{"id":650541,"date":"2018-11-29T07:00:10","date_gmt":"2018-11-29T14:00:10","guid":{"rendered":"https:\/\/nmpolitics.net\/index\/?p=650541"},"modified":"2018-11-29T19:43:36","modified_gmt":"2018-11-30T02:43:36","slug":"hospital-competition-leaves-kids-in-the-lurch","status":"publish","type":"post","link":"https:\/\/nmpolitics.net\/index\/2018\/11\/hospital-competition-leaves-kids-in-the-lurch\/","title":{"rendered":"Hospital competition leaves kids in the lurch"},"content":{"rendered":"<div id=\"attachment_650549\"  class=\"wp-caption module image alignnone\" style=\"max-width: 771px;\"><img loading=\"lazy\" decoding=\"async\" class=\"size-large wp-image-650549\" src=\"https:\/\/nmpolitics.net\/index\/wp-content\/uploads\/2018\/11\/love_stein3-771x514.jpg\" alt=\"Dr. Bill Stein and Dr. Jon Love\" width=\"771\" height=\"514\" srcset=\"https:\/\/nmpolitics.net\/index\/wp-content\/uploads\/2018\/11\/love_stein3-771x514.jpg 771w, https:\/\/nmpolitics.net\/index\/wp-content\/uploads\/2018\/11\/love_stein3-336x224.jpg 336w, https:\/\/nmpolitics.net\/index\/wp-content\/uploads\/2018\/11\/love_stein3-768x512.jpg 768w, https:\/\/nmpolitics.net\/index\/wp-content\/uploads\/2018\/11\/love_stein3-1170x780.jpg 1170w, https:\/\/nmpolitics.net\/index\/wp-content\/uploads\/2018\/11\/love_stein3.jpg 1200w\" sizes=\"auto, (max-width: 771px) 100vw, 771px\" \/><p class=\"wp-media-credit\">Jett Loe \/ UNM Health Sciences Center<\/p><p class=\"wp-caption-text\">Dr. Bill Stein, pediatric cardiothoracic surgeon at Presbyterian Hospital, works alongside pediatric cardiologist Dr. Jon Love, right, at the University of New Mexico Hospital. The doctors are pioneering an effort between the two hospitals to unite pediatric specialties.<\/p><\/div>\n<p>The\u00a0two\u00a0pediatric heart doctors made for an odd couple\u00a0at the Legislature\u2019s Health and Human Services Committee: Bill Stein in his conservative gray suit and Jon Love with his blond ponytail, three earrings and shiny blue blazer \u2013 both\u00a0testifying\u00a0to\u00a0their desire to work together.<\/p>\n<p>Their\u00a0respective employers had been\u00a0in open\u00a0\u2013 at times\u00a0cutthroat \u2013 competition for years. The result has been a health system in which very\u00a0sick kids are more likely to be sent out of state than two miles down the road to the competitor.<\/p>\n<p>Stein, 42, who\u00a0is employed by\u00a0Presbyterian\u00a0Healthcare Services,\u00a0is the state\u2019s sole pediatric cardiothoracic\u00a0surgeon. Love, 56,\u00a0is the lone pediatric interventional cardiologist at the University of New Mexico.\u00a0Together, the specialists put forward a simple answer that pediatricians and\u00a0parents of medically fragile children have been longing to hear:\u00a0collaboration.<\/p>\n<p>The\u00a0two hospitals\u00a0are the state\u2019s\u00a0largest\u00a0providers of pediatric specialty care\u00a0and\u00a0serve\u00a0one of the country\u2019s most Medicaid-dependent\u00a0populations\u00a0of children.\u00a0In\u00a02013, their longstanding antagonism\u00a0boiled over\u00a0after\u00a0insurers failed to reach a deal that would have let patients easily access both networks.<\/p>\n<aside class=\"module align-left half type-aside\">\n<h3>About this article<\/h3>\n<p>This article comes from\u00a0<a href=\"http:\/\/searchlightnm.com\/\" target=\"_blank\" rel=\"noopener\">Searchlight New Mexico<\/a>, a nonprofit, nonpartisan news organization dedicated to investigative journalism. Read its Raising New Mexico series\u00a0<a href=\"https:\/\/nmpolitics.net\/index\/series\/raising-new-mexico\/\" target=\"_blank\" rel=\"noopener\">by clicking here<\/a>. Support its work\u00a0<a href=\"https:\/\/www.newsmatch.org\/organizations\/searchlight-new-mexico\" target=\"_blank\" rel=\"noopener\">by clicking here<\/a>.