When Seattle Children’s hospital chose to close its after-hours clinic in Seattle, but not in Bellevue, they said it was a result of changes in health-care delivery and economics, not a reaction to Seattle blocking expansion plans for its Laurelhurst campus.
According to a Seattle Times article, a hearing examiner in August recommended the Seattle City Council turn down the hospital’s proposal, which would more than double Children’s bed capacity over the next 15 years and has been hotly contested by some neighbors.
Children’s, the only pediatric hospital in a four-state region, has said it needs to expand or it will be forced to build outside Seattle.
The council’s Planning, Land Use and Neighborhoods Committee is to take up the proposal beginning Jan. 13, with the council’s decision expected in the spring — some three years after Children’s first started the process.
Since then, the situation for children needing after-hours care has changed in several ways, said Dr. Sanford “Sandy” Melzer, the hospital’s senior vice president for strategic planning and business development.
He said that in the mid-1990s, when the hospital’s two after-hours clinics were opened, kids with fevers, earaches or small cuts often had trouble getting into a pediatrician’s office during the day because their parents were at work, or the medical problem began after hours.
But in response to working families over the past few years, more pediatric practices are offering evening and weekend hours or saving a few slots for same-day appointments, Melzer said. As a result, demand for the Seattle after-hours clinic has fallen off.
In addition, Children’s began changing how it handles sick kids who come to its emergency room. A decade ago, all went into “one big funnel” at the ER, whether they had life-threatening conditions or an earache. As a result, kids with the less-serious problems sometimes endured long waits.
Children’s has since restructured its Seattle ER into two tracks — one for emergencies, the other for less serious problems.
A third factor in the Seattle clinic closure was the “significant economic pressures” on Children’s, Melzer said, including decreased reimbursements from Medicaid and more children requiring charity care. Meanwhile, insurers weren’t willing to pay a premium for expensive after-hours care.
“You can’t run a clinic in a hospital like that, with a bigger and bigger gap every year,” Melzer said.
Half its patient care is reimbursed by Medicaid, and large budget cuts from the state loom for the next two years. Uncompensated care at Children’s, Melzer said, rose to $100 million in 2009, up from $86 million in 2008 and in the mid-$60 million range in 2007.
With two after-hours clinics and an emergency room, he said, something had to go. “We knew we couldn’t continue to operate all three. We have to prioritize.”
Children’s made the decision to close the Seattle clinic in the summer, when demand was lighter, and consolidate after-hours clinic appointments at the Bellevue location, Melzer said. The clinic in Bellevue will move later this year to become part of a “very large and quite comprehensive outpatient specialty center” slated to open in August, with operating rooms, same-day surgery and imaging capabilities.
Melzer said any suspicion of some parents that Children’s was signaling a lack of commitment to Seattle was “fairly preposterous,” given its 100-year history in the city.
The same economics that forced closure of the Seattle after-hours clinic also reduced access to the hospital’s nurse-consulting telephone line, Melzer said, which is now mainly reached through the answering services of local pediatricians, who pay for the service.
“The reality is that these are very, very expensive programs … but insurance companies do not pay for doctors or nurses to take those calls,” he said.
Melzer said Children’s notified pediatricians of the changes, but some parents were caught by surprise.
“I thought it was really weird that they would change the two ‘on-demand’ things that help the community, especially low-income, without having talked to the community,” said Glenn Fleishman, a Seattle parent of two young children. On a recent Saturday, he brought one of his children to the Bellevue clinic for an eye infection he thought should get care before Monday.
“We love Seattle Children’s,” he said, calling the after-hours clinic in Seattle an “incredible resource” his family has come to rely on. “If they’d told us it was a money thing, maybe we’d go out and help fundraise.”