The new contract ends a long-running arrangement that Kaweah Delta has had with Visalia-based Sequoia Pediatric Group.
And it extends the presence of Valley Children’s Hospital in the South Valley. The medical group is affiliated with the Madera County-based hospital, which opened a pediatric clinic on Akers Street in Visalia last year.
Kaweah Delta officials and Valley Children’s Medical Group said the change in providers will allow more seriously ill babies and children to stay close to home. “Right now, we transfer kids to Children’s when we cannot handle them,” said Dr. Edward Hirsch, chief medical and quality officer at Kaweah Delta.
But doctors who have been providing the hospital’s pediatric care said they were not included in contract discussions and question the hospital’s decision. “I have great respect for the physicians involved with this, but I don’t quite understand the motives behind this,” said Dr. Christine Nelson, a pediatrician with Sequoia Pediatric Group.
Right now, we transfer kids to Children’s when we cannot handle them.
Dr. Edward Hirsch, Kaweah Delta Medical Center
Sequoia Pediatric Group has provided pediatric care at the hospital since 2006. Its contract was to end Dec. 31, 2017, but the hospital abruptly terminated the agreement on Sept. 6, Nelson said. The contract now ends March 7.
Valley Children’s Medical Group will provide care across the board for children at Kaweah Delta, including in the neonatology unit. The contract amount is being negotiated but should be similar to the $3 million contract the hospital had with Sequoia Pediatric Group, Hirsch said.
The agreement with Valley Children’s Medical Group will not affect Kaweah Delta nurses, respiratory therapists and other staff who are employed by the hospital.
Valley Children’s Medical Group will provide two neonatologists for neonatal intensive care during the day, and there will be a neonatologist and a neonatal nurse practitioner at night, Hirsch said. Currently, one neonatologist is present during the day and a pediatrician who is a pediatric hospitalist covers the unit at night, he said. With an increase in staffing of the intensive care unit, the pediatrician will have more time to see children who are admitted to the hospital, as well as to respond to the emergency department for pediatric cases, Hirsch said.
Nelson said the Sequoia Pediatric Group pediatrician has been available to respond to emergency department calls. “We are not called very often,” she said.
Hirsch said Valley Children’s Medical Group’s doctors and nurse practitioners will bring experience and training, particularly to the neonatal intensive care unit. Kaweah’s unit is a Level III – a step below the NICU at Valley Children’s Hospital, which is licensed to care for the most ill and fragile babies.
“This is a win for Kaweah and a win more importantly for the patients in our community,” Hirsch said.
Nelson questioned whether the change in provider groups will lead to a higher quality of care. “Our NICU and our providers have been at the 90th percentile or above in meeting the standards that all the NICUs are judged against in California and nationally,” she said. “There really isn’t a quality issue.”
Valley Children’s Hospital stands to gain from the new partnership with Kaweah Delta.
There really isn’t a quality issue.
Dr. Christine Nelson, Sequoia Pediatric Group
“Children’s hospitals require a huge geographic service area to maintain the volume they need to maintain their expertise,” Hirsch said.
For the past two years, Valley Children’s Hospital has been in a fight with Fresno-based Community Medical Centers for pediatric patients, including those needing neonatal intensive care. Both health systems have said demand for care, not competition for patients, has driven expansion plans.
Tulare County can supply patients.
Last year, Tulare County patients accounted for 1,801 patient cases and 11,764 inpatient days at Valley Children’s Hospital. Tulare County children accounted for 12 percent of the outpatient visits. And the Akers Street clinic in Visalia has been busy since opening in March, with 1,000 individual patients and 1,199 total visits through Sept. 30.
Clinics increase access to health care, said Michael Goldring, administrative officer for Valley Children’s Medical Group. And the contract with Kaweah Delta “really fits within our mold of keeping the kids at home.”
Nelson said Sequoia Pediatric Group doctors supported the opening of the Akers Street clinic because it improved access to specialty care for children in the area. And the doctors in the group would have had no problem working with Valley Children’s Hospital had they been given the opportunity, she said.
Kaweah Delta is considering making the neonatal intensive care a “closed unit,” which would mean only doctors employed by Valley Children’s Medical Group would take care of patients. Last week, Kaweah Delta’s board of directors approved a request for a medical executive committee to investigate the merits of closing the unit.
Board President Carl Anderson said the hospital has other closed units, including cardiac surgery. “It turns out there are advantages with closing a unit and contracting with a specific unit of providers,” he said. “It provides us with more of an iron grip on quality control, efficiency, things like that.”
But Anderson said he will need more information before he could make a decision to close the neonatal unit.
The hospital’s contract with Valley Children’s Medical Group will not be affected by the decision, he said.