Science

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

Horrible lack of beds in children’s hospital A byproduct of financial decisions made by hospitals over the past decade, as they closed children’s wards, which often operated in the red, and freed up the number of available beds for more profitable endeavors such as joint replacement and cancer care. has been expanded.

to deal with the flood of young patients ill by broad convergence Bad Bugs – Especially respiratory polynuclear virusinfluenza, and coronavirus Medical centers across the country have set up triage tents, delayed elective surgeries, and transferred seriously ill children out of state.

Mark Veitecha, CEO of the Children’s Hospital Association, said a major factor in the bed shortage is a years-long trend among hospitals to eliminate pediatric units, which tend to be less profitable than adult units. Hospitals optimize revenue by striving to keep their beds 100% full – and filled with patients whose conditions demand generous insurance reimbursement.

“It really has to do with the dollar,” said Dr. Scott Krugman said. “Hospitals rely on high-volume, high-reimbursement procedures from good payers to make money. There is no incentive for hospitals to provide money-losing services.”

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

The current surge in dangerous respiratory illnesses among children is another example of how COVID-19 has turned the health care system upside down. The lockdown and isolation that marked the first years of the pandemic left children largely unaffected – and still vulnerable – to viruses other than Covid for two winters, and doctors are now essentially predicting years of respiratory illness. are treating.

The pandemic has also triggered changes in the health care industry, with many communities having fewer hospital beds available for seriously ill children, as well as fewer doctors and nurses to care for them.

When intensive care units flooded with older Covid patients in 2020, some hospitals began using children’s beds to treat adults. Dr. Daniel Rauch, chair of the American Academy of Pediatrics Committee on Hospital Care, said many of those children’s beds have not been restored.

In addition, the continuing pace of the pandemic has led more than 230,000 health care providers – including doctors, nurses and physician assistants – to lose their jobs. Before the pandemic, about 10% of nurses left their jobs every year; Vitecha said that rate has shot up to about 20%. They estimate that pediatric hospitals are unable to maintain up to 10% of their beds due to staffing shortages.

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

“We have doctors cleaning beds so we can get kids to bed faster,” said Rainey, deputy dean of Brown University’s School of Public Health.


Respiratory “tripledemic” worries the nation’s doctors

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There is not much money for the treatment of children. About 40% of American children are covered by Medicaid, a joint federal-state program for low-income patients and people with disabilities. Base Medicaid rates are typically 20% higher than those paid by Medicare, the government insurance program for older adults, and are even lower than private insurance. While specialized care for a range of common adult procedures, from knee and hip replacements to heart surgery and cancer treatment, generates major profits for medical centers, hospitals complain that they typically provide inpatient pediatric care. But lose money.

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

Rauch said the children’s hospital, which specializes in treating rare and serious conditions such as pediatric cancer, cystic fibrosis and heart defects, has been designed to handle the crush of children seriously ill with respiratory bugs this season. has not been done.

Even before autumn’s viral trifecta, pediatric units were straining to absorb growing numbers of young people in acute mental distress. Stories abound of children languishing in mental distress for weeks in emergency departments while awaiting transfer to a pediatric psychiatric unit. On a good day, Rainey said, 20% of pediatric emergency room beds at Hasbro Children’s Hospital are occupied by children experiencing mental health problems.

In hopes of adding pediatric capacity, the American Academy of Pediatrics last month joined the Children’s Hospital Association in urging the White House to declare pediatric respiratory infections a national emergency and provide additional resources to help cover the cost of care. called upon to do. The Biden administration has said the flexibility given to hospital systems and providers to address some staffing needs during the pandemic also applies to RSV and the flu.

Dornbacher Children’s Hospital at Oregon Health & Science University has moved to “crisis standards of care,” enabling intensive care nurses to treat more patients than they are typically assigned. Meanwhile, hospitals in Atlanta, Pittsburgh, and Aurora, Colorado, have treated young patients in overflow tents in parking lots.

Dr. Alex Cone, a pediatric critical care physician at Community Medical Center in Missoula, Montana, said providers there plan to care for older children in the adult intensive care unit and to divert ambulances to other facilities if necessary Is. With only three pediatric ICUs in the state, that means young patients may have to be flown to Seattle or to Spokane, Washington or Idaho.

Innocent child is being treated on the hospital bed
A young child with RSV is being treated 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 he developed a fever, cough and shortness of breath for several days. He spent seven hours in the emergency room before the hospital found an open bed and transferred him by ambulance to Walter Reed National Military Medical Center in Maryland.

With proper therapy and instructions for home care, Calder’s virus was easily treatable: He recovered after being given oxygen and treated with steroids, which fight inflammation, and albuterol, which counteracts bronchospasm. does. He was discharged the next day.

Although hospitalization rates for RSV are falling, rates are well above the norm for this time of year. And hospitals can’t 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, which competes with other viruses, “the normal seasonal pattern of viruses has gone out the window,” he said.

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

Krugman doubts the health care industry will learn any quick lessons from the current crisis. “Unless we make radical changes to the way we pay for pediatric hospital care,” Krugman said, “the bed shortage is only going to get worse.”

KHN (Kaiser Health News) is a national newsroom that does in-depth journalism about health issues. Along with policy analysis and polling, KHN is one of the three major operational programmes. kff (Kaiser Family Foundation). KFF is a thriving non-profit organization that provides information on health issues to the nation.

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