THE CURRENT STATE AND FUTURE OF SHRINE HOSPITALS

Written by By Ben Boothe Sr. Member of Board of Governors,
LA Shrine Children’s Hospital, Los Angeles, California
Member of Shriners, State of New Mexico

When the Shrine Hospitals were organized we were almost “the only ones on the block” who were interested in children’s care and particularly uninsured children, or those who could not afford healthcare. There were few children’s specialists and fewer children’s hospitals. The Shrine Hospitals for 90 years have never charged a child for medical treatment and have built a huge reputation of good will. Because of this, on March 26, 2014, Mr. and Mrs. Klause Kiskell, (immigrants from Germany) visited our board meeting, and Mr. Kiskell (who is a Shriner), donated a check of $100,000.00. This is the type of support enlightened Shriners are willing to give, because of the good work of this hospital, and our 100+ employees and staff were greatly encouraged by this. Amazing isn’t it…the good people who create encouragement, build people up and this helps all to “help the kids” with even more commitment.

In today’s health care system, the Shrine Hospitals are showing progressive innovation, because the health care industry has changed drastically. Now hospitals in every city are competing for “kid” patients, because now, kids are profitable, for the bottom line. The conversion to a “For Profit” hospital system has, in the opinion of the Shiners, been detrimental to health treatment in some ways, and the Shrine Hospitals stand out as one of the few major charitable hospital systems for children, with 22 hospitals in the USA and more under construction.

The Shrine Hospital for Children in Los Angeles, committed to serving as a “hospital” providing surgery, until the new hospital center is completed.

The new center has been designed with input by doctors, architects and Shriners, and the design concept has been called brilliant, and is voted, approved and contracts already let for construction by the board. Regular reports and invitations to Divans and Potentates throughout the Southwest have been provided during this process with overwhelming support over the past years.

Plus the hospital is gleaning international recognition, with the Children of War Foundation patients (Shah Bibi and Abdul) who lost limbs due to the American war in Afghanistan, and who this hospital treated. BBC and others are giving this world-wide media exposure. We have also expanded outreach to Spanish Leaders in Care, through publications and have many new patients in the Tijuana Clinic.

Over the years, health care in the USA has changed which offers fantastic new opportunities for service, IF WE ARE SMART AND PROPERLY USE THE NEW HEALTH CARE SYSTEM. Now, insurance has become a powerful motivator, for hospitals to seek a profit motive, while many pure charitable or county hospitals have been sold, or consolidated into “for profit” entities. One might say that when we changed the mix from “health care” to “profit motive”, hospital systems began to reflect amazing increases in health care costs. This increase continued to rise up to 30% per year, until economists realized that this could break our economic system. So a new format of healthcare was implemented, to control insurance companies and health providers in a way that the costs would stop skyrocketing. The new health care law, essentially puts charitable hospitals on a rare category, because the “pool” of kids who are not covered by insurance has been reduced, as under the new law, a goal is that every child will be insured. Thus, the Shrine Children’s Hospitals (as a non-profit organization) are seeing that not only are we not the only game in town…because every town now has a “for profit” children’s hospital. But we are a part of a diminishing number of pure charitable organizations. We are finding that increasingly, with giant “for profit” hospitals spending hundreds of millions, perhaps billions on new equipment and new facilities, that if we find ways to work with them, allowing them to satisfy reporting and regulatory requirements of this new age, then we can give our “Shrine kids” the best of both worlds and still remain a charitable organization. 

The 22 Shrine Hospitals will need to partner or affiliate with other large hospitals to be able to function within the new healthcare laws. This is the future of the Shrine hospitals, and this strategy has been led by the Shrine Children’s Hospital of LA, and adopted by the Shine Hospital system.

