Matt Cook [00:00:02]:

It’s a real issue. Having been a hospital CEO and we had tough times, we had to go through this exercise of thinking through how would we keep the doors open and the issue becomes one of services. So if I’m going to have a significant cut in funding, let’s just say it’s because policymakers and lawmakers choose to cut the Medicaid program. Then I have to figure out how am I going to keep the doors open. And so almost by definition to start cutting services.

Narrator [00:00:36]:

Welcome to Hospitals in Focus. From the Federation of American Hospitals, here’s your host, Chip Khan.

Chip Kahn [00:00:45]:

Medicaid is critical path for the health and well being of millions of American children. Medicaid, coupled with the Children’s Health Insurance Program, otherwise called chip, provides a lifeline of care from routine checkups to life saving tertiary hospital services for nearly 40 million kids. This care is now under threat. Congress is considering massive cuts to Medicaid which could put America’s kids health and well being in jeopardy. Joining me today is Matt Cook, President and CEO of, of the Children’s Hospital Association. Matt brings decades of experience leading children’s hospitals and now heads the national voice advocating for their future. He will help us understand what’s at risk if policymakers fail to protect Medicaid and what potential cuts mean for the kids who depend on Medicaid. Thanks so much for joining us today, Matt.

Chip Kahn [00:01:50]:

Great to have you on the show.

Matt Cook [00:01:52]:

Thanks for having me, Chip. I really appreciate it.

Chip Kahn [00:01:55]:

So Matt, let’s get started with the big picture. What’s the role of Medicaid for kids in children’s hospitals across the country?

Matt Cook [00:02:07]:

Yeah, that’s a great question, Chip. And as you mentioned in your intro, Medicaid covers almost 40 million children in this country. Perhaps more importantly though, it’s about 50% of children that have special needs. And part of what’s interesting about Medicaid and this is really understanding the faces of Medicaid, which most people don’t. There’s a lot of children who are connected to military families that are also covered by the Medicaid program. There’s like 3 million children who are connected to military families that are covered by it. As you mentioned, I have a lot of experience running children’s hospitals. I can think of my last two organizations that I worked at.

Matt Cook [00:02:49]:

I worked at UCSF in the Bay Area running the Children’s Hospital in San Francisco and the one in Oakland, the Oakland Hospital. 70% of its patients are covered by the Medicaid program. So more than two thirds of the patients coming into the hospital are covered under this program. I worked in Indianapolis, I was the president of Riley Hospital for children, and 60% of those patients recovered under the Medicaid program. And so I think there’s this lack of understanding of just how important the Medicaid program is for our nation’s children. The average coverage for any children’s hospital is about 55%, meaning 55% of the patients coming through the doors are covered by this program. That’s the average.

Chip Kahn [00:03:41]:

So obviously you had a front row seat in your various positions across the country. I assume as someone running a hospital, that you went and walked the halls. Do you have any personal anecdotes or just, you know, personal stories? Just from what you saw when you went up to the floors or had other kinds of experience directly with patients?

Matt Cook [00:04:01]:

I used to walk the floors every day. And, you know, part of what’s interesting about running a children’s hospital is that anytime you’re thinking you’re having a bad day, all you have to do is go up on a floor and you realize that somebody else is having a much worse day than you. And from that perspective, it’s, it’s really inspiring to go see the work that we do in our nation’s children’s hospitals. It’s hard to go up on the floor and not meet a Medicaid family because of the numbers that we just talked about. So every day you walk up there and you meet somebody, I’m just gonna tell you what’s been going on the last couple weeks for me. I have some very close friends on the west coast up in Washington state. They had a child that was living with them that was in the foster care program. They adopted this child.

Matt Cook [00:04:50]:

And because they adopted this child in Washington state, this child is on Medicaid until age 18. This child is also a medically complex child and requires a procedure for her gastrointestinal tract that only two hospitals in this country perform. And so I’ve been helping this family try and figure out how they’re gonna get their child into one of these two children’s hospitals when the child’s covered by the Medicaid program to receive life saving care. And that’s what happens every day. That’s an access issue, you know, trying to figure out, well, where do I, how do I help a family that requires specialized care? Get to the right program. But every single day in our country, we have children’s hospitals performing life saving procedures on kids and kids that are covered by the Medicaid program.

Chip Kahn [00:05:44]:

So what are the major challenges facing these hospitals that help them support that kind of effort.

Matt Cook [00:05:51]:

Well, we don’t design programs around one payer, meaning we have an insurance program called Medicaid, and we don’t design programs around that. We design programs around children. So this notion that I can somehow cut Medicaid services and not have it impact the entire hospital, not have it impact all of its programs, is a complete fallacy. And so every single day when a children’s hospital is, you know, opening the doors of its clinics is, you know, performing diagnostic tests on children and trying to understand what’s going on with them, they’re doing it with blinders on. They don’t know who the payer is and, and they don’t care. And so they perform these services for kids so that they can grow up and be healthy independent of who’s paying for those services. And so this notion that we can cut the funding for a significant payer and not have it impact the healthcare system for children is, as I said, a complete fallacy.

