1 00:00:05,305 --> 00:00:07,355 - This is the Becker's Healthcare Podcast created 2 00:00:07,355 --> 00:00:08,515 by the team at Becker's Healthcare, 3 00:00:08,675 --> 00:00:10,395 a multimedia company devoted to the people 4 00:00:10,415 --> 00:00:11,715 who power us healthcare. 5 00:00:11,985 --> 00:00:14,835 Four new 15 minute episodes are released daily containing 6 00:00:14,995 --> 00:00:16,755 industry news analysis and thought leadership. 7 00:00:16,755 --> 00:00:19,675 From powerful healthcare decision makers Support our show 8 00:00:19,775 --> 00:00:22,595 by leaving it a five star rating and review on Apple Podcast 9 00:00:22,815 --> 00:00:24,075 or other platforms you use. 10 00:00:24,225 --> 00:00:26,075 It's a chance to tell us what you like about the show 11 00:00:26,095 --> 00:00:27,315 and act on your feedback. 12 00:00:27,315 --> 00:00:29,275 Thanks for listening. Now here's the episode. 13 00:00:30,385 --> 00:00:32,715 - This is Chris Oster with the Becker's Healthcare Podcast. 14 00:00:33,515 --> 00:00:35,995 I feel today to be joined by Larry Levine, president 15 00:00:35,995 --> 00:00:38,515 and CEO of Live Dale Children's Hospital in New York. 16 00:00:38,805 --> 00:00:40,235 Larry, thank you for joining us today. 17 00:00:41,675 --> 00:00:43,875 - A pleasure to be with you, Chris. Thank you for having me. 18 00:00:45,265 --> 00:00:46,435 - Much appreciated. Larry, 19 00:00:46,435 --> 00:00:47,715 would you mind introducing yourself 20 00:00:47,715 --> 00:00:49,595 and telling us a bit more about your background? 21 00:00:51,175 --> 00:00:54,195 - Oh, sure. So I'm the, uh, president 22 00:00:54,195 --> 00:00:57,475 and CEO here at Blythedale Children's Hospital in New York. 23 00:00:58,375 --> 00:01:01,515 Uh, I've been CEO here since 2001, 24 00:01:02,495 --> 00:01:05,595 and um, this is my 48th year 25 00:01:06,255 --> 00:01:07,875 of work in the healthcare field. 26 00:01:08,655 --> 00:01:12,955 Uh, started way back in 1976 as a graduate at the University 27 00:01:12,955 --> 00:01:14,075 of Michigan School of Public Health. 28 00:01:15,455 --> 00:01:17,515 And Chris, my, my career has kind 29 00:01:17,515 --> 00:01:19,035 of spanned three different jobs. 30 00:01:19,345 --> 00:01:23,195 I've worked in Capitol Hill, I worked then as a consultant, 31 00:01:23,975 --> 00:01:25,635 as a healthcare management consultant 32 00:01:25,635 --> 00:01:27,595 with expertise in children's hospitals 33 00:01:28,335 --> 00:01:30,715 and of course the last several years working in 34 00:01:30,835 --> 00:01:31,955 children's hospital management. 35 00:01:33,405 --> 00:01:35,635 - Larry, we definitely appreciate you bringing your 36 00:01:35,635 --> 00:01:37,515 expertise to our podcast today. 37 00:01:38,015 --> 00:01:40,515 Here's where we're gonna start. So while I understand it's a 38 00:01:40,515 --> 00:01:43,635 very long list, what issues facing children's hospitals do 39 00:01:43,635 --> 00:01:45,395 you find most preceding today? 40 00:01:47,215 --> 00:01:51,065 - Well, sure. Well, there's, uh, a few that I can, 41 00:01:51,265 --> 00:01:53,265 I can click off the top of my head. 42 00:01:54,365 --> 00:01:58,105 One is, uh, it's really important for children's hospitals 43 00:01:58,165 --> 00:02:01,345 to protect Medicaid from funding cuts. 44 00:02:01,925 --> 00:02:06,305 And the reason for that is nationally, Chris, about 50% 45 00:02:06,305 --> 00:02:08,225 of kids are covered by Medicaid. 