Tennessee trauma doctors urge stable funding as patient load rises and cigarette revenue falls

Representatives of the Trauma Care Advisory Council told the Senate Finance, Ways and Means Committee on Feb. 18 that Tennessee’s trauma system is treating many more patients while revenues that historically supported the system have fallen, leaving readiness and uncompensated-care costs underfunded.

The council’s presentation outlined three budget categories supported by the state trauma fund — statewide system management and registry work, readiness costs for trauma centers (the nonpatient costs of maintaining 24/7 trauma capability) and uncompensated care payments — and asked the committee to consider replacing lost cigarette‑tax revenue to stabilize the fund.

“We seek to replace the revenue lost with that continued decreased use of cigarettes, to stabilize that fund and ensure sustainable funding for the statewide system,” said Reagan Bullock, who identified himself as representing the University of Tennessee Medical Center and the Trauma Care Advisory Council’s member hospitals.

Bullock and colleagues described the system’s configuration and the council’s recent statewide audit. They said Tennessee now has 17 level‑1 trauma centers, no level‑2 centers listed in the presentation, 10 level‑3 centers and one level‑4 center, plus four comprehensive regional pediatric centers (CRPCs) that treat pediatric trauma. They attributed the rise in trauma registry cases to population growth and to stronger routing of injured patients to designated trauma centers.

Brad Dennis, trauma medical director at Vanderbilt and TCAC member, answered questions about center designations and the American College of Surgeons standards used for level designations. “Level 1 is … the all‑encompassing services,” Dennis said, describing level‑1 centers as those with full subspecialty services, research activity and the capacity to treat patients from admission through post‑discharge.

Council presenters emphasized that readiness requires paying for personnel and services that must be in place before a patient arrives. According to the presentation, readiness‑cost estimates developed from the council’s recent survey found very large readiness costs statewide. The presenters said the statewide total readiness cost was determined by their survey to be approximately $171,000,000, and that readiness contributes a small percentage of overall readiness-cost funding presently covered by the trauma fund.

The council traced the funding problem to a long decline in tobacco sales. They said the trauma fund portion that came from the cigarette tax has dropped substantially over the past decade even as trauma cases increased; a $5 million recurring general‑fund allocation was added by the legislature in 2022 but the council said that alone does not offset the revenue decline and expanded caseload.

Committee members asked for specifics on the drivers of case growth; presenters said the increase is likely a mix of population growth, greater recognition and routing of trauma patients to designated centers, and improved data collection that brings more cases into the state trauma registry.

Senators also asked about common injury types and geographic variation; presenters said falls are the most common cause of trauma admissions statewide, followed by motor vehicle crashes and then penetrating injuries (gunshots and stabbings), with penetrating injuries concentrated in urban centers.

The council’s formal request to the committee was to consider measures that would stabilize the trauma fund by replacing or supplementing revenue lost from declining cigarette sales so the statewide trauma system can meet readiness and uncompensated‑care needs.

The council provided a statewide map and audit slides to the committee; members asked staff to follow up with details about the 2022 $5 million allocation and how it was classified (recurring vs. one‑time). The presenters said the 2022 allocation was recurring but that a separate allocation referenced from the previous year had been one‑time and that staff would confirm those details.

The committee did not take formal action on trauma funding during the hearing; presenters left the committee with a request that lawmakers consider stabilizing the fund in upcoming budget deliberations.

The council recommended lawmakers review funding sources and consider aligning trauma funding with statewide needs as trauma volume continues to rise.