Children’s Hospital & Medical Center

Inaugural Edition

Contents

4 Vision

8 Specialty

12 Unique

16 Lead

20 Reform

Spira

Spira is the biannual magazine of

Children’s Hospital & Medical Center,

8200 Dodge St., Omaha, NE 68114.

Spira@ChildrensOmaha.org

SpiraMagazine.org

Welcome. I am proud to introduce the inaugural edition of Spira, the new magazine of Children’s Hospital & Medical Center.

A biannual magazine, this fi rst issue is timed to coincide with the unveiling of our new jewel, the Specialty Pediatric Center. You’ll fi nd an article telling about the new facility and the Children’s Specialty Physicians who practice here, as well as stories detailing the expertise of our Newborn Intensive Care Unit and our Critical Care Transport Service; our vision for pediatric health care; my commentary on health care reform; and a profi le of

Nebraska Hospital Association Trustee of the Year and longtime Children’s Board of Directors member and former chairman, G. Richard “Rick” Russell.

The name Spira is borrowed from our striking logo, the “spira mirabilis” or marvelous spiral, a colorful, symmetrical design that depicts the energetic spirit of a child and the care Children’s extends throughout the region and the nation.

Since opening our doors to sick children in 1948, Children’s has grown as an asset to the community while earning a solid reputation for outstanding pediatric health care. I am confi dent you will fi nd the articles and other information in this and future issues of Spira to be enlightening and inspiring. When you’ve fi nished reading the magazine, please consider sharing it with an associate or a friend.

After all, good news deserves to get around.

With best wishes,

Gary A. Perkins, FACHE

President and CEO

Children’s Hospital & Medical Center

With best wishes,

vi s

It is rare that a mission statement is taken to heart by so many people. Yet at Children’s Hospital & Medical Center, from the newest specialist to the most veteran nurse and every medical and support professional in between, the Children’s mission –

“so that all children may have a better chance to live” – is more than words on paper.

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i on

It’s a part of everything we do.

“We are first and foremost a children’s hospital,” says Children’s President and CEO Gary A. Perkins, FACHE. “Because we understand the health needs of children and the needs of the community and the region, we are better equipped to design programs and recruit the specialists and sub-specialists and other pediatric health professionals required to meet those needs and fulfill our mission.”

Perkins recalls the adage, “The more you do of something, the better you do it.”

“That is especially true here at Children’s,” he says. “We are better at treating and healing children because that is all we do.”

Children are not small adults but are small people, each with individual needs and requirements. They require individualized care, experienced and well-trained caregivers, and specialized medications and treatments – resources not found in most adult care hospitals, even those that advertise pediatric care.

“Treating kids is different from treating adults,” says Steve Seline, chairman of Children’s Board of Directors. “We don’t have to stop and calculate what the proper anesthesia is for a child. We do this all day, every day.

“The phrase ‘We know children’ isn’t a marketing expression. It exactly describes our expertise.”

Children’s hospitals are a rare commodity. Of nearly 6,000 American Hospital Association registered hospitals in the

United States, only about 250 are children’s hospitals. Of these, only 50 are free-standing, acute care children’s hospitals – virtually all of which have an academic affiliation agreement with a medical school or college. Children’s is one of those 50.

The demand for the care Children’s provides increases each year, now reaching more than a quarter-million patient visits annually. But while demand for pediatric care rises, the funding sources continue to diminish.

“Our greatest challenge in terms of funding comes from the regulatory changes presented by health care reform,” Seline says. “We are facing enormous financial restraints being put on Medicaid and on private dollars being spent in health care.”

Those restraints are coupled with the increasing cost of technology and equipment.

“Health care today is so much better than it was even five years ago,” Seline says. “But these improvements in care come with a price, and those costs keep going up.”

In addition, the health care reform legislation passed by the federal government specifically excludes from Medicaid coverage non-United States citizens and those in the country illegally.

“The population we serve includes many non-legal residents, as well as uninsured and under-insured children,” Seline says. “Even with government-mandated reforms,

Gary A. Perkins

Steve Seline

And because these words that have been the foundation of care at Children’s for more than six decades are taken literally, they also serve as the springboard for the future, a vision of pediatric health care that ranks among the best available not only in our region but anywhere.

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we will continue to see increased bad debt and charity care.

“We’ll never get to the point where we turn sick children away. But that commitment means we will have to bear a heavier financial burden. In a growing number of cases, we simply won’t be reimbursed.”

That makes philanthropy even more vital.

