Giving News & Highlights
App - Advocacy and Health Policy
Children’s Hospitals and Clinics stands out because of our expertly trained pediatric specialists and pediatricians.
Parents want their child to see a children’s doctor when they are sick or need specialized care. Our physicians are specially trained to meet the unique needs of children who are constantly growing and developing. For example, our neurosurgeons are trained to operate on a newborn brain one-quarter the size of an adult brain.
Children's is the state’s largest pediatric hospital, and the 7th largest stand-alone pediatric hospital in the country. Last year alone, Children’s trained approximately 400 students, residents and fellows in primary care and a variety of pediatric specialties.
Unfortunately, that specialized training is threatened by medical eduation program cuts at the state and federal level.
Because of the unique challenges involved in treating children, in 1999 Congress enacted the Children’s Hospitals Graduate Medical Education (CHGME) program to provide children’s hospitals with graduate medical education (GME) support similar to the support given to adult teaching hospitals through Medicare. This funding allows children’s hospitals that receive CHGME to train more than 6,000 pediatricians each year. That is roughly 45 percent of all pediatricians and 50 percent of all specialists in the U.S.
Since the start of the CHGME program, the number of residents trained by children’s hospitals across the country increased by 40 percent, helping to close the gap between supply and demand for pediatricians.
In addition to the federal CHGME program, Minnesota has a Medical Education and Research Cost (MERC) program that provides funding to teaching hospitals in Minnesota to help offset the costs associated with training healthcare professionals including: physicians, pharmacists, dentists, advanced practice nurses, physician assistants and chiropractors.
In response to the state’s budget deficit in 2011, the Minnesota legislature and Governor implemented a 50% reduction in MERC funding. At the same time, Congress has cut CHGME funding by 15% from $317.5 million in FY 2010 to $265.2 million in FY 2012. These cuts have resulted in the elimination of Children's funding to services and training experiences in many of our hospitals. As an example, Children’s was forced to eliminate its funding of several residency and fellowship programs including pediatric specialties such as: neurosurgery, infectious disease, critical care, cardiology, hematology and oncology, pulmonary, and dentistry.
What do we need?
Medical training in general and pediatric specialty training in particular is extremely important for Minnesotans from every part of the state. Because of the volume of pediatric training we offer, Children’s is a resource for any community that wants their kids to have access to a pediatrician. We need to preserve and restore Minnesota’s Medical Education and Research Cost (MERC) program and provide additional funding for Children’s Hospitals Graduate Medical Education (CHGME) program.
It is extremely important for Minnesotans from every part of the state to have Children’s as a resource to train doctors in these medical disciplines. CHGME and MERC help fund the next generation of Minnesota’s pediatricians and pediatric specialists-doctors our children cannot live without.
Health Care Innovation
At Children’s, we understand that the health care landscape is rapidly changing, and that the way we do business is going to change. Children’s is undertaking a number of initiatives to make our hospital system a model for pediatric care in the country.
Accountable Care Organizations
As an example, Children’s is one of the phase one projects in the Minnesota Department of Health’s (MDH) Healthcare Delivery System demonstration project. One of these is the Health Care Demonstration.
In 2011, the state of Minnesota undertook a nation-leading effort to streamline care for its 600,000+ Minnesota Health Care Programs (MHCP) patients. Children’s was one of 9 providers statewide chosen to participate in the new HCDS demonstration project.
The HCDS project is Minnesota’s first attempt at an Accountable Care Organization-type fee arrangement. Under the HCDS, Children’s will contract with the Minnesota Department of Human Services (DHS) to care for MHCP patients in both fee-for-service and managed care under a payment model that holds Children’s accountable for the total cost of care and quality of services provided. Children’s will be gauged on performance against a risk-adjusted total cost of care target for all qualifying MHCP participants. The amount of shared gain/loss will be negotiated with DHS.
Children’s is excited to partner with DHS, and looks forward to providing coordinated, streamlined care to Minnesota’s children.
