Even as surgery and office visit volume rebounds, hospitals across the country continue to report that emergency department volume remains persistently depressed, down 10 to 20 percent compared to before the pandemic. The shift is even more drastic in pediatrics, with some pediatric hospitals and programs reporting that emergency care volume is seeing double the rate of decline.
Pediatric volume has been hit with a “double whammy”: with many schools and day cares still closed, contagious illnesses have plummeted. Fewer kids in youth sports means fewer injuries. And unlike adult hospitals, pediatric facilities haven’t filled their beds with COVID patients. “Of all our services, pediatric hospitalists have taken the greatest hit,” one children’s hospital physician leader shared. “Their service is usually full this time of the year with flu and RSV [respiratory syncytial virus]. But with kids not interacting with each other, general pediatric admissions have cratered.” Empty EDs have led some pediatric hospitals to shutter adjacent urgent care clinics: “It doesn’t make sense to operate an empty ED and an empty after-hours clinic”.
For patients, however, this can bring unexpected financial consequences, as they’ll now get an ED bill for services they would formerly have received in urgent care. But while pediatric hospitals have taken a greater volume hit, they’re also likely to see a faster rebound. Once kids are back to school and sports, the usual illnesses and injuries will likely return, and we’d guess parents won’t hesitate to seek care.
State-level reports are the best publicly available data on child COVID-19 cases in the United States. The American Academy of Pediatrics and the Children’s Hospital Association are collaborating to collect and share all publicly available data from states on child COVID-19 cases (definition of “child” case is based on varying age ranges reported across states; see report Appendix for details and links to all data sources).
As of November 12th, over 1 million children have tested positive for COVID-19 since the onset of the pandemic. The age distribution of reported COVID-19 cases was provided on the health department websites of 49 states, New York City, the District of Columbia, Puerto Rico, and Guam. Children represented 11.5% of all cases in states reporting cases by age.
A smaller subset of states reported on hospitalizations and mortality by age; the available data indicated that COVID-19-associated hospitalization and death is uncommon in children.
The number of new child COVID-19 cases reported this week, nearly 112,000, is by far the highest weekly increase since the pandemic began. At this time, it appears that severe illness due to COVID-19 is rare among children. However, there is an urgent need to collect more data on longer-term impacts on children, including ways the virus may harm the long-term physical health of infected children, as well as its emotional and mental health effects.
Summary of Findings (data available as of 11/12/20) :
(Note: Data represent cumulative counts since states began reporting)
Cumulative Number of Child COVID-19 Cases*
- 1,039,464 total child COVID-19 cases reported, and children represented 11.5% (1,039,464/9,037,991) of all cases
- Overall rate: 1,381 cases per 100,000 children in the population
Change in Child COVID-19 Cases*
- 111,946 new child COVID-19 cases were reported the past week from 11/5-11/12 (927,518 to 1,039,464)
- Over two weeks, 10/29-11/12, there was a 22% increase in child COVID-19 cases (185,829 new cases (853,635 to 1,039,464))
Testing (10 states reported)*
- Children made up between 5.0%-17.4% of total state tests, and between 3.9%-18.8% of children tested were tested positive
Hospitalizations (23 states and NYC reported)*
- Children were 1.2%-3.3% of total reported hospitalizations, and between 0.5%-6.1% of all child COVID-19 cases resulted in hospitalization
Mortality (42 states and NYC reported)*
- Children were 0.00%-0.21% of all COVID-19 deaths, and 16 states reported zero child deaths
- In states reporting, 0.00%-0.15% of all child COVID-19 cases resulted in death
* Note: Data represent cumulative counts since states began reporting; All data reported by state/local health departments are preliminary and subject to change
- In-person doctor visits plummeted during the start of the COVID-19 crisis in the United States, but have rebounded to a rate somewhat below pre-pandemic levels, according to a new analysis issued by The Commonwealth Fund and conducted by researchers from Harvard Medical School, Harvard University and the life sciences firm Phreesia.
