Pediatrics: 'Exhausting but rewarding'

Monday, March 26, 2012

COLUMBUS, Ohio - For provider John Reed, the workdays are long and demanding, but he says it's "like being on vacation."

The difference is that he now spends those long days focused on patient care, rather than  trying to "squeeze the last nickle out of the labor force," he says.

Reed, the former CEO of Cincinnati, Ohio-based Pro2 Respiratory Services, co-founded Central Ohio Specialty Care (COHSC), which coordinates and provides care for medically fragile children, last fall. 

"I had a great run with Pro2, but I didn't want to be in the middle of (competitive bidding)," said Reed.

COHSC will provide everything from ventilators, oxygen and enteral nutrients to alarm systems and custom seating. 

Offering a one-stop shop lets parents focus on caring for their child, said co-founder Nick Kalogeras.

"We've heard these parents can spend 30 or 40 hours a month dealing with different providers," said Kalogeras, a pharmacist who most recently worked at Columbus Prescription. "We give them our number, they call us and it's done."

The primary payer for pediatric patients is Medicaid, which is better than Medicare but still has its cons, said Reed.

"The guidelines are clear, there's a prior authorization process, and you have an idea of what you are going to get paid for," he said. "What's problematic is that coverage (guidelines) are often built around the Medicare benefit."

That can mean sharply limited coverage for some items, said Reed. For example, COHSC provides trach tubes that can cost a few hundred dollars each but are reimbursed at $47. The provider offsets the loss with other items.

"We have the ability to balance five or 10 loss leaders in a package because we do 60 or 70 items (for each patient)," said Reed.

COHSC serves a 60-mile radius that includes two major children's hospitals that serve as major referral sources. Other referrals come from nursing agencies and, perhaps the most important, the families.

"These families have a pretty unique bonded network," said Reed. "They go to the same clinics, belong to the same organizations. Families talk to families."

Reed and Kalogeras do everything from intake to deliveries.

"We are seeing the difference we make in these patients lives and getting affirmation that what we are doing is necessary," said Reed. "It's exhausting, but it's rewarding, too."