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Becker’s Healthcare Podcast
Dr. Tom Shanley on Expanding Pediatric Access and Advancing Lurie Children’s Mission
00:27:36
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A
This is where healthcare leadership comes together. Becker's 16th annual meeting brings more than 3,500 hospital and health system executives and nearly 800 speakers to Chicago, April 13th through the 16th. This year's event includes keynote conversations with Dallas Cowboys legend Troy Aikman and former President George W. Bush. For the agenda and event details, visit Beckershospitalreview.com and click on the Events tab in the upper right. We're looking forward to hosting you in Chicago.
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B
Hello, everyone.
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C
This is Jacob Emerson with the Becker's Healthcare Podcast. Thrilled today to be joined by Dr. Tom Shanley, who's the President and CEO of Lurie Children's. Dr. Shanley, thank you so much for taking the time to be with me on the podcast this morning.
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B
My pleasure. Thanks for having me, Jacob.
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C
Absolutely. And Tom, before we dive into everything we want to talk with you about, can you first tell us a little bit more about yourself, your background in healthcare, and for our listeners who might not be familiar, a little bit about what you do at Lurie's?
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B
Sure. So. Well, first, in addition to now serving as president and CEO, my professional background is as a physician trained as a pediatric intensive care unit doctor and also did a number of research work as well in the area of immunology. So that always tried to combine the discovery enterprise in advancing what we do in clinical care. And so certainly relevant in terms of opportunities to do that with critically ill and injured kids that I had the opportunity to care for.
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C
Fantastic. No, appreciate the personal background, Tom. And can you tell us, just for anybody who's not familiar, a little bit about Lurie Children's, who you serve, where you're based, and just a little bit about your facilities?
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B
Sure. Well, we, we're a very unique organization in both the city and the and across the state. We are the only freestanding comprehensive acute care pediatric hospital in the state and really proud of Our ranking in U.S. news and World Report as the number one children's hospital in the state of Illinois and among the leading the nation's leading children's hospitals. We are in the process of really evolving from a hospital literary children's hospital to more of a health system. I'm sure we'll talk a little bit more about that, but in doing so, really privileged to care for kids that come actually from just about every county across the state, as well as the Midwest region and nationally and internationally. An aspect many people don't typically know about us, perhaps, is that we're also the top Medicaid, the pediatric Medicaid provider in the state, nearly 60% of our inpatient activity is covered by Medicaid. So, you know, thinking about it from that standpoint, we really are a bit of a critical safety net hospital for organizations. In addition to that, we have our academic partnership with Northwestern University's Feinberg School of Medicine that really embraces much of our training activities for our pediatric residents and fellowship program. And then of course, our research enterprise. What we really ground ourselves in is our multipillar mission. And we describe that as care, which includes C for clinical care, A for advocacy, R for research, and E for education. And so each of the areas, we strive for excellence in advancing the health and well being of kids we're privileged to serve.
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C
And Tom, let's dive into some of the things you just mentioned evolving into more of a health system. The Medicaid piece of what you mentioned, we'll talk about that in just a little bit. But obviously, as you know, Lurie just opened a new outpatient facility out in Schaumburg. You're planning a new inpatient facility in Downers Grove. So talk to our audience about what's driving the strategy here for these suburban facilities and how you're really thinking about which services can move into these communities versus what needs to remain concentrated at the flagship hospital here in the city.
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B
Sure. Well, I think first and foremost the principal driver of the strategy is a focus on the kids and access that they need for excellent and high quality specialty and primary care. And what we recognize as we look across both our market in Chicagoland as well as the national market, there's an increasing recognition that what we do here at Leary Children's and many of our national leading peers do, is not easy to put together comprehensive multidisciplinary programs with a plethora of faculty that are expert at that and to have the degree of patient volume to drive the experience that results in the high quality of care. And when you think about the systems that aren't necessarily laser focused just on kids, it's very challenging for them to provide that kind of service line. And so we're seeing across our market and others, people getting out of the pediatric service business. And that leaves a dearth of where these kids, particularly in the far northwest region. That explains why we wanted to get more proximal in the Schaumburg outpatient facility and then the western suburban region as well. It also makes strategic sense for us as an organization because we do believe that we have the opportunity to develop sustainable clinical service programs with this expansion. And I'll talk a little bit about what that looks like, both from the ambulatory standpoint in terms of casting a broader net for our subspecialty, but also as well. You asked the question about the differential of care, if you will, for example, in our plan Downers Grove Initiative. So as we think about that particular market, first of all, we've had services there for a number of years in our Westchester site where we provide ambulatory surgical care as well as some ambulatory subspecialty care. We knew over time we were outpacing our capacity there, and we're looking at how to phase our next replacement strategy there. As we did so, we looked very closely across all the types of pediatric services that are requested by patients and families in that region and how they may or may not be adequately met and delivered. And so we recognized it provides us an opportunity not just to expand those services, ambulatory surgical care and ambulatory subspecialty access, but also provide both inpatient and emergency care. We recognize that about half of the kids in that region leave that region to get inpatient