HomeHealthHospital financial decisions play a role in the critical shortage of pediatric...

Hospital financial decisions play a role in the critical shortage of pediatric beds for RSV patients:

the terrible shortage of pediatric hospital beds hitting the nation this fall is a byproduct of financial decisions made by hospitals over the past decade, as they closed children’s wards, which often operate in the red, and expanded the number of beds available for more profitable efforts like replacements. joint and cancer care.

To cope with the onslaught of young patients sick from a sweep convergence of nasty bugs – especially respiratory syncytial virusflu and coronavirus — Medical centers across the country have set up triage tents, delayed elective surgeries and transported critically ill children out of state.

A major factor in the bed shortage is a years-long trend among hospitals in eliminating pediatric unitswhich tend to be less profitable than adult units, he said brand wietecha, CEO of the Children’s Hospital Association. Hospitals optimize revenue by striving to keep their beds 100% full, and filled with patients whose conditions require generous insurance reimbursements.

“It really has to do with the dollars,” said Dr. Scott Krugman, vice president of pediatrics at Sinai Herman and Walter Samuelson Children’s Hospital in Baltimore. “Hospitals rely on high-volume, high-reimbursement procedures from good payers to make money. There is no incentive for hospitals to provide services that lose money.”

The number of pediatric inpatient units in hospitals fell 19% from 2008 to 2018, according to a study published in 2021 in the journal Pediatrics. This year alone, hospitals have closed pediatric units in Boston and Springfield, Massachusetts; Richmond, Virginia; and Tulsa, Oklahoma.

The current rise in dangerous respiratory illnesses among children is another example of how covid-19 has upended the health care system. The lockdowns and isolation that marked the early years of the pandemic left children largely unexposed to, and still vulnerable to, viruses other than Covid for two winters, and doctors are now essentially treating multi-year respiratory illnesses.

The pandemic has also accelerated changes in the health care industry that have left many communities with fewer hospital beds available for seriously ill children, along with fewer doctors and nurses to care for them.

When intensive care units were inundated with older covid patients in 2020, some hospitals began using children’s beds to treat adults. Many of those pediatric beds have not been restored, said Dr. Daniel Rauch, chair of the hospital care committee for the American Academy of Pediatrics.

Furthermore, the relentless pace of the pandemic has spurred more than 230,000 healthcare providers — including doctors, nurses, and physician assistants — to quit smoking. Before the pandemic, about 10% of nurses left their jobs each year; the rate has risen to around 20%, Wietecha said. He estimates that children’s hospitals cannot keep up to 10% of their beds due to staff shortages.

“There just isn’t enough space for all the children who need beds,” said Dr. Megan Ranney, who works in several emergency departments in Providence, Rhode Island, including Hasbro Children’s Hospital. The number of children seeking emergency care in recent weeks was 25% higher than the hospital’s previous record.

“We have doctors clearing the beds so we can get the kids in faster,” said Ranney, vice dean of the Brown University School of Public Health.

The respiratory “tripledemia” worries the country’s doctors


There is not much money in the treatment of children. On 40% of American children are covered by Medicaid, a joint federal and state program for low-income patients and people with disabilities. Medicaid basic rates are usually more than 20% below those paid by Medicare, the government insurance program for the elderly, and are even lower when compared to private insurance. While specialized care for a variety of common adult procedures, from knee and hip replacements to heart surgeries and cancer treatments, generates significant profits for medical centers, hospitals complain that they often lose money on pediatric care. for hospitalized patients.

When Tufts Children’s Hospital closed 41 pediatric beds this summer, hospital officials assured residents that young patients could receive care at nearby Boston Children’s Hospital. Now, Boston Children’s is delaying some elective surgeries to make room for children who are seriously ill.

Rauch noted that children’s hospitals, which specialize in treating rare and serious diseases such as pediatric cancer, cystic fibrosis and heart defects, are simply not designed to handle the onslaught of children seriously ill with respiratory viruses this season.

Even before the fall viral trifecta, pediatric units were struggling to absorb a growing number of young people with acute mental disorders. Stories abound of children in mental breakdowns being abandoned for weeks in the emergency department while awaiting transfer to a pediatric psychiatric unit. On a good day, Ranney said, 20 percent of Hasbro Children’s Hospital pediatric emergency room beds are occupied by children experiencing mental health issues.

Hoping to increase pediatric capacity, the American Academy of Pediatrics joined the Children’s Hospital Association last month in asking the White House to declare a national emergency due to childhood respiratory infections and provide additional resources to help cover the costs of care. The Biden administration has said that the flexibility hospital systems and providers have been given during the pandemic to circumvent certain staffing requirements also applies to RSV and flu.

Doernbecher Children’s Hospital at Oregon Health & Science University has switched to “crisis care standards,” allowing critical care nurses to treat more patients than they are normally assigned. Meanwhile, hospitals in Atlanta, Pittsburgh and Aurora, Colorado have turned to treating young patients in overflow tents in parking lots.

Dr. Alex Kon, a pediatric intensive care physician at the Community Medical Center in Missoula, Montana, said providers have made plans to care for older children in the adult intensive care unit and divert ambulances to other facilities when be necessary. With only three pediatric ICUs in the state, that means young patients can fly all the way to Seattle or Spokane, Washington or Idaho.

A little boy is treated in a hospital bed
A young boy with RSV receives treatment at the Community Medical Center in Missoula, Montana.

community medical center

Hollis Lillard took her 1-year-old son, Calder, to an Army hospital in northern Virginia last month after experiencing several days of fever, cough and shortness of breath. They spent a harrowing seven hours in the emergency room before the hospital found an open bed and they were taken by ambulance to Walter Reed National Military Medical Center in Maryland.

With proper therapy and home care instructions, Calder’s virus was easily treatable: He recovered after he was given oxygen and treated with inflammation-fighting steroids and anti-inflammatory albuterol. bronchospasms. He was discharged the next day.

Although RSV hospitalizations They’re falling, rates remain well above the norm for this time of year. And hospitals may not get much relief.

People can become infected with RSV more than once a year, and Krugman worries about a resurgence in the coming months. Because of the coronavirus competing with other viruses, “the usual seasonal pattern of viruses has gone out the window,” she said.

Like RSV, influenza arrived early this season. Both viruses usually peak around January. Three strains of flu are circulating and have caused an estimated 8.7 million illnesses, 78,000 hospitalizations and 4,500 deaths, according to the Centers for Disease Control and Prevention.

Krugman doubts that the health care industry will learn quick lessons from the current crisis. “Unless there is a step change in the way we pay for pediatric hospital care,” Krugman said, “the bed shortage will only get worse.”

KHN (Kaiser Health News) is a national newsroom that produces detailed journalism on health issues. Along with Policy Analysis and Polling, KHN is one of the top three operating programs in KFF (Kaiser Family Foundation). KFF is an endowed non-profit organization that provides information on health issues to the nation.

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