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Health will suffer with predicted hospital cuts
They may not bring in big money, but we can't afford to lose pediatrics, obstetrics and mental health services.
By Sophia Vinogradov, Joseph Neglia and John Fischer
August 6, 2023 at 11:00PM
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Last week we read about the financial stress facing Twin Cities' hospitals, as well as health systems throughout the U.S. Many forecasters predict that hospitals will undergo job cuts this year, possibly focused on "less profitable services" like pediatrics, obstetrics and mental health.
We are the leaders for the University of Minnesota Medical School's departments of pediatrics; obstetrics, gynecology and women's health; and psychiatry and behavioral science. Our mission is to train the next generation of doctors, foster discoveries that lead to better treatments and offer state-of-the-art patient care. Unlike the high-tech medical procedures and treatments performed by our colleagues in cardiac surgery or other procedure-heavy specialties, our day-to-day services for patients do not generate large amounts of revenue under the current fee-for-service model and are sometimes considered "money losers."
This is ironic, given the foundational role that our specialties play in ensuring the overall health, well-being and productivity of our society. Young adults are set up for success when we have met their physical and mental health needs during childhood and adolescence. Babies are set up for success when we have met the health needs of future and current mothers. Across their entire life span, individuals can only lead thriving and productive lives when their mental health needs have been addressed. Pediatrics, obstetrics and mental health may look like money losers in the short term, but they actually save money and improve lives over the long term.
Consider these basic facts:
- About 1 in 5 children has a chronic condition, such as asthma, kidney disease, ADHD or sickle cell anemia. However, less than half of them have access to the best treatment practices. When they do have this access, their outcomes improve significantly, and health care costs and caregiver burden are reduced.
- Women in the U.S. are more likely to die in childbirth or in the immediate postpartum period than women in other developed countries. Women who receive recommended health care services before, during and after pregnancy are more likely to lead healthier lives postpartum and deliver healthier babies, both leading to reduced health care costs.
- The overall disability burden of mental illnesses is estimated at about 8% of the U.S. gross domestic product. For every $1 spent on a mental health program, $5 are saved in future costs related to reduced productivity and increased health care needs.
What steps can we take so that our specialty areas are not the first ones on the chopping block, simply because they do not generate enough revenue for hospitals?
Most experts agree that we could quickly create a new dynamic with a shift from the current fee-for-service payment structure to a value-based care system. In value-based care, hospitals and clinics are reimbursed for helping patients avoid getting ill — referred to as preventive care — and providing services that reduce risks of chronic illness, while also keeping costs down. Some programs also promote collaborations across specialists, meeting patients where they are. This is why we have already established a mental health clinic specifically for OB-GYN patients, as well as specialized child psychiatry programs; we know that they pay off not just now, but well into the future.
This is a time for truly forward thinking. We've seen where the current road leads and it's not good. It is time to shift our focus to long-term health and well-being. We welcome the opportunity to do this.
Sophia Vinogradov is the U Medical School's department head of psychiatry and behavioral science; Joseph Neglia is the U Medical School's department head of pediatrics; and John Fischer is the U Medical School's department head of obstetrics, gynecology and women's health.
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Sophia Vinogradov, Joseph Neglia and John Fischer
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