With All Our Might...Elevating Child Health Policy

Congressional Action on FMAP is a “Must Do”

In Washington, DC, we love our acronyms and an important one for Medicaid policy is the Federal Medical Assistance Percentage or FMAP.  This is the percentage that the federal government matches state expenditures for Medicaid.  This is a very important percentage for state Medicaid programs because it determines the federal investment in Medicaid.  It is also important for those who are enrolled in the Medicaid program and those doctors and hospitals that provide care in the program. 

Medicaid is a very important program for children, providing coverage to 1 in 4 children.  It is also critical for children’s hospitals because, on average, more than half of their patients rely on Medicaid for health insurance coverage. Therefore, changes to the program and its funding can have a significant impact on many children and the providers who care for them.

The FMAP is even more important today because of the severe economic downturn in the states which has resulted in decreasing revenues and unprecedented budget shortfalls. States often turn to Medicaid cuts to fill budget gaps because Medicaid is such a large part of many state budgets. 

Congress is considering the “The American Jobs, Closing Tax Loopholes and Preventing Outsourcing Act” (H.R. 4213) that includes an extension of a 6.2 percentage point increase in states’ FMAP enacted as part of the stimulus bill last year.  The bill under consideration this week would extend the bump in FMAP for states through June 30, 2011.  Without this extension, many states would have to go back to the drawing board to fill budget holes, which would in many cases result in additional payment cuts to Medicaid providers. 

Take Children’s National Medical Center in Washington, DC as an example.  As a regional hospital, Children’s National must work closely with its three surrounding jurisdictions—the District of Columbia, Maryland and Virginia—because that is where the bulk of their patients come from. If Congress does not extend the FMAP increase, each of these three jurisdictions would need to pursue further budget cuts, and a likely target is Medicaid payments to hospitals and physicians. During the 2010 session, the Virginia General Assembly essentially enacted two biennial budgets: one that takes into account an FMAP bump, and one that does not. If the FMAP funding is not extended, hospitals such as Children’s National face cuts in inpatient and outpatient reimbursement rates, and physicians will face significant reimbursement cuts as well. If the FMAP extension is approved, the cuts will not take effect. Maryland built the FMAP extension into its budget assuming it would happen.  If it does not, the state will look to make additional cuts—again, Medicaid providers will be a top target. The District of Columbia City Council is considering an assessment of $1,500 per licensed hospital bed to help fill its Medicaid budget gap.

All these cuts add up to additional financial pressures on critical providers of care for children.  The extension of the enhanced FMAP is a “must do” for Congress to best support state Medicaid programs during this difficult economic time.

Hometown Celebrity on Upcoming Visit to Capitol Hill

By guest blogger, Caroline Benton, mother of Joey

Every year, Joey is interviewed by a local morning radio personality, Brooke Ryan, about his fundraising for the Cystic Fibrosis Foundation. As she and the show's followers have gotten to know Joey, she has been including more questions about other things going on in his life. Recently, she asked him about his upcoming trip to Washington. You can hear Joey’s thoughts about why he was chosen and what he would be discussing next month at the 2010 N.A.C.H Family Advocacy Day. Download JOEY-WASHINGTON-DC

It's the Extras that Count!

By guest blogger, Michael Dosedel, patient representative for the Children's Medical Center of Dayton.

Children’s hospitals have been a blessing, not only for me, but for my family over the years. They have provided us with the most kind and professional care possible.  Everything is made available for, accessible to and fundamentally to serve the needs of the children and their families. The colors on the wall, the cartoons in the X-Ray room, the TV sets in the room hooked up to DVD and game consoles, and the frequent array of visitors all make for a much more pleasant stay for the patients they serve.

What many adults who don’t have children regularly in a hospital cannot understand is just how pivotal the entertainment is for the children, and also the children’s doctors and nurses! The kids are distracted enough to let the medical experts treat them. They have games, toys and books for all ages! Even the rooms are designed with kids’ comfort in mind. Everything is on the kids’ level, making them feel more in control.  It is hard to treat a child who is terrified and hospitals can be quite scary for kids. Too many tubes and needles for most kids comfort levels! The atmosphere and staff accommodate this fear and seek to mitigate its effects on their littlest patients. If you can’t understand the procedure, it really helps if everything else is made to appease the fear.

