Pediatric Specialty Care

Ashley MaladyRonald Hernandez

Tanya WhartonGinger Blankevoort

Erica Cruz

Are dedicated to meeting the unique needs of medically complex and technology dependent individuals

Pediatric specialty doctors available to serve children from birth to age 21

Specialty physicians are supported with a team of professionals in child life, nutritionist and patient and family services

Focus on creating a home like environment

Pediatric Specialty Care

Ashely

“Those who have or are at a increased risk for a chronic physical, developmental, behavioral or emotional condition and who also require health and related services of a type or amount beyond that required by children generally”

Children with Special Health Care Needs

Ashley

Approximately 11.2 million children in U.S have health care needs

1 of ever 5 households have at least one child with special health care needs

60% of the children have needs that go beyond a primary need for prescription medications to manage their health condition

Children with Special Health Care Needs

Ashley

Ranked the worst out of the U.S In California alone almost 1 million children

have special need suffering from chronic physical, developmental, behavioral and emotional condition the requires routine health are related services

1 out of every 7 children have health care needs

California

Ashley

To dedicate their time to provide the best possible long term, short term and transitional care available for technology dependent and medically fragile infants, children and young adults.

Mission of Pediatric Specialty Care

Ashley

Pulmonary Neurology Endocrinology Gastrointestinal Cystic fibrosis Hematology Neurosurgery Pediatric dentistry

Pediatric sub specialties

Ashley

Pediatric sub specialty treatments Pulmonary-Asthma Treatments

◦ Newborn-4year: Nebulizer Nebulizer: Uses Beta2-agonists,Cromolyn,

Anticholinergic. Uses a face mask to deliver medication to the lungs. Liquid medication to fine mist. Not a precise form of delivering medication.

◦ 4-6 Year olds: Inhaler Inhaler: Gives out a specific dose of medicine to the

child’s lungs. Form of early prevention to asthma attack

Ronald

Neurosurgery treatments Neurosurgical disorders: tumors of the

brain, spinal cord, and peripheral nervous system ◦ Spinal Cord tumors: Rare amongst children, the

accountabilities taken before surgery are,1. Spinal stability 2. Surgical VS non surgical interventions 3. Preservation of Neurological functions

◦ Surgical Treatments: Tumor normally removed through complete en bloc resection

Ronald

Cystic Fibrosis Cystic Fibrosis: Cystic fibrosis is a disease

that causes mucus in the body to become thick. The mucus builds up causes problems in many of the body organs.

Cystic Fibrosis is not curable but is treatable. Treatments: All early recommended forms of

Immunization. Including the PVC. Bronchodilators: Allow for easy breathing Inhale Salt water: Clears mucus from lungs. Other forms of treatments include Good diet, Healthy

Weight, Normal exercise.

Ronald

Endocrinology Major Child illness: Type 1 Diabetes, A disease

that occurs when the pancreas stops making insulin.

Treatment: 1. Take Insulin through daily shots.2. Eat a healthy diet that spreads carbs throughout the

day3. Check blood sugar levels several times a day4. Get regular exercise

Parents are responsible for continuously observing their child’s blood sugar levels.

No prevention for Type 1 Diabetes.

Ronald

Specialty care located in academic medical centers where institutional rules determine accepted insurance.

Budget cuts in states seek ways to reduce expenditures◦ Include reducing covered services◦ Increasing copayments◦ Limiting those eligible for coverage◦ Implementing enrollment freezes in SCHIP (State Children’s

Health Insurance Program) Fewer than 5% of providers in any given pediatric

specialty care are located in HMOs which may limit access◦ Chronic pediatric conditions are relatively rare=less demand

Specialty Care affecting communities

Uninsured Use less specialty care and

experience greater delays in referrals than insured children

Have the greatest length of time before referral to a cardiac specialist for congenital heart disease

Uninsured children have more difficulty accessing primary care which leaves specialty care out of the picture

Public insurance Usually includes Medicaid or SCHIP. Have better or similar access to care

compared to private insurance. ◦ An example is a study of asthmatic

children found that children in a state health insurance plan for low-income children and children with Medicaid were more likely to be referred to a specialist than children with private insurance

Children with special health care needs who had public insurance were no more likely than children with private insurance to have unmet needs for specialty care

Children with public insurance were less likely to have seen a specialist than children with private insurance

Managed Care Studies were reported that

children in managed care arrangements had worse access to specialty care.

