Children’s hospitals are being pushed to the brink as they face a growing respiratory illness outbreak coupled with a surge in COVID-19 cases and a mental health epidemic. It’s a multifaceted threat that could recur without policy fixes.
Children’s hospitals have been spared the worst of the pandemic because of the low number of COVID-19 cases among children compared to adults. But diagnoses of COVID-19 and respiratory syncytial virus in children have been on the rise in recent months. These patients are coming to hospitals where capacity has been limited by a skyrocketing number of children and young adults with behavioral health conditions.
“Children’s hospitals are in crisis right now,” said Lisa O’Connor, senior managing director at FTI Consulting. “They are putting in place emergency preparedness policies and enabling everything that is functionally possible 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 American Academy of Pediatrics committee on hospital care. “If most hospitals are smaller and have a safety net, preferably break even with Medicaid, they can’t afford to open up pediatric beds.”
Child care is often a small element of health system performance, so for units with fewer resources, viral outbreaks can be overwhelming. For example, Orange County in California declared a health emergency this week as health care providers there battle COVID-19, RSV, and influenza.
At the same time, hospitals are still struggling to hire workers. Health systems have trained downline doctors to treat fewer 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 that have been made with regard to recruitment and retention, we have only need more agencies.
Overcoming the ‘perfect storm’
The RSV surge happened earlier than expected this year, forcing 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: “She said there have been as many RSV infections in the past week as there were last month.
Dr. Elizabeth Meade, medical director of pediatric quality at Providence Sweden in Seattle, said inpatient pediatric units are already at capacity in that area. Between 50% and 75% of pediatric patients in Providence Sweden are being treated for RSV, 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. Moving workers from adult care to pediatrics is another potential solution, says Meade. And Swedish emergency agency Providence is assessing where to place the baby when there are no beds available, she said.
Hospitals elsewhere have canceled non-emergency procedures and set up tents outdoors to cope with the wave of sick children.
RSV patients are grouped together in Providence Sweden, where the pediatric and pediatric intensive care units are located on the same floor, Meade said. If they need more space, adolescent patients with noncommunicable conditions, such as behavioral health issues or post-surgery needs, will be referred, she said.
The North Carolina Healthcare Association implemented a centralized communication system, which was used to facilitate patient transfers before Hurricane Florence made landfall in 2018 and more recently during COVID-19 surge, to place patients in harder-to-find beds, such as in children’s ICUs. .
Combined with the RSV crisis is the escalating rate of mental illness among children and young people, which further increases capacity in children’s hospitals. Children with mental health problems will stay in hospital emergency departments longer – sometimes weeks – because inpatient or outpatient services have been cut or facilities are full.
The limitations in the mental health capacity of pediatric providers are symptoms of long-standing and often neglected deficits. Access to mental health care for children was previously limited because of low reimbursement rates, few financial incentives for students to choose a specialty, and a narrow insurance network.
“Part of the solution needs to be upstream. Anne Dwyer, associate professor of research at Georgetown University’s Center for Children and Families, said:
Policy proposal
Policy experts and healthcare trade associations have proposed short-term solutions to enhance capacity and long-term solutions to stabilize the pediatric industry.
The Centers for Medicare and Medicaid Services should codify looser rules enacted during a public health emergency due to the coronavirus that facilitate remote access, such as no-shows. Clinicians must be licensed in the same state as their patients, Rauch said.
Bob Garrett, CEO of Edison, New Jersey-based Hackensack Meridian Health, said extending the public health emergency facility exemption would allow hospitals to convert spaces that are not normally used for patient care. In the long run, adding more graduate medical training facilities for pediatric psychology and pediatric psychology students will increase the pool of specialists, he said.
Texas Hospital Association is developing a $65.5 million legislative proposal to increase loan repayments for nursing students, fund training programs to replace medical professors retired nurses and increasing the capacity of nursing schools. Last year, nursing schools in Texas turned down more than 15,000 qualified applicants because of insufficient resources, Kroll said.
“Whenever you’re looking for a pediatrician, the pool of applicants narrows,” says Kroll. “The only real way to turn the boat upside down is to bring more people into the workforce.”
Congress should raise limits on graduate medical education payments to teaching hospitals, and the federal government and states should increase children’s Medicaid reimbursements to match Medicare rates, Rauch said. Otherwise, many pediatric beds would disappear, he said.
The number of inpatient pediatric beds 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 increase prevention by eliminating diagnostic requirements for access to treatment, expanding provider capacity by training primary care providers or medical staff behavioral health community health and increased payment for behavioral health integrated primary care.
States can also tap into additional funding through the American Rescue Plans Act, which provides $12 billion in Medicaid home and community services. 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 of infection prevention and control at Lurie Children’s Hospital Chicago. “Hospitals are businesses and hospitals need a profit to stay afloat, and so hospitals are making business decisions about how to staff those beds so they can cover the costs.” the cost of providing health care services.”
Dr. Keith Jensen, regional medical director of pediatric emergency medicine for Texas Women’s Hospital and HCA Houston Healthcare, said pediatrics should focus on primary care, which will reduce the burden on children. hospitals have to bear. “Higher pay for primary care will also encourage more people to choose pediatrics as a specialty,” he said.