46 00:02:09,475 --> 00:02:12,495 And Medicaid is the leading payer by far at most 47 00:02:12,495 --> 00:02:14,335 of our nation's children's hospitals, 48 00:02:15,035 --> 00:02:17,655 around 55% on average. 49 00:02:18,195 --> 00:02:21,535 And here at Blythedale, more than 70% 50 00:02:21,535 --> 00:02:23,495 of our patients are covered by Medicaid. 51 00:02:24,675 --> 00:02:28,535 So you can understand when the budget is being talked about 52 00:02:28,825 --> 00:02:32,535 nationally and even at the state level when the deficit 53 00:02:33,015 --> 00:02:34,015 hawks come out. 54 00:02:35,215 --> 00:02:38,455 Medicare and social security are always protected, 55 00:02:39,075 --> 00:02:42,695 but Medicaid is never considered as a sacred cow. 56 00:02:43,435 --> 00:02:45,375 We really have to worry about Medicaid funding 57 00:02:45,655 --> 00:02:47,535 'cause it's so important for children's health. 58 00:02:48,835 --> 00:02:52,095 Second, what's really interesting is there's a lack 59 00:02:52,095 --> 00:02:56,335 of adequate numbers of home care nurses in the nation 60 00:02:56,435 --> 00:02:58,455 to care for medically complex kids. 61 00:02:59,195 --> 00:03:00,805 It's a real national problem. 62 00:03:01,905 --> 00:03:04,285 And what's happening in pediatrics is 63 00:03:04,285 --> 00:03:08,205 that many kids can be treated on an ambulatory basis. 64 00:03:09,275 --> 00:03:12,575 So the kids who remain hospitalized tend to be much sicker 65 00:03:12,845 --> 00:03:15,335 with complicated illnesses and conditions. 66 00:03:16,315 --> 00:03:19,695 In order for these kids to be successfully discharged home, 67 00:03:20,475 --> 00:03:23,375 you have to have home care nurses in numbers 68 00:03:23,595 --> 00:03:27,735 and with experience to care for kids on ventilators, kids 69 00:03:27,735 --> 00:03:31,815 that have tracheostomies or complex medication regimens. 70 00:03:32,595 --> 00:03:36,095 And yet there is a national shortage of these nurses 71 00:03:36,825 --> 00:03:39,815 which places burdens on parents to care for these kids 72 00:03:40,475 --> 00:03:44,335 as well as on hospitals and discharging them safely home. 73 00:03:44,955 --> 00:03:47,815 So that's kind of a second problem for us. 74 00:03:48,215 --> 00:03:51,735 A third one is really protecting children's 75 00:03:52,255 --> 00:03:55,335 GME funding GME funding. 76 00:03:55,385 --> 00:03:58,335 Chris is important for children's hospitals 77 00:03:58,995 --> 00:04:02,415 as it's an important funding source for pediatricians 78 00:04:03,155 --> 00:04:07,295 and pediatric specialists coming out of, uh, residency 79 00:04:07,355 --> 00:04:08,455 and training programs. 80 00:04:09,565 --> 00:04:13,035 Since freestanding children's hospitals don't get CGME 81 00:04:13,035 --> 00:04:14,315 funding through Medicare, 82 00:04:15,915 --> 00:04:18,555 children's hospitals have a separate program of, 83 00:04:18,855 --> 00:04:20,155 uh, C-H-C-M-E funding. 84 00:04:21,315 --> 00:04:25,455 And again, unlike Medicare, GME, which is mandatory funded, 85 00:04:26,775 --> 00:04:29,055 C-H-C-M-E is a discretionary grant 86 00:04:29,555 --> 00:04:33,095 and we have to get that reauthorized every five years. 87 00:04:34,395 --> 00:04:37,735 What's really important for us to note is 88 00:04:37,735 --> 00:04:42,615 that CME funding GGME hospitals make up only 1% 89 00:04:43,395 --> 00:04:46,895 of our nation's hospitals, only 59 per 59 90 00:04:46,895 --> 00:04:48,735 of us get C-H-G-M-E funding, 91 00:04:49,595 --> 00:04:52,255 and yet we train nearly 40% of the workforce. 