<\/p>\n<\/aside>\n<p>New Mexico\u2019s relatively small pool of patients means that neither institution has the critical mass it needs\u00a0to hang onto key pediatric specialists.\u00a0On the human level, it\u00a0has\u00a0been a nightmare for families whose\u00a0children require highly\u00a0specialized\u00a0care.<\/p>\n<p>Ask\u00a0Siah\u00a0Hemphill,\u00a0whose son\u00a0Nicholas, 22, was born in New Mexico with a\u00a0rare\u00a0syndrome that caused abnormal growth and bone cancer that resulted in a leg amputation. Ask Amanda\u00a0Salaiz, whose 10-year-old son Josiah suffers from blindness and a sensory deficiency that requires a feeding tube. Or Charlotte\u00a0McGaughey, who crisscrossed the Southwest to find care for Matthew, now 21, who is autistic, nonverbal and has suffered debilitating gastrointestinal problems.<\/p>\n<p>Ask what it took\u00a0for Hemphill,\u00a0Salaiz, and\u00a0McGaughey\u00a0to get the treatment their kids needed and you will inevitably be met with tears of anger and frustration.<\/p>\n<p>Getting\u00a0Nicholas\u00a0a new wheelchair took\u00a0Hemphill\u00a0four grueling years.<\/p>\n<p>\u201cThere\u2019s so much miscommunication and disorganization,\u201d said the Silver City mother, recalling the\u00a0phone calls, lost work days and the sores her son developed from using an outdated chair.\u00a0In the process, the family went through two primary-care doctors, two physical therapists,\u00a0and\u00a0multiple\u00a0480-mile round trips to Albuquerque.<\/p>\n<p>\u201cIt is so convoluted and confusing and unclear, and I have a master\u2019s degree,\u201d\u00a0Hemphill\u00a0added, explaining that last year the family switched Medicaid providers in order for Nicholas to see the appropriate specialist at UNM. Finally, he got the wheelchair he needed. \u201cI don\u2019t know how anyone can navigate this disaster of a health care system.\u201d<\/p>\n<div id=\"attachment_650550\"  class=\"wp-caption module image alignnone\" style=\"max-width: 771px;\"><img loading=\"lazy\" decoding=\"async\" class=\"size-large wp-image-650550\" src=\"https:\/\/nmpolitics.net\/index\/wp-content\/uploads\/2018\/11\/Syah-Hemphill-and-son-Nicholas--771x514.jpg\" alt=\"Siah Hemphill and Nicholas\" width=\"771\" height=\"514\" srcset=\"https:\/\/nmpolitics.net\/index\/wp-content\/uploads\/2018\/11\/Syah-Hemphill-and-son-Nicholas--771x514.jpg 771w, https:\/\/nmpolitics.net\/index\/wp-content\/uploads\/2018\/11\/Syah-Hemphill-and-son-Nicholas--336x224.jpg 336w, https:\/\/nmpolitics.net\/index\/wp-content\/uploads\/2018\/11\/Syah-Hemphill-and-son-Nicholas--768x512.jpg 768w, https:\/\/nmpolitics.net\/index\/wp-content\/uploads\/2018\/11\/Syah-Hemphill-and-son-Nicholas--1170x780.jpg 1170w, https:\/\/nmpolitics.net\/index\/wp-content\/uploads\/2018\/11\/Syah-Hemphill-and-son-Nicholas-.jpg 1200w\" sizes=\"auto, (max-width: 771px) 100vw, 771px\" \/><p class=\"wp-media-credit\">Don Usner \/ Searchlight New Mexico<\/p><p class=\"wp-caption-text\">Siah Hemphill enjoys a quiet moment with her son Nicholas in their Silver City house.<\/p><\/div>\n<h3>Joining forces<\/h3>\n<p>There are signs\u00a0of\u00a0a turnaround.\u00a0Nearly a year into joint talks, Presbyterian and UNM\u00a0leaders\u00a0are quietly mapping a collaborative relationship that could benefit New Mexico kids \u2013 including taking baby steps that could lead to a unified children\u2019s hospital.\u00a0Stein and Love\u00a0pioneered\u00a0the\u00a0initial\u00a0agreement\u00a0to link the hospitals\u2019\u00a0pediatric specialties.<\/p>\n<p>\u201cWorking with UNM is one of the best things we can do for the state,\u201d\u00a0Presbyterian Chief Medical Officer Jason Mitchell\u00a0told Searchlight New Mexico.\u00a0\u201cMaking sure we have enough pediatric specialists in our state to take care of our kids is really, really important.