MHE: How has the ACA impacted your hospital?
Feldman: As a pediatric hospital, the protections that came with ACA have and continue to positively impact many of the children we care for here. The elimination of life-time maximums and providing protection for those with pre-existing conditions for our privately insured families has been extremely beneficial.
Although Ohio is a Medicaid expansion state, children in Ohio were already eligible for Medicaid up to 211% of the federal poverty level, covered by the combined Medicaid and CHIP. We did advocate strongly for Medicaid expansion because we recognized that the health of the entire family significantly impacts the health and well-being of children as well as impacting the long-term economic vitality of our state.
MHE: What specific value-based purchasing agreements have you established with managed care plans and how effective in improving outcomes and reducing costs have they been?
Feldman: Dayton Children’s, through its clinically integrated network, has entered a shared savings contract with Anthem. It is in the first year of this contract and doesn’t have outcome or cost results yet. It has been tracking data on a number of health indicators through its Anthem plan and has targeted several measures for focus in this first year, including well child visits, asthma medication compliance, and emergency department utilization.
MHE: Opioid addiction is another problem high on the radar of providers and payers. How is your hospital approaching pain management?
Feldman: As a pediatric hospital, our challenges with opioids are somewhat different than the adult hospitals. However, we do have an innovative pain management program for our children that includes the use of spinal blocks.
Kristen Spisak, MD, a physician in the anesthesiology department and a member of the pediatric anesthesiology team at Dayton Children's Hospital, started the Dayton Children’s acute pain service. She and her team have increased the use of nerve blocks at Dayton Children’s to better manage pain and decrease the amount of opioid pain medication a child needs after surgery. By injecting medication around the nerve of the affected area, we can provide pain relief for up to 24 hours. A regional block can also be combined with general anesthesia, so a child will still be asleep for their operation, but they will require less anesthetic and need lower doses of other painkillers after their surgery. Fewer opioids means quicker recovery times after surgery, less nausea, less constipation, quicker return to solid foods, and quicker return to movement—all equaling quicker recovery overall. In the first few months, we did more than 100 blocks a month. When surveyed, 93% of respondents said the child had little or no pain after surgery and 98% said they had little or no nausea. This truly is giving our kids a much better experience.