July 20, 2017

Why pediatric 'mega-hospitals' are booming—even as smaller hospitals cut pediatric care

Daily Briefing

    Lurie Children's Hospital and other pediatric "mega-hospitals" are expanding to meet demand for specialty pediatric care—even as many other community hospitals are curbing or closing down their pediatric services, Brigid Sweeney writes for Modern Healthcare.

    The case for improving coordination between behavioral health and pediatrics

    Expansion details

    According to Sweeney, Lurie is establishing the Chicago Institute for Fetal Health—one of only a few fetal surgical centers in the world—and investing $51 million to add 44 pediatric intensive care beds and four neonatal intensive care beds, bringing the total number of beds to 336. Executives also plan to propose a second expansion project to the board later this summer, Sweeney writes.

    Lurie's expansion aims to meet increasing demand for specialized pediatric services, Sweeney reports. The hospital five years ago opened a new campus adjacent to Northwestern Memorial Hospital, and it's in the midst of recruiting faculty from other top-ranked children's hospitals. For instance, Lurie in 2012 hired Aimen Shaaban, one of the few surgeons in the world who can do in-utero surgery to treat congenital defects before birth, from Cincinnati Children's Hospital Medical Center.

    Other major pediatric hospitals expanding, too

    According to Sweeney, Lurie isn't alone among specialized children's hospitals to launch expansion projects. Boston Children's Hospital, for instance, got the go-ahead on a $1 billion expansion last year, and Cincinnati Children's this summer announced plans to expand as well.

    Even in the local arena, Lurie's competitors are eying expansion projects, Sweeney writes. For instance, the University of Chicago Medicine Comer Children's Hospital recently added six new neonatal intensive care beds, while Advocate Children's Hospital plans to add an additional 11 NICU beds by 2018.

    As with Lurie, the hospitals said their expansion plans come amid increased demand for specialized pediatric care. "We will have to turn away hundreds of patients this year from our South Campus (in Oak Lawn) due to lack of space," Matt Robbins, chief strategy officer at Advocate Children's, said.

    But smaller hospitals are cutting pediatric services

    But even as major Chicago pediatric hospitals are expanding, at least 15 other hospitals in the area are reducing or closing down their pediatric care offerings, Sweeney writes.

    John Cunningham, the chair of pediatrics at the University of Chicago, explained that while a local community hospital 20 years ago might have treated less acute pediatric cases—such as a child who's experiencing a severe asthma attack—such cases are now treated at outpatient centers and preventive care facilities, such as the University of Chicago's South Side asthma center.

    And since small children's hospitals transfer more severe cases to specialty hospitals, small facilities no longer have sufficient patient demand for less acute pediatric care services to justify keeping those wards open.

    As Cunningham put it, from the hospital's point of view, it's more marketable to convert those otherwise empty pediatric wards into adult inpatient care space for aging baby boomers.

    Smaller children's hospitals might also lack the market share to compete against their larger rivals, Sweeney writes.  Paul Ginsburg, director of the Center for Health Policy, explained, "This is a broad phenomenon: Small hospitals are having a hard time because they don't have the clout to negotiate high rates, so some are falling by the wayside."

    The strong brand of pediatric mega-hospitals is a factor too. "Boston is a classic example," Ginsburg said. "Lots of patients who need (less-acute) care like to go to the academic medical centers because of the brand. And so Massachusetts has the highest health care spend of any state."

    Pediatric specialty hospitals push 'right place' approach

    But Lurie and other pediatric specialty hospitals are taking steps to ensure care is provided in the most effective manner and location, Sweeney writes.

    For instance, Stephenson has created what she calls "right care, right place, right cost" partnerships aimed at having children with less-critical conditions receive treatment at community hospitals rather than at Lurie.  To that end, Lurie has established various partnerships with 16 hospitals in the area.

    According to Sweeney, other children's hospitals in the area have done the same. For example, Comer and Advocate have both teamed up with "dozens" of hospitals to help children access care in their own communities, Sweeney writes. Advocate also maintains pediatric space at 10 of its non-pediatric specialty hospitals, even if that space isn't filled.

    According to stakeholders, the strategy is a smart move, both for patient care and for hospital business. Sweeney points out that the pediatric boom may bust in the future, given the current decline in birth rates (Sweeney, Modern Healthcare, 7/17).

    The case for improving coordination between behavioral health and pediatrics

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    The CDC estimates that nearly $247 billion is spent annually on the treatment and management of childhood mental disorders. Further, pediatric patients and caregivers often struggle to access high-quality behavioral health expertise due to a limited number of specialists and fragmented approaches to behavioral health services.

    In this presentation, we review the case for improving coordination between behavioral health and pediatrics, and describe four successful models that increase access to behavioral health care.

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