Community hospital partnerships facilitate geographic expansion in 13 counties; subspecialty practices grow
Spurred by the success of the Nemours’ lean journey that began in 2008, the opening two years ago this month of Nemours Children’s Hospital (NCH) in Lake Nona Medical City, and the resulting organizational synergy, Nemours is expanding geographically and boosting pediatric specialty services.
“We’re creating a medical system that can take care of all aspects of patient care,” said Nemours CMO Lane Donnelly, MD. “Outreach was a big part of the planning. There were portions of it that involved primary care, expansion of our sub-specialty practices, development of urgent care services, and partnerships with community hospitals, such as our hospitalist program.”
Last month, Nemours expanded specialty pediatric hospital care in Brevard County at Wuesthoff Medical Center-Rockledge by providing newly recruited, hospital-based pediatric physicians specializing in the care of acutely ill infants, children and adolescents. Nemours’ pediatric hospitalists work closely with primary care providers and other pediatric specialists in Wuesthoff-Rockledge’s newly renovated pediatric wing consisting of nine private rooms. They are also available to consult with Wuesthoff-Rockledge’s emergency department personnel. Nemours has similar arrangements with hospitalists at the Heart of Florida Regional Medical Center in Haines City.
“This relationship brings a new level of expertise to the Wuesthoff Health System that will help us provide hospitalized children with high quality, specialized medical care,” said Wuesthoff Health System CEO Tim Cerullo. “We’re pleased to work with (Nemours) to make these services available in our community.”
John Kennedy, MD, a pediatrician in Brevard, called the agreement between Wuesthoff Health System and NCH “an exciting chapter in the future of healthcare for our county and its youngest residents ... (and) an invaluable resource in the event of a childhood illness or medical emergency.”
Nemours’ coverage now extends to 13 Florida counties – Brevard, Clay, Duval, Escambia, Holmes, Indian River, Lake, Okaloosa, Orange, Osceola, Polk, Seminole and Volusia. Nemours has cared for patients from 60 of 67 Florida counties, 49 states, and 54 foreign countries.
In addition to the Wuesthoff agreement, Nemours recently moved a children’s subspecialty practice from Viera to Melbourne to implement added benefits.
“The relocation allowed us to provide additional subspecialty services than we could fit in our old facility, and also provide improved ancillary support to round out a more effective pediatric orthopedic clinic,” explained Donnelly. “We’ll also begin to offer urgent care services, using the same facility at nights and on weekends, specifically for children.”
Since NCH opened, Nemours has grown from three satellite subspecialty clinics to 19 locations in the region, including Nemours Children Primary Care, Nemours Children’s Urgent Care and Nemours Children’s Specialty Care.
Over the same 24-month period, the number of NCH physicians has mushroomed from 16 to 142. Of those, 115 are pediatric subspecialists, 16 are primary care providers, and 11 are urgent care providers. Of the pediatric subspecialists, two are pediatric interventional radiologists. Nemours has a neurologist specializing in the treatment of neuromuscular disorders and also employs the only surgeon in the southeastern United States treating children who live with intestinal failure.
“For the most part, we recruited pediatric subspecialists from the top pediatric medical centers all around the country,” said Donnelly, a native Philadelphian recruited to Orlando four years ago from Cincinnati, Ohio. “We were able to attract top talent because they were very aware of Nemours’ vision and mission. They were excited to participate in the opening of a children’s hospital, which is very uncommon these days, the geographic location in Lake Nona Medical Center near the Orlando International Airport, and to be part of the creation of an academic-type atmosphere where we’re not only providing top local care for children, but we’re also striving to improve that care for the future.”
The greatest challenge of growing at a fairly rapid pace has been matching staffing with the rate of growth in an accurate way, said Donnelly.
“Predicting accurately where we believe the volume will be the next quarter is a fairly consistent challenge,” he explained. “Our biggest challenge is with nurse staffing because of the lead time for idenifying and orienting new staff. In addition to accurately predicting growth, being a startup ortangization has both advantages and disadvantages. Being new, we’re nimble to adjusting to change, but we’re also still creating critical mass and growing tertiary niche services.”
Telehealth services is the next significant priority for Nemours, Donnelly emphasized. However, state legislative action will be needed in 2015 to reimburse telehealth visits at the same rate as in-office visits. The Florida Medical Association is lobbying for that change.
“We’re looking at ways to implement telehealth in an attempt to bring the most cost effective and convienent care to children and families. In addition, we have plans for continuing to develop multiple subspecialty clinic sites, other primary care centers, and expanding urgent care … to also make care more convienent for families,” noted Donnelly. “All these things will continue to grow. Our relationship with community hospitals is extremely important to us, partnering with them in a way we can promote children being cared for in their own community and only being transferred to Nemours Children's Hospital when they need more intensive care.”