The groundbreaking ceremony for the new Children’s Hospital took place in June and construction is well underway for the facility that’s scheduled to open in late 2018. With that background, we spoke with CEO Don Mueller about his background, the work that went into making this project happen and what’s to come. Mueller wanted to make it clear that making the dream a reality was a group effort and he had a lot of praise for everyone involved.

HCB News: How did you get involved in health care?
Don Mueller: When I got out of college, I started looking at growth industries that had great potential, but they weren’t interesting. Then, I started to look at industries that had the great potential for growth. A friend of a friend got me a job at an HMO and things went from there.

HCB News: How long have you been with Erlanger?
DM: A little over two years.

HCB News: How did you get tapped for this position?
DM: The vision for the new children’s hospital was started four years ago when Kevin Spiegel (CEO of Erlanger Health System) joined the organization. It was in the works when I was hired. Kevin recruited me with the goal of creating a system that maximizes access and clinical care while leveraging the advantages of a larger system.

HCB News: How was the determination made to break ground on a new children's hospital in Chattanooga?
DM: It was due to the reality of where we are in providing care for children. We have world-class physicians and nurses, but our current building and infrastructure is more than 40 years old. When Kevin came on, he saw great people in a facility that should have been replaced 20 years ago. The system at the time was losing a lot of money and wasn’t able to sustain itself. When he talked about the idea of building a new hospital, people thought he was crazy. He brought me on board, with my extensive experience in fund-raising, and we put together a plan to help make this happen.

Erlanger set a goal as a health system to raise 85 to 90 percent of the money before we broke ground. Over a two-year period, we raised a significant amount of money and actually were ahead of schedule. The industry standard is 85 percent of funds on hand before breaking ground, but we weren’t there yet when we decided to move forward. We made that decision because we received so much signaling from the community that we felt if we took a little leap of faith, it would act as a catalyst and it really has. We’re well above 85 percent today. We only have $4.5 million left to go. Had we not taken that leap, we might have just been breaking ground now or even still waiting.

In part, Chattanooga is an amazing community that has realized a huge part of the infrastructure for our town is the Children’s Hospital. It’s a significant investment we need to keep economic development happening. Back in 1969, (CBS Evening News anchorman) Walter Cronkite said this was the dirtiest city in America due to the steel industry. Today, we’re the top outdoor city three years in a row. Chattanooga has turned itself around in a big way, and now we’re doing the same thing with infrastructure.

Prior to two years ago, we really did not have a huge culture of philanthropy. Now, we have close to 6,000 people participating in our campaign. Normally, these types of projects are done with two or three huge gifts. In our case, we’ve had one $4 million anonymous gift, and Erlanger Health System put in about $11 million, but the majority of the funds have come from people writing checks at their kitchen tables. It’s been a group effort with work done by Girl Scout and Boy Scout troops as well as a host of nonprofits. It’s important to note that our community isn’t just Chattanooga. We cover a 50,000-square-mile area, so people an hour and a half away . . . this is their children’s hospital.

HCB News: How are you staffing up the facility?
DM: What we’ve done is try to rightsize it. Our strategy is to create access that is defined by geography and time. We aim to have enough doctors and nurse practitioners for each specialty so children can get an appointment in a reasonable time. We’re also using outreach clinics to help improve geographic access as well as telemedicine suites for consultations throughout the region.

HCB News: What challenges does your facility have at the regional level and/or at the national level?
DM: The biggest problem with pediatric health care is that the majority of the kids in our country are covered by Medicaid. When the ACA was enacted, it expanded to include a lot of adult working poor. Now, people are talking about doing away with the ACA and it will disproportionately hurt children when Medicaid gets a cut. Medicaid already pays less than what it costs to provide care. As Congress and the president talk about reducing Medicaid, if they’re not considering the children, they’re not considering the long-term implications. Children used to be two-thirds of the enrollees, but one-third of the cost. Now, they’re only one-third of the enrollees.

I think the other conversation we need to have is how we can control the rising costs and actually reduce costs. Of course, you do things more efficiently and more cost-effectively. So we don’t have any offices in the hospital, for instance. You can’t justify office space in a building that costs so much per square foot. There’s also the way we’re constructing our medical space. By planning and scheduling to share spaces, focusing on one type of specialty one day and a different the next, we’ve picked up a significant amount of capacity. We’re also offering a school-based health care program where we’re supporting 33 school nurses and that also supports the medical home.

Another big challenge is helping people understand that pediatric care is different. Kids aren’t just small adults. Their biology, treatment and emotional state is different. You need to explain to a child why you’re doing things in a way they can understand. Overall, the way you approach treatment is different. If a child comes in with appendicitis, we’ll see what we can do to avoid removing it, since they have a long life ahead where they’d benefit from having it to fight infections. If we’re operating, we work hard to minimize scars so that they don’t show when they go to the beach, because other kids can be mean. However, when non-pediatric facilities go into care, if they don’t have the infrastructure, if they don’t have the flow of pediatric patients, they’re just not going to get those nuances. I think the message is that kids belong in pediatric hospitals.


HCB News: What are your advantages over other facilities of your size?
DM: Our advantage is that we’re part of a health system that recognizes and supports the pediatric differential. I define this not just by the kids that come through the door, but by every child that touches any one of our facilities or our competitors’ facilities. We spend time training our emergency personnel on the best way to treat children, and even expand that training to our competitors because they really need to be competent on the best way to treat kids in an emergency situation. We’ll do simulations, come in with a doll, and say, “here’s a 2-year-old that’s not breathing – how are you going to respond? No, that mask is too large, dose is too much,” etc. We have redefined what it means to be a children’s hospital in our region.

The way we look at it is we’re here to support children. Competition should never come into a dialogue about children. It’s a very different strategy than adult medicine. Children’s hospitals work together to ensure we have what we need. I’ve met with other CEOs and I’ve talked to them about it. Their own kids are in our community, their employees have kids in our region, and they realize the value.

HCB News: What are your predictions for how caring for children will change 10 years into the future?
DM: There will be less money to care for kids and adults than there is today. There won’t be enough nurses and doctors. We’re going to have to start practicing medicine in a way that maximizes the licensing for nurses and doctors. Nurses can’t be running to get formula. Dieticians or techs can. Everyone will need to work at the top of their licensure. There will be more shared space and smaller spaces. We’ll continue to come up with ways to do things for less and provide more value. We’ll continue to improve timeliness of care through better access, and through that, we’ll provide better care.