Final
Presentation by The Children's Hospital

HEALTH CARE TASK FORCE

Votes:
Action Taken:
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09:21 AM -- Presentation by The Children's Hospital

A notebook entitled "Kids Need a Kids' Hospital" was given to each of the committee members from The Children's Hospital. The notebook was a compilation of the power point presentations and a summary of what each of the The Children's Hospital presenters would be discussing. A copy of each of the powerpoint presentations is available on the Health Care Task Force web page at: http://www.state.co.us/gov_dir/leg_dir/lcsstaff/2005/comsched/05HealthCareTFsched.htm. A copy of the notebook is on file at the Legislative Council Office and at the State Archives.

Dori Biester, President and CEO of The Children's Hospital, began the presentation and talked about the role it serves in the community and region. She explained that The Children's Hospital specializes in treating children with complex, chronic or congenital conditions. Further, it provides preventative and primary care and serves as a safety net hospital for uninsured and under-insured children. The committee was then played a nine minute film about three of The Children's Hospital's patients. Ms. Biester indicated that children do better in The Children's Hospital then regular hospitals because it is geared toward children and has 47 medical specialties including pediatrician cardiology and heart transplantation.




Ms. Biester went over some of the current challenges The Children's Hospital faces with mental and pediatric care. She then responded to questions.


09:40 AM

Senator Gordon asked Ms. Biester what happens when a child comes into The Children's Hospital without insurance. She explained the child is treated the same as any other child and that they will work with the family to cover costs if they can using either Medicaid or a child health plan. Senator Keller asked if there are any clinics in the rural parts of the state. Ms. Biester said yes, and they include clinics in cardiology, gastrointestinal disease, and rehab consultation centers and are found throughout Colorado, Wyoming and Montana. Senator Keller then asked if any of those other states help support those clinics. Ms. Biester stated they do support them through Medicaid, for example, if a Wyoming child is sent to The Children's Hospital then they pay using Wyoming's Medicaid program.

Senator Keller asked if The Children's Hospital had any type of workforce shortage. Ms. Biester explained that the hospital has a low vacancy rate for nurses, around five percent, but they do have shortages in specialized areas from time to time. Senator Tochtrop asked if they offer any tuition forgiveness programs. Ms. Biester said they did not, but that they do encourage employees through scholarships to pursue other areas such as nursing.


09:46 AM

Dr. Marianne Wamboldt introduced herself as the chair of Psychiatry of Behavioral Sciences at The Children's Hospital and gave a power point presentation on the challenges in children's mental health. She stated she would be giving an overview of what child psychiatric problems look like, what the economic realities are in treating those children, and what the The Children's Hospital is doing in this area. She explained that if illnesses such as anxiety are not treated early, there is an increase in pregnancy, school failure, unemployment, and marital instability through childhood and into adulthood. Dr. Wamboldt said the rate of these disorders is increasing. When asked why by Senator Keller, she responded by stating she was not sure but they think it is due to decreased structure and values in families, exposure to traumatic events (hurricane, 911), obesity, and less funding for school programs such as sports, music, and art that can help children cope.
Dr. Wamboldt then explained that children are going untreated due to economic realities: Colorado's public funding per capita for health care is below the national average, and private insurance is hard to access, thus a lot of parents have to pay out of pocket for therapy. She stated they see six patients in the emergency room every day and about two or three of those are suicide attempts. She said many of the inpatient clinics have closed because they are not getting appropriately reimbursed for the care they deliver. Senator Keller asked if it would be helpful if the adolescent unit at Fort Logan was re-opened. Dr. Wamboldt replied that a long-term inpatient unit in Fort Logan or Pueblo would be more helpful then having private residential treatment centers.




09:59 AM

Senator Keller asked what the average length of stay was for their patients. Dr. Wamboldt replied about seven to eight days, and then the hospital attempts to transfer them so the total length of stay on average is about twenty days. Senator Tochtrop asked why the kids are not being diagnosed early. Dr. Wamboldt stated that a lot of pediatricians, family care doctors, and primary care providers need more training in how to diagnose these kids early because either they do not know how to identify the symptoms, or if they do, then
they do not know what to do with them or where to refer them. She explained that the hospital has submitted grants to try and place mental health professionals in primary care clinics to train them to intervene early so it does not get severe. She stated that she thinks that is where psychiatry needs to go in the future that they need to be consultants to primary care providers.