Children’s campus-based primary care clinics are currently a state-certified Health Care Home (“HCH”), caring for more than 1,000 children with medically complex needs. Children’s was a pioneer in establishing this coordinated model, operating one of the first pilots projects which helped shape the model the state uses today.
The HCH model includes coordinators who work with families to provide more personalized and efficient services in concert with the physician's care. Regularly scheduled clinic visits allow for additional time to evaluate and coordinate care, including access to ancillary services such as dietary services and social work, as well as assistance with scheduling specialty appointments. Over the course of our HCH’s existence, the model has demonstrated significant savings. In its first full year of operation, Children’s HCH saved the health care system more than $2.5 million in fewer clinic visits and hospitalizations. Because of the success of the HCH, Children’s intends to extend the applicable parts of its HCH care coordination model to additional primary care patients.
Children’s HCH program initiated an innovative pilot project to evaluate the effectiveness of medication therapy management (“MTM”) in a pediatric medical home setting. The program utilizes an on-site pharmacist in the clinic setting. The pharmacist is responsible for meeting with patients and families, reviewing the patient’s medication, looking for medication therapy problems, and finding ways to improve the medication regimens. In the first iteration of the pilot, 37 patients were seen and 93 drug therapy problems were identified and addressed. A majority of these patients, 29 of 37, were enrolled in Minnesota public health care programs. The MTM model provides an excellent opportunity to identify medication therapy problems and reduce unnecessary medication use and cost.
Minnesota’s budget forecast: deficit, uncertainty, potential cuts
Photo courtesy of the Minnesota State Legislature website.
On Wednesday the Minnesota Management and Budget office released an updated budget forecast for the 2012-2013 and 2014-2015 budget cycles. The forecast sets the stage for the budget discussions that will happen in 2013 at the state capitol. In each odd-numbered year, a budget is set for the upcoming biennium (in this case, 2014-2015).
What did we learn?
The budget forecast news was a mixed bag and reveals the uncertainty that surrounds the budgeting process. The current projections show a $1.1 billion deficit for the upcoming budget cycle. State law dictates that the budget must be balanced, so we know that budget talks in 2013 will have to include difficult decisions about how to eliminate the pending deficit.
What’s more, we know that this budget forecast is shrouded in uncertainty, because it assumes that the pending fiscal cliff (a series of automatic spending cuts that will go into effect on January 1, 2013 if a deal is not reached at the federal level) will not come to pass. If the U.S. Congress and President Obama are unable to reach agreement to avoid the fiscal cliff, the Minnesota budget picture will look considerably bleaker. (We’ll be blogging about the fiscal cliff and impacts on pediatric health care next week).
Minnesota’s health care spending
The Health and Human Services (HHS) line of the state budget compromises a large portion of total expenses. Within HHS, health care programs like Medical Assistance (MA, Minnesota’s Medicaid program) account for the majority of spending. Human services spending in 2012-2013 shows a decline of $262 million from the February forecast. The bulk of that reduction comes from reduced costs related to Medical Assistance, including a lower cost of average care for families with children.
What does this mean for pediatric care?
As policymakers look for solutions to the projected $1.1 billion shortfall during the upcoming legislative session, both revenue increases and spending cuts will be on the table. Given that Children’s serves many children who rely on Minnesota’s Medical Assistance program (42% of our revenue), we are always concerned about potential cuts to that program. Beyond this, we’ll keep an eye on other proposals – cuts, surcharges, taxes – that could negatively impact our organization or the services our patients count on for care.
We’ll update you on the 2013 budget talks and how they impacting children’s health care throughout the 2013 session. You can also follow us on twitter @childrenspolicy.
Medicaid (Medical Assistance)
What is Medicaid?
Medicaid is a joint federal-state program that provides health coverage to certain categories of low-asset people, including children, pregnant women, parents of eligible children and people with disabilities. The program has a significant impact on Children's Hospitals and Clinics of Minnesota because Medicaid is the largest children's health program in the United States. Minnesota’s Medicaid program is called Medical Assistance and covers a broad range of health care services with few costs paid by the family.