“Sustained philanthropy will be extremely important as we proceed,” he says. “It’s a fact that our margins are going to shrink and we’ll be more dependent on the money we get from our donors.”

Other challenges include the risk of fragmentation of service due to adult-care hospitals attempting to expand by offering pediatric services. By recruiting pediatric sub-specialists to their own facilities, adult hospitals will make a valuable resource even more scarce for the children’s hospitals that need them the most.

To meet this challenge, “We’ve proven that we can be successful recruiting specialists to Omaha as a direct result of

our academic affiliation with the University of Nebraska Medical Center (UNMC) College of Medicine,” says Perkins. “To afford pediatric physicians and specialists the chance to practice in a children’s hospital, and at the same time be a part of the dynamic academic and research opportunities at UNMC, benefits the community, the state and the region.”

Creative vision can turn challenges into opportunities. Facing what lies ahead with innovation and expertise, Children’s will continue to serve as a source of hope and healing for all children.

“We have some of the best physicians and specialists in the world right here,” Seline says. “We think about children 24/7, 365 days a year. We don’t need a cost-benefit analysis. All we ask is what’s best for the children. It all goes back to our mission, and having that mission gives us so much clarity.

“In terms of our decision making, it becomes real simple. Which option will provide the best care for the children?

“Done. Move forward.”

“We are better at treating and healing children because that is all we do.” Gary A. Perkins, FACHE

Children’s President & CEO

7

specialTyn. 1. a special pursuit, occupation, aptitude or skill. 2. a branch of medicine or surgery in which a physician specializes; the fi eld or practice of a specialist. 3. an asset of special worth. 4. The state or quality of being special. 5. a place of a distinctive kind or particular superiority.

8

“The Specialty Pediatric Center is not just new space or more space, it’s better designed space that allows our outstanding Children’s Specialty Physicians to deliver even more comprehensive care,” says Children’s President and CEO Gary A. Perkins, FACHE. “This new building and the experienced medical professionals working in it enable us to serve the needs of children, their families and the community for the next 20 years and beyond.”

At five stories tall and 135,000 square feet, the Specialty Pediatric Center is the source of expanded outpatient pediatric specialty services for children with chronic conditions including cardiac issues, diabetes, neurologic disorders, developmental delays and cancer.

Designed by HDR Inc. and constructed by the Kiewit Building Group, the facility sets the standard for clinical innovation by weaving family-friendly features and state-of-the-art technology into the latest in design functionality.

Representing the next step in the growth and development of Children’s as a regional pediatric medical center, the Specialty Pediatric Center brings together clinics from the Scott Pavilion with those

which had been housed off site, such as diabetes and orthopedic programs and the pediatric dental clinic. “We now have one home for everyone,” says Vanessa Walls, vice president of ambulatory services at Children’s.

John W. Sparks, M.D., chairman of the Department of Pediatrics at the University of Nebraska Medical Center (UNMC) College of Medicine, says the new center “puts in concrete form the joining of the pediatric specialists in this community and Children’s.”

Dr. Sparks, who also serves as chairman of the board of directors of the 127-member

Children’s Specialty Physicians group, says the new clinical space, as well as the use of former clinic space in the Scott Pavilion as physician and academic offices, furthers interaction and collaboration.

“It’s all centered here,” he says, “and that yields a real sense of community within the pediatric subspecialty group.”

Begun in 2008 as Nebraska Pediatric Practice Inc. as a result of the affiliation agreement between Children’s and the UNMC College of Medicine, Children’s

Specialty Physicians gives access to world-class care and revolutionary new treatments while affording academic physicians and medical students an opportunity to study in the region’s most advanced pediatric setting.

“Children’s and UNMC share a common vision to establish a nationally prominent destination for pediatric health care,” Dr. Sparks says, “a place that provides state-of-the-art clinical care with an emphasis on education, research and discovery.”

He says the affiliation, under which Children’s specialists are also faculty members at UNMC, has fortified an already strong relationship between the two entities and has led to the recruitment of approximately 30 new pediatric specialists. The Specialty Pediatric Center, he says, takes that relationship to the next level.

“We’ve been able to assemble the largest and most comprehensive group of pediatric physicians, specialists and subspecialists in the region,” Dr. Sparks says. “This expertise, along with the new center, means Children’s can take its place among the best in the country in terms of the care of children.”

Strikingly complementary to the hospital and Scott Pavilion structures, the Specialty

“This experTise, along wiTh The new cenTer, means children’s can Take iTs place among The besT in The counTry in Terms of The care of children.”John w. sparks, m.d.