care. And so we felt that being able to keep kids closer to home, where they play, where they learn and where they study makes much more sense for them. And it enables us to not have to make parents make a differential choice between convenience versus competence and excellence. And so rather than saying we're going to go somewhere different because it's closer and don't have to come downtown, we want to make sure that we're bringing that service capability much closer so families aren't sort of forced to make that decision. So excited. The other asset that will be out there is the pediatric emergency department. And right now we staff, with our partnership with Northwestern Medicine, most of the day at Central DuPage Hospital, with pediatric emergency medicine trained physicians. That's really the only service that's out in that entire region that is focused on pediatric emergency care, which is very different and requires very different expertise than adult emergency care. So we believe that too is going to be an enormous, enormous asset for this region to be able to provide stability for kids. I'll just touch briefly, Jacob, you asked about sort of that level of care. And this institution in Streeterville, the flagship hospital, will always be the place where we provide that high quality and high tertiary, so called coronary care. So kids with heart failure that may need a cardiac transplant, kids with cancer that may need a bone marrow transplant, though that type of care will always be anchored here at this facility because it requires a unique environment and a unique workforce. What we will be placing out in the Downers Grove is a slightly lower level of care capability. So, for example, today we have a number of kids in our hospital impacted by lung viral infections where their oxygen level in normal room air is not sufficient and they need a little bit of oxygen to recover, but they don't need extensive services beyond that. We have kids that often come in with significant vomiting and diarrhea, that might be dehydrated and can't do that on their own, but need intravenous fluid therapy for a period of time. Those are the kinds of kids that we anticipate often leave their region to get that kind of inpatient care that will now be able to provide for them and keep them local for that aspect of it. And we've had a number of, you know, we've had experience in managing how to triage that level of care. So I think it's something very familiar to our providers that we'll do safely and effectively with our new site.
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C
Understood. So these new sites, they're going to be working in tandem with the flagship hospital downtown. But this is all really to meet the access demands that you are seeing and hearing from patients out in the suburbs. Staying on this topic, Tom Lurie is opening the Austin Hope center on the west side of Chicago later this year. Can you tell us a little bit more about this project and more contextually how you think other children's hospitals should be thinking about meeting the needs of more underserved populations across the country?
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B
For sure, I think it's such an, such an important area today. Jacob, the high level summary I would put on this is that, you know, two things kind of come to mind. One, too often a child's zip code has a much higher impact on their health outcomes than their genetic code. And that's because of all what we describe as social influencers of health. It's often described as the determinants of health that, that conveys a deterministic factor from those situations. And we believe they can just be influential and that we can help address them. And so the other component is that health is not just about healthcare, but it's the broader environment. And we believe that we need to be a component of the comprehensive health and well being of kids. So we have a number of initiatives that progress in that area through what we call our Magoon Institute for Healthy Communities. I'm privileged to succeed Patrick Magoon, who was the CEO for 22 years here at Lurie Children's and with his retirement took the opportunity to name this area which was such a high priority and focus for him that we're extremely proud to carry on. And in Austin, as we work through an opportunity to enter into the neighborhood in partnership with the Stone Church to develop this, it's an effort for us to be a component of a holistic approach to what our real vision is. And that's to be a transformational force for health and well being to achieve a healthier future for every child. And that's every child, regardless of where they live. We know that this particular area of the west side of Chicago has been under resourced for a number of years. And we have an opportunity to come in at what I would describe as the generational ground level. Because one of the most important challenges we have in Chicago and many urban sites is the differential in terms of longevity of health. And we have too, too much of an adult disparity in terms of health outcomes. Here in Chicago and in other urban sites, you can try to address that at the adult level. But we believe that this requires a generational investment in kids and that if we can elevate the health and the well being and the education of kids, they can be that next generation of adults that continues to remain healthy and to remain productive and to really drive the future of our city. So you can't do that just with health care. And so this is an effort where we're bringing both our clinical services that the community has identified as needing most. And that's the key component of this. You can't go in as a system and say, we believe we know what you need. You need to go in and understand from them and from the community based organizations, from the patients and the families, and from other providers that are already existing in that community to not duplicate what they do well already, but to complement that. So we're very excited to have an integration of the primary care services, bring some behavioral health and social support structures, along with access to subspecialty care that too often is not provided and results in unnecessary hospitalizations and too often is not being taken care of in the community and necessitates them coming in to the emergency department really unnecessarily. So I will just say, parenthetically to keep in mind, this is certainly first and foremost an investment in the kids, that it is going to make a tangible difference in them. But in the long run, this is also an investment in reducing the cost of care. And so when we think about the challenges, I'm sure we'll talk about the Medicaid funding challenges that we have coming. This is a way to overall reduce the cost of care by significantly elevating the health outcomes. So we believe not only is this the right thing to do for kids, but honestly, in the long term we think it's the right thing to do for the state of Illinois in terms of the cost of care.