Chip Kahn [00:07:03]:

So we could get into the details of the various proposals that are possible that are going to be discussed. Whether it’s work, having those adults who are on Medicaid have to work, that obviously doesn’t affect our group here. We’re talking about children. But then almost every other aspect, whether it’s disproportionate share or providing limits that reduce what’s called state directed payments, in a sense we could go through all those, but at the end of the day, frankly, it’s all payment and it’s just a question of pushing down payment. So if you have these payment reductions and if you put on your hat as a former CEO of a children’s hospital, and considering what you just outlined, in a sense that when a patient walks through the door, you take care of that patient. On the other hand, when you’re CEO, you’re managing all of these revenues from various sources and Medicaid is the big banana in a sense. If you look at that payer mix, if you press down on that Medicaid, what happens as a leader of a hospital, how do you respond? And then how does that affect the floor and how does that affect the patient and those providing care to that patient?

Matt Cook [00:08:19]:

Well, it’s a great question and it’s a real issue. Having been a hospital CEO and we had tough times, we had to go through this exercise of thinking through how would we keep the doors open and the issue becomes one of services. So if I’m going to have a significant cut in funding and let’s just say it’s because policymakers and lawmakers choose to cut the Medicaid program. Then I have to figure out how am I going to keep the doors open. And so almost by definition, I have to start cutting services. So I have to go through and say, gee, is that clinical program nice to have, or is it a must have? And so ultimately, I need to stop providing certain services, and I have to figure out which ones I can stop providing and still keep the hospital doors open. So am I going to stop providing rehab services? Am I going to shut down care for chronic complex kids, and I’m just going to provide the lowest level of tertiary care that I can provide? So that’s the mental gymnastics that hospital CEOs are going to have to work themselves through is which programs can I now stop offering in order to keep the doors open. And then the impact of that is families who need those services no longer have access to them, and that becomes the public crisis, if you will.

Matt Cook [00:09:47]:

There’s nowhere to get these services anymore, or I have to leave the state and go get them somewhere else.

Chip Kahn [00:09:52]:

I guess that is the. An aspect of this is that for some types of patients, that children’s hospital may be the only source of the service.

Matt Cook [00:10:02]:

Yeah, I mean, I think that’s true in most communities, right? There’s. There aren’t a lot of places where we have multiple children’s hospitals. And there are a lot of places where, if you have a children’s hospital and an adult general provider where the services overlap that much, because children’s hospitals tend to be pretty specialized and pretty niche in what they do, because you need a lot of children in order to support a children’s hospital. And so if you shut down services in a children’s hospital, it’s not like I can go across town and go to the adult provider. They’re not going to offer those services either. In fact, the trend that we have seen is for, you know, adult general hospitals to shut down whatever pediatric services they have because they don’t have the numbers. They don’t. It’s hard to keep staff competent.

Matt Cook [00:10:56]:

And because they don’t have the numbers, they lose money on it. And so it doesn’t make sense for them to be providing those services. And so if you cut services at the children’s hospital, you’re really cutting the only provider of those services, most likely in that community.

Chip Kahn [00:11:11]:

And we’re talking here about developmentally disabled kids who have unique healthcare problems. We’re talking about cancer, we’re talking about probably intricate cardiac issues. Right?

Matt Cook [00:11:24]:

Oh, yeah. I mean, you’re, you know, most kids, this is the issue. Most kids are healthy until they’re not. And if they’re sick, they tend to be pretty complicated. And that’s where, you know, the children’s hospitals come into play, that we take care of complicated health conditions for children. And so when you talk about these types of services, cardiac care, you mentioned, there aren’t the type of surgery that we do in children’s hospitals that’s life saving for kids who have congenital heart defects. Adult providers don’t do that. They actually don’t understand it.

Matt Cook [00:12:01]:

When an adult cardiologist sees a grown up patient that had surgery as a child, they’re like, wow, I don’t understand how this works. And so that’s the issue again, that we create, is who’s going to provide these services? How are people even going to understand how the body functions when the children’s hospital can no longer support the services?

Chip Kahn [00:12:25]:

Another aspect of this is the referral nature of children’s hospitals, which you had an anecdote which you referred to. Can we talk a bit about the sort of relationship between rural Americans and rural kids and children’s hospitals? Because we know what’s happening in rural America, which is you’ve got young people and old people. And that’s one of the reasons for the hospitals out there are so dependent on Medicaid and Medicare now because of that sort of dichotomy. But at the end of the day, going back to the point you just made, when a kid really gets sick, they’ve got to somehow find their way. How does that work across the country? And does Medicaid play a role in that in states across the country?

