By Liz Szabo, Kaiser Health News
The severe shortage of pediatric hospital beds plaguing the country this fall is a byproduct of financial decisions made by hospitals over the past decade as they shut down children’s wards, which often operate in the red, and increased the number of beds available for more profitable endeavors. such as joint replacements and cancer care.
To cope with the flood of young patients sickened by a drastic convergence of nasty insects — particularly respiratory syncytial virus, influenza and coronavirus — medical centers across the country have deployed triage tents, delayed elective surgeries and transferred critically ill children out of state.
A major factor in the bed shortage is the years-long trend of hospitals eliminating pediatric units, which tend to be less cost-effective than adult units, said Mark Wietecha, CEO of the Children’s Hospital Association. Hospitals maximize 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 money,” said Dr. Scott Krugman, vice president of pediatrics at Herman and Walter Samuelson Children’s Hospital of Sinai 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 waste 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 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 upended the healthcare system. The lockdowns and isolation that marked the early years of the pandemic left children largely unexposed — and still vulnerable — to non-covid viruses for two winters, and doctors are now essentially treating several years of respiratory illnesses.
The pandemic has also accelerated changes in the health care industry that have left many communities with fewer hospital beds available for critically ill children, as well as fewer doctors and nurses to care for. them.
When intensive care units were inundated with older covid patients in 2020, some hospitals started using children’s beds to treat adults. Many of those pediatric beds have not been restored, said Dr. Daniel Rauch, chair of the American Academy of Pediatrics Hospital Care Committee.
Additionally, the relentless pace of the pandemic has prompted more than 230,000 healthcare providers – including doctors, nurses and physician assistants – to quit. Before the pandemic, about 10% of nurses quit their jobs every year; the rate rose to around 20%, Wietecha said. He estimates that children’s hospitals are unable to maintain up to 10% of their beds due to a lack of staff.
“There just isn’t enough space for all the kids who need beds,” said Dr. Megan Ranney, who works in several emergency departments in Providence, Rhode Island, including the hospital. for children Hasbro. The number of children requiring emergency care in recent weeks was 25% higher than the hospital’s previous record.
“We have doctors cleaning the beds so we can get the kids in there faster,” said Ranney, associate dean of the Brown University School of Public Health.
There is not a lot of money in 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. Medicaid base rates are typically more than 20% lower than those paid by Medicare, the government insurance program for seniors, and are even lower compared to private insurance. While specialist care for a range of common adult procedures, from knee and hip replacements to heart surgeries and cancer treatments, generates significant profits for medical centers, hospitals generally complain of wasting money. money on inpatient pediatric care.
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 critically ill children.
Rauch noted that children’s hospitals, which specialize in treating rare and serious diseases such as childhood cancer, cystic fibrosis and heart defects, are simply not designed to handle this season’s crush on children. seriously ill with respiratory insects.
Even before the viral trifecta of the fall, pediatric units were struggling to absorb increasing numbers of young people in acute mental distress. Stories abound of children in mental crisis stuck for weeks in emergency departments waiting to be transferred to a pediatric psychiatric unit. On a good day, Ranney said, 20% of pediatric ER beds at Hasbro Children’s Hospital are occupied by children with mental health issues.
Hoping to add pediatric capabilities, the American Academy of Pediatrics joined the Children’s Hospital Association last month in calling on the White House to declare a national emergency over childhood respiratory infections. and to provide additional resources to help cover the costs of care. The Biden administration has said the flexibility hospital systems and providers have had during the pandemic to circumvent certain staffing requirements also applies to RSV and influenza.
Oregon Health & Science University’s Doernbecher Children’s Hospital has moved to “crisis care standards,” allowing critical care nurses to treat more patients than they are usually assigned. Meanwhile, hospitals in Atlanta, Pittsburgh and Aurora, Colorado resorted to treating young patients in overflow tents in parking lots.
Dr. Alex Kon, a pediatric intensive care physician at Community Medical Center in Missoula, Montana, said providers there planned to care for older children in the adult intensive care unit and divert ambulances to other facilities if necessary. With only three pediatric intensive care units in the state, that means young patients can be airlifted to Seattle or Spokane, Washington or Idaho.
Hollis Lillard took her one-year-old son, Calder, to an Army hospital in Northern Virginia last month after experiencing several days of fever, coughing and labored breathing. They spent seven agonizing hours in the emergency room before the hospital found a vacant bed and transferred them 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 being given oxygen and treated with inflammation-fighting steroids and albuterol , which counteracts bronchospasm. He was released the next day.
Although RSV hospitalizations are decreasing, rates remain well above the norm for this time of year. And hospitals may not be much relieved.
People can get 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 usual seasonal pattern of viruses has disappeared,” he said.
Like RSV, the flu 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 the healthcare industry is learning any quick lessons from the current crisis. “Unless there is a dramatic change in how 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 in-depth journalism on health issues. Along with policy analysis and polls, KHN is one of the three main operating programs of the KFF (Kaiser Family Foundation). KFF is an endowed non-profit organization providing information on health issues to the nation.
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