Representative Frangas commented on the possibility of having a consulting psychologist available for police officers or social workers to call for assistance, and asked if that would fit into what Dr. Wamboldt was talking about and if so how the state could help in supplying that. Dr. Wamboldt stated that child psychologists should be used as consultants because they are highly trained but unfortunately private payment for consultation is almost nonexistent. She said that if the state could subsidize the salary for them there were some great people that would be very interested.

Representative Butcher asked what role the schools have in identifying those types of children. Dr. Wamboldt stated she was not aware of any formal screening by school nurses. Representative Todd asked if there is any collaboration between The Children's Hospital and teachers such as a program that would inform teachers about mental health. Dr. Wamboldt stated currently the Rosenberry conference is held each year for social workers, nurses and teachers.


10:08 AM

Joan Bother, M.D. and Vice President of Physician Services and Ambulatory and Satellite Operation showed a power point presentation and discussed the trauma services at The Children's Hospital, the only level one trauma center in the region for pediatrics. Dr. Bother explained that the majority of their patients are between ages zero and five and are most commonly treated for falls, motor vehicle accidents, child abuse and burns. Dr. Bother stated that the death by trauma rate at The Children's Hospital is 2.9 percent and the number one cause of death is child abuse from shaken baby syndrome. She added that they provide the majority of paramedic training on pediatrics in the region. Dr. Bother discussed the hospital's advocacy and outreach efforts and goals to prevent traumatic injury through research, education, product safety education through community outreach and specialized training for pediatric emergency care givers.

Representative Frangas asked if legislation that would attach a 2 percent increase on auto insurance coverage to cover costs of catastrophic care would alleviate some of the hospital's problems. Dr. Bother stated that is would alleviate some of the problems but the adult trauma centers need it more than they do because The Children's Hospital is different in its immediate availability to sub-specialty coverage. Dr. Bother concluded her presentation.




10:20 AM

Mr. Dryer introduced himself as the CFO of The Children's Hospital and provided a powerpoint presentation about the impact of Medicaid on the hospital. He talked about how Medicaid and uninsured patients are growing at the same rate and that there is about the same number of uninsured patients as Medicaid patients now. Mr. Dryer pointed out that although children make up half of the Medicaid enrollees, they only make up fourteen percent of the expenditures. Senator Keller asked about the impact of indigent children from other states. Mr. Dryer stated that those children are a small number and most of them have their own state's Medicaid. However, the hospitals cannot continue to pass on their Medicaid shortfalls to the State of Colorado. He explained that hospitals are not being reimbursed their costs from Medicaid and that recently it has been getting worse. Mr. Dryer stated that those costs are shifting to employers who cannot handle it anymore. He went on to say that the cost shifting is causing higher deductibles and small companies to not insure their employees. Senator Keller asked if The Children's Hospital has been audited on their reimbursement levels because of the $10 billion cut federally and Mr. Dryer responded that yes they had, and that they audit themselves as well. Mr. Dryer explained that the $10 million cut is mostly for drugs, and that their biggest fear is that people just will not get them and then and the kids will not get the medicine they need.
Representative Butcher asked what percent of full cost is The Children's Hospital not billing or over-billing. Mr. Dryer stated their cost of service and charge for service used to be close to the same amount twenty five years ago, but now in order to make up for Medicaid shortfalls, for every fifty cents in cost, they charge about a dollar to commercial insurers. Mr. Dryer also discussed how the hospital deals with uninsured patients. He stated the hospital will charge thirty percent of its charge to those patients, and in some low income cases they limit the patient's hospital costs to ten percent of the family's yearly income. He also mentioned that The Children's Hospital had about a $38 million dollar loss last year and explained how it is getting harder to pass the loss onto commercial insurers. Senator Keller commented that employers cannot afford the cost shifting anymore and asked Mr. Dryer if he had any ideas on how Colorado can maintain solvency in hospitals. Mr. Dryer stated the HIFA waiver would be a wonderful thing and would allow children to get primary care. Mr. Dryer finished his presentation with a summary noting that The Children's Hospital has the largest percentage, based on revenues, of Medicaid compared to any hospital in the state.


10:41 AM

Dori Biester, President and CEO of The Children's Hospital, returned to the table to close the presentation stating that she hoped the committee now understood the role The Children's Hospital plays in Colorado. Ms. Biester stressed that solutions, such as medical homes, need to be made because the current situation is not sustainable.