• Skip to main content
  • Skip to primary sidebar
  • Skip to footer

SPS Newsletter

An official publication of the Society for Pediatric Sedation

An official publication of the
Society for Pediatric Sedation®

    • President’s Message
      • Culture of Diversity in SPS
    • 2018 Annual Conference Reviews
      • Reviews of Monday Sessions
      • Reviews of Tuesday Sessions
      • Reviews of Wednesday Sessions
    • Literature Review
      • Neuropsychological and Behavioral Outcomes after Exposure of Young Children to Procedures Requiring General Anesthesia: The Mayo Anesthesia Safety in Kids (MASK) Study

Meeting Reviews

Keynote Address: How sedate is the future of pediatric healthcare?
Reviewed by Pradip Kamat, MD

Presented by James D. Fortenberry, MD, MCCM

Dr. Fortenberry the pediatrician-in-chief was the keynote speaker at the Society for Pediatric Sedation (SPS) Conference 2018 in Atlanta.

Dr. Fortenberry’s keynote addressed the following issues in healthcare:

  • The Healthcare Reform Landscape
  • Reimbursement-Medicaid
  • Behavioral Health Tsunami
  • Pharmaceutical Industry
  • Imaging
  • Hope

The Healthcare Reform Landscape
In 2014 an estimated 22 million Americans received healthcare under the Affordable Care Act (ACA). The expanded coverage cost the US ~46 billion dollars in 2014-2016. Additionally the health and human services (HHS) estimated the US national health expenditure to be ~ 5,000 billion dollars by 2025. While ACA expanded coverage it really didn’t bend the cost curve for providing healthcare. The new era of healthcare under the administration of President Trump was designed to reduce the price of healthcare. The reduction in the amount would be enabled by payers pulling pricing levers to decrease healthcare spending, driving providers to reduce the cost of care. Dr. Fortenberry briefly touched upon alternative models including value-based and risk-based proposals. In December 2017, the ACA was repealed and American Healthcare Care Act (AHCA) was passed. The Congressional Budget Office (CBO) estimated that coverage would increase by 13 million and result in a saving of 338 billion dollars. The AHCA would also eliminate individual mandate policy by 2019. About 47% of Americans are provided healthcare through an employee shared program, whereas 19 % received healthcare through Medicaid and CHIP. Only 4% received healthcare through public exchanges.

Dr. Fortenberry touched very briefly on Medicare Access and CHIP Reauthorization Act (MACRA), which would replace current reimbursement schedule and many value-based care incentives into single Merit-based Incentive Payment System (MIPS). The MACRA increase participation in accountable care organizations (ACO’s). All this means is the consumer is will have to be willing to accept higher deductibles to keep cost down.

Dr. Fortenberry also discussed the Children’s integrated network and its quality evaluation program. Despite consolidation by hospitals, prices were still on the rise and forcing some hospitals to provide innovative scheduling, virtual visits, use of apps, etc. for the provision of primary care. As people look for options, there has been a substantial increase in retail clinics since 2012, which could potentially decrease revenue for hospitals.

Another big shocker slide was the revelation that there was an increasing number of administrators in healthcare and a decrease in physicians. In the future, the fee for service model could potentially change to a value-based care model. The majority of children are covered by private insurance, whereas as 42% were covered by a government program such as Children’s Health Insurance Program (CHIP) or Medicare. The CHIP is based on a state-federal partnership. As of 2017 October, only 31 states and DC have approved for expansion of CHIP.

The Pharmaceutical Landscape
There has been and will be shortages of drugs used for patients including sedatives (e.g., Ketamine) in the future.  Facility quality issues, as well as drug quality issues,  were the most cited reasons for the shortage. A majority of pharmaceutical manufacturing occurs in Puerto Rico, which was recently hit by hurricane Irma. The disaster caused considerable problems with drugs manufactured in there, feeding into shortages even further. Some pharmaceuticals are fighting to prevent generic agents from being produced by suing to expand patents, which can also increase cost and create shortages.

Behavioral Health Tsunami
There is an increasing need to provide healthcare for children with behavioral issues. Adding to this is the opioid crises epidemic.

Changes in Imaging
The majority of the radiology imaging is slowly shifting towards an outpatient model rather than being attached to hospitals. The impact of the radiology imaging moving towards outpatient model on sedation services reimbursement is unknown.

In the end Dr. Fortenberry emphasized that the future of healthcare is bright. Every obstacle can be an opportunity. Detecting new disease indicators, powering evidence based decisions and precision medicine will transform healthcare.

Primary Sidebar

NEXT MEETING

View the program and register through the Mobile Meeting Guide.

CME MODULES

Check out the Society’s online educational modules for physicians and nurses.

 

Footer

About SPS News

SPS News is an official publication of the Society for Pediatric Sedation®

SPS News Editor
Carmen D. Sulton, MD

Contributing Authors
Nancy Crego, PhD, RN, CCRN
Benjamin F. Jackson, MD
Sue Kost, MD
Ali Ozcan, MD
Amber Rogers, MD
Anne Stormorken, MD

Share Your News!

Have an interesting story about your sedation team to share? Has your institution recently been recognized for something? We are looking for content for the next issue of SPS News, due out this summer.

Being a contributor is a great way to get involved in the Society. Contact Joye Stewart at the SPS headquarters office.

Get your SPS member app!

Take full advantage of your membership and download the SPS Member App for quick access to:

  • Renew your dues
  • Conference information
  • SPS News
  • Member section
  • And more!
It's available at your app store!

Copyright © 2022 Society for Pediatric Sedation