Child Life is a critical component of any stay at the hospital. They strive to make everyone’s stay, while perhaps not quite enjoyable, at least ‘bear’-able!  But the most important aspect is the sincere respect and kindness showed by the staff to their patients. They take the time to answer all questions of the kids and patiently listen to accounts of the latest SpongeBob episodes. I would bet that many of them are now regular Disney channel connoisseurs so as to keep up with their little patients’ interests. I’m not sure you could find many doctors, outside of children’s hospitals that can quote, offhand, such movies as “Pokémon” and “Lilo and Stitch”.

For these reasons (not withstanding the most excellent milkshakes I receive when inpatient at Dayton Children’s Hospital!), I believe that a hospital geared toward children is a necessity.  You can find medical treatment at any hospital…but it’s the extra mile that children’s hospitals go that make them the best place for children!

To read more about Michael, visit the 2010 Family Advocacy Day All-Star blog.

Ending Prematurity Is the Best Health Reform There Is

The following blog excerpt was reprinted with permission from Nationwide Children's Hospital and was authored by the hosptial's CEO, Steve Allen, MD.

Tanya could have fit into the palm of my hand. She was seven days old, but born two months too early. Glowing under her incubator's special lighting to prevent jaundice, Tanya was covered in bandages, weighed down by needles, and breathing with the help of a ventilator. Even if she survived her underdeveloped lungs and bacterial infection, she faced the probability of a lifetime of disabilities. The cost of her care as a newborn may exceed $1 million. Her lifetime cost of care could far exceed this amount. The saddest part of this story is that for many cases such as Tanya's, risks of prematurity could be reduced or even prevented.

Unfortunately, Tanya's story is not unique. Every year, more than 500,000 babies are born prematurely, defined as birth before 37 weeks gestation. Shockingly, North America has the second highest rate of preterm birth among the continents.

This week, two critical, but underreported events happened that could have a big impact on preterm birth and the broader health care landscape.

On Tuesday, the Centers for Disease Control and Prevention released a report citing that, for the first time in nearly three decades, the rate of premature birth in the U.S. declined two years in a row, down four percent between 2006 and 2008. Importantly, preterm births declined among ethnic and minority groups that have historically had high rates.

And on the heels of this report, the U.S. House Committee on Energy and Commerce Subcommittee on Health held a hearing to examine the causes and consequences of preterm birth and infant mortality. This was a welcome demonstration of the government's concern about decreasing preterm births, and its understanding of prematurity's broader implications.

While the causes of preterm birth vary, the outcomes are similar. Research shows that preterm birth is the leading cause of infant mortality, with premature babies comprising two-thirds of all infant deaths. It is associated with extremely high rates of lung disease, eye disease, hearing loss, neurological disabilities, developmental delay, and other chronic disease.

In addition to the tragedy of losing our youngest, most vulnerable babies, this problem costs the United States more than $26 billion annually in medical and educational costs and lost productivity. For example, the average cost of an infant admitted to Franklin County neonatal intensive care units is $66,000, but can occasionally exceed $2 million. Children born preterm are more vulnerable to infections, and are more likely to require lifelong medical care, special education services, and constant care. Moreover, mothers who conceive within six months of delivery have a 40 percent chance of delivering the second infant preterm; that rate doubles to 80 percent when the first infant is preterm.

Eighty percent of children who experience chronic illness become adults with life-long health problems, and chronic disease accounts for 75 percent of health care spending in America. Reducing preterm birth is therefore critical to containing overall health care costs.

To read the full article visit The Huffington Post.

Lessons from Massachusetts

Jon Kingsdale, outgoing executive director of the Massachusetts Health Connector, authored an op-ed in The Boston Globe over the weekend that outlines key lessons learned for the rollout of health reform. The article outlines the simultaneous focus needed on multiple fronts to implement national health reform effectively. And the Red Sox (my favorite baseball team!) even played a part. 

Kingsdale answers the question of what comes next, “A whole lot of work, of course – hundreds of new, complex federal regulations to be drafted, lobbied and revised…” among other things. Our task within this gargantuan effort by federal and state governments will be to highlight children and how the various health reform provisions will impact them. In a recent meeting with HHS staff, we advocated that all new policies, guidance or regulations be viewed through a children’s lens to ensure that their unique health care needs are considered and addressed. We will continue to re-enforce this message as we move ahead on all fronts. Now bring on those regulations…

CHGME: Critical for All Children

By guest bloggers Magi Curtis, associate director of legislative advocacy programs, N.A.C.H. & Liz Parry, assistant director, policy analysis, N.A.C.H.