Pediatric Center is a model of innovation and efficiency balanced with comfort and consideration.

A drive-up canopy and extensive handicapped parking access the two-story lobby, while elevators link lower levels of the parking garage to a central registration area and clinic floors. Later this year, a multi-story sculpture by Omaha artist Matthew Placzek will depict children playing outside with umbrellas and parasols rising on a ribbon through a stairwell.

Because many children are accompanied by their siblings, a lobby level “Kids’ Camp” play area staffed by employees and volunteers offers age appropriate toys and activities, from a giant play house to Wii games.

The exterior’s soft, welcoming curves carry over to the interior. The clinics feature spacious waiting areas with spectacular views through bowed floor-to-ceiling windows. Families are given pagers that transmit a message where they should go when their turn is called. Color splashes everywhere, from the carpet with inlaid shapes of stars and snowflakes to the bright circles that rim the recessed lighting.

Each clinic floor has three “modules” that can be used by one specialty one day

and another the next. Exam rooms are larger than those in the Scott Pavilion to accommodate children, parents and siblings. Workrooms and conference rooms give the multidisciplinary teams ample space to meet and collaborate. “In the pavilion, everyone would just meet in the hallway,” Walls says.

The center is wired to accommodate electronic medical records, with handy computer docking stations for data entry. “There are no paper records in the building,” Walls says.

Clinics will relocate early this fall, with the last to be moved by the first quarter of 2011.

The center, and the availability of the specialists within, are hoped to lessen the burden for many families.

“The majority of our children see more than one specialist,” Walls says. “Many have to make multiple visits to access multiple services. The Specialty Pediatric Center allows us to efficiently centralize all those services in one place.”

One place for all children.

John W. Sparks, M.D.

Vanessa Walls

11

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families aren’t the Only Ones whO turn tO Children’s hOsPital & mediCal Center tO Care fOr the tiniest Of newBOrns.

many Other hOsPitals dO, tOO.

These most vulnerable infants are often brought to the NICU by Children’s Critical Care Transport Service, a team of medical professionals trained in neonatal and pediatric critical care who respond by air and by ground using the hospital’s own ambulance.

Sometimes, even before the baby is born.

“When a hospital outside of the city can’t transport the mother here prior to delivery, we go to them and are present for the delivery and to assist if needed,” says Pamela Carlson, MSN, RN, NE-BC, vice president of Patient Care Services & Chief Nursing Offi cer at Children’s. “Then we take over as the transport team and bring the baby to Children’s. That’s the uncommon adaptability our team has to offer.”

Of the 276 transports completed between January 1 and June 30 this year, 59 were newborns. Two were from Council Bluffs, while the rest were from outside the metropolitan area, says Donnetta Perkins, RN, PMP, manager of programs and systems development at Children’s.

To expand its outreach, the transport service is planning to add fi xed-wing aircraft to its modes of critical care travel. “We’re limited to about a 150-mile radius by helicopter, but we’ve brought neonates here by ambulance from much farther away,” Carlson says. “Fixed wing will enable us to offer faster service to a greater share of the region.”

The Children’s transport team is led by 13 neonatal nurse practitioners, advanced practice nurses who are trained

to medically manage a wide variety of neonatal health problems.

The team also includes about 20 intensive care nurses, shares Carlson. “Children’s is the only hospital in the area to actively involve neonatal nurse practitioners in transports. Additionally, many of our team members hold national certifi cations in pediatric critical care, neonatal critical care and/or neonatal pediatric-transport.”

The transport team nurses are also bedside nurses. “The members of the transport team are part of the intensive care team that will treat the infants and children here at the hospital,” Perkins says. “It’s another example of the continuity of care patients receive at Children’s.”

The 46-bed NICU – the largest in Nebraska – is a designated Level IIIC unit, the highest available for NICUs.

The designation recognizes the hospital’s ability to perform advanced neonatal interventions, including extracorporeal membrane oxygenation (ECMO), the use of an artifi cial heart-lung machine for infants whose hearts or lungs are failing despite other treatments; and Ex-Utero Intrapartum Treatments, or EXIT procedures. These EXIT procedures utilize prolonged placental support to allow a multidisciplinary team of caregivers to address abnormalities that may otherwise prevent newborns from breathing on their own upon delivery.

