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Regional West Health Services in Scottsbluff is beginning the process of changing its trauma level designation from a Level II to Level III Trauma Center.
In a Feb. 20 announcement, Regional West President and CEO Ned Resch said the decision was based on community health care needs and financial sustainability.
“Our dedication extends beyond delivering essential trauma and emergency care; we also aim to enhance the patient experience by consistently offering high-quality care across our primary and specialty clinics,” Resch said in the statement. “That is one reason it is essential for health care systems to continually assess the services they provide to ensure they effectively meet patient needs while remaining financially responsible. The trauma designation is one area we felt we could change while still offering specialty services without the 24/7 call coverage requirement for some services.”
Trauma centers provide lifesaving care for patients with severe, immediate injuries that could cause permanent damage or death. Falls, motor vehicle accidents, assaults, burns and other sudden medical emergencies are common causes of traumatic injuries.
Only two Level II trauma centers will remain in Nebraska – one in Lincoln and one in Kearney. Omaha has the only two Level I trauma centers in the state.
Resch said the health service will still be able to provide high-level care.
“We absolutely feel and think of ourselves as a regional trauma hub, and that has not changed at all,” Resch said. “Our mindset is that we are a regional provider, that we are a regional trauma catchment hospital, and that we will continue to care for most -- if not all -- of the trauma that we traditionally have.”
High-volume treatments to keep 24/7 care, rarer specialties may have gaps
Though Level III trauma centers aren’t required to have 24/7 access to certain specialty services, Resch said round-the-clock service will be maintained for the most common trauma treatment areas.
“General surgery, orthopedics and neurosurgery are the bulk of our trauma,” Resch said. “None of those are changing. As a result, our overall trauma catchment really shouldn't change much.”
Moving from Level II to Level III allows Regional West flexibility if a specialist physician is not available on-call 24/7 or a position is left unfilled.
“If there's a gap in our ability to recruit, if there's a gap in availability providers in general, then we are not required by the state at that point to have that [as a Level III trauma center],” Resch said. “And that's the conundrum we've been in.”
Some 24/7 specialty services will be deprioritized, such as ear, nose and throat and ophthalmology surgery. As trauma areas that see very few incidents a year, Resch said it can be costly to find and keep a specialist physician.
“We feel like this is a pretty low impact to our overall offerings and what we're doing, but it has a really significant finance offset for us. Many rural hospitals are making very difficult decisions every day along these lines.” Resch said.
In cases where specialty services aren’t available in an emergency, Regional West has the capability to transfer a patient to a higher-level trauma center once they are stabilized. However, Resch said Regional West is not expecting a significant increase in transfers.
“We have really strong EMS and inter-facility transport services here,” Resch said. “We’re still a regional trauma hub, and we will navigate that as we work through it, but we have strong services here.”
From Scottsbluff, the closest Level II Trauma Centers will be in Cheyenne, Wyoming, and Rapid City, South Dakota. Regional West is the only Level II Trauma Center west of Kearney, about a four-hour drive away, and the nearest Level I trauma center is located south of Fort Collins, Colorado.
Once paperwork is complete, Resch said the conversion to Level III will be official by the end of the month.
Nebraska’s rural hospitals face common challenges with staffing, finances
Jed Hansen, president of the Nebraska Rural Hospital Association, said Regional West isn’t the only rural hospital struggling to recruit and maintain staff.
“It’s that combination of struggling to find those more stable clinical resources, and then the significant cost that goes into doing that.” Hansen said.
Amid Medicaid cuts and rising Affordable Care Act health insurance premiums, Hansen said rural hospitals must make difficult choices to keep their operations afloat.
“They’re having to make those decisions on the types of services and the level of services that they’re offering,” Hansen said. “Scottsbluff is going through that situation as well.”
He said rural hospitals must look for “creative solutions” to address workforce shortages.
“They've got to have the right people, and they've got to have the right technology, and we need to be doing what we can to be able to help in those spaces,” Hansen said.
One of those creative solutions could come in the form of Rural Health Transformation Program funding, a $50 billion federal government allotment aiming to strengthen rural health care across the country over the next five years.
Nebraska has $218.5 billion a year to put toward rural health initiatives. Many of those dollars won’t go directly to hospitals and cannot be used to offset a near trillion-dollar reduction in Medicaid spending.
“Ultimately the concern is, are we going to have a bunch of these projects over the next five years, and are we effectively hanging a shiny ornament on a dead tree?" Hansen said.
Nebraska’s RHTP funding plan sets aside over $88 million for rural provider recruitment initiatives. It would pay for stipends up to $75,000 to incentivize health care professionals to live and work in rural areas, and temporary housing and relocation fees are also available.
For rural hospitals and state health care leaders, the fruits of those RHTP recruitment efforts remain to be seen.