92 00:04:53,465 --> 00:04:56,605 So those are some of the most important, the top three 93 00:04:57,245 --> 00:04:58,885 problems I think that we have. 94 00:05:00,905 --> 00:05:03,415 - Thank you for laying laying those out for us, Larry. 95 00:05:03,555 --> 00:05:05,615 So on that note, why is it so important 96 00:05:05,615 --> 00:05:07,495 for healthcare executives, particularly those 97 00:05:07,495 --> 00:05:08,975 that pediatric care centers 98 00:05:09,515 --> 00:05:11,375 to come involved in legislative process? 99 00:05:14,065 --> 00:05:17,955 - Yeah, I think we as CEOs could really utilize our position 100 00:05:18,575 --> 00:05:21,955 to vigorously advocate for our patients and our families 101 00:05:22,845 --> 00:05:26,185 and to fully engage in the public policy process. 102 00:05:26,965 --> 00:05:29,265 You know, Chris, there's two types of advocacy. 103 00:05:30,085 --> 00:05:33,865 So we can do, one is first and foremost is to protect 104 00:05:33,865 --> 00:05:35,865 and advance the interests of our hospitals, 105 00:05:37,225 --> 00:05:40,205 but also to advocate for broader policies 106 00:05:40,345 --> 00:05:42,045 to help our patients and families, 107 00:05:43,105 --> 00:05:46,845 and particularly for children's hospitals, we have 108 00:05:46,845 --> 00:05:49,845 to educate policy makers about what the needs of kids are, 109 00:05:51,165 --> 00:05:56,035 write legislation, comment or testify regarding regulations, 110 00:05:56,815 --> 00:05:58,485 and certainly to weigh in on state 111 00:05:58,485 --> 00:06:00,365 and federal and state budget. 112 00:06:01,425 --> 00:06:04,405 Um, you know, I just mentioned three of the top 113 00:06:05,035 --> 00:06:09,285 institutional concerns that we have at children's hospitals, 114 00:06:09,865 --> 00:06:13,125 uh, Medicaid funding, C-H-C-M-E funding 115 00:06:14,105 --> 00:06:15,805 and home care nurses, 116 00:06:16,905 --> 00:06:21,045 but children's hospital CEOs are also really worried about 117 00:06:21,045 --> 00:06:24,885 broader issues that impact a child's physical 118 00:06:24,885 --> 00:06:27,575 and mental health and their quality of life. 119 00:06:28,535 --> 00:06:31,755 And so, you know, I think we as a group of 120 00:06:32,315 --> 00:06:37,235 children's hospitals have to really go to bat for these kids 121 00:06:37,255 --> 00:06:39,995 and these families, many of whom are at a very 122 00:06:40,605 --> 00:06:42,155 vulnerable time in their life. 123 00:06:42,405 --> 00:06:44,555 Thank God most children don't get sick, 124 00:06:45,255 --> 00:06:48,915 but those that are sick that have a lot of different issues, 125 00:06:49,995 --> 00:06:54,715 I think as CEOs, we really need to advocate 126 00:06:54,735 --> 00:06:59,035 for policies and for regulations and budgets to protect 127 00:06:59,035 --> 00:07:00,555 and advance the quality of life 128 00:07:01,135 --> 00:07:02,555 and the healthcare of these kids. 129 00:07:03,575 --> 00:07:07,675 And I've always taken that as a mantle of importance for me 130 00:07:07,695 --> 00:07:10,075 as a CEO to be an, uh, an activist 131 00:07:10,575 --> 00:07:12,475 to really work at the federal 132 00:07:12,535 --> 00:07:17,155 and the state level, um, to put together policies that, um, 133 00:07:17,385 --> 00:07:19,275 that help these children and families. 