\u201d<\/p>\n<p>Historically, fierce competition between the two hospitals meant that physicians at one hospital rarely got privileges to work at the other. Health plans \u2013 including the Medicaid plans that cover more than half of all children in New Mexico \u2013 would sooner send a sick child to Denver, Dallas or Phoenix to see a specialist than to the other system.<!--more--><\/p>\n<p>This tendency worsened\u00a0five years ago\u00a0when\u00a0one of the largest Medicaid providers, Presbyterian Health Plan, restricted\u00a0clients to its own hospital system. At the time, Presbyterian\u00a0cited\u00a0the high cost of care at UNM, which\u00a0as an academic institution may charge more than commercial providers.<\/p>\n<p>\u201cIt drives me crazy as a practitioner when I can\u2019t get kids the care they need, because health systems and managed care organizations don\u2019t cooperate,\u201d said Brian Etheridge, a Silver City pediatrician and past president of the New Mexico Pediatric Society.<\/p>\n<p>Etheridge said he has seen Presbyterian deny access to specialty care at UNM over and over again, and he believes \u201cthey deserve to be held accountable for letting system issues routinely interfere with doing what\u2019s best for patients.\u201d<\/p>\n<p>An estimated 98,000 New Mexico children have special health care needs, according to a\u00a0Kaiser Family Foundation\u00a0study, and 59 percent of them are on Medicaid. For families living near the poverty line, a hospital stay in another state\u00a0imposes\u00a0immense hardships. Medicaid pays for some travel expenses but not for\u00a0the\u00a0\u201chidden\u201d costs \u2013 the missed days at work, the lost jobs, childcare for siblings, the stress of family separation.<\/p>\n<p>\u201cFor most families, you make the choice: Can I leave my job? Can I leave my other kids? What is it going to be like when I get there?\u00a0Traveling out of state is the last resort for most families,\u201d said Cathy Salazar, who became an expert in New Mexico\u2019s health care system by necessity.<\/p>\n<p>In addition to being the mother of six adopted children\u00a0with special needs, she is a family liaison with Parents Reaching Out, an Albuquerque nonprofit that helps parents navigate their children\u2019s health\u00a0care, education and other needs.<\/p>\n<h3>Lawmakers step in<\/h3>\n<p>Convinced that the state\u2019s population\u00a0is\u00a0too small and its families too fragile,\u00a0pediatricians, parents and\u00a0physician\u00a0specialists\u00a0last year\u00a0launched a strong lobbying effort in the state Legislature. In 2018,\u00a0the House unanimously approved\u00a0a memorial\u00a0instructing the New Mexico Pediatric Society to convene a task force to propose solutions.<\/p>\n<p>First on their list\u00a0is \u201ca single, unified Children\u2019s Hospital, incorporating all pediatric specialties available in New Mexico\u201d\u00a0\u2013\u00a0not necessarily\u00a0calling for a new building but advocating\u00a0for an institutional framework that would eliminate the barriers families face\u00a0trying to access\u00a0care at both hospitals.<\/p>\n<p>At the legislative hearing\u00a0in November,\u00a0Love\u00a0told the story of\u00a0a 6-month-old who,\u00a0over the summer,\u00a0needed a procedure that Love couldn\u2019t safely perform without\u00a0surgical\u00a0back-up.\u00a0Over the past three years, three of\u00a0his peers at UNM\u00a0had\u00a0decamped to\u00a0the University of Iowa, leaving\u00a0him as\u00a0the\u00a0hospital\u2019s\u00a0only pediatric interventional cardiologist.\u00a0Stein, the pediatric heart surgeon, was\u00a0less than two miles away, at Presbyterian Hospital. The problem was, he didn\u2019t have privileges at UNM.<\/p>\n<p>The baby was transferred to Presbyterian\u00a0within a couple of weeks.\u00a0\u201cIt started the question,\u201d Love told legislators, \u201cwhy can\u2019t we just be working with one another across institutions?