Stroger weighs closing its pediatrics unit
Saturday, July 18, 2015
Crain's Chicago Business
by Kristen Schorsch
Years of sick kids bypassing John H. Stroger Jr. Hospital of Cook County for its rivals have apparently taken their toll.
Cook County Health and Hospitals System, a two-hospital safety net for the poor and uninsured, is considering phasing out its inpatient pediatric unit at Stroger, according to a June 4 memo. The health system also is weighing whether to consolidate its residency training program in pediatrics into another program and focusing its primary pediatric care at outpatient sites, the memo says.
It's not clear how much money the changes would save or how many people could lose their jobs, if any. In an email, Cook County Health spokeswoman Caryn Stancik says no decision has been made. She notes that the health system is identifying what services it would offer at a $100 million outpatient medical office building planned for the Near West Side campus anchored by Stroger.
“CCHHS is thriving in the new competitive environment, but much like private business, we need to position the organization for the future. For us, this involves the assessment of specific clinical operations,” she says. “Just as private industry does not make decisions overnight, CCHHS will not make decisions overnight.”
Stroger's pediatric unit isn't brimming with children. It had 40 staffed beds at its busiest time in 2013, the latest figures available, and they were only 26 percent occupied. Those low usage numbers have held steady for nearly a decade, according to data from the Illinois Department of Public Health. Nevertheless, Stroger has a legacy of treating patients few other hospitals want and for teaching future doctors with some of the most difficult cases they would ever encounter.
Stroger “has a long, proud history of both taking care of pediatric patients for over 100 years and for training some of the premier pediatricians both in Chicago and really across the country,” says Dr. David Soglin, longtime head of the hospital's pediatric department, who left this year to be chief medical officer at La Rabida Children's Hospital in Jackson Park.
Stroger is facing a growing trend in health care: Fewer kids need to be hospitalized as technology advances and doctors focus on preventive care. On top of that, the projected number of births is declining, particularly in Cook County, where it's predicted to decrease 9 percent from 2015 to 2025, according to a new state report.
Hospitals in turn have been shuttering pediatric units, reducing their bed count and treating children in beds typically reserved for adults. In the Chicago area, health systems big and small have shed pediatric beds in recent years, from 10 at Northwestern Lake Forest Hospital in the affluent North Shore to 10 at Loretto Hospital on the impoverished West Side.
It's a wise move for Cook County Health, experts say. Hospitals with a lagging pediatric business, already a niche service, could use the resources to invest in services that bring in more patients. Chicago, in particular, has several hospitals that specialize in pediatrics. The 288-bed Ann & Robert H. Lurie Children's Hospital of Chicago, which treats the sickest children, is just 5 miles east of Stroger in downtown Streeterville. Lurie also has established partnerships with 14 area hospitals, prompting some of them to add pediatric beds.
“It's not advantageous to be a small player in a specialty like (pediatrics),” says Allan Baumgarten, a Minneapolis-based health care analyst who follows hospital markets.
The Cook County Health memo describes ideas discussed during a meeting focused on outpatient strategy. It does not specify how the inpatient pediatric department would be phased out or which program—at Cook County Health or elsewhere—the pediatric residency would be consolidated with.
articlePara - html?
EFFECT ON TRAUMA CENTER
More than 50 pediatricians work at Stroger, specializing in cardiology, neurology and critical care, according to the health system's website. Closing the inpatient pediatric unit could jeopardize Stroger's Level I pediatric trauma center. The state designation is for hospitals that provide the highest level of care to young people with the most serious injuries, from gunshots or a car crash, for example. A spokeswoman for the state Public Health Department says a hospital cannot be a pediatric trauma center without inpatient pediatric services. Cook County Health's Stancik says, “One thing we can tell you with certainty is that we have no intention to eliminate pediatric trauma services.”
Doug Fenstermaker, a vice president who leads the health care practice at Atlanta-based Warbird Consulting Partners, says, “It doesn't make sense from a cost standpoint to do a few procedures just to say that you can do pediatric specialty care.” A high volume of patients leads to more experienced doctors who can provide a high level of care, he says. That quality care attracts more families with sick children.