboration in regions or with groups that struggle to agree on trauma system issues. We have been trusted to lead processes that effectively establish or strengthen high-quality trauma systems, but occasionally this can also lead to recommendations to close or downgrade an underperforming trauma center. We keep “hearts and minds” at the center of what we do and will empower your trauma system leaders to make informed, responsible, and future-oriented decisions.
Components of the Project
The components of a typical trauma system assessment project may include the following:
Identification and mapping of defined trauma service areas for each existing trauma center based on regional trauma system rules, distance between hospitals and other trauma centers, expected population growth, and other trauma patient referral patterns.
Analysis of the regional trauma market to determine current volume, severity of injury, and payer mix of the defined trauma service areas.
Analysis of hospital data, trauma registry data (if applicable), EMS data, and state hospital discharge data that informs the overall process.
Projections of population growth and potential gaps in trauma care, as well as assessment of whether a new trauma center is needed in the trauma system
Recommendations and next steps for expanding state or regional trauma center capacity.
Identification of potential state or regional financial support alternatives.
Solicitation of feedback from regional Emergency Medical Services providers (ground and air) to ascertain their experiences with current trauma centers and challenges they have in patient transport.
Creation of optimal trauma system stakeholder structures, committees, or governance models.
Evaluation of disaster management/preparedness initiatives and assessment of how the current trauma system supports those initiatives.
Development of pediatric trauma centers or enhanced pediatric readiness capacity at adult trauma centers to meet identified gaps in pediatric trauma coverage.
Reports, tools, and presentations to trauma system stakeholders to ensure understanding and to receive feedback throughout the process.
We’ve Got Your Back for the Long Term
B+A provides strong support to former clients and can work with individual hospitals to optimize or upgrade trauma care to meet the needs of the trauma system. Our clients will tell you they feel supported by us when needed. We stand by our work.
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Strengthening Trauma Hospitals for The Future
As innovators in the field of trauma care, B+A is uniquely qualified to advise hospitals on their Trauma and Acute Care Surgery (TACS) programs and other medical staffing challenges. Trauma centers bring a broad 24/7 surgical presence that can provide exceptional value to hospitals but staffing the trauma center can also be expensive and challenging. TACS programs are the future of trauma care.
Trauma and Acute Care Surgery (TACS) Model
Due to an increasing shortage of general surgeons and requirements for surgeons to maintain their surgical acumen, many hospitals are turning to the TACS model to fill their general surgeon staffing needs. This can, in turn, create more enjoyable practices for surgeons and stabilize trauma and emergency general surgery call coverage. The TACS model can create new strategic opportunities for hospitals, including:
Application of the trauma system multi-disciplinary approach to other surgical disciplines (such as geriatric fracture care).
In-house surgical hospitalist duties, such as chest tube placement, central line placement, and ventilator management.
Surgical safety net to include first response to in-house surgical emergencies for other surgical specialists, such as assisting an OB surgeon who encounters problems performing a C-section.
Assigned general surgery emergency call to provide surgical opportunities for general surgeons.
Enhanced hospital reputation among EMS and area hospital for accepting surgical cases, including complex cases.
Assessment, admission, and stabilization of emergency cases for other surgical specialists at night.
Opportunities for general surgeons to build elective surgery practices (e.g., robotics, minimally invasive surgery).
Creation of hospital or healthcare system Surgical Centers of Excellence to unify and escalate surgical offerings and optimize surgical quality.
The components of a typical TACS project may include the following:
Assessment of the current roles of surgeons in the hospital, specifically trauma and general surgeons.
Identification of challenges and call gaps in subspecialty fields (e.g., neurosurgery, facial fractures).
Exploration of strategic opportunities for service and market expansion.
Benchmarks for surgical workloads and productivity using national and industry data sources.
Definition of surgeon and mid-level staffing configurations.
Exploration of opportunities for Level I trauma center residency training programs.
Partnership with the surgeon group to assess compensation, optimize contracts and incentives, and maximize trauma professional billing fees.
Assistance in recruitment of new acute care surgeons and other medical staff.
Complex and Contentious Medical Staff Challenges
The American College of Surgeons requires 23+ surgical and medical specialties in Level I and Level II trauma centers. Trauma centers often face major challenges in sustaining physician specialty coverage and receiving appropriate value in return for support costs, which makes trauma centers a ripe environment for medical staff problems. Strengthening the Trauma and Acute Care Surgery (TACS) program can add major value to the hospital, can lead to improved care in other departments, and often results in a positive halo effect on other hospital services. (See Trauma and Acute Care Surgery and Staff Solutions.)
B+A has had exceptional success in working with hospital management and surgical specialties. We can work with your hospital to establish state-of-the-art, cost-effective medical staff structures for both trauma and emergency call. Having worked with surgeons across the country, we enjoy a high degree of credibility with even the most skeptical or divided medical staff. Our hands-on approach to medical staff optimization goes well beyond consulting norms. B+A will assist you in working with your physicians to arrive at an optimal structure that avoids contentious relations between the hospital and its providers. We work to bring out the best a medical staff has to offer.
The components of a typical medical staff solutions project may include the following:
Cultivation of effective medical staff leadership within trauma and other surgical specialties
Establishment of a strong TACS service to serve as the nucleus of your trauma center.
Assessment and development of effective call structures for key surgical and medical specialties.
Identification of enhanced ways for the TACS service to support inpatient care and ancillary support services (e.g., OR, ICU).
Creation of pathways for attracting new surgeons and staff.
Design of a compensation system that generates the best value from call payments.
Preparation of compliance letters regarding call arrangements with trauma medical staff reflecting call payment norms and appropriate staffing arrangements.
Proposal for a Surgical Center of Excellence that unites and escalates surgical services at your hospital.
We’ve Got Your Back for the Long Term
B+A traditionally provides strong support to former clients. Our clients will tell you they feel supported by us as long as needed, rarely at added cost. We know that hospitals often need months or even years to fully digest the project results and make the decision to proceed with the recommendations. If circumstances change, we are equipped to reevaluate the recommendations. We stand by our work.