All Children’s Hospital celebrated its 90-year anniversary in April, and to mark the hospital’s full integration with Johns Hopkins Medicine, it officially changed its name to Johns Hopkins All Children’s Hospital. The institution is now embarking on the journey toward becoming a leading academic pediatric medical center. Ellen, who is also vice dean at the Johns Hopkins University School of Medicine, talks with H&HN about the hospital’s future, along with some of the biggest challenges in today’s pediatric care.
What does the full integration with Johns Hopkins Medicine mean for the future of the hospital?
ELLEN: It means we will be delivering what we believe is leading, cutting-edge care. To do that, we have moved toward an organization that is led, like many of Johns Hopkins’ hospitals, by clinicians who are taking care of the patients and making many of the decisions about how the organization runs and where it’s focused strategically. We have invested, and are investing, in a new residency program that trains pediatric residents on how to offer value-based, family-centered care. At the same time, we’re making investments in research — particularly translational research. We’ve invested in a bio repository. We’re building a new 225,000-square-foot research and education building; we broke ground a couple of months back. All those things, we think, will help us to provide what we consider is the best care for children in the state and the region.
You took part in a summit tied to transparency of pediatric, congenital heart disease outcomes. Why is transparency so key to addressing this problem?
ELLEN: The current world of health care is moving toward consumerism, where the patient has the opportunity to choose from different providers and, to some degree, that affects their out-of-pocket costs as well as the quality of the outcomes. What’s happening in the concept of transparency is the idea that we have to give tools, or at least information, to the patients so they can decide, given whatever opportunities or options they have, the best place to go for care and the best value of care. Where are they going to get the best outcomes? Where are they going to have the best experience? And what is going to be their out-of-pocket expenses for that care? To be able to make that judgment as a patient or a consumer, you need to have information that’s transparent to you. This is a general question that’s being asked on many different levels. It arose out of the heart disease issue because it’s not a high-incidence condition and there are hospitals that do more or fewer of them. The idea that there could be variation in the quality of outcomes related to how often you get to practice your trade was something that came out of that discussion.
What are some of the challenges facing your hospital specifically and child care in general?
ELLEN: Child care is a Medicaid program. Many of the children get Medicaid so, in our case, about 68 to 70 percent of our patients have Medicaid, which is a state and federal program. It’s a state-run program, but requires federal matching dollars, and the relationship between the state and federal government has impact, year to year, on how our funding will flow. We always have a challenge, every year, to make sure we can get adequate reimbursement for the care we provide. That’s one issue. I think the other one is the shortage of physician and pediatric specialists. Being able to find and recruit the best cohort of specialists to provide care for our children is something that’s always going to be a challenge. It’s not so much about getting reimbursed, but rather about being able to count on how that reimbursement is flowing. And it’s not so much that pediatricians are not interested in caring for kids, but finding those who have highly specialized training and having them come to your organization — that’s always challenging.