Has your child ever seen a pediatric specialist? Chances are that specialist was trained at a children’s hospital. In fact, independent children’s hospitals train 35 percent of all pediatricians, half of all pediatric specialists and the great majority of pediatric researchers. However, until eleven years ago children’s hospitals were largely excluded from the predominate payer of graduate medical education and they could be in danger of losing funding for their programs next year.

Medicare is the predominate payer of graduate medical education, but because children’s hospitals treat kids and not the elderly, they received virtually no reimbursement for their training programs. So, in 1999, Congress established the Children’s Hospital Graduate Medical Education (CHGME) program to address the disparity in federal graduate medical education support that existed between adult teaching hospitals and independent children’s teaching hospitals. The authorization for the CHGME program is set to expire on Sept. 30, 2011 and without authorization, the program may not be funded each year.

CHGME isn’t just important to children’s hospitals, it’s important to pediatrics overall. Here are the eight things you should know about CHGME.

• Without CHGME funding, there would likely have been a net decline in the number of general pediatricians trained per year
• As a result of CHGME funding, children’s hospitals have been able to sustain and improve their teaching programs, which has allowed them to expand their programs and reverse a decline in pediatric residencies that began in the 1990s
• Since CHGME was authorized, children’s hospitals have more than doubled the number of total pediatric specialty residents in response to local, regional and national needs
• Children’s hospitals have increased the number of new training programs by approximately 50 percent
• Although progress has been made in the number of pediatric residents and fellows, there are still shortages in pediatric subspecialties
• Shortages cause families to experience challenges accessing timely and appropriate care due to long wait times for medical appointments for their children
• Shortages will only intensify as patient volume increases as a result of health reform.
• CHGME is funded through an annual appropriation from Congress, which can change from year to year but is much easier to advocate for if the program is currently authorized by Congress

N.A.C.H. is already busy working to reauthorize the CHGME program. Earlier this year, we commissioned a report by an independent group to identify the pros and cons of the possible legislative vehicles for renewal of the CHGME program and we began discussions with legislative champions on Capitol Hill about the various legislative options. We’re also working with member hospitals to gather stories to help make the case for reauthorization to legislators and their staffs.

While we’re working to reauthorize CHGME, we’re simultaneously working to ensure that the program receives its full authorized funding of $330 million for fiscal year 2011. This program has always enjoyed strong bipartisan support, but during these tough economic times it is as important as ever for children’s hospitals and allied organizations to remind Congress that CHGME is a sound investment in the health of all children.

Looking Forward to Visiting 'Friends' in Washington, D.C.

by guest blogger, Linda Traute, parent of Madison Traute-Santos

One afternoon in Sept. of 2003 while walking to my office at Children’s Specialized Hospital, I came in contact with a medically fragile baby girl as she was receiving therapy. Madison weighed 1lb 2oz at birth. She had been admitted to Children’s to receive continued treatment and therapy for multiple medical issues and developmental delays due to her premature status. I learned that Madison was in need of a foster home that would be attentive to her medical needs.

During the months that followed my partner, Teresa, and I became actively involved in her care and well being. Getting Madison discharged from the hospital became our top priority. She was placed in our home on Dec. 19, 2003 after spending the first 11 months of her life hospitalized. At that time, Madison was still dependent on a gastronomy tube for her sole nourishment. She was unable to roll over, sit without assistance or bear weight on her arms or legs. Madison continued to receive therapies to assist in her development as well as receive regular pediatrician and specialists visits to maintain good health.

While Madison’s future medical prognosis is good, she still receives speech and occupational therapy and is under the care of a neurodevelopmental pediatrician for continued developmental delays and learning disabilities. If it weren’t for the medical care afforded to Madison this once medically-fragile baby girl would not have been able to grow and develop into a well adjusted healthy 7-year-old.

Recently, Teresa and I sat down with Madison the other evening to tell her that we will be taking a trip to Washington, D.C. to participate in the 2010 N.A.C.H. Family Advocacy Day and share her medical story. In true Madison fashion, she was ecstatic, clapping her hands and jumping around at the prospect of going to Barack Obama's house for a visit. We explained that while we would not be visiting with the President we would be meeting with some of his "friends". Apparently, we have a lot more explaining to do as I received an e-mail from Madison's teacher saying that Madison made an announcement in class about her upcoming trip to Washington, D.C. to see Barack Obama, who she loves, and be on the radio. We have our work cut out for us . . .