Aurora plan could bring greater competition with Children’s Hospital – Milwaukee Journal Sentinel

Aurora Health Care plans to begin building a network of pediatric specialists throughout eastern Wisconsin, a move that could put the state’s largest health care system in competition with Children’s Hospital of Wisconsin.

The move is the next step toward Aurora’s goal of building an integrated health care system — a one-stop shop that can provide coordinated care for most of a person’s or family’s health care needs.

“We want to be able to provide the top-quality pediatric specialty care in a location that’s close to home,” said Kevin Dahlman, a pediatrician and chair of Aurora Children’s Health.

Aurora’s expansion may include collaborating with Children’s Hospital, but it also could mean fewer referrals to the hospital, cutting into the patient volumes needed to support highly specialized pediatric care.

Children’s Hospital of Wisconsin is one of the country’s largest children’s hospitals in part because other hospitals in the Milwaukee area and much of eastern Wisconsin have not provided pediatric care.

That has given Children’s Hospital and the Medical College of Wisconsin the patient volumes needed to employ highly specialized pediatric physicians and offer services typically not found in metropolitan areas the size of Milwaukee.

Children’s Hospital cites its heart program as an example.

To be considered a top heart program, a hospital generally must perform 500 procedures a year, Children’s Hospital said. About 700 children in Wisconsin need heart surgery each year, and Children’s Hospital does about 550 procedures a year.

“To be able develop that sort of program in a market like ours, which is not that big and is not growing, requires working together and partnering,” said Marc Gorelick, a physician and chief operating officer of Children’s Hospital. “We’ve done that, and Children’s success over the years is a demonstration of how that plays out very well.

“If moves are being made that would threaten that — that would fragment that care — we’ll end up with a bunch of not very good programs, and for the highly specialized things, Wisconsin will become like a lot of other markets, where kids are going to have to leave the state to go get care.”

Aurora’s plan includes contracting with pediatric physicians affiliated with UW Health’s American Family Children’s Hospital in Madison. Those doctors are more likely to refer patients to Madison than to Children’s Hospital of Wisconsin.

The concern is that if specialty cases were split between Children’s Hospital of Wisconsin and American Family Children’s Hospital, neither would have the volumes to support a strong program and attract sought-after doctors.

Children’s Hospital just recruited Viktor Hraska, a cardiac surgeon from Germany, to be its medical director of cardiothoracic surgery and division chief of congenital heart surgery at the Medical College of Wisconsin. In all likelihood, that would not have been possible if Children’s Hospital’s heart program did not have a high volume of patients.

The Aurora expansion

Last week, Aurora and UW Health announced that they would begin providing pediatric specialty services at the campuses of Aurora BayCare Medical Center in Green Bay and Aurora Medical Center in Oshkosh. Pediatric specialists from UW Health will travel to Green Bay and Oshkosh on regular schedules, such as weekly or once every two or three weeks, depending on the demand for their services.

The collaboration will bring pediatric neurosurgeons, urologists, pulmonologists and nephrologists to Green Bay and pediatric pulmonologists, orthopedic surgeons, urologists, gastroenterologists and cardiologists to Oshkosh.

It also will expand other pediatric specialty care, such as cardiology and orthopedics, in Green Bay.

“The advantage for us is that we have the care right in our clinic,” Dahlman said.

That could be more convenient for patients and their families. Families also would receive one bill. And costs could be lower because health insurers, employers and families would not incur the facility fees typically charged by academic medical centers, such as Children’s Hospital and Froedtert Health.

But Children’s Hospital also provides specialty care in the Green Bay area, Neenah and other parts of the state.

Aurora’s plans for Green Bay and Oshkosh are just a start.

“We are looking to expand our specialty services throughout our entire footprint,” Dahlman said.

The health system has no intention of offering pediatric care, other than neonatal intensive care, in its hospitals, he said.

The Aurora-UW Health collaboration has the potential to increase the number of patients at American Family Children’s Hospital. UW Health’s pediatric program, which has about 220 pediatric physicians, is much smaller than Children’s Hospital Health System, which has 460 pediatricians and pediatric specialists.

Information on the websites of American Family Children’s Hospital’s and Children’s Hospital of Wisconsin shows the difference in the two hospitals’ patient volumes:

■3,739 admissions for American Family Children’s Hospital, compared with 23,256 in 2014 for Children’s Hospital of Wisconsin.

■5,625 surgical procedures for American Family Children’s Hospital, compared with 21,229 for Children’s Hospital of Wisconsin.

■132,313 clinic visits for primary and specialty care for American Family Children’s Hospital, compared with 282,804 for Children’s Hospital of Wisconsin.

Children’s Hospital Health System also is strong financially, reporting $140.3 million in cash and $641.8 million in investments as of last Dec. 31. But roughly half of Children’s Hospital’s patients are covered by BadgerCare Plus and other Medicaid programs, which generally pay hospitals and doctors far less than the cost of providing care.

Children’s Hospital is concerned that Aurora will offer pediatric specialty care in areas such as Summit and Grafton, where most children have commercial insurance that pays much higher rates.

Another scenario

On the other hand, if the Aurora expansion evolves into a broader collaboration with Children’s Hospital, as opposed to more intense competition, the entire region could benefit.

“Recruiting pediatric specialists is very challenging, because there are not many of them,” said Gorelick, who also is executive vice president of Children’s Hospital Health System.

It also could lessen the duplication of services.

“It’s been well shown that for specialized pediatric services, fragmentation is not good for quality and it is not good for value,” Gorelick said. “It increases costs and decreases quality. I don’t think that’s what this community wants or needs.”

The state’s health care market, however, is increasingly being divided into two competing networks: AboutHealth and Integrated Health Network of Wisconsin.

The two networks — which include most of the state’s health systems — are working to prepare when hospitals and doctors are paid a set amount to provide care for a specific group of patients.

That will require closely monitoring the costs and quality of care and is partly why Aurora wants to provide pediatric specialty care within its own system.

“Bringing in more specialty pediatric care where it needs to take place is where ultimately our organization needs to go,” Dahlman said.

Children’s ideally would like to be Switzerland among the two competing networks.

“What we would like be able to do — and have been working to do — is to work with anybody who is willing to partner with us, including Aurora and UW and anybody else, as we have successfully in the past,” Gorelick said.

But Children’s Hospital is closely aligned with the Medical College of Wisconsin, which belongs to Integrated Health Network, and it competes with UW Health’s American Family Children’s Hospital, which belongs to AboutHealth.

Remaining neutral, Gorelick acknowledged, is becoming harder.

“We still think that is the best thing for kids,” he said.