{"id":255306,"date":"2020-05-19T05:52:23","date_gmt":"2020-05-19T09:52:23","guid":{"rendered":"https:\/\/canadianinquirer.net\/v1\/?p=255306"},"modified":"2020-05-19T05:54:20","modified_gmt":"2020-05-19T09:54:20","slug":"the-pandemic-is-hurting-pediatric-hospitals-too","status":"publish","type":"post","link":"https:\/\/canadianinquirer.net\/v1\/2020\/05\/19\/the-pandemic-is-hurting-pediatric-hospitals-too\/","title":{"rendered":"The Pandemic Is Hurting Pediatric Hospitals, Too"},"content":{"rendered":"
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Pediatric hospitals offered themselves as backups to their adult counterparts in case of a surge of coronavirus patients. They suspended nonemergency surgeries and stockpiled protective gear and virus test kits, according to hospital executives and financial analysts. (FIle Photo: National Cancer Institute\/Unsplash)<\/figcaption><\/figure>\n

Children have largely escaped the ravages of COVID-19, but children\u2019s hospitals have not eluded the financial pain the pandemic has wrought on health care providers.<\/p>\n

Pediatric hospitals offered themselves as backups to their adult counterparts in case of a surge of coronavirus patients. They suspended nonemergency surgeries and stockpiled protective gear and virus test kits, according to hospital executives and financial analysts.<\/p>\n

But, in many regions, the surge was smaller than anticipated \u2013 or hasn\u2019t materialized. And children\u2019s hospitals that have offered to take sick kids off the hands of adult hospitals, or extend the age of people they admit, have not seen an influx of patients to fill the beds they emptied. As a result, numerous pediatric facilities, like many of the adult ones, face sharply declining revenues and extra expenses.<\/p>\n

\u201cWe turned off a significant volume of our activity for a surge that isn\u2019t going to occur. And since we\u2019ve had continuing expenses, it\u2019s been pretty devastating,\u201d said Paul A. King, CEO of Stanford Children\u2019s Health, which runs Lucile Packard Children\u2019s Hospital<\/a> in Palo Alto, California.<\/p>\n

King said he expected annual net revenue for the hospital and its affiliated clinics to drop about 10%. Lucile Packard\u2019s net revenue in 2019 was about $1.7 billion, according to data from California\u2019s Office of Statewide Health Planning and Development.<\/p>\n

Other children\u2019s hospitals have given similarly downbeat assessments.<\/p>\n

Many<\/a> of them \u2014 including Lucile Packard<\/a> and UCSF Benioff Children\u2019s Hospital \u2014 have furloughed staff members, required them to use paid vacation time, or cut hours or pay.<\/p>\n

Robin Leffert, a registered nurse at UCSF Benioff\u2019s hospital in Oakland, California, said she\u2019s seen a \u201chuge drop-off\u201d in patients. Many staffers have been temporarily cut, requiring the nurses who are still working to perform extra tasks. \u201cThe physical environment feels different,\u201d she said. \u201cThere\u2019s an eerie, empty quality to it. But that doesn\u2019t decrease the tension we are feeling.\u201d<\/p>\n

Stay-at-home orders have reduced car accidents, injuries and illnesses that would normally bring kids to the ERs of children\u2019s hospitals, while parents\u2019 fear of exposing their families to the COVID-19 virus has exacerbated the trend.<\/p>\n

In early February, Jennifer Griffin, a 44-year-old mother of two boys, decided against taking her 9-year-old for adenoid removal surgery at Renown Children\u2019s Hospital in Reno, Nevada, where they live.<\/p>\n

\u201cWe were not comfortable with what was going on with COVID and didn\u2019t know what the exposure was going to be like,\u201d Griffin said.<\/p>\n

Renown, like many other children\u2019s hospitals, has begun to resume some of the nonemergency surgeries it halted as the COVID pandemic spread. Griffin is still not convinced it\u2019s safe to bring in her son, however.<\/p>\n

\u201cIf people continue to not abide by the distancing guidelines and isolation guidelines, I might wait,\u201d she said.<\/p>\n

Nicholas Holmes, chief operating officer of Rady Children\u2019s Hospital<\/a> in San Diego, said his facility faces similar parent concerns and is making a push \u2014 via social media and in collaboration with local pediatricians \u2014 to \u201cmake sure families know it is safe to come to the campus.\u201d<\/p>\n

For all their current problems, however, pediatric hospitals were generally in a stronger financial position than adult facilities before the pandemic, so many of them \u201care absolutely well positioned to weather the storm,\u201d said Kevin Holloran, a senior director at Fitch Ratings.<\/p>\n

