"The hospital does it because it's the right thing to do for kids and families for asthma care and provide it as a model. But it's primarily a saver to the payers....who are reducing their expenses (but) they're not paying us currently for the services," says Woods. "What we've been advocating for is that there be a more sustainable way of funding this, that also takes into account the money upfront to prevent the hospitalizations."
So here's a great program, but one whose success could hurt the hospital's bottom line, one that costs money and reduces business.
Brigham and Women's Hospital surgeon and author Atul Gawande wrote me in an e-mail this week that he was told by Children's CEO Jim Mandell that the asthma prevention efforts are "a good example of the tension between doing great work on quality and safety that then threatens you with major money losses," since such a huge portion of revenue comes from hospitalizations of children with uncontrolled asthma.
In a recent talk to hospital leaders, Gawande suggested the hospital could be looking at "bankruptcy" if this major source of admissions revenue dropped significantly.
Use of that word irritates Josh Greenberg, Children's Hospital Boston's vice president for government relations, because he insists that's not the way his hospital's chiefs are thinking about this. "That's complete nonsense," Greenberg says, adding that he knows Gawande "likes to say that."
Rather, Greenberg says, the hospital will do "the right thing for kids," and that involves keeping them from needing inpatient care. Some of the losses might be made up by not providing worthless or futile care, he says.