Dr. F. Sessions Cole, chief medical officer at St. Louis Children’s Hospital, has a passion for pediatric medicine and the dicey economic issues attached to health care dollars.
He’s not shy about urging the local business community to support the hospital’s clinical programs, or trying to shame the National Institutes of Health into increasing its research funding on child health. The federal giant spends far more on adult-centered research.
Cole and his colleagues in pediatric care are a committed lot, spending much of their time caring for the poor. Physician reimbursements from the Medicaid program comprise a small fraction (about 15 percent to 18 percent) of what physicians handling seniors receive from the Medicare program for comparable hours on an individual case.
But when it comes to children in need, Cole tries not to let money stand in the way.
“There’s a culture here that if a child needs hospitalization we will find the resources to take care of it,” said Cole, whose duties include overseeing a neonatal intensive care ward filled with premature babies.
The non-profit hospital is part of the St. Louis-based BJC Healthcare system and benefits from close ties with Washington University School of Medicine and its brain trust of faculty members and researchers. The hospital is also linked to the Children’s Discovery Institute, a research partnership with the university that was launched in 2005.
(Cole is involved in genomic research to isolate genes that will predict a child’s future susceptibility to chronic diseases. And he’s doing clinical research to develop pre-natal nutritional supplements to help reduce asthma and prevent neurological disorders in newborns.)
The hospital has one of the nation’s largest heart failure programs, drawing children from across the region and the country. It has one of the most active transplant programs for children’s hearts, lungs, livers, and kidneys. And one of its top docs, neurosurgeon T.S. Park, has pioneered spinal cord surgeries that can restore mobility to children with certain forms of cerebral palsy.
Cole sat down this week with the Post-Dispatch for questions related to the economic impact of children’s health issues. Here’s an edited transcript of the interview:
What are some of the biggest health challenges these days for children… and the economic and societal impacts of those conditions?
Obesity … asthma … pre-term birth … And all of these problems impact children for their life spans. So in contrast to my having a heart attack, which will impact me for the next five years, children’s health problems impact them sometimes 70 to 90 years. So the amplification effect of the health problems of children for the community, for the educational system, for the economic vitality of the region, is frequently not appreciated. The importance of child health, therefore, is very high and should represent not only a major health care priority but also a major community and economic priority for this region.
How have government cuts in reimbursements for children’s Medicaid patients affected the hospital’s business operations and the quality of care for the poor?
The cuts in the Medicaid programs in both Missouri and Illinois, because patients come here from both states, have significantly impacted the operations of the hospital and the physicians… forcing the hospital last summer to reduce non-clinical staff associated with the hospital. And those kinds of cuts are painful because children require an environment in addition to medicines, in addition to a nurse and a doctor. (They require) a suite of programs: a school, play therapists, social workers, etc. Creating that environment in the hospital has become more difficult in the current Medicaid budget. Any time the hospital can’t maintain and grow its commitment to child health services, I think there’s a problem… I recognize the importance of bending the cost curve for health care nationally, regionally, and locally. We all need to be more efficient, and I want to do more for less. But children have been at the bottom of the financial pipeline for many, many years, and trying to reduce reimbursement for child health when the resources currently going to child health are already close to inadequate, will compromise the long-term outcomes of the children in our community.
Why does the United States have one of the worst infant mortality rates among industrialized nations?
Our country does not understand the importance of pregnancy … If one looks at how pregnant women are viewed in developed countries with better infant mortality rates than we have, you would see that those women are provided a suite of services, both in access to prenatal care and pre-conceptual care, as well as the opportunity to take care of their children after they’ve delivered — without compromising their professional status or income. …. I would maintain that infant mortality, which is a big cost to society, could be reduced if we as a nation decided to assign a high priority of importance to pregnancy… Investment in pregnancy would have an enormously favorable impact on reducing infant mortality and an enormously favorable impact on child health and adult health (because emerging evidence indicates that healthy babies have fewer health problems later in life). However, that takes national will. The business community and federal government need to support pregnancy as an important priority for society.
What sort of health differences do you see between children of the rich and children of the poor?
Since the early tracking of child health, poverty and adverse child health outcomes have always been linked. We don’t understand today what the medical mechanisms are that cause a child in poverty to be at higher risk of asthma … obesity … educational failure or attention deficit types of problems, but they are the types of problems that are more prevalent in socially disadvantaged children…. This is not necessarily a race-based comparison. This is a resource-based comparison. So, rural children from poor-socioeconomic environments have many of the same challenges that poor children have in urban environments.
To what extent does the hospital rely on philanthropic donations, and what’s that money used for?
Philanthropic donations are very, very important for the three big missions of Children’s Hospital: clinical care, education, and discovery or research. From a clinical care standpoint, philanthropy supports many in a suite of services that children need — for example, palliative care … which is unreimbursed or very modestly reimbursed … In terms of education, philanthropy has had a major impact on the hospital’s ability to create and provide educational programs for many of the staff here and many staff people at hospitals in the region who don’t have pediatric expertise. … In terms of transformation and discovery, children’s health relies on discovery to ensure that we identify ways of reducing risk for asthma even among poor kids or that we identify ways to reduce the risk of pre-term birth, even among poor families… We have the opportunity here to leverage Washington University’s considerable intellectual assets on behalf of child health. Children’s Discovery Institute and the Children’s Hospital Surgical Sciences Institute have both been created by philanthropy to ensure that resources are available that the university’s many talent investigators can use to study child health related questions.