June 18, 2008
On Wednesday, June 18th, Dr. Karen Sheehan of Children’s Memorial Hospital testified at a hearing of the Chicago City Council’s Committee on Health and Human Relations in favor of Resurrection Health Care’s 1,000 Healthy Kids Campaign.
At the hearing, Dr. Sheehan also highlighted the need to increase reimbursement for pediatric specialists under All Kids to ensure that children enrolled in the program will have access to the medical treatment they need. Read Dr. Sheehan’s full testimony below:
Testimony for Karen Sheehan, MD
Chicago City Council
Joint Committee on Health and Human Relations
Wednesday, June 18, 2008
12:00 p.m.
City Council Chambers
Good afternoon, members of the Joint Committee on Health and Human Relations. Thank you for the opportunity to speak to you today. My name is Dr. Karen Sheehan. For over 15 years, I have had the privilege of serving as an attending physician in the Division of Emergency Medicine at Children's Memorial Hospital. I also serve as the Medical Director of the Children's Memorial Injury Prevention and Research Center and the Associate Chair for Advocacy.
Children's Memorial Hospital – the State’s largest partner in the provision of inpatient, outpatient and physician Medicaid services for children, commends Governor Blagojevich and the General Assembly for making Illinois the first State in the nation to offer health insurance to every one of its children. We affirm how essential it is that our children have access to the medical care they need and we are proud to support the campaign to enroll eligible children in All Kids. But we also are here to speak the truth about the All Kids program that holds such promise for our children. Right now at this very moment, mothers and fathers of children with All Kids coverage are having great difficulty accessing the care and expertise of pediatric specialists for their children because reimbursement for pediatric specialists is so poor that these doctors have to limit the amount of care they can afford to provide to All Kids and Medicaid patients. It is uncomfortable to speak about, but it is absolutely the truth.
The promise of the All Kids program depends on children having access to the physicians they need. Many of these children have complex medical and special needs requiring the care of pediatric sub-specialists --physicians who are highly-trained to treat a child’s specific disease, illness or condition.
While non-physician providers of Medicaid have seen increased reimbursement, physicians have gone more than 8 years without any rate increase. Specifically, pediatric specialists who treat children covered by All Kids receive reimbursement that amounts to only one-third – or 33 cents for every dollar - of the cost of care these physicians provide.
The physicians affiliated with Children's Memorial Hospital are the largest group of providers of pediatric Medicaid services in Illinois, totaling 410 subspecialists. Nearly 42% of children served are part of the All Kids program. Because of the depth and breath of their expertise, these physicians care for children from every ward in the City, every county and every legislative district in the State of Illinois. These physicians provided over 120,000 combined inpatient and outpatient Medicaid patient encounters for 98,000 pediatric patients.
However, in FY 2007, Children's Memorial’s physicians were reimbursed $20 million less than it cost them to provide care to children insured by Medicaid and All Kids. This is simply not sustainable.
While I share the experiences of Children’s Memorial pediatric specialists, the problem exists for children seeking specialty care in the City, Cook County and throughout the State. Since January a coalition of some 20 organizations from throughout the State -- child advocates, physicians, hospitals, and associations – have proposed legislation that will increase funding for these specialty pediatricians from 33 percent to 66 percent and we need your support for this initiative.
Under reimbursement of pediatric specialists has serious consequences. While the number of children covered by All Kids increases, the number of pediatric specialists across the State serving All Kids recipients is actually declining. As a result, it often takes months to see a specialist that will care for their child, and then families must drive hours to get to that specialist.
Let me just quick a quick example of one of our parents, Beth Jones. Beth is the mother of seven year old Sommer who has Type I diabetes. The Jones family lives in St. Charles, Illinois. Having recently signed up for the All Kids program, Beth shared the incredible challenges that their daughter has faced in trying to gain access to a pediatric endocrinologist who would accept children with Medicaid or All Kids coverage. The family has to travel over 90 minutes to see an endocrinologist at Children’s Memorial who will take them.
Unfortunately, Sommer’s story isn’t unique. Each shift I work in the ED I take care of at least one child whose parent has driven for hours trying to find a subspecialist to take care of their child’s asthma, or manage their seizures, or obtain follow up for a broken bone. Because of the long wait for subspecialty care, the parents think if they come to the ED, they can see a subspecialist more quickly. As I know you are aware, using the Emergency Room to access the subspecialty system is ineffective and frequently ends up providing inefficient and fragmented care.
Further, poor physician Medicaid reimbursement makes Illinois unattractive to the handful of sought after pediatric specialists who have the option to go to any state in the country. There is a critical shortage of pediatric specialists on both the local and national level.
The American Board of Pediatrics reported that in 2006 for the entire nation there were only 65 pediatric endocrinologists, 17 pediatric rheumatologists, and 23 pediatric cardiologists who completed their studies and passed their boards.
Our ability to attract and retain these essential specialists to Illinois is hampered by inadequate Medicaid reimbursement. And, failure to attract these specialists has adverse consequences on all Illinois children, not just Medicaid beneficiaries.
In closing, I reiterate that Children's Memorial supports the 1,000 Healthy Kids and Family Campaign and is proud to be a part of an effort to galvanize communities around the State to advocate for solutions to the heath care coverage crisis. In good times and in especially in tough economic times such as now, families rely on the All Kids program more than ever. But elected and appointed officials must provide the funding necessary to allow the All Kids program to be successful. This can happen only if adequately funding is provided so that children can truly access specialty care when they need it.
It is an honor and a privilege to partner with the State in the care of our children. We know that resources are tight and we hope that as our elected and appointed officials weigh budget priorities, they will prioritize access to specialty care for children.
Thank you very much for your attention.