A 2019 Fitch report<\/a> based on 2018 hospital audits showed the aggregate operating profit margin of a representative sample of not-for-profit children\u2019s hospitals was nearly triple that of nonprofit adult hospitals. The pediatric facilities had enough cash on hand to last 1.6 times longer than the adult hospitals.<\/p>\n

In California, the average operating profit margin of children\u2019s hospitals<\/a> was almost three times that of non-children\u2019s facilities last year \u2014 though individual results ranged widely, from an extremely profitable 25.38% for Rady to operating losses for UCSF Benioff\u2019s Oakland hospital (-0.78%) and Lucile Packard (-2.53%), according to the Office of Statewide Health Planning and Development.<\/p>\n

Holloran and others say children\u2019s hospitals typically benefit from strong philanthropic and public support, and their specialization in complex acute cases results in higher prices while often affording them a commanding pediatric market share.<\/p>\n

In 2018, California voters approved $1.5 billion in state bonds to help children\u2019s hospitals with capital expenses including equipment, construction and seismic retrofitting. That means they can save some of the dollars they would have spent on such projects.<\/p>\n

So far, however, just 9% of that money \u2014 $142.1 million \u2014 has been distributed, and to only three hospitals, according to Frank Moore, executive director of the California Health Facilities Financing Authority.<\/p>\n

Children\u2019s hospitals across the U.S. have reported declines in surgery and outpatient procedures of 60% to 80%, with inpatient admissions cut by nearly half as of the end of April, said Amy Knight, chief operating officer of the Children\u2019s Hospital Association in Washington, D.C.<\/p>\n

At Children\u2019s Hospital New Orleans<\/a>, ER visits plummeted from 4,000 in February to 1,700 in April, said Matt Schaefer, the chief operating officer. Outpatient visits dropped from 1,100 to about 400 over the same period. The hospital, like others around the country, has managed to offset some of the loss in outpatient volume with telehealth.<\/p>\n

When COVID-19 was wreaking havoc in southeastern Louisiana, the children\u2019s hospital offered to take pediatric patients from adult hospitals and admit patients up to age 30, said George Bisset, the chief medical officer. \u201cBut we didn\u2019t get a lot of takers.\u201d<\/p>\n

Children\u2019s facilities received virtually none of the first $30 billion in federal relief money intended for hospitals and other providers, though they have received some of a subsequent $20 billion tranche.<\/p>\n

Children\u2019s hospitals that are part of larger health systems may also benefit from the aid received by affiliated adult hospitals. And belonging to a hospital chain can allow for greater operational flexibility, industry executives say.<\/p>\n

Cohen Children\u2019s Medical Center<\/a> in Queens, New York, part of the $13.5 billion, 23-hospital Northwell Health<\/a> system, redeployed numerous staff members to the adult hospitals that were struggling to cope with an onslaught of COVID-19 cases, said Dr. Charles Schleien, Cohen\u2019s vice president for pediatric services.<\/p>\n

Cohen also turned over more than half its beds to Long Island Jewish Medical Center, an adult hospital connected to Cohen by a hallway, and converted virtually every available space to more adult beds, Schleien said.<\/p>\n

But filling beds with COVID patients doesn\u2019t offset the lost revenue from suspending profitable elective surgeries anyway, Schleien said. \u201cThe economics of it are brutal, because when you lose elective surgeries, that\u2019s where your margin is.\u201d<\/p>\n

Even though children\u2019s hospitals have begun to resume nonemergency surgeries, they will likely continue to face financial challenges.<\/p>\n

\u201cIf we enter into a recession, and particularly if it is prolonged, that will have an effect on hospitals, including children\u2019s hospitals, because people won\u2019t have jobs and may be uninsured, or more may be on Medicaid, which doesn\u2019t pay as well,\u201d said Lisa Martin, a senior vice president on the not-for-profit health care ratings team at Moody\u2019s Investors Service.<\/p>\n

In California, nearly 60% of children\u2019s hospital charges are tied to Medicaid, more than double the proportion for adult hospitals, according to OSHPD data. At some pediatric facilities in the U.S., that figure is well above 70%.<\/p>\n

After spending staggering sums to mitigate the consequences of the pandemic, Congress will be looking for programs to prune, said Knight, of the Children\u2019s Hospital Association. \u201cOne with a target on its back is Medicaid.\u201d<\/p>\n

Jordan Rau, a senior correspondent for Kaiser Health News, contributed to this report. <\/em><\/p>\n

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