The unit’s furnishings, equipment and technology are designed specifi cally for newborns and their families. This

RECOGNIZED FOR IMMEDIATE ACCESS TO NEONATOLOGISTS,

PEDIATRIC SURGEONS, CARDIOLOGISTS, NEUROLOGISTS

AND A HOST OF OTHER SPECIALISTS, THE NEWBORN

INTENSIVE CARE UNIT (NICU) AT CHILDREN’S TREATS THE

MOST CRITICALLY ILL AND COMPLEX NEWBORNS REFERRED

BY HOSPITALS THROUGHOUT THE REGION.

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includes low lighting and a reduced-noise environment – features for newborns pioneered by Children’s.

Attracting neonatal patients and families from more than 20 states and 415 cities, Children’s strives to produce NICU outcomes that are better than the national averages. “We constantly look at what’s best in evidence-based practice,” Carlson says. “We have a system in place to evaluate where we are and what new procedures and processes we can put into practice.”

Because of their training and experience, the neonatologists, nurse practitioners, nurses and other healthcare professionals at Children’s are capable of handling “the knowns and the unknowns,” problems that are known in advance and those which arise unforeseen. “We have the specialists, the expertise and the facilities to care for the most complex cases imaginable,” Carlson says.

It’s all part of Children’s focus on the child and the family, Carlson says.

“Our knowledge, skills and resources are there for whatever the child and the family need,” she says. “The NICU is a family unit because we understand that the family is a vital part of the caregiving team. From admission to the day they go home, we work together and we provide a solid support system.

“We introduce them to the specialists they may see for many years to come,” Carlson says. “They’ve connected with our case workers, social workers and chaplains. They’ve become comfortable with the care we provide and the services we make available.

“We help them to understand and to learn and to move forward.”

Along the way, personal relationships are forged, as evidenced by the dozens of photos of NICU “alums” that decorate the unit’s waiting area. Carlson says invitations to birthday celebrations, graduations and weddings are received – and often accepted.

“The NICU is a special place for the children, the families and the people who work here,” she says. “The bonds we make last a lifetime.”

Lifetimes that are lengthened because the experts at Children’s go the extra mile – sometimes several hundred miles – to provide the best neonatal care available.

“Our knOwledge, skills and resOurCes are there fOr whatever the Child and the family needs.”Pamela Carlson, MSN, RN, NE-BC

Pamela Carlson, MSN, RN, NE-BC Donnetta Perkins, RN, PMP

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G. Richard “Rick” Russell

has been a force behind

the growth in facilities,

expertise and reputation

at Children’s Hospital &

Medical Center for more

than three decades.

LEAD

e has witnessed the profound effect of progress at Children’s as a member of the board of directors, as board chairman, fundraiser, trustee – and as a

very worried grandfather.

Russell’s daughter, Sara Russell Boyd, and her husband, Matt, were preparing a nursery for their first child when, unexpectedly and nine weeks before her due date, her water broke. Their son Jacob weighed 3.5 pounds and spent four weeks in the Newborn Intensive Care Unit (NICU) at Children’s.

Prior to Jacob’s birth, Russell visited an out-of-town NICU, as well as a new unit in Omaha. “I realized that I hadn’t been through ours (Children’s) in some time, so I took a tour,” he recalls. “I had no idea that within a few weeks I’d be there every day for a month with Jacob.”

Two more grandchildren have followed (Isaiah and Emily Elizabeth), their early arrivals also necessitating brief stays at Children’s. Their successful outcomes served to solidify Russell’s opinion that Children’s “is the right place to be.”

Born in Yankton, S.D., Russell moved with his family to a small town called Millard in 1948, where his father, George (the “G.” in Russell’s name), co-founded Millard Lumber & Grain Co.

A fan of science in high school, Russell had contemplated becoming a doctor, and twice was accepted to medical school. Instead, he graduated from the University of Nebraska-Lincoln with a bachelor’s degree in economics and went on to attend Northwestern University, earning an MBA in finance in 1971.

He briefly worked in the banking industry before being asked by his father to join him at Millard Lumber, which he did in 1973.

Today, Russell serves as president and CEO of a growing corporation with operations in Omaha, Lincoln and Des Moines and more than 200 employees. Russell’s sons, Joel and Mark, are part of his leadership team.

This year marked the 40th wedding anniversary for Russell and his wife, Carol, a former medical technologist who served in the Division of Oncology and Hematology at the University of Nebraska Medical Center.

“She trained at St. Joseph Hospital in Chicago and received her master’s degree in pathology from UNMC,” Russell says. “Her work primarily involved pediatric patients.”

Russell began his own education in pediatric medicine thanks to a request in 1977 from a friend to join the Children’s Hospital Board of Directors. “I wasn’t 30

years old yet. I needed time to consider it. I wasn’t sure what level of commitment it required.”