- According to data compiled through Aug. 1, all physician visits were down 9% from pre-pandemic levels. That’s significantly improved compared to data from late March, when visits were down 58%. Although the rebound got major traction beginning in late April, it began plateauing in early June, when all visits were 13% lower than normal. As of early August, in-person visits were down 16% compared to pre-COVID levels. States that are currently coronavirus hot spots are seeing bigger declines than states where the case levels are lower.
- Meanwhile, telemedicine encounters have settled in at rates much higher than pre-pandemic levels. However, they still make up just a fraction of patient-provider encounters for care. As of the start of this month, they comprised 7.8% of all such encounters. That’s compared to a peak of 13.8% in the latter part of April. Prior to COVID-19, they were only 0.1% of all visits.
COVID-19 has widely disrupted healthcare delivery in the United States. However, it is becoming clear that as the pandemic has become a part of everyday life for the time being, how patients visit their medical providers has also settled into a pattern.
According to Harvard researchers using data from Phreesia’s more than 50,000 provider clients, the plunge in patients seeing their physicians has rebounded from its nearly 60% dive in early spring. However, with all patient-physician encounters still consistently down from pre-COVID levels, the study’s authors warn that “the cumulative number of lost visits since mid-March remains substantial and continues to grow.”
Meanwhile, COVID-19 hotspots in the South and Southwest are depressing patient-provider encounters for the time being. Encounters were down as of late July by 15% in Arizona, Florida and Texas, compared to 12% in the Northeast and 8% in all other states.
Among medical specialties, only dermatology has seen a rebound beyond pre-COVID levels, with encounters up about 8% overall. But primary care visits are down 2%; surgery encounters, 9%; orthopedics, 18%; and pediatrics are in a 26% decline.
That the encounters between patients, doctors and other providers remains lower than normal has sparked some concerns about practices and other medical enterprises moving forward. HHS just earmarked $1.4 billion for nearly 80 children’s hospitals across the United States to try to shore them up financially.
The private sector has also undertaken an initiative to encourage patients to return to their providers. Insurer Humana, along with the Providence and Baylor Scott & White healthcare systems, launched an advertising campaign last month to encourage patients to seek out healthcare needs, even during the historic pandemic.
Solving the mystery of how the coronavirus impacts children has gained sudden steam, as doctors try to determine if there’s a link between COVID-19 and kids with a severe inflammatory illness, and researchers try to pin down their contagiousness before schools reopen.
Driving the news: New York state’s health department is investigating 100 cases of the illness in children, Gov. Andrew Cuomo said at a Tuesday press briefing, Axios’ Orion Rummler reports.
- Three children in the state have died: an 18-year-old girl, a 5-year-old boy, and a 7-year-old boy. The state’s hospitals had previously reported 85 cases on Sunday.
Doctors have described children “screaming from stomach pain” while hospitalized for shock, Jane Newburger of Boston Children’s Hospital told the Washington Post.
- In some, arteries in their hearts swelled, similar to Kawasaki disease, a rare condition most often seen in infants and small children that causes blood vessel inflammation, she said.
- Researchers remain uncertain if this is being caused by COVID-19, but most children appear to have a link. Some affected children have tested positive for coronavirus antibodies, suggesting that the inflammation is “delayed,” Nancy Fliesler of Boston Children’s Hospital wrote on Friday.
What’s next: The CDC is funding a $2.1 million study of 800 children who have been hospitalized after testing positive for the coronavirus through Boston Children’s Hospital. The study aims to understand why some children are more vulnerable to the disease.
Every January, the United States celebrates the lasting legacy of Dr. Martin Luther King Jr. Not widely known is how his civil rights advocacy made a lasting impact on modern-day hospitals, including children’s hospitals.
Today in 170 Children’s Miracle Network Hospitals, every young patient is treated regardless of their race or background. CMN Hospitals are deeply committed to offering world-renowned treatment to all kids in need and that’s why donations to your local hospital can make such a difference for families facing health crises.
