Listen to thisBest pediatric care model: Keep it close to home
Like most parents with young children, I have been closely following the public debate about the potential for a standalone children’s hospital in Richmond and appreciate all viewpoints involved in the discussion.
If one of my three children had a rare medical problem, I would absolutely seek out one of the nationally renowned pediatric hospitals – specifically, one with top researchers treating the largest number of patients with that specific medical condition. The stronger the clinical competence of the medical team, the better my child’s chance would be for a positive outcome. Establishing an independent children’s hospital in Richmond would not be a comprehensive, one-stop shop for every highly specialized pediatric issue.
The good news for Central Virginians is our community offers a number of great choices for pediatric care. As a parent, I want to know that I can quickly take my child to a convenient, skilled hospital. The current PACKids proposal for an independent, standalone hospital undoubtedly puts that freedom of choice at risk.
Limiting where pediatric care is delivered would negatively affect many families who do not live in close proximity to the new facility and could face up to a 45-minute drive. It is a daunting thought to have my child in pain facing a long drive to a children’s hospital rather than my current 5-minute commute to a skilled ER.
As we consider this issue, I think one of the concerns we have to address is how to enhance and complement care for the children in our community, rather than limit it. Proximity of care for my child in need is as important as quality.
I believe I offer a unique perspective for two reasons. I am the CEO of HCA Virginia’s Chippenham and Johnston-Willis Hospitals. Additionally, I’ve lived in a wide variety of communities with and without children’s hospitals. Two of these cities have nationally recognized pediatric medical centers – Children’s National Medical Center in Washington, and the Children’s Hospital of Alabama in Birmingham. They offer extraordinary pediatric care.
However, in all of the communities I have lived, large and small, I’ve found pediatric health care was solely dependent on skilled physicians supported by strong hospitals. Richmond is fortunate to enjoy both. At HCA Virginia, we partner closely with several hundred pediatric and family medicine physicians and specialists, as well as VCU Health System, to ensure when a child needs care, we can respond quickly and with the most effective option to meet their need.
What does all this mean for our families? It means high-quality pediatric care currently is available close to home for the majority of our community. It means that highly trained, skilled practitioners (physicians, nurses, technicians, therapists) are already in our backyard.
At HCA Virginia’s seven hospitals alone, we cared for more than 47,000 children in our ERs, admitted more than 4,200 to our hospitals and treated more than 60,000 via outpatient lab work, imaging and procedures. The quality outcomes for these patients are unsurpassed.
We are fortunate to have skilled pediatric surgeons and other sub-specialists across our region today. The reality is the delivery of pediatric medical care has significantly shifted from the inpatient setting to more than 90 percent outpatient. That shift means there is likely not a demand for the PACKids proposal for a free-standing, independent 200-bed hospital. This $500 million building would be a financial burden on our community.
Rather, the vast majority of our families would be better served by a variety of locations close to their homes that can provide excellent emergency and surgical care for their children. This model encourages complementary services rather than competing services for our children.
I am intrigued with the recent announcement from VCU Health System about building a pediatric hospital within its network. If a pediatric hospital is to be built, it is critically important that it be closely affiliated with an academic, teaching organization working collaboratively with existing pediatric services in our community. I have found that most people value choice and most people value their existing relationship with their doctors and hospitals. At HCA Virginia, we are proud to offer such choices.
It is important to note our community is fortunate to have a generous donor interested in funding a significant portion of the building cost of an independent pediatric hospital; however, a large remaining portion of funds would need to be raised. These are significant dollars that could be allocated toward any number of worthy charitable causes or to support the innovative research and work already being done in our community on pediatric health care.
Furthermore, the high operating costs and low reimbursement would be an ongoing financial struggle for an independent hospital. Today, Medicaid pays hospitals only 64 cents for every dollar of cost. The lowest estimates for the proposed hospital are that 44 percent of its patients would be covered by Medicaid. It is likely that the actual percentage of Medicaid could be well in excess of 50 percent, based on similar hospitals in other markets.
So what happens when a community asset such as a standalone pediatric hospital falls short on funding? It has to raise revenue by either cost-shifting to other patients or asking the state and federal government for assistance through subsidies, which means all of our taxes would likely increase.
We are fortunate to have both an excellent breadth and depth of pediatric services in the greater Richmond area. The key is to drive the coordination of care across all inpatient and outpatient settings. Today, we have comprehensive, evidence-based protocols available to our clinical teams to serve the complex needs of our patients. Over decades, HCA Virginia has made substantial investments in the teams, technology and clinical approach at our Central Virginia hospitals to meet the needs of parents and their children.
Let me give you one example. If you are a high-risk expectant mother, you want to know you have close access to a hospital that can effectively treat both you and your newborn. At our local HCA Virginia hospitals, we have 80 neonatal beds, in addition to a number of superlative services for moms in perinatology, antepartum, labor and delivery, and postpartum services. Complementing these acute services are child development followup clinics, NICU family support groups and March of Dimes community programs. These substantial resources make all the difference to families in our community.
This comprehensive approach allows the mother to stay in the same hospital as her newborn – something that would not always happen under the proposed pediatric hospital model. As a father, I cannot imagine having my newborn child separated from my wife. I cannot imagine the added burden these parents would face if their newborn, requiring a NICU, was moved away from the mother to a free-standing pediatric hospital. That, to me, does not enhance the care we deliver to our families.
Opening a free-standing children’s hospital and shifting all pediatric care to this single site will significantly jeopardize all of the pediatric services across the Richmond area.
A new independent facility will mean lower pediatric patient volumes at surrounding hospitals and will likely mean a reduction of services near everyone except those in close proximity to the new facility. Consequently, I think our community’s children and parents are best served by building on the strong health care facilities in existence today.
Tim McManus
30 June 2013