Why is Medicaid such an important issue for Children's?
Medicaid makes up approximately 42% of Children’s revenue. An average adult hospital receives between 5-10% Medicaid. As a result, cuts to Medicaid over the past several years have hit Children’s four to five times harder than most hospitals, disproportionately impacting health care for children. Over the course of the last decade, Children's Medicaid funding has been cut by more than $40 million. We bear the brunt of these cuts especially considering kids generate less than 20% of the healthcare costs of Medicaid, even though they constitues 50% of the program's enrollment.
What does Medicaid provide to children?
Medicaid covers all services identified as medically necessary including: physician and hospital visits, well child care, health screenings, and vision and dental care.
Why is Medicaid vital to kids at Children’s?
Children's hospitals across the country provide a significant amount of the care for Medicaid children and are major providers of outpatient care to children assisted by Medicaid. Most provide a full range of outpatient services to children on Medicaid including primary, specialty and emergency care.
What is the impact of cuts and what do we need?
At Children’s, we strive to provide the most innovative approaches to keeping kids healthy, but we are constantly being asked to do more with less. Additional cuts threaten our ability to invest in the approaches that will pay dividends in the future and ultimatley improve patient outcomes. We must protect Medicaid funding so our kids have access to the best possible care now and in the future.
Where can I go for more information?
For more information on Medicaid, visit the links below:
Children’s Hospitals Association – Medicaid in Minnesota
Minnesota Department of Human Services – Medical Assistance
Centers for Medicare & Medicaid Services
Minnesota Chapter American Academy of Pediatrics
Pediatric emergency training hits the road
As a nonprofit hospital, Children’s Hospitals and Clinics of Minnesota provides community benefit services each year to meet some of the most pressing health concerns in our community. One of the services we are uniquely positioned to offer as a regional destination for treating complex pediatric health needs is training to assist medical professionals in dealing with pediatric emergencies. Like all other aspects of pediatric health care, emergency care for babies and children requires specialized approaches.
Training for pediatric emergencies
Children’s provides training and education to health professionals in a number of ways and one of the most unique among them is the Mobile Simulation Center. The Center is a 40 foot long bus equipped with an area to simulate a hospital environment (an emergency room, surgery room and more) and a room for participants to review and debrief video of their training session.
Teams practice scenarios using mannequins of various sizes to simulate working on a child anywhere from a newborn to a teenager. The mannequins display different symptoms depending on the scenarios trainees ask to work on, which can be anything from an unconscious child to medication management to a cardiac arrest. You can watch simulation training in action here. These scenarios also provide training on how to communicate effectively and work as a team in an emergency situation, since more than 65 percent of mistakes in health care occur due to communication and team work errors.
Why do we need a simulation center?
Even though children account for 27 percent of all emergency department (ED) visits, only about 6 percent of EDs in the U.S. have all of the needed supplies to manage pediatric emergencies (about half have 85 percent of needed supplies). We also know that pediatric skills can deteriorate after a short time if not practiced. The Mobile Simulation Center is important to caring for children in our community because it provides this needed training and practice for health professionals across the state. The bus travels to Greater Minnesota to provide training for Emergency Medical Service providers, hospitals and others.
Mobile Simulation Center travels statewide
In 2012 alone the Mobile Simulation Center has traveled throughout the state to cities and towns like Mankato, Mora, Fairmont, Blue Earth, Glencoe, Madelia, Albert Lea, Winona, Red Wing and more. From 2008 – 2010 more than 90 percent of trainings were held outside the seven-county metro area. And over the past four years the Simulation Center has provided training to over 4,300 Children’s staff and more than 1,400 health care professionals in Minnesota and Wisconsin.
Learn more about community benefit at Children’s
At Children’s we’re continuously working to make sure that we provide excellent care to the kids we treat, and that we give back to our community by providing additional health programs and services. Find out more about the community benefits we provide.