The severe shortage of children’s beds raging across the country this fall is a by-product of financial decisions made by hospitals over the past decade, as they closed children’s wards, which often operating at a loss, and expanding the number of beds available for more profitable endeavors such as joint replacement and cancer care.
To deal with the flood of young patients sickened by a far-reaching convergence of nasty bacteria — particularly respiratory syncytial viruses, influenza, and coronaviruses — health centers across the country have deploy triage tents, delay elective surgeries, and move critically ill children out of state.
A major factor driving the bed shortages is the years-long tendency by hospitals to phase out pediatric units, which are oftentimes, said Mark Wietecha, CEO of the Children’s Hospital Association. less profitable than adult units. Hospitals optimize revenue by trying to ensure 100% of their beds are always full — and filled with patients with health conditions that require generous insurance reimbursements.
“It really involves dollars,” said Dr. Scott Krugman, vice president of pediatrics at Herman and Walter Samuelson Children’s Hospital in Sinai, Baltimore. “Hospitals rely on high-volume, high-return procedures from good payers to make money. There is no incentive for hospitals to provide services that cost money.”
According to a study published in 2021 in the journal Pediatrics, the number of children’s inpatient units in hospitals fell by 19% between 2008 and 2018. Just this year, hospitals have had closing pediatric departments in Boston and Springfield, Massachusetts; Richmond, Virginia; and Tulsa, Oklahoma.
The current rise in fatal respiratory illnesses among children is another example of how covid-19 has affected the health care system. Lockdowns and quarantines mark the first years of the pandemic, leaving children virtually untouched — and still vulnerable — to viruses other than covid for two winters, and doctors currently mainly treating respiratory diseases for many years.
Not a Modern Healthcare subscriber? Sign up today.
The pandemic has also accelerated changes in the healthcare industry that have left many communities with fewer hospital beds for critically ill children, along with fewer doctors and nurses to care for them.
As intensive care units overflow with older covid patients in 2020, some hospitals are starting to use baby beds to treat adults. Many of those beds have yet to be restored, said Dr. Daniel Rauch, chair of the hospital care committee of the American Academy of Pediatrics.
In addition, the unrelenting pace of the pandemic has put more than 230,000 healthcare providers — including doctors, nurses, and physician assistants — out of work. Before the pandemic, about 10% of nurses quit their jobs every year; Wietecha says that percentage has increased to about 20%. He estimates that children’s hospitals cannot maintain up to 10% of their beds because of a lack of staff.
Dr Megan Ranney, who works in several emergency departments in Providence, Rhode Island, including Hasbro Children’s Hospital, said: “There is not enough room for all the children who need a bed. The number of children going to the emergency room in recent weeks is 25% higher than the previous record of the hospital.
“We have doctors making beds so we can get kids to bed faster,” said Ranney, associate dean at Brown University’s School of Public Health.
There is not much money in the treatment of children. About 40% of children in the United States are covered by Medicaid, a joint federal and state program for low-income patients and people with disabilities. Medicaid’s base rate is typically 20% less than the rate paid by Medicare, the government’s insurance program for older adults, and even lower when compared to private insurance. While intensive care for a wide range of common adult procedures, from knee and hip replacements to heart surgery and cancer treatments, generates huge profits for medical centers, Hospitals complain that they often lose money on inpatient care.
When Tufts Children’s Hospital closed 41 pediatric beds this summer, hospital officials assured residents that younger patients could be cared for at nearby Boston Children’s Hospital. Now, Boston Children’s Hospital is delaying some elective surgeries to make room for critically ill children.
Rauch notes that children’s hospitals, which specialize in treating serious and rare conditions like childhood cancer, cystic fibrosis and heart defects, are simply not designed to handle young children. I have an acute respiratory illness this season.
Even before the fall virus triad, pediatric units were straining to take on growing numbers of young people suffering from acute mental breakdown. There are many stories of mentally challenged children who are left for weeks in emergency departments while awaiting transfer to pediatric psychiatry. On a clear day, 20% of the beds in the pediatric emergency room at Hasbro Children’s Hospital are for children with mental health issues, says Ranney.
Hoping to increase capacity for children, the American Academy of Pediatrics joined the Children’s Hospital Association last month to call on the White House to declare a national emergency due to respiratory infections in children. children and provide additional resources to help cover the cost of care. The Biden administration has said that flexible hospital and provider systems have been put in place during the pandemic to avoid some of the staffing requirements that also apply to RSV and the flu.
Download Modern Healthcare’s app to stay informed when there’s breaking industry news.
Doernbecher Children’s Hospital at Oregon Health & Science University has moved to a “standard of care in times of crisis,” allowing intensive care nurses to treat more patients than they are normally assigned to. determined. Meanwhile, hospitals in Atlanta, Pittsburgh, and Aurora, Colorado, had to treat young patients in overcrowded tents in parking lots.
Alex Kon, a pediatric intensive care physician at the Community Health Center in Missoula, Montana, said providers there have planned to care for older children in the intensive care unit. adults and transport ambulances to other facilities as needed. With only three pediatric ICUs in the state, that means younger patients can be taken as far as Seattle or Spokane, Washington or Idaho.
Hollis Lillard took her 1-year-old son, Calder, to a military hospital in Northern Virginia last month after he developed a fever, cough and difficulty breathing for several days. They spent seven harrowing hours in the emergency room before the hospital found an empty bed and transported them by ambulance to Walter Reed National Army Medical Center in Maryland.
With proper therapy and home care guidance, Calder’s virus is easily treatable: He recovered from oxygen and treatment with steroids, anti-inflammatory agents, and albuterol, an anti-inflammatory agent. bronchospasm. He was discharged the next day.
Although the number of hospital admissions for RSV is decreasing, it is still much higher than normal for this time of year. And hospitals may not get much relief.
People can get RSV more than once a year, and Krugman is worried about a resurgence in the coming months. “As the coronavirus competes with other viruses, the “conventional seasonal virus pattern has disappeared,” he said.
Like RSV, flu comes early this season. Both viruses typically peak around January. Three strains of the flu are circulating and are estimated to have caused about 8.7 million illnesses, 78,000 hospitalizations and 4,500 deaths, according to the Centers for Disease Control and Prevention.
Krugman doubts the healthcare industry will learn any quick lessons from the current crisis. “Unless there’s a radical change in how we pay for children’s hospital care, bed shortages will only get worse,” says Krugman.
Kaiser Health News is a national health policy news service. This is an editorially independent program of the Henry J. Kaiser Family Foundation not affiliated with Kaiser Permanente.
