Recently, longtime hospital executive Matthew Cook moved to DC for a new job as CEO of the Children’s Hospital Association, the trade group for more than 200 of the nation’s pediatric hospitals. He spoke with us about what he wants to achieve. “Kids are the future of this country,” he says, “so we should be investing more in them, not less.”
What are the main healthcare issues facing children today?
One is the mental-health crisis, which has been steadily growing for a decade. But right now, the leading cause of death for kids is actually guns. And that’s important when we also have this mental-health crisis, because we certainly don’t want kids that have thoughts about suicide having easy access to a firearm.
What obstacles do hospitals face when they’re trying to take care of children?
Most kids in this country are covered by Medicaid, and that makes financial sustainability really challenging for children’s hospitals, because the reimbursement rate is really low. It’s difficult when your primary insurance program is one that produces a loss on every patient, so you have this real issue of financial sustainability.
We also have significant workforce issues in children’s hospitals. There are specialties where there’s just a handful of people coming out of training programs in any given year—pediatric neurology, genetics, child and adolescent psychiatry—and you have an entire country trying to recruit that very limited number of specialists. We just don’t have a workforce that meets the needs of the country, and we need to figure out how to get there.
Providing gender-affirming care has been thorny for children’s hospitals. Have you worked on that?
It’s a really complicated issue. A number of states have restricted gender-affirming care, but we operate more at the federal level. Where we have been active is that there were some attempts by certain law-makers, primarily in the House, to tie funding for [a pediatric workforce program] to gender-affirming care—essentially, that you couldn’t receive the workforce funds if you were providing gender-affirming care. Our position was that this is a workforce program; don’t confuse it with views on very specific medical decisions. We think [gender-affirming care] is an issue between patients and families and their physicians.
What was Covid like for children’s hospitals?
The pandemic impacted children’s hospitals very differently than adult hospitals. Covid wasn’t as big of an issue for children—they were not as sick as adults. And so children’s hospitals really struggled during the pandemic because their patients went away. Everybody stayed home. Then children’s hospitals weren’t included initially in the provider relief funding that went to hospitals. Those dollars largely went to adult hospitals. So the pandemic really had a detrimental impact on the financial sustainability of children’s hospitals, and it’s persisting to this day. We have a lot of children’s hospitals that have very, very tight operating margins, and they’re really struggling to figure out what the path forward is.
This article appears in the April 2024 issue of Washingtonian.