To detail this, the Shrine as a system, has determined that instead of us trying to keep a 24 hour radiology, 24 hour anesthesia access, 24 hour emergency rooms, or extensive surgery rooms, or long term care arrangements that we must “work smarter” and be more efficient. With new changes in the national health care environment, all hospitals must meet even higher standards. To spend hundreds of millions of dollars on equipment and facilities, to replicate equipment and facilities already in place at neighboring hospitals is foolhardy, and a waste of the contributions the Shriners work so hard to bring to help kids. The giant hospitals in every community are often thrilled to have an association with the Shrine Hospitals. As an example Los Angeles has spent considerable time, thought and research, to create this new model, that is being adopted throughout the Shrine Hospital system, thus “partnering” with large, giant and modern facilities, and working with the best specialists in any given market to provide the best facilities and care for kids. When we build, we are building next to or near giant hospital complex facilities. In the long term, it is anticipated that every Shrine Hospital will be converted to a facility that works with and often uses specialized equipment of the big hospital next door. We may even have ‘Shrine Wings’ in large hospitals with our statue, logo and our people taking care of the kids, doing the surgeries and also with local doctors consulting with our Shrine people every step of the way.

QUALITY IS KEY:

The Shriners Hospitals for Children of Southern California was subject of a Joint Commission Status Survey Audit, an independent audit/survey reviewing and auditing details of the treatment, operations, facility and critiquing the medical facility treatment. This is in compliance with required regulations. The surveyors were Jacquelyn Duplantis, RN, MSN, Team Leader, and Michael Bernstein, CHFM, MBA, Life Safety Code Specialist and Dr. Richard Rabens, MD, MPH, FAAP-IMQ Physician Surveyor. The results of this very detailed study were helpful, and immediate steps were taken to respond to all findings. Joint Commission survey comments to hospital executives were: “The quality of staff and procedures is exceptional and leads the Shrine system in quality and best practices”. At a meeting of the Board of Governors on 3/26/2014, there was review and acceptance of this audit and the conclusions. The Shiners deem “quality of service” to the kids of highest priority and it is one of the reasons the LA Shrine has continued to lead the way for the system to continue the traditions of progress and leadership for service to children. This type of quality is something that we encourage throughout the Shrine system, and as a result “Shrine Hospitals” do a better job for children, than almost anyone.

The LA Hospital has done 40 surgeries at Huntington hospital, on a facility shared partnering basis and this has improved the quality of medical care substantially because of access to the best, modern equipment and facilities available…something that our specialized hospitals simply cannot afford or justify. Pain management is superior at Huntington, it has more advanced equipment, with many back up anesthesiologists allowing our Shrine surgeons and staff to do a better job. We have back up of many doctors to help our Shrine physicians, when we work with a larger hospital and this support staff saves lives, plus we can thus do many more complex cases. It is safer and far less costly than doing some of the surgery in our facility.

While the Shrine Hospital of LA continues to function as a hospital at this board meeting Dr. Mosley (former Chief of Staff and current MD for training) said: “We still do surgeries and procedures here and will continue to do so.” We admit and see children in our LA Children’s hospital and treat the basic and straightforward cases, at this historic facility. But if a complex cases requires better equipment, facilities, and the back of medical staff that only a larger hospital can provide, we use the superior equipment of Huntington hospital and it is a “Win-Win” situation. This enables the Shriners to handle a broader array of children issues.

Our new hospital is being built in close proximity to other medical facilities, because there are so many advantages in being near the “big boys” who have more comprehensive people and equipment. In every case, our doctors and our people do the surgery. Our treatment is done by and supervised by Shriners. Hospitals throughout the Shrine system are making similar changes or planning to do so, because it is our new Shrine working model that is logical and best for kids. Recently I spoke to Cecil Starks who has a hospital construction team to ask if they thought the Shrine concept was feasible and he said: “Yes, I can envision building state of the art clinics in Shrine Temples (in places that have never had this quality of facility) , free standing units at teaching hospitals or regional medical giants, or even hospital wings in big hospital buildings throughout the nation for Shriners, that give the most effective integration and coordination with large ‘for profit’ hospitals. In our view it is brilliant planning on the part of Shriners as led by the Shrine Children’s Hospital of LA.”