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C
Absolutely. No. It's incredible to hear the investments that you're making into this part of the city. And, and I do want to follow up with you on the Medicaid changes that we are seeing coming down the pipeline under HR1, largely going into effect next year. But I know, I know your organization has been really preparing for this ahead of time. You, you said publicly, I believe, last year, that you were conducting a clinical program review in response to some of these, these changes under H R1. And it's. Nearly 60% of your inpatient stays are covered by the program. I believe so. You know, we've been hearing from leaders all over the country, both from health systems to insurers, about how they're, how everyone is prepping now to get ahead of this, this massive change for the entire system. Can you give us the Lurie's version of that and how you're navigating this?
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B
Yeah. The Lurie perspective of all that. Well, you know, I mean, in, in doing so, you know, I think it's important. Look, Medicaid is, is a critically important program for the country. People often don't realize that half the country's kids are covered by Medicaid, and that's certainly the case here in Illinois. Despite that, they're only responsible for about 18, maybe 20% of the overall Medicaid cost. So to me, it would, again, it makes sense to make the long term investment in kids is to really sustain the Medicaid program, at least as it relates to kids. And so let's make no mistake about it. HR1 is a disaster that at the same time, I'll give the federal government credit for recognizing there are opportunities to make it better, to make the program better. And that's part what we just talked about in the Austin community. That's part of what we believe are opportunities to improve the quality of the care and the outcomes at a lower cost for many kids that are covered in Medicaid. So we're all in on that. But to do it in the way that the HR1 bill proposes to do it is not, not the way that we would believe to be approaching that. Nonetheless, that's what the future, at least at this point, looks like we have coming and so certainly we have to look at what impact that that will have on the future. I will, before we jump to that, just parenthetically also just state, you know, I want to give our Illinois Hospital association leadership and our health and family services in the state of Illinois leadership credit for the success in getting a state directed payment altered for the next couple years. For us, that brings in a higher Medicaid rate for the time being before HR1 hits. And so that frankly, is a lifeline for many of us, our critical access and safety net institutions. And so we have some breathing room. And that breathing room is, to your point, giving us the time to understand what clinical programs we want to continue to maintain that we know are high quality, we know that they're mission aligned. And importantly, as we look at what the rates are anticipated to bring, they are also financially sustainable from that aspect of it. So we also are looking at opportunities in terms of technologies that, you know, the AI opportunities that allow us to be more operationally efficient and be able to reduce the overall cost and burden of the work, but still being able to maintain these delivery services overall from that aspect of it. But there's, there's no doubt all of us, I mean all of us that have a significant amount of Medicaid business are going to be having to make these hard decisions as we look at it. And so my, my bigger concern as we look at what the future brings is to not forget where the biggest bang for health care investment, including Medicaid investment, is in the country. And that's still in the future generations of this country. And so I think as long as we, we keep that in mind and consider how we might be able to adjust the future of Medicaid to ensure that the children are covered and that they're continuing to drive health and well being, that is the future of driving our healthy communities that will benefit all of us. So a lot of advocacy. I'm very proud that we're an important voice of pediatric expertise and advocacy advocacy, both with a very favorable administration in Springfield, but even with the work that we do at the federal level in D.C. but these are going to be challenging times coming around the corner and we'll continue to work hard on making sure that we continue to meet the demands of the kids that we're privileged to care for.
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C
Certainly, certainly tough decisions, challenging times ahead. But it is good to hear that the state is supportive of expanded assistance to help navigate this. Going back to what you had said earlier, Tom, and just in terms of why you're expanding in certain areas. And the dearth me trying to meet that dearth of lack of care access you see in certain parts of Chicagoland. I want to read you a stat from some of our recent reporting that 20% of hospital pediatric units nationally have closed over the last decade. I'm sure that's not a surprising statistic to you, but I wonder what role an organization like Lurie should play in the broader pediatric care system and how you're thinking about virtual care partnerships like the one with Northwestern labor training pipelines to further address some of these access gaps that sound like they, they could worsen in the region.
