Latest / Becker’s Healthcare -- Pediatric Leadership Podcast / Dr. Scott Krugman, Vice Chair of the Department of Pediatrics at LifeBridge Health

Transcript

Dr. Scott Krugman, Vice Chair of the Department of Pediatrics at LifeBridge Health · Becker’s Healthcare -- Pediatric Leadership Podcast

• 0:00
  This is Chris Sosa with the Becker's Healthcare
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  podcast.
• 0:02
  And today, we'll be joined by doctor Scott
• 0:04
  Krugman, director of pediatric operations at Herman and
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  Walter Samuelson Children's Hospital at Sinai. Doctor Krugman,
• 0:10
  thank you for joining us today.
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  Thanks for having me. Excellent, doctor. Would you
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  please introduce yourself and give us a bit
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  about your background?
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  Yeah. So I am a, general pediatrician,
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  and I have been in, pediatric leadership positions
• 0:25
  for many years.
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  I ran a department of pediatrics
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  at a community hospital in Baltimore County for
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  20 years,
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  and did that with,
• 0:35
  I thought great success until they decided to
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  close pediatrics in, 2018.
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  And since then, I've been at the Children's
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  Hospital at Sinai in Baltimore where I've been
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  vice chair of pediatrics and now,
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  the director of pediatric operations because I hold
• 0:49
  another hat, which is a a senior associate
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  dean for the George Washington University School of
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  Medicine where we're now a regional medical campus
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  for that school.
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  Thank you for laying all that out for
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  us, doctor. And you touched on briefly the
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  subject that we wanna touch today. And the
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  question I have for you, just to get
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  things started, is from your perspective, could you
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  please detail the challenges that pediatric inpatient units
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  are facing and why some are closing?
• 1:13
  Yeah. So this has been going on for
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  a couple decades sort of under the radar.
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  But over the past 5 to 7 years,
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  if you're paying attention to the, Becker's Weekly
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  notifications that a lot of us get,
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  more and more often you're seeing that pediatric
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  units are closing. And the reason is that
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  community hospitals really have a hard time,
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  supporting
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  a money losing venture, which is inpatient pediatrics.
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  It costs a lot of money to
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  staff
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  units with pediatricians,
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  with pediatric specific nurses,
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  and most pediatric units in community settings will
• 1:54
  have very variable volume. So at one point
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  in the middle of winter, there might be
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  10 kids on their unit and they're overflowing.
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  In the summer, there might be one child.
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  Sometimes, the variation goes from day to day,
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  whereas one day it's full, the next day
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  it's empty. And to staff that kind of
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  unit is very, very challenging because
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  nothing in pediatric works on a average daily
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  census.
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  Whereas, if you have a hospital that has
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  multiple adult units,
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  usually, the average doesn't vary that much that
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  you can predictably
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  staff with nursing and doctors
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  how to run those units, or you can
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  flex people from one to another. But, typically,
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  in community hospitals,
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  there's only 1 pediatric unit, and there's nowhere
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  to flex people to. So
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  the costs are
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  higher than expected.
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  And, of course, we're dealing with hospital based
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  revenue. And depending on what state you're on,
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  things vary a lot. But for the most
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  part, pediatrics is not high end
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  money making
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  procedures like neurosurgery and orthopedic surgery. So for
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  when the hospital is looking at their bottom
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  line, the easiest thing to cut off in
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  is inpatient pediatrics.
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  Thank you so much for laying out all
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  those challenges, and, clearly, there are many.
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  Doctor, the next thing I wanna ask you
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  is given those challenges,
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  what are the ripple effects of pediatric inpatient
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  units closing
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  respectful
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  respective to both the children and the communities
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  where they live?
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  Yeah. And this is where things are starting
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  to,
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  come to a head, and they really came
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  to a head during COVID time when
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  we had the initial lockdown and pediatric volumes
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  plummeted, and a lot of units
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  closed, shut down, some temporarily, some not. But
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  the year after, we had a huge respiratory
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  viral surge in pediatrics, and kids were being
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  sent all over,
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  all from state to state and all over
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  the world you know, all over farther away
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  to get care because there were not enough
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  beds in the area anymore. So what we're
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  seeing is,
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  especially in rural areas but also in many
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  suburban areas, that the local hospital that closes,
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  children have to go farther to seek definitive
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  care. So we're seeing an increase in number
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  of kids who are being transferred from one
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  hospital to another,
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  increasing number of kids who are being cared
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  for at children's hospitals,
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  and that consolidation
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  is really having an effect that it takes,
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  the the care that was once able to
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  be delivered in the community out of the
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  community.
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  And because those hospitals are doing less children,
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  less pediatric care in general, we're finding that
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  most emergency departments in community settings are not
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  prepared
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  to take care of kids. So the most
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  recent data is that 80% of hospitals are
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  not
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  have do not have the guidelines and the
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  procedures and the equipment
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  to successfully care for kids, and that's causing
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  potentially bad effects of kids not getting the
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  care they need or having bad outcomes like,
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  worse morbidity or mortality because they're not ending
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  up in a place initially who has is
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  the bill has the ability to care for
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  them.
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  At this point in time, doctor, what are
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  the steps that you think health care leaders
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  and others, whether it be legislators or other
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  leaders in
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  certain positions, what can they do to improve
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  this situation?
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  So we haven't really had very large conversations
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  as a society about how we wanna care
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  for kids.
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  It's always an afterthought. Most of
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  the models that have been put in place
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  to reduce costs around hospital
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  care have been done so around the Medicare
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  population for good reason because they cost a
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  lot of money.
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  So we need to decide if we wanna
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  care for kids or not and what
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  what number of hospitals and what sort of
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  distances are we is acceptable for kids to
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  get care. And
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  if we went from it from a
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  standpoint of what's in the best interest of
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  kids, we could design a completely different system
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  in this whole in our whole country. And
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  the problem is unless we have better payment
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  mechanisms
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  for pediatric care, there is not gonna be
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  any impetus to change, and pediatrics is gonna
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  have to end up being a community benefit
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  or,
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  a loss leader that a hospital might tolerate.
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  And my recommendation to local hospitals is decide
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  if you're in or not. And if you're
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  not in, what are the mechanisms you're gonna
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  put in place to make sure kids are
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  getting safe care? And I I don't know
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  how often those conversations are happening, but the
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  more that those can happen, I think we're
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  gonna be in a much better place. And
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  we really need to have a a structure
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  in place that puts the kids first and
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  puts the payment for those services first so
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  that we can assure that, you know, in
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  a certain
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  rural area, kids have a point access to
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  care, and then there might be a, like,
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  a a, like, a spoke part, and then
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  there's a hub where they need to go
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  if they actually need to go there. But
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  if it's something simple, they can stay in
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  their community, which is better for the family
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  and better for the child.
• 6:55
  Doctor, thank you so much for sharing your
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  time and insights with us today. We're gonna
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  get them out to our audience as soon
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  as possible, and we look forward to connecting
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  with you again soon. Thank you so much
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  for having me.