RESEARCH:

The Los Angeles Children’s hospital lists the following current research projects:

1. Complications associated with intraoperative distraction for scoliosis correction
2. VEPTR (Vertical Expandable Prosthetic Titanium Rib)
3. Eccentric ossification of the proximal femoral epiphysis in developmental hip dysplasia
4. Complications in pediatric plastic surgery and correlation with body mass index
5. The chest wall and spine deformity registry study
6. Sensory and motor function of surgery for congenital hand deformities
7. Frisk factors for osteoporosis in children with spina bifida
8. Research on compression garment scar and Webcreep after congenital Syndactyly release.
9. Radiographic complications and functional outcomes after Pollicization
10. Outcomes of constriction band release in the upper and lower extremities without the use of Z-plasties
11. Effect of open reduction surgeries on final radiographic outcome in developmental dysplasia of the hip.
12. Maternal exposures, genetic susceptibility and environmental factors in the etiology of oral clefts

Dr. Matt Bernstein from Cedars Sinai and Dr. Todd Milbrandt from SHC Lexington, Kentucky and Dr. Steve Frick from Nemour’s Children’s Hospital led an extensive symposium on wide areas of pediatric orthopedic surgery at the Children’s Hospital , Los Angeles April 18 and 19th.

Dr. Cho is presenting a research abstract to the national Pediatric Orthopedic Society.

Dr. Song has developed an abstract for the American Academy of Orthopedic Surgery on Comparative Effectiveness Research. 

The hospital is working to establish an external HIRB review process with an academic partner.

The hospital has recruited a new PA with research experience to oversee and help lead research efforts.

Take a look at some of our doctors:

If we do not progress and adapt we will not have a system. For example, the State of New Mexico provides fewer and fewer children to the Shrine hospitals in the current environment and often the kids and parents object to long travel from NM all the way to a far off Shrine hospital. Sometimes this is hard on both the kids and the parents, not to mention the expense to local temples. Then when they arrive, matters of food, lodging and living expense must be considered. Plus the new health care law takes much of the population of kids into a “non charity status” and they are likely to be served by the biggest hospitals who do a good job of managing government insurance programs. 

22 Shrine Hospitals are moving toward having a Shrine Clinic in every major city, to work and partner with the biggest and best hospitals of the area! The new system will give the “big boys” reason to send us their kids because we can fill the gap in “deductibles and co pay” for those who need the help. It may be a matter of survival if we wish to continue to attract and treat more kids. But the lack of kids is one reason the “Wounded Warrior” program is being developed, to use the many empty beds that we already have in a positive way! Consider this. If you were a wounded veteran, would you wish to go to a VA Hospital, or to a Shrine Hospital with ours?

Let me give you an example of how “shared partnering” with our facilities and a giant hospital nearby works.

I have a grandson who was born prematurely and almost died in a giant hospital in Dallas. He also had a club foot and after $150,000 in expenses the insurance company ran for the hills. My son was looking at crippling hospital bills. It was then that the “Big” hospital recommended our sister organization, the “Scottish Rite Children’s Hospital” of Dallas, to partner in treatment with the giant “for profit” hospital that my grandson was in, in Dallas and took over the care of this baby. The Scottish-Rite still used the facilities of the “Giant” hospital, but consulted with and took control of the treatment. It was a financial lifesaver for the parents and the child has done very well, with the doctors and hospitals working together. Both refer patients to each other and it is a win-win for all concerned. This is an example of the future of the Shrine system, and through this we can provide even better service for our kids. 

Our future: The Shrine System, will succeed and expand as long as Shriners support progress, innovated approaches and flexibility to change as health care delivery in the United States changes. Thus far, most Shriners in the USA have been supportive, and have encouraged change instead of fearing or opposing it. 

My prediction is that enlightened people will see change and flexibility as a positive. If we can imitate the Shrine Hospital of LA, and see how they have adapted to the new environment, I predict another 90 years of Shiners helping our kids!