Unfortunately, certain hospitals in America were still segregated in the not too recent past. When Brown vs. Board of Education passed in 1954, schools began to desegregate, and this paved the way for institutions like hospitals to follow suite. King’s healthcare justice advocacy advanced health care access in particular for the African American community.
A History of Unequal Healthcare
When patients enter a hospital, they expect to receive a standard of care that will improve their lives regardless of who they might be. That expectation, unfortunately, has not always been backed up by medical institutions across the United States. African Americans, in particular, experienced a history of receiving substandard care and outright abuse within the framework of medical science.
Notable examples of this include:
- The 40-year-long Tuskegee experiments that lasted into the 1970s
- Dr. Eugene Saenger’s experiments during the Cold War, exposing unknowing African American cancer patients to lethal levels of radiation to observe the effects.
- The unauthorized tissue sample acquisition and cloning of Henrietta Lacks’ cells
While the details of those specific examples weren’t publicly known in the 1960s, African Americans were certainly aware that they received care that was inferior to white patients. Doctors and hospitals continued perpetuating this double standard even after the passage of the Civil Rights Act in 1964. The disparity in treatment quality was so egregious that Dr. Martin Luther King Jr. spoke out against it, calling for an awakening in the conscience of the United States.
King uttered his famous words on healthcare while addressing the press before attending the annual meeting of the Medical Committee for Human Rights, an organization formed because the American Medical Association was segregated at the time. “Of all the forms of inequality, injustice in health is the most shocking and the most inhuman because it often results in physical death,” said King.
The Civil Rights Act of 1964 isn’t typically associated with healthcare. However, at that point in history, it was well known that some hospitals and medical institutions were resisting the push for desegregation, a practice which hospitals used to provide less than adequate care to African American patients. Hospitals would continue to hold onto such discriminatory practices unless something was done.
Legal Gains for Equality in Hospitals
The reason King spoke out so vehemently in 1966 was due to the passage of Medicare and Medicaid in 1965, something that was only possible due to the efforts of the Medical Committee for Human Rights and its head, W. Montague Cobb. The organization made use of the non-violent protest strategies of King and the Civil Rights Movement. The passage of the Social Security Act, which created Medicare and Medicaid brought federal funding into every hospital and medical institution in the United States, forever binding each facility to the Civil Rights Act, a stipulation of which was that any organization receiving federal funding could not discriminate on the basis of race.
From that point onward, hospitals that clung to the old ways of discrimination were subject to lawsuits from mistreated African Americans and pressure from activists like King and the Medical Committee for Human Rights. This gave King the legal ground to stand on when calling on hospitals to abandon the evil practice of systemic discrimination in 1966 with those now famous words from that 1966 conference.
While we know there’s more work to be done to promote equal healthcare access to every child in need across North America, we’re proud that our non-profit children’s hospitals can be a part of the solution.
Thank you, King.
West Reading, Pa.-based Tower Health and Drexel University completed the $50 million acquisition of St. Christopher’s Hospital for Children in Philadelphia on Dec. 15.
St. Christopher’s was put up for sale after it and Philadelphia-based Hahnemann University Hospital filed for Chapter 11 bankruptcy at the end of June. Hahnemann closed in September, the same month Tower Health and Drexel University entered into a $50 million agreement to acquire St. Christopher’s.
With the sale complete, 188-bed St. Christopher’s will return to nonprofit status.
“We are grateful for the continuing dedication and hard work of the physicians and employees at St. Christopher’s,” Tower Health President and CEO Clint Matthews said in a press release. “We are excited about a bright future for St. Christopher’s as it continues to serve as a center for healthcare, medical education and research, and innovation.”
Rich Goode, vice president and CFO of Dallas-based Children’s Health, resigned Sept. 24, about a month after another finance leader left the organization, according to The Dallas Morning News.
