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white coat notes

Tufts seeks top trauma label; rivals want delay

From the Globe’s health care blog.

Tufts Medical Center is seeking to become a level one trauma center, an elite designation that would bring more prestige and potentially more patients to the Boston teaching hospital.

But the surgery chiefs at four of Tufts’ competitors are questioning whether the city needs another top trauma center and have asked public health officials to delay their decision.

Tufts won approval three years ago to become a level two trauma center. Before then, Tufts was the only major Boston teaching hospital not approved as an adult trauma center.

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As a result, ambulances carrying victims of car accidents, falls, or violence often bypassed that hospital for Beth Israel Deaconess Medical Center, Boston Medical Center, Brigham and Women’s Hospital, or Massachusetts General Hospital - all state-designated trauma centers.

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Now, Tufts wants to take its role a step further. The hospital has asked the American College of Surgeons to designate it as a level one trauma center. The state Department of Public Health must give final approval.

“Level one tells the community and referring physicians and hospitals we really have met the highest standard,’’ said Dr. Brien Barnewolt, head of emergency medicine. “We’re proud of that.’’

But in a letter last week to John Auerbach, Massachusetts public health commissioner, surgery chiefs at the four other hospitals argued that designating a fifth level one trauma center in the city could harm public health by diluting physician and staff expertise.

Dr. Keith Lillemoe, surgery chief at Mass. General, said adding a level one trauma center in Boston doesn’t seem like the best use of resources, particularly since some other regions of the state have thin trauma coverage. “Why doesn’t someone look at what we really need?’’ he asked.

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The surgery chiefs - including Dr. Michael Zinner at the Brigham, Dr. Gerard Doherty at Boston Medical Center, and Dr. Elliot Chaikof at Beth Israel Deaconess - asked the health department to delay its decision until the American College of Surgeons finishes an assessment of the state trauma system, which was commissioned by the health department.

Barnewolt called the letter “a little self-serving. If we have met the criteria, there’s really no reason to wait,’’ he said.

Madeleine Biondolillo, director of health care safety and quality for the health department, said in a written statement: “The Department awaits the determination of the ACS review and cannot comment further at this time.’’

More coverage, more cost

The state’s landmark health insurance law significantly increased the number of residents ages 19 to 64 with coverage - now at 94.2 percent. A survey released last week found that, since it passed in 2006, more people are staying healthier and out of emergency rooms and hospitals.

Unfortunately the law has done little to control costs.

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“There was a significant increase in premium costs paid by workers, reflecting Massachusetts’ decision to put off efforts to address lowering health care costs in the 2006 legislation,’’ according to Health Affairs, the journal that published an article based on the survey.

Between fall 2006 and fall 2010, emergency department use fell 3.8 percent overall, and the use of emergency departments for non-emergency conditions also dropped 3.8 percent.

At the same time, about half the adults surveyed reported their families were spending more on health care in 2010 than in the prior year, and a quarter were not confident in their ability to afford care in the coming year.

Visit boston.com/whitecoatnotes for the full blog. Liz Kowalczyk can be reached at kowalczyk@globe.com.