134 00:07:21,535 --> 00:07:22,585 - Clearly patients 135 00:07:22,585 --> 00:07:24,705 and caregivers need people like yourself, 136 00:07:24,705 --> 00:07:25,985 Larry, to be doing that work. 137 00:07:26,085 --> 00:07:28,225 And you've been doing this clearly a 138 00:07:28,225 --> 00:07:29,265 long time as you mentioned. 139 00:07:29,845 --> 00:07:33,385 Uh, zooming in a little bit, could you detail a little bit 140 00:07:33,905 --> 00:07:35,625 policies that you've helped bring to fruition 141 00:07:35,765 --> 00:07:37,145 and what that process entails? 142 00:07:39,195 --> 00:07:42,365 - Yeah, so Chris, I've gotten, 143 00:07:42,765 --> 00:07:44,525 actually in my tenure here at blythedale, 144 00:07:44,555 --> 00:07:48,285 I've gotten three pieces of legislation written passed 145 00:07:48,425 --> 00:07:49,925 by our state legislature 146 00:07:50,065 --> 00:07:52,885 and signed into law by three different governors. 147 00:07:54,265 --> 00:07:57,645 And they've dealt with improving covered benefits 148 00:07:58,405 --> 00:07:59,675 under the SSIP 149 00:07:59,695 --> 00:08:04,315 or the Child Health Plus program, uh, here in New York, uh, 150 00:08:04,795 --> 00:08:07,475 Medicaid hospital reform for children's hospitals. 151 00:08:08,335 --> 00:08:12,515 And most recently our governor, uh, signed into a law, 152 00:08:13,295 --> 00:08:17,595 uh, a statute which provides sweeping requirements 153 00:08:18,325 --> 00:08:19,785 for Medicaid managed care 154 00:08:19,965 --> 00:08:23,755 and commercial payers in determining the way medical 155 00:08:23,945 --> 00:08:28,875 necessity, uh, is defined and provides special protections 156 00:08:29,015 --> 00:08:31,315 and accommodations for medically fragile children. 157 00:08:32,095 --> 00:08:34,515 And that law went into effect on September one. 158 00:08:36,985 --> 00:08:38,325 - That's excellent, Larry, thank you 159 00:08:38,345 --> 00:08:40,525 for letting us know about those efforts. 160 00:08:40,955 --> 00:08:43,245 Looking ahead a little bit, are there changes 161 00:08:43,805 --> 00:08:45,165 policies you're hoping to enact next? 162 00:08:45,225 --> 00:08:48,845 And what advice would you give others, CEOs in particular 163 00:08:49,025 --> 00:08:51,925 who are looking to follow in footsteps that you've laid out? 164 00:08:53,965 --> 00:08:58,885 - Yeah, so right now, uh, an important policy, uh, 165 00:08:59,105 --> 00:09:03,085 in front of Congress is to extend the child tax credit. 166 00:09:04,085 --> 00:09:07,295 This helps lift many children out of poverty. 167 00:09:08,235 --> 00:09:13,135 Uh, and it has during the pandemic when, um, the, uh, 168 00:09:13,855 --> 00:09:18,735 American Recovery Act, uh, was, uh, um, passed, it 169 00:09:19,015 --> 00:09:22,455 provided a significant, uh, tax credit for, 170 00:09:22,675 --> 00:09:24,175 for low income families. 171 00:09:24,955 --> 00:09:27,935 Uh, national studies indicated that, uh, up to 40% 172 00:09:27,935 --> 00:09:30,735 of children were lifted out of poverty were regrettably 173 00:09:31,645 --> 00:09:35,535 that, uh, tax extension did not occur at the end 174 00:09:35,535 --> 00:09:36,735 of 2022. 175 00:09:37,675 --> 00:09:40,775 And it's back up, um, for consideration, 176 00:09:41,265 --> 00:09:44,695 there actually is a bipartisan bill in front of Congress. 