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B
Yeah, well, there's a there. It's important for folks to realize the, some of, some of the factors that have drive that and it is not surprising because it was research team that published that work. So we're too intimately familiar with those challenges across the country. I think what we just talked about was Medicaid. Much of this really started and was even much of it started before the pandemic, but was accelerated from the pandemic. And a very practical thing that happened during that time. Fortunately, kids were not impacted by Covid as much as adults. And because of the number of adults that needed inpatient beds, many of these systems that had small inpatient pediatric beds provided them to adults. And suddenly realize that when there's an adult in the bed paid for by Medicare, you do much better than when you have a kid in that bed provided by Medicaid. So it does get back to that differential of adult versus pediatric reimbursement for care, even though I believe pediatric care is much harder than adult care. So that's one driver is it's just financially it's more challenging in terms of providing that kind of care. The second you mentioned and alluded to the workforce, there are additional statistics that look at the increasing challenge that we're seeing of medical students coming out of school and deciding to pursue pediatrics, and then even folks that pursue pediatric training going into subspecialty fellowship training. Those are all on decline. And so we know that there's a growing dearth of subspecialists that are available, which, which really creates a couple things. Number one, it creates really a national competition for expertise. And then when you go down to a local market like Chicagoland, you realize it's really hard to have sufficient workforce to be able to provide the kind of services that I've alluded to that, that we're privileged to be able to provide because of the special workforce that we have. So that certainly is a key strategy for us is to continue to have one of the most competitive pediatric residency programs. We're estimated to be the third most competitive. Meaning folks really want to come to Lurie Children's for their pediatric training. And I think Chicago as a great city is also a great draw for that. And then we're continuing to try to encourage them to come out of that residency training program and stay in our subspecialty fellowship program programming. So being able to sort of train your own and populate that critically important workforce is really critical there, whether you can continue. And I will say that those strategies are ones that are being shared across really the national leading peers that we have. You know, it's been estimated or projected that these large independent children's hospitals in large urban areas like ourselves and other peers are going to be the few, few remaining pediatric institutions across the country that are able to continue to sustain the kinds of high level, high quality expertise in the subspecialty area that we're known for. But we're also now seeing that come out of the community based opportunities in providing care. And so we're all taking the opportunity and responsibility to lean into that access challenge. So we're not the first to develop a community based hospital like we're doing in Downers Grove. You've seen Children's Hospital of Philadelphia do this along their area. You've seen Seattle expand with partnerships in the Tacoma region. We're seeing our other peers have to take a similar strategy and really doing it because of the access challenge that kids in their market are having. And so we take that as an important responsibility to do so. I think the other unique piece about ourselves in the Chicagoland market, and this does extend to other peers, is you can't have a static system, a static health system. You have to advance it. And I think what we're so proud of is the extraordinary growth of our research enterprise. When I got here 10 years ago, we probably had around $20 million of research expenditures. We're now well over $140 million of research expenditures. And what does that mean? It only means that we have a research enterprise that is advancing what we understand about diseases. It's identifying new therapeutic ways to take care of kids, it's developing new treatment strategies, and it's informing us what the next questions are. So to your point, our research enterprise being able to tell us, hey, places are closing around the country, we better step in and do it. So I think that important essentiality of our discovery enterprise that complements and advances what we do on the clinical side is it's just our mission focus. And again, I think it's our responsibility as the only laser focused children's hospital in Chicago and across Illinois to continue to drive that mission.
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C
Well, Tom, we've covered a lot of ground today. Anything else we're missing that you want to make sure we mention to our audience or any final bits of advice you want to offer all your colleagues listening in from around the country?
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B
No, you know, I mean, I, I, I think the one thing I would reflect on is, is how, how challenging it is today. We've talked about the, the reimbursement pressures with Medicaid and what's coming down the pipe in the pediatric world. And, and each, you know, the adult world has its own aspects of it, but we have challenges in terms of where, how people are recognizing the important, critical importance of vaccination strategies. For example, right. We're looking at the ability to provide appropriate drugs and access to those both for kids and adults. So the pressures on the 340B program, there's just enormous challenges that we have. And I think what I've always encouraged our folks to do is to make sure that despite the challenges, we stayed anchored in our mission and that as things continue to be challenged and things continue to evolve, you can put your head down and be defeated by them. But frankly, I think that's not the position we take. And we have to just take the opportunities in looking at how we devise strategies, how we devise operations, and frankly, how we educate and advocate for changes to those policies that are impacting negatively the well being of our kids and therefore the, the future of our city and the future of our country. So I think as long as folks remain so anchored and committed to what we come to work every day to do and improving the health and well being of the, of the patients that we're privileged to care for, whether it's adult or kids. I think we will continue to thrive and continue to drive the best health outcomes and therefore the best communities that we have for our great city and our great state.
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C
It's a great message to close us out with Dr. Shanley, I want to thank you for taking the time to sit down with us and for sharing all about the stuff that's going on under your leadership at Lurie Children's with our audience. We really appreciate it.
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B
I appreciate the opportunity. Jacob, thanks again for having me.
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C
Absolutely. Anytime. And to our audience, if you'd like to listen to more podcasts from Becker's Healthcare, you can visit Beckershospitalreview.com.