The Future of Pediatrics: Advancing to the Medical Home
November 14, 2010
Posted by chcablogadmin in : Industry Trends
We had the privilege of having Dr. Maddie McDowell from Sg2 present “The Changing Pediatric Landscape“ at our fall Forum series. In her well researched and well received presentation, Maddie highlighted pivotal trends in pediatrics that will affect children’s hospital utilization and resources in the future. We asked her to create a high-level overview for you. — Don
By Madeleine McDowell, M.D., FAAP, Sg2 Clinical Advisor
Pediatrics has made great strides in improving health care outcomes for children, with the opportunity to do even more in the years to come. However, improved outcomes will mean less future need for some services and, at the same time, health care reform will demand that care becomes more standardized and cost-efficient, focusing on prevention and outcomes data.
Madeleine McDowell, M.D.
While overall pediatric admissions have declined below population-based growth levels in the past few years, children’s hospitals have consistently increased their inpatient admissions, with a 21.4% climb in medical/surgical discharge rates (excluding normal newborns) from 2000 to 2006. A rise in the incidence of common chronic diseases like asthma and obesity in the 1980s and 1990s has driven demand for pediatric specialty care, primarily provided by children’s hospitals. Dramatic improvements in survival rates during this same time period for many traditionally fatal conditions have further fueled demand for specialty services. For example, survival rates for leukemia improved from 50% in the 1980s to 85% early in this decade and the survival rate for preterm infants at 22 to 24 weeks gestation has gone from 0% in the 1980s to 46% in this decade.
This trend has allowed children to live longer with complex medical conditions that require ongoing tertiary care. These advances, combined with a pediatric specialist shortage and heightened customer expectations, have translated into a shift in consumer demand from community hospitals to children’s hospitals. However, even though children’s hospital discharge volumes will grow by 9% in the next 10 years, this is a significant slowing of the growth experienced in the past decade, and Sg2 expects overall pediatric inpatient utilization to decline nationally by 1% by 2020.
Innovations and Future Outlook
Many pediatric diseases and conditions occur less frequently today, contributing to better children’s health, but subsequently diminishing service needs. At the same time, the growth in many pediatric chronic diseases has begun to level off, signifying that these conditions will no longer be a main driver of growth for children’s hospitals. For example:
- Pediatric asthma increased dramatically from 1980 to the late 1990s, but prevalence rates have since leveled off. In addition, although asthma prevalence has stayed consistent overall, inpatient discharges have declined. Improved disease management and more therapeutic options for controlling asthma have led to an increase in ambulatory care since 2000, reducing the demand for inpatient care.
- Childhood obesity has also been a driver of recent inpatient growth. Obese children require more than twice the rate of hospitalization and emergency department visits than children of normal body weight. Obesity often complicates preexisting chronic diseases like asthma, as well as increasing the risk of developing new diseases. However, childhood obesity rates may be leveling off, according to the Centers for Disease Control and Prevention, with the prevalence of a high body mass index remaining stable overall for children from 1999 to 2008 and even declining from 2005 to 2008 for children ages 2 to 5 years. Still nearly 17% of children today are obese.
- Preterm births have increased 36% since the1980s, driving demand for neonatal intensive care unit services and downstream services for former premature infants with complex medical conditions. A reversal of this trend occurred for the first time with 2 consecutive years of preterm birth rate declines in 2007 and 2008. Sg2 anticipates that future care delivery practices and innovation (ie, molecular diagnostics, high-risk perinatal prevention programs, advanced assisted reproduction technologies) will continue to modestly decrease the number of preterm births in the next 5 to 10 years.
- Vaccines have been responsible for significant declines in infectious disease admissions for children. For example, rotavirus hospitalizations declined 84% from January 2006 to June 2008 after the 2006 licensure of a vaccine for the disease.
Health Care Reform
Health care reform has already made changes in children’s health care coverage. From now through 2012, for example, children may retain coverage under their parents insurance until age 26 and the government guarantees 100% well child care coverage, as well as guaranteed issue and renewal of insurance. As coverage expands from 2013 to 2015, Medicaid reimbursement will be increased to 100% of Medicare for pediatric care. Then, in 2017, disproportionate share hospital (DSH) payment discounts will top out at $5.6 billion (a 30% reduction from 2009 total payments). These reforms will shape payment incentives. In the short term, improvements in children’s access to primary care services may stress capacity, particularly for states with high numbers of uninsured and underinsured children. In addition, the shift in payer mix will pose operational and profitability challenges for hospitals. In the long-term, DSH payment cuts will challenge children’s hospitals ability to provide unprofitable services. Additionally, shifts in payment structure will incentivize prevention and reduce inpatient utilization.
The Quality Incentive
Under the current fee-for-service system, success (for example in asthma prevention programs), often translates into empty hospital beds, resulting in lost revenue and creating a lack of incentive for prevention. As children’s hospitals are expected to do more with less, a focus on prevention will be required and payment models that align incentives will emerge. Delivering the highest quality care is paramount for pediatric providers and, with a culture of continuous performance improvement, the standard of care is rising, which will ultimately reduce utilization through reducing average length of stay and avoidable admissions. Comparative effectiveness research (CER) will support the quality movement and reshape pediatric care delivery. CER is the direct comparison of existing interventions to determine which treatment works best, for whom and under what circumstances The Institute of Medicine has created 100 initial priorities for CER, 50% of which will impact pediatric care and 25% of which pertain to pediatric-specific research.
With the advances that pediatrics may offer in the years ahead, providers and children’s health care leaders need to shift their perspective from a facility focus to an integrated network focus, piloting their System of CARE (Clinical Alignment and Resource Effectiveness) from children’s entry into pediatric care, through disease surveillance and hospital admission, to their return home. Future care delivery will be driven by payment models that shift risk to the provider, while a focus on safety and quality will require children’s hospitals to do more with less. Anticipate these changes in demand and a shift to the outpatient setting for many conditions as technology advances, quality research and payment incentives combine to reduce costly inpatient stays, while prevention and disease management help children achieve optimal health.
Top Pediatric Trends:
- Leveling off or decline in incidence rates for many common pediatric chronic diseases (e.g., asthma, obesity, diabetes).
- Slowing in survivorship gains for most pediatric diseases (e.g., preterm births, leukemia).
- Leveling off of the preterm birth rate.
- Changing focus to prevention of disease and reducing morbidities.
- Shift in payment risk to the provider, fueling growth in ambulatory preventive services and a Systems of CARE approach.
- Increasing pressure to demonstrate performance.
- Increasing focus on reducing gaps in care and promoting self-management for chronic diseases.
- Adoption of convenient and efficient care delivery models that extend care access closer to home or even in the home setting (e.g., telemedicine, e-visits).
About Sg2
Sg2′s advanced analytics, business intelligence, education and publications deliver measurable value across the full continuum of health care services. The Sg2 team includes MDs, PhDs, RNs and health care leaders with extensive strategic, operational, clinical, academic, technological and financial experience. Clients include hospitals and health systems, academic medical centers, physician organizations, private equity and investment firms, health insurance providers and medical device manufacturers.
Contacts:
Maddie (Madeleine C. McDowell, MD)
Clinical Advisor, Sg2 Pediatric Intelligence Team
mmcdowell@sg2.com
Mary Blanchard
Sg2 Regional Director
mblanchard@sg2.com
Briony Maxwell
Sg2 Account Manager
bmaxwell@sg2.com
Comments»
no comments yet - be the first?