Children with chronic conditions who enrolled in a gate keeping arrangement had a 57% decrease in specialist use while children who remained in a FFS (fee for service) arrangement had a 31% increase in specialist use

Erica

• Nonprofit, academic, pediatric medical center

• First and largest pediatric hospital in Southern California• Ranked in all 10 pediatric specialties in the U.S (only one in California)• Major regional referral center for children who require life-saving acute care

• Work with an extensive amount of providers, establish payment plans, also provide other programs for those that do not have health insurance or have high health care bills• Medi-Cal• Charity and discounted care programs

Erica

Clinical Performance More than 4,200 employees and 588 medical staff

deliver care to patients

Annual statistics log:◦ 10,920 inpatient visits◦ 301,838 outpatient visits◦ 65,919 Emergency Department visits◦ 15,459 pediatric surgeries performed

more complex procedures than any other hospital in Southern California.

◦ Number of active licensed beds: 365

Erica

Department of Pediatrics Bone marrow transplant Cardiology Clinical immunology and

allergy Emergency and transport

medicine Endocrinology and

metabolism Gastroenterology and

nutrition General pediatrics

Hematology-oncology Hospital medicine Infectious disease Medical genetics Neonatology Neurology Psychiatry Pulmonology Rehabilitative medicine Rheumatology Transition care

Erica

Department of Pediatrics Largest department

Emphasize on research, tertiary clinical services, and educational programs

Family-centered care

National benchmarks for maintaining a culture of safety◦ Lowest rates of catheter-associated bloodstream infections◦ Pediatric Intensive Care Unit

Infection rates well below national average

Erica

Tanya

There are billions of dollars flowing through children’s hospitals every year pay for care for tens of thousands of children.

Many of them extremely sick or suffering from chronic conditions requiring a lifetime of treatment.

Costs are high because the care is complicated and the technology expensive. In addition, the hospitals help fund research into the causes and treatment of diseases.

Growing Size And Wealth Of Children's Hospitals

Essential to the financial viability of children’s hospitals, Medicaid, on average, pays for 56 percent of all inpatient days of care provided by freestanding children’s hospitals.

In 2007, 29.8% of children under the age of18 were covered under Medicaid and 59.8%under private insurance (National Centerfor Health Statistics 2010).

Medicaid

Nation’s 39 largest independent children’s hospitals viewed within the industry as elite providers, are all nonprofit.

In 2009, the 39 largest children’s hospitals reported $22 billion in revenue from their hospital and outpatient operations.

The top 10 alone earned more than $800 million in profits. Children’s Hospital of Philadelphia reported a $197 million surplus and paid its CEO nearly $2.1 million.

Elite Hospitals Well Positioned To Make Money

The big, freestanding children’s hospitals generally have a huge advantage in the marketplace: They face little competition and provide an essential service, giving them leverage to negotiate favorable prices with health insurers.

Top children’s hospitals provide relatively little charity care.

On average, about 2 percent of what children’s hospitals spend is for free medical care. (NACHRI)

In 2009, less than one-half of one percent of Texas Children’s Hospital’s spending went to charity care, according to its tax return. The 639-bed Houston hospital reported $1 billion in revenue and $1.9 billion in cash and investments that year. It spent $4.3 million on free care.

Lack of Charity

Name State Revenue

Expense

Profit/Loss

P/L % Net Assets

Childrens Hospital Los Angeles

CA

$546,993,497

$597,085,259

($50,091,762) -9.00%

$757,880,688

Children's Hospital Orange County

CA

$419,642,149

$394,180,765

$25,461,384 6.00%

$170,231,578

Rady Children's Hospital San Diego

CA

$515,220,872

$453,690,576

$61,530,296 12.00%

$313,475,957

Financial Information