Hospital officials did not give a reason for his departure. The organization has not responded to Becker’s request for comment.
Mr. Goode’s resignation comes after the August departure of Ryan Bailey, head of investments at Children’s Health, who left to form an investment firm.
Mr. Goode served as CFO for three years, joining Children’s Health in 2016. He was previously vice president of finance and CFO at Cook Children’s Health Care System in Fort Worth, Texas.
Mr. Goode is credited with doubling the system’s net operating income and implementing analysis tools to offer better insights into its financial health during his tenure.
Hospitals that care for a large share of Medicaid, low-income and uninsured patients stand to receive less funding from the federal government after the D.C. Circuit reconsidered how Medicaid disproportionate-share hospital reimbursement is calculated.
A three-judge panel of the U.S. Court of Appeals for the District of Columbia Circuit reversed a lower court and reinstated a 2017 rule establishing that payments by Medicare and private insurers are to be included in calculating a hospital’s DSH limit, ultimately lowering its maximum reimbursement.
“By requiring the inclusion of payments by Medicare and private insurers, the 2017 rule ensures that DSH payments will go to hospitals that have been compensated least and are thus most in need,” Henderson wrote.
The case, brought by four children’s hospitals in Minnesota, Virginia and Washington and an association representing eight children’s hospitals in Texas, concerns the calculation of the uncompensated costs of treating Medicaid beneficiaries known as the “Medicaid shortfall.”
For instance, if a hospital spends $1 million on treating Medicaid patients who have no other healthcare coverage and Medicaid pays $600,000, then the Medicaid shortfall is $400,000. In some instances, Medicaid patients have additional third-party coverage such as Medicare or private insurance.
Hospitals cannot receive more money in Medicaid DSH payments than they spent to treat Medicaid beneficiaries or the uninsured. Part of the motivation behind that stipulation was to prevent hospitals from double dipping by collecting DSH payments to cover costs that had already been reimbursed. Previous cases also revealed that some states have made DSH payments to state psychiatric or university hospitals that exceed the net costs, or even total costs, of operating the facilities.
Providers successfully fought the 2017 rule that limited hospitals’ reimbursement. A federal judge sided with the hospitals that claimed the CMS overstepped its authority and essentially ignored payments by commercial insurers and Medicare. That was overturned Tuesday.
The Children’s Hospital Association of Texas said in a statement that it is exploring its options.
“We are disappointed with the result because it will reduce critical Medicaid funding to safety net providers like children’s hospitals,” the association said. “These hospitals are heavily reliant on Medicaid payments because between 50% and 80% of their inpatient days are covered by Medicaid. Children’s hospitals care for all children, and are, in fact, often the only place that children with complex conditions can get life-saving care.”
Four healthcare organizations based in Philadelphia have created a consortium to collectively negotiate with American Academic Health System for the potential purchase of St. Christopher’s Hospital for Children in Philadelphia.
St. Christopher’s, along with Philadelphia-based Hahnemann University Hospital, was included in a June 30 Chapter 11 bankruptcy case filed by Philadelphia Academic Health System, a subsidiary of AAHS.
The four consortium institutions — Einstein Healthcare Network, Jefferson Health, Philadelphia College of Osteopathic Medicine and Temple Health — said July 17 they plan to submit a letter of intent to AAHS for the purpose of keeping St. Christopher’s open.
“In a time of difficult transition for healthcare in Philadelphia, four healthcare organizations stepping up to do what’s right by St. Christopher’s patients is truly emblematic of neighbors helping neighbors,” said Achintya Moulick, MD, CMO at St. Christopher’s as well as its chairman of cardiothoracic surgery. “This will ensure continuity of care and service to the children of the community it serves, especially the underserved population.”
The four healthcare organizations formed the consortium as AAHS continues to wind down services at Hahnemann University Hospital. Under a closure timeline released July 16, Hahnemann will shut down Sept. 6.