177 00:09:44,715 --> 00:09:47,015 And so I've been actively lobbying on behalf 178 00:09:47,595 --> 00:09:49,815 of the extension, uh, of this. 179 00:09:50,715 --> 00:09:54,415 Uh, another thing that we're, uh, also talking about, Chris, 180 00:09:54,595 --> 00:09:56,975 is protecting the food stamp program, 181 00:09:57,105 --> 00:09:58,415 which is known as snap. 182 00:09:59,205 --> 00:10:03,225 Um, that unfortunately is on the topping block, not 183 00:10:03,225 --> 00:10:05,225 to be cut entirely, but to be cut back 184 00:10:06,015 --> 00:10:09,145 significantly in the continuing resolution. 185 00:10:10,755 --> 00:10:13,355 I, I note the fact that one out of seven children 186 00:10:13,815 --> 00:10:15,795 or 11 million children nationally go 187 00:10:15,795 --> 00:10:17,115 to bed hungry every night. 188 00:10:17,875 --> 00:10:19,415 And so as the CEO and, 189 00:10:19,635 --> 00:10:21,935 and working with our families here, I know 190 00:10:21,935 --> 00:10:24,815 that food insecurity is a major problem. 191 00:10:25,035 --> 00:10:29,935 And so I've been lobbying for those two things right now on, 192 00:10:30,235 --> 00:10:31,335 on Capitol Hill. 193 00:10:32,495 --> 00:10:34,595 So the last piece is we're ready 194 00:10:34,655 --> 00:10:36,915 to tackle this home care nursing shortage 195 00:10:37,495 --> 00:10:39,075 for medically complex kids. 196 00:10:40,135 --> 00:10:44,515 Um, and what I'm doing right now is gathering a coalition 197 00:10:44,515 --> 00:10:49,195 of hospitals, parent groups, child advocacy organizations, 198 00:10:50,105 --> 00:10:51,315 home care agencies 199 00:10:51,375 --> 00:10:54,435 before legislation could be written to more 200 00:10:54,995 --> 00:10:56,395 specifically define the problem 201 00:10:56,975 --> 00:10:59,955 and what the policy solutions should be at our state 202 00:10:59,955 --> 00:11:02,315 government, which hopefully could be a model 203 00:11:02,315 --> 00:11:03,395 for the rest of the nation. 204 00:11:04,255 --> 00:11:05,835 That's what I'm working on right now. 205 00:11:07,565 --> 00:11:09,475 - Larry, we certainly wish you continued. 206 00:11:09,475 --> 00:11:10,755 Good luck in all these efforts. 207 00:11:11,015 --> 00:11:13,315 And we also thank you for being so generous 208 00:11:13,315 --> 00:11:14,675 with your time and insights today. 209 00:11:15,135 --> 00:11:16,835 We cannot wait to share them with our audience, 210 00:11:16,835 --> 00:11:18,395 and we look forward to connecting with you soon. 211 00:11:19,505 --> 00:11:20,525 - Thanks so much, Chris. 212 00:11:20,605 --> 00:11:22,045 I appreciate you having me on your program. 213 00:11:23,875 --> 00:11:26,685 - It's so important for leaders at the top of organizations 214 00:11:26,685 --> 00:11:29,165 to keep learning, stay sharp, grow their networks, 215 00:11:29,595 --> 00:11:32,045 help our audience better do this in a more simplified, 216 00:11:32,045 --> 00:11:33,725 personalized, and meaningful way. 217 00:11:34,285 --> 00:11:36,765 Becker's Healthcare has launched my BHC, 218 00:11:37,235 --> 00:11:39,205 it's your trusted Becker's healthcare experience 219 00:11:39,205 --> 00:11:41,285 and more with content, connections, events 220 00:11:41,305 --> 00:11:42,325 and learning opportunities. 221 00:11:43,115 --> 00:11:44,325 Join the community free 222 00:11:44,325 --> 00:11:49,125 of charge@www.my dot becker's hospital review.com 223 00:11:49,225 --> 00:11:50,045 and we'll see you there.