\u201d<\/p>\n<p>There are\u00a0also\u00a0market pressures\u00a0pushing the change.\u00a0If both hospitals\u00a0continue to\u00a0lose\u00a0cases to\u00a0out-of-state\u00a0children\u2019s hospitals, they will not only lose money; they risk losing some of their most important doctors,\u00a0who are expensive to recruit and difficult to retain amid a national shortage of pediatric specialists.<\/p>\n<p>\u201cOur\u00a0[pediatric cardiology]\u00a0program fell apart because the volume just wasn\u2019t there,\u201d\u00a0explained\u00a0Frantz\u00a0Melio, chief strategy officer for\u00a0the UNM health system. \u201cThe volume has significantly flipped over to Presbyterian. We were looking at this and saying, what makes the most sense for the population?\u00a0What makes the most sense is to have a stable, sustainable program. We made the decision to collaborate with Presbyterian so that we both, together, could provide the care that was needed in the state.\u201d<\/p>\n<p>With a formal agreement now in place linking their pediatric cardiology units \u2013 inked four months ago \u2013 Presbyterian and UNM are\u00a0moving\u00a0specialty by\u00a0pediatric\u00a0specialty to build bridges. The\u00a0next steps are\u00a0to\u00a0extend dual hospital privileges, coordinate patient care and convince health plans to pay both systems.<\/p>\n<p>\u201cAny consolidation could only benefit the providers and families,\u201d said\u00a0McGaughey, who has spent two decades navigating New Mexico health care for her\u00a0autistic\u00a0son Matthew.<\/p>\n<p>McGaughey, who lives in Silver City, recalled that when\u00a0Matthew\u00a0needed psychiatric care as a teenager, she was given a list of doctors. There were five names on it. Three were no longer practicing in the state, and one wasn\u2019t taking new patients. \u201cThat was extremely frustrating,\u201d she said.<\/p>\n<p>Besides helping keep physicians in the state, greater collaboration\u00a0between Presbyterian and UNM could mean that\u00a0\u201cthe providers would have more access to each other,\u00a0and the parents would have more access to support groups,\u201d she said. \u201cThere are a lot of things that make it hard to raise a disabled child in a poor state.\u201d<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Now, Presbyterian and UNM\u00a0leaders\u00a0are quietly mapping a collaborative relationship that could benefit New Mexico kids.<\/p>\n","protected":false},"author":1,"featured_media":650549,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[11],"tags":[234,117],"class_list":["post-650541","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-news-and-analysis","tag-children","tag-health-care","series-raising-new-mexico"],"_links":{"self":[{"href":"https:\/\/nmpolitics.net\/index\/wp-json\/wp\/v2\/posts\/650541","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/nmpolitics.net\/index\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/nmpolitics.net\/index\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/nmpolitics.net\/index\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/nmpolitics.net\/index\/wp-json\/wp\/v2\/comments?post=650541"}],"version-history":[{"count":3,"href":"https:\/\/nmpolitics.net\/index\/wp-json\/wp\/v2\/posts\/650541\/revisions"}],"predecessor-version":[{"id":650552,"href":"https:\/\/nmpolitics.net\/index\/wp-json\/wp\/v2\/posts\/650541\/revisions\/650552"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/nmpolitics.net\/index\/wp-json\/wp\/v2\/media\/650549"}],"wp:attachment":[{"href":"https:\/\/nmpolitics.net\/index\/wp-json\/wp\/v2\/media?parent=650541"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/nmpolitics.net\/index\/wp-json\/wp\/v2\/categories?post=650541"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/nmpolitics.net\/index\/wp-json\/wp\/v2\/tags?post=650541"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}