Hospitals are pulling the rug out from under kids with Asthma
Or more accurately, not pulling the rug out from under them. A new Washington Post investigation chronicles the skyrocketing costs of Asthma care in Baltimore, much of which is preventable with the right intervention — such as simply removing moldy carpets and wallpaper from families’ homes.
Nationally, asthma rates are 50 percent higher in families below the federal poverty line. This socioeconomic disparity is clearly visible in Baltimore’s Lemmon st. neighborhood, which has four times the asthma-related hospital visits of the city’s wealthy counties.
The issue isn’t that we don’t know what to do: As the piece details, “Science has shown it’s relatively easy and inexpensive to reduce asthma attacks: Remove rodents, carpets, bugs, cigarette smoke and other triggers. Deploy community doctors to prescribe preventive medicine and health workers to teach patients to use it.”
It’s also not about figuring out how to pay for interventions. The federal government has spent $1.3B on asthma prevention research, $200M of which has gone to Johns Hopkins, right in Baltimore. Extensive analyses have outlined alternative approaches to financing interventions based on the simple cost savings of avoided readmissions, as well as the more complex but sensible economic cost-savings that come from higher school attendance and better overall health for kids, less time missed from work for caregivers, and so on.
A distance between the status quo and common sense
As Eric Letsinger, the CEO of DC-based social impact investing firm Quantified Ventures points out, “There’s a distance between the status quo approach and applying common sense.” Letsinger’s firm has administered a small pay for success project in Baltimore to rip out carpets in asthmatic households.
Medicaid agency officials claim their hands are tied as to housing-related interventions they’re able to use department funding towards, while the Housing agencies claim the same thing about health-related interventions. Finding a third party payer to fund carpet removal and home cleanup could save millions of dollars, which could then be recouped by investors and payers alike.
The problem here is scale and inertia. Baltimore’s City Health department’s asthma task force has just three employees who have a waitlist to visit houses and conduct manual interventions, such as getting landlords to pay for cleanup. In some other places around the country, such as Kansas City, MO New York City’s Bronx neighborhood, and Rochester, NY, cities have been able to align resources and incentives through partnerships between payers and providers, or the use of philanthropic grant funding as a bridge to permanent payer funding.
Not in Baltimore, yet. Hospitals make far more money treating asthma attacks (and collecting federal research dollars to look into the problem) than preventing them. According to the Post, Baltimore’s three largest hospitals collected $84M in Asthma-related revenues from 2012–2015 (including $6.1M of profits generated by just 50 “frequent flier” asthma patients) while touting small awareness and prevention campaigns at health booths and charity fairs in the city.
In neighboring Washington, Children’s National Hospital reduced asthma-related admissions by 40 percent by acting on recommended evidence to implement an intervention program, only to suffer a multi-million dollar hit to their bottom line.
Unfortunately, this is yet another case where the research to practice gap of public health is intentionally pried apart by perverse financial incentives of our profit-driven healthcare system. The transition towards value-based care is supposed to be reducing the amount of hospital profiteering off of the volume of suffering families, yet it seems to be propping up a reliance on predictable profit centers like pediatric asthma admissions.
Here’s hoping that the Post exposé will lead to some positive behavior change.