Matt Cook [00:13:11]:

So it does. As you mentioned, Medicaid’s a significant insurer for rural America, particularly for kids. I think the number something like 40% of kids in rural America are covered under the Medicaid program. And so to your point, when a child does get sick and requires specialized care, more often than not they have to leave their community and go to an area where there is a children’s hospital that can provide that care. The challenge we have with the Medicaid program, and by the way, no one is saying the Medicaid program’s perfect. It is not a perfect program. It’s a very complicated program. And it varies state by state because Medicaid is a federal state program.

Matt Cook [00:13:57]:

And so when a child is sick in a rural community and needs to go to a children’s hospital, and let’s just say there’s not one in the state, then they have to cross state lines. The challenge we have with the Medicaid program is that it doesn’t easily cross state lines. So in the anecdote that I was giving earlier in our talk, Chip, the challenge for the family that I was talking about is they need to the hospital that the child is going to has to negotiate a single case agreement with the state of Washington in order for the hospital to provide those services. And so that’s the challenge we get into when kids have to cross state lines for Medicaid services. It’s really hard to do. It’s really complicated. And that’s where there’s a little bit of bureaucracy, administrative work and making that happen.

Chip Kahn [00:14:52]:

Clearly, from all of our conversation, Medicaid is this incredible lifeline. And not that it’s not an important piece of care for general hospitals and other kinds of healthcare facilities and nursing homes, but it plays this unique role with children’s hospitals as an organization. Are you mounting advocacy? What’s your messaging? What are you trying to get across to policymakers, to the public about the basically the threat of reducing what Medicaid provides today in terms of supporting the care?

Matt Cook [00:15:30]:

We’re doing a few different things. One is we’re trying to remind lawmakers and the public who’s covered by Medicaid. You know, I think there are these perceptions about who’s really covered by the program and it’s easy to forget that half of the nation’s children are covered under this program. So number one, we’re trying to remind folks who’s on this program. Number two, what we’re trying to say is if you make significant cuts to the Medicaid program, you can try and make the argument that you’re targeting a different population covered by Medicaid. So, for example, adults or able bodied adults who are covered by the program. But the minute you do that, you’re going to necessarily impact kids because you can’t take significant funding from one part of the Medicaid program and not think that it’s going to impact the entirety of the program. And so by therefore impacting children.

Matt Cook [00:16:30]:

And so we’re trying to make the argument be careful of what you do because if you try and make significant cuts, you will fundamentally impact children. And if we think about the future of this country, what’s the future of this country? Well, kids are the future of this country. And if you’re going to cut a program that is going to destabilize the health of children, then you are therefore destabilizing the future of this country.

Chip Kahn [00:16:58]:

Matt, I just want to thank you so much. That’s so helpful. And I think you’ve shined light on, on just how vital Medicaid is for America’s kids, so many of America’s kids. And I appreciate all you’re doing and hope we’ll, you know, be successful at preserving this important program.

Matt Cook [00:17:18]:

Yeah, thanks, Chip. I also have to thank you for your partnership. You know, this is, you know, a situation where all of us have to come together and advocate for the program and certainly appreciate what you’ve done and your association for this as well.

Narrator [00:17:38]:

Thanks for listening to Hospitals in Focus from the Federation of American Hospitals. Learn more at fah.org. Follow the Federation on social media @FAHHospitals and follow Chip @ChipKahn. Please rate, review and subscribe to Hospitals in Focus. Join us next time for more in depth conversations, conversations with healthcare leaders.

Matthew Cook is President and CEO of Children’s Hospital Association (CHA), representing over 200 children’s hospitals and health systems as the leading national advocates for children’s health.    

Cook is an established health care industry executive with decades of unparalleled leadership which includes leadership roles at children’s hospitals and maternal health programs. Cook also previously served as a member of CHA’s Board of Trustees and Public Policy Committees.   

Prior to joining CHA, Cook served as president of UCSF Benioff Children’s Hospitals and senior vice president of Children’s Services at UCSF Health, where he oversaw strategic direction, operations, and clinical services for all pediatric services in both Oakland and San Francisco, as well as serving on the UCSF Health leadership team.    

Cook previously served as president of Riley Children’s Health and chief strategy officer for Indiana University Health and served as executive vice president of strategic planning and business development at Children’s Hospital of Philadelphia. Cook was also a principal at the Chartis Group, a health care consulting firm based in Chicago.   

Cook earned a Master of Business Administration from New York University and graduated cum laude with a Bachelor of Science in Economics from The Wharton School of the University of Pennsylvania.