How Children's is trying to control costs

Given that there has been a lot of conversation about cost control in the health care debate, I’d like to talk a little bit about how we at Children’s Hospital Boston view as our responsibility in controlling costs.

We necessarily are focused on providing safe and effective care for the most severely ill children in our region. Most of those kids and families rely on Children’s for both acute and chronic care for difficult, life-long problems. We also have become the largest primary care providers for the underserved pediatric population of Boston and its surrounds. Still others come here for less serious conditions to see the pediatric specialists not available throughout the state or anywhere else in New England.

One issue that has gotten lost in the health care reform debate is that pediatric care is more costly than adult care for many reasons:

  • Fidgety children often need to be sedated during procedures and imaging so the tests will be successful
  • There is increased potential for harm in infants and since there’s such a wide range of sizes between the tiniest premature infant and a full-grown adolescent, medication dosing has to be individualized for each patient
  • This size range also requires us to have many different sized instruments and devices created exclusively for kids – for instance, we use eight different blood pressure cuffs here
  • On top of that are all of the necessary social supports that patients at adult hospitals don’t need, from Child Life Specialists, whose job it is to be a child’s bridge between home and the hospital, to family support that includes taking care of our patients, their parents and, often, their siblings.

None of this means, however, that we don’t have to look for ways to reduce cost wherever and when ever we can.

We talk a lot about “bending the cost curve,” which means trying to reduce the trend of rising health care costs. In order to do so, we asked every program and department in the hospital to reduce “controllable” costs by up to 12 percent. I was amazed to see how everyone stepped up and really brought incredible suggestions on reducing costs while maintaining the quality of care. The list was enormous but included energy savings, reduction of unnecessary material waste, extending clinic times into nights and weekends, replacing manual or redundant processes and many others.

These costs savings must be translated into reductions in the growth of spending across the board for families and those that pay for the health care. Here at Children’s we are simultaneously committed to improving access, clinical innovation and the family experience for those who come to us for care. Isn’t that what health care reform should be about?

What ideas do you have in regards to these issues?

– Jim

PS – If you have another couple minutes, here’s a video I filmed earlier this year that covers some of these topics and delves into Children’s not-for-profit status.