Eventually he said yes – and hasn’t said no since.

At his first board meeting, discussions centered on the first of two major moves for Children’s – from 45th Street and Dewey Avenue to the Methodist Hospital campus at 84th and Dodge.

The relocation was completed in 1981. Nineteen years later, Children’s moved across the street from Methodist to its own building, now complemented by the new Specialty Pediatric Center.

Recognized in 2009 as Nebraska Hospital Association Trustee of the Year, Russell has twice served as Children’s board chairman and as a member of “nearly every committee they have.” One of three original trustees for the Children’s Foundation, his dedication to the cause has included securing donations to help Children’s continue its move forward – an effort that has often resulted in amazement.

He recalls visiting one prominent Omaha couple and asking them to consider giving a specific suggested amount. “He paused and then told me he thought he and his wife would like to do more. I think he gave four times what I had asked.”

Russell and his wife, who also has volunteered for a variety of events and functions at Children’s, have been members of many civic boards and

Carol & Rick Russell

H

community organizations. Russell’s work on behalf of Children’s, however, clearly occupies a special place in his heart.

“I have truly enjoyed being a part of a very dynamic, growing organization with a wonderful mission,” he says. “I know what it was like 30 years ago. I’ve seen the dramatic growth in services and experience Children’s has to offer. We are so fortunate as a city to have a freestanding pediatric hospital the caliber of Children’s.”

More than the state-of-the-art facilities, Russell says it is the dedicated medical professionals who make Children’s a treasure for the region.

“These people combine their talents to bring about natural miracles every day,” he says. “So many children are alive because of Children’s Hospital & Medical Center.”

Including three who know him as “Grandpa.”

“I know what it was like 30 years ago. I’ve seen the dramatic growth in services and experience Children’s has to offer.”

19

Reform

Inaugural Edition20

It’s a simple answer to an extremely complex question.

The legislation enacted by the leadership in Washington, D.C., known as the Patient Protection and Affordable Care Act (amended later by the Health Care and Education Reconciliation Act), is intended to make health care more available, more affordable and more accountable for all Americans. But like all good intentions, the end result might not be exactly what they had in mind. We won’t know for perhaps a decade or more. The ingredients are there, but until it bakes a while none of us can be certain how it’s going to taste.

What we do know is that many changes lie ahead. There will be dozens of revisions to insurance and benefit packages, increased numbers of Medicaid-eligible children, greater demand for pediatric services and, quite possibly, shortages of skilled physicians, specialists and medical caregivers.

At Children’s, our policy is to treat all sick children no matter their family’s ability to pay. That will not change. But many other things could.

We will feel pressure to reduce costs, contend with increasing federal and state regulation, and survive with the additional financial constraints placed upon us by

the funding of the Medicaid program. The feasibility of low-volume, high-cost services may need to be debated. Fees that no longer will be reimbursed and not passed along to those who are paying for care will surely increase our charity care and bad debt.

It’s not all bad news. Because Children’s is a leader and innovator, there are areas in which we are better prepared to handle these challenges than other hospitals.

For example, we already aggressively promote quality improvements, the cost-effective coordination of care, and collaboration between physicians, specialists and medical professionals. The need to prove our value through data collection and the tracking of outcomes is being met by the ongoing installation of our electronic medical records system. Because of our academic affiliation with the University of Nebraska Medical Center (UNMC) College of Medicine, we are in a prime position to help develop the latest in pediatric treatments, procedures and medicines, and to benefit from their early implementation.

We are a leader in these areas and more because “We know children” – and always put them first.

Obviously, the ways our nation insures and provides access to health care for

our children needed to be improved. And that is good for children. But I believe this vision is extremely short-sighted if our country fails to address the other side of the coin – the measures we should take to prevent pediatric illness, injuries and disease. The most valuable way to spend our dollars is to be certain early and continuing care takes on a preventive tone to help reduce the need for sick care in the future. Our elected leadership has a choice to make: either treat the disease or be content with masking the symptoms.

In time, as the number of children seeking treatment rises and the reimbursement for services declines, as payments and coverage are denied, and as the effects of the health care reform package become clear, only then will we know how much more we are expected to do – and with how much less.

Commentary by Gary A. Perkins, FACHE President and CEO Children’s Hospital & Medical Center

Reform

When asked what I think health care reform will mean to Children’s Hospital & Medical Center, I summarize a 2,600-page federal document in one sentence: We’re going to have to do more with less.

So that all children may have a better chance to live.

ChildrensOmaha.org