Children’s Hospital of Pittsburgh of UPMC, Research Paper Example

The Children’s Hospital of Pittsburgh of UPMC is a healthcare organization that provides medical treatment to children.  It has one of the best reputations in the country for care, and receives a good portion of its funding from donations, charities, and grants.  Located in the urban city of Pittsburgh, Pennsylvania, Children’s Hospital of Pittsburgh of UPMC has continued to thrive in an uncertain economy, even with political upheaval between Pittsburgh’s two major insurance companies.

Because the mission is to help sick children and their families, Children’s Hospital of Pittsburgh of UPMC accepts many insurance plans, including commercial, Medicaid, and CHIP.  Commercial insurances accepted are Aetna, Cigna Health Care, Health American/ Health Assurance, Highmark, United Healthcare, UPMC Health Plan, and TriCare.  Medicaid and CHIP programs include UPMC for You, UPMC for Kids, Gateway, UHC for Families, and Coventry Cares/ Aetna Better Health PA.  For children who do not have insurance coverage, the Free Care Fund can help to pay for their medical bills.

There has been concern about children whose parents are covered under Highmark.  The division between UPMC and Highmark, two of Pittsburgh’s major insurance companies, has inhibited Highmark patients to receive care with UPMC doctors and at UPMC hospitals.

Highmark and UPMC have been fighting since Highmark purchased the financially ailing West Penn Allegheny Health System in 2013. That became the backbone of Highmark’s since-renamed, seven-hospital Allegheny Health Network, and made Highmark more of a rival to the much larger 20-hospital UPMC network, which has its own health insurance plan (Mandek, 2015)

However, the president of Children’s Hospital of Pittsburgh has repeatedly assured concerned parents and officials that the rift between the two insurance companies would not affect children.  If parents have Highmark insurance, their children are still able to receive covered care at Children’s Hospital of Pittsburgh of UPMC.

Children’s Hospital of Pittsburgh of UPMC is able to provide uncompensated care to children, largely due to the Free Care Fund.  Because of this charity, children who do not have health insurance, who have an illness that exceeds what insurance will pay, has a chronic illness, or needs experiemental treatment (Kunkicy & Lukasiak, 2013).  In 2012, Children’s Hospital of Pittsburgh of UPMC was able to provide $43 million in free and uncompensated care to more than 28,000 children in the region (Kunicky & Lukasiak, 2013).

Children’s Hospital of Pittsburgh of UPMC has an excellent reputation throughout the nation.  According to Kunicky and Lukasiak (2014), the hospital has been named one of America’s Best Children’s Hospitals by U.S. News & World Report, ranking ninth on the magazine’s 2014-15 Honor Roll of America’s Best Children’s Hospitals.  Children’s Hospital of Pittsburgh of UPMC also ranks in each of the 10 pediatrics specialties ranked by U.S. News, making it the fifth consecutive year it has been named to U.S. News’ Honor Roll (2014).   According to Kunicky and Lukasiak (2014), Children’s Hospital of Pittsburgh of UPMC ranked in the top 25 for the Best Children’s Hospitals in the United states for the following specialties: cancer; cardiology and heart surgery; diabetes and endocrinology; gastroenterology and GI surgery; neonatology; nephrology; neurology and neurosurgery; orthopedics; pulmonology; and urology.  It ranked fifth in diabetes and endocrinology; sixth in gastroenterology and GI surgery; sixth in pulmonology; eighth in neonatology; and ninth in neurology and neurosurgery (Kunicky & Lukasiak, 2014).  It is no surprise that the case mix of Children’s Hospital of Pittsburgh of UPMC continues to increase.  According to Belotti (2012), the case mix rose from 1.22 in 2001 to 1.57 in 2011.

Perhaps because of their reputation for outstanding care, Children’s Hospital of Pittsburgh of UPMC is doing well financially.  In addition to investments from UPMC, charitable donations, both private and public, help the hospital supply its funds.  In 2013, The 60th Annual Free Care Fund Benefit Show for Children’s Hospital of Pittsburgh Foundation raised more than $2.2 million in donations and pledges (Kunicky & Lukasiak, 2013).  In 2014, the Patient-Centered Outcomes Research Institute (PCORI) gave a $1.9 million grant to help research early rehabilitation protocols (ERP) in the pediatric intensive care unit (PICU) for children with acute brain injuries (Kunicky & Lukasiak, 2014).  Another example of generosity towards the hospital is the Mario Lemieux Foundation pledges to donate $2.5 million to Children’s Hospital of Pittsburgh of UPMC over a periods of seven years.  UPMC promises to match the donation of $2.5 million (Kunick & Lukasiak, 2014).

The Affordable Care Act (ACA) has provided many families with the opportunity to have health insurance. Even though the deductibles may be high, Children’s Hospital of Pittsburgh receives assistance from the Free Care Fund so that no child would go without care.  Overall, the Affordable Care act has had a positive impact on Children’s Hospital of Pittsburgh of UPMC. Walter et al. (2015) quotes a 2013 study by Berry, Agrawal, Cohen, & Kuo, stating that the “ACA has the potential to maximize the health and well-being of high-cost and high-need populations, such as children with medically complex conditions, by increasing access to affordable care, high quality care, and appropriate care over the life course.” Because of the ACA, more children are able to be treated for their conditions.

The reputation of Children’s Hospital of Pittsburgh of UPMC allows this healthcare organization to stand strong in an uncertain economy.  While many people are able to pay for their care with their insurance, a large portion of their funds is generated from donations and grants.  The excellence of their care and the societal concern for sick children has ensured the success of Children’s Hospital of Pittsburgh of UPMC.

References

Belotti, M.  (2012). BRIDGES.  Retrieved from http://www.chp.edu/cs/Satellite?blobcol=urldata&blobheader=application%2Fpdf&blobkey=id&blobtable=MungoBlobs&blobwhere=1294171378361&ssbinary=true

Kunicky, A. & Lukasiak, M. (2013). 60^th annual Free Care Fund benefit show on KDKA raises more than $2.2 million for Children Hospital of Pittsburgh Foundation.  Retrieved from http://www.chp.edu/CHP/122013

Kunicky, A. & Lukasiak, M. (2014).  $1.9 million PCORI grant supports study of early rehabilitation protocols at Children’s Hospital of Pittsburgh of UPMC. Retrieved from http://www.chp.edu/CHP/082814.

Kunicky, A. & Lukasiak, M. (2014).  Children’s Hospital of Pittsburgh Foundation receives $2.5 million gift from the Mario Lemieux Foundation to establish new lymphoma center. Retrieved from http://www.chp.edu/CHP/060414

Kunicky, A. & Lukasiak, M. (2014).  Children’s Hospital of Pittsburgh of UPMC named one of America’s top 10 children’s hospitals. Retrieved from http://www.chp.edu/CHP/061014

Mandek, J. (2015). PA Supreme Court hears UPMC’s appeal of Medicare Ruling.  Retrieved from http://www.wtae.com/news/pennsylvanias-supreme-court-gives-upmc-expedited-appeal-in-highmark-battle/35176408

Walter, A.W., Yuan, Y., Dworetzky, B., Comeau, M., Ablavsky, E., & Bachman, S. (2015). The Affordable Care Act and value-based purchasing: What’s at stake for children with medical complexity? Retrieved from http://www.hdwg.org/catalyst/publications/vbp