The pediatric heart doctors made for an odd couple at the Legislature’s Health and Human Services Committee: Bill Stein in his conservative gray suit and Jon Love with his blond ponytail, three earrings and shiny blue blazer – both testifying to their desire to work together.
Their respective employers had been in cutthroat competition for years, with the result being a health system in which very sick kids are more likely to be sent out of state than two miles down the road to the competitor.
Stein, 42, who is employed by Presbyterian Healthcare Services, is the state’s sole pediatric cardiothoracic surgeon. Love, 56, is the lone pediatric interventional cardiologist at the University of New Mexico. Their message of collaboration was one that pediatricians and parents of medically fragile children have been longing to hear.
The two hospitals are the state’s largest providers of pediatric specialty care and serve one of the country’s most Medicaid-dependent populations of children.
In 2013, their longstanding antagonism boiled over after insurers failed to reach a deal that would have let patients easily access both networks.
New Mexico’s relatively small pool of patients means that neither institution has the critical mass it needs to hang onto key pediatric specialists. It has been a nightmare for families whose children require specialized care.
Siah Hemphill’s son, Nicholas, 22, was born with a rare syndrome that caused abnormal growth and bone cancer and resulted in a leg amputation. Ask what it took to get her son a new wheelchair and you will be met with tears: It took four grueling years.
“There’s so much miscommunication and disorganization,” said the Silver City mother, recalling the phone calls, lost workdays and the sores her son developed from using an outdated chair.
Last year, the family switched Medicaid providers in order for Nicholas to see the appropriate specialist at UNM. Finally, he got the wheelchair he needed.
“I don’t know how anyone can navigate this disaster of a health care system,” she said.
Nearly a year into joint talks, Presbyterian and UNM leaders are now quietly mapping a collaborative relationship that could benefit New Mexico kids — including taking baby steps that could lead to a unified children’s hospital.
Stein and Love pioneered the initial agreement to link the hospitals’ pediatric specialties.
“Working with UNM is one of the best things we can do for the state,” said Presbyterian Chief Medical Officer Jason Mitchell. “Making sure we have enough pediatric specialists in our state to take care of our kids is really, really important.”
Historically, fierce competition between the two hospitals meant that physicians at one hospital rarely got privileges at the other. Health plans – including the Medicaid plans that cover more than half of all children in New Mexico – would sooner send a sick child to Denver, Dallas or Phoenix to see a specialist than to the other local system.
This tendency worsened five years ago when Presbyterian Health Plan restricted clients to its own hospital system. At the time, Presbyterian cited the high cost of care at UNM, which as an academic institution may charge more than commercial providers.
“It drives me crazy as a practitioner when I can’t get kids the care they need, because health systems and managed care organizations don’t cooperate,” said Brian Etheridge, a Silver City pediatrician and past president of the New Mexico Pediatric Society.
An estimated 98,000 New Mexico children have special health care needs, according to a Kaiser Family Foundation study, and 59 percent of them are on Medicaid. For families living near the poverty line, a hospital stay in another state imposes immense hardships – missed days at work, lost jobs, the stress of family separation.
“Traveling out of state is the last resort for most families,” said Cathy Salazar, a family liaison with Parents Reaching Out, an Albuquerque nonprofit that helps parents navigate their children’s health care, education and other needs.
Lawmakers step in
Convinced that the state’s population is too small and its families too fragile, the state House in 2018 unanimously approved a memorial instructing the New Mexico Pediatric Society to convene a task force to propose solutions.
First on their list is “a single, unified Children’s Hospital, incorporating all pediatric specialties available in New Mexico” – not necessarily calling for a new building but advocating for an institutional framework that would eliminate the barriers families face trying to access care at both hospitals.
At the hearing in November, Love told the story of a baby who, over the summer, needed a procedure that Love couldn’t safely perform without surgical back-up. Three of his peers at UNM had recently decamped to the University of Iowa. Stein, the pediatric heart surgeon, was less than two miles away, at Presbyterian Hospital – but he didn’t have privileges at UNM.
“It started the question,” Love told legislators, “why can’t we just be working with one another across institutions?”
If both hospitals continue to lose cases to out-of-state children’s hospitals, they will not only lose money; they risk losing some of their most important doctors, who are expensive to recruit and difficult to retain amid a national shortage of pediatric specialists.
“Our (pediatric cardiology) program fell apart because the volume just wasn’t there,” said Frantz Melio, chief strategy officer for the UNM health system. “We made the decision to collaborate with Presbyterian so that we both, together, could provide the care that was needed in the state.”
With a formal agreement now in place linking their pediatric cardiology units, Presbyterian and UNM are moving specialty by pediatric specialty to build bridges. The next steps are to extend dual hospital privileges, coordinate patient care and convince health plans to pay both systems.
“Any consolidation could only benefit the providers and families,” said Charlotte McGaughey, who has spent two decades navigating New Mexico health care for her autistic son Matthew, 21, who is nonverbal and has suffered debilitating gastrointestinal problems.
McGaughey, who lives in Silver City, recalled that when Matthew needed psychiatric care as a teenager, she was given a list of five doctors. Three were no longer practicing in the state, and one wasn’t taking new patients. “That was extremely frustrating,” she said.
Besides helping keep physicians in New Mexico, greater collaboration between Presbyterian and UNM could mean that “the providers would have more access to each other, and the parents would have more access to support groups,” she said. “There are a lot of things that make it hard to raise a disabled child in a poor state.”