Children’s hospitals are being pushed to the brink as they face a growing respiratory illness outbreak alongside rising COVID-19 infections and a mental illness epidemic. It’s a multifaceted threat that could recur without policy fixes.
Children’s hospitals have escaped the worst of the pandemic because of the low number of COVID-19 cases among children compared to adults. But COVID-19 and respiratory syncytial virus diagnoses in children have increased in recent months. Those patients are coming to hospitals where capacity is already overcrowded due to a spike in the number of children and young adults with behavioral health conditions.
Lisa O’Connor, senior executive director of FTI Consulting said: “Children’s hospitals are in a state of crisis right now. “They are pulling out emergency preparedness policies and activating every possible function from a policy and regulatory standpoint.”
Policy experts say healthcare providers and governments must invest in child care and prevent future crises.
“It was a perfect storm,” said Dr. Daniel Rauch, professor of pediatrics at Tufts University and chair of the hospital care committee of the American Academy of Pediatrics. “If most hospitals were smaller and had a safety net that, at best, broke even on Medicaid, they couldn’t afford to keep opening children’s beds.”
Child care is often a small part of the health system’s operations, so for units with fewer resources, the virus outbreak could be too large. For instance, Orange County in California declared a health emergency this week as healthcare providers there battle COVID-19, RSV, and the flu.
At the same time, hospitals are still struggling to hire workers. Health systems have trained lower-level physicians to treat less acute patients during the COVID-19 pandemic, but that approach is not viable for most childcare services. because it’s so specialized.
“Despite the efforts involved in recruitment and retention, we only need more people.
Overcoming the ‘perfect storm’
The increase in RSV happened earlier than expected this year, which forced hospitals to adjust their operations to accommodate a large influx of pediatric patients.
In California, the Santa Barbara area is seeing a significant increase in RSV infections. Dr Lynn Fitzgibbons, an infectious disease physician at Santa Barbara Cottage Hospital, said cases doubled three weeks ago and have since doubled again. She said that there have been as many RSV infections in the past week as there have been in the last month.
Dr. Elizabeth Meade, medical director of pediatric quality at Providence Swedish in Seattle, said pediatric inpatient units are operating at full capacity in that area. Between 50% and 75% of pediatric patients at Providence Swedish are receiving RSV treatment, more than the facility would see in a typical winter.
As a result, the hospital is implementing a contingency plan that applies lessons from the pandemic. Meade said shifting staff from adult care to child care is another potential solution. And Providence Sweden’s emergency department is evaluating where to place children when beds are not available, she said.
Hospitals elsewhere have canceled non-emergency procedures and set up tents outdoors to deal with the wave of sick children.
Meade said RSV patients are grouped together at Providence Swedish, where the pediatric and pediatric intensive care units are on the same floor. If they need more space, adolescent patients with non-communicable diseases, such as behavioral health issues or post-surgery needs, will be referred, she said.
The North Carolina Health Care Association implemented a centralized communication system that was used to facilitate patient transfers before Hurricane Florence made landfall in 2018 and more recently. during the COVID-19 outbreak, to place patients in beds that are harder to find, such as in a children’s ICU.
Combined with the RSV crisis is the escalating rate of mental illness cases among children and young people, which further increases capacity in children’s hospitals. Children with mental health problems stay longer in hospital emergency departments — sometimes weeks — because inpatient or outpatient services have been cut or facilities are full.
The limitations in the mental health capacity of mental health providers are symptomatic of long-standing and often overlooked deficiencies. In the past, access to mental health care for children was limited due to low reimbursement rates, little financial incentive for students to choose a specialty, and a narrow insurance network.
“Part of the solution needs to be upstream. “What are we doing in terms of prevention and how do we make sure children get appropriate care at home or at home,” said Anne Dwyer, associate professor of research at Georgetown University’s Center for Children and Families. outpatient facility, which is not always available?” .
policy proposal
Policy experts and healthcare trade associations have proposed short-term solutions to strengthen capacity and long-term solutions to stabilize the pediatric industry.
The Centers for Medicare and Medicaid Services should codify looser rules enacted during the coronavirus public health emergency to facilitate access to healthcare, Rauch said. distance, such as not requiring clinicians to be licensed in the same state as their patients.
Bob Garrett, CEO of Edison, New Jersey-based Hackensack Meridian Health, said extending the public health emergency facility exemption will allow hospitals to transform spaces are not normally used for patient care. In the long run, he said, adding more graduate medical training positions for pediatric psychology and pediatric psychology students will increase the pool of specialists.
Texas Hospital Association is developing a $65.5 million legal proposal to increase nursing student loan repayments, fund training programs to replace nursing professors retired and increased the capacity of the nursing school. Kroll said that last year, nursing schools in Texas turned down more than 15,000 qualified applicants because of insufficient resources.
“Whenever you’re looking for a pediatrician, the pool of candidates narrows,” says Kroll. “The only real way to turn the tide is to bring more people into the workforce.”
Rauch says: Congress should lift the graduate medical education payment cap for teaching hospitals and the federal government and states should increase children’s Medicaid reimbursements to match rates of Medicare. Otherwise, many pediatric beds would disappear, he said.
The number of inpatient beds for children fell between 2008 and 2018, according to an analysis of American Hospital Association data published in the journal Pediatrics last year.
CMS notified state Medicaid agencies in August of its Early and Routine Screening, Diagnosis, and Treatment benefit, which funds preventive mental health care for children. CMS encourages states to promote prevention by removing diagnostic requirements for access to treatment, expands provider capacity by training primary care providers or healthcare workers behavioral health communities and promote payment for behavioral health integrated primary care.
States could also tap into additional funding through the American Rescue Plans Act, which provides $12 billion for home and community services under Medicaid. Eligible states may receive a 10 percentage point increase in Medicaid matching rates for related services.
“Child care in general is not as profitable as adult care,” said Dr. Larry Kociolek, medical director for infection prevention and control at Lurie Children’s Hospital in Chicago. “Hospitals are businesses and hospitals need a profit to stay afloat, so hospitals are making business decisions about how to staff those beds so they can recoup. the cost of providing health care.”
Keith Jensen, regional medical director for pediatric emergency medicine at Texas Women’s Hospital and HCA Houston Healthcare, said pediatrics should focus on primary care, which will reduce the burden on patients institute. “Higher pay for primary care will also encourage more people to choose pediatric specialties,” he said.
