E49: Dr. Ross Sommers on Bringing NICU-Level Care Into the Home

Dr. Ross Sommers, neonatologist and founder of First Day Health, joins Timothy Chou to discuss the challenges premature infants and their families face when transitioning from the NICU to home. He explains how remote monitoring, neonatal clinical oversight, AI-driven prediction, and in-home support could reduce readmissions, shorten hospital stays, and create a safer bridge between intensive care and home-based recovery.

This episode is brought to you by BevelCloud—powering distributed AI in healthcare and driving the Pediatric Moonshot forward. Learn more at BevelCloud.ai."

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SPEAKER_00 0:14

Good morning, good afternoon, good evening, everyone, to another edition of the Pediatric Moonshot Podcast series. I'm pleased today to be joined by Dr. Ross Summers. Uh Dr. Summers or Ross graduated medical school from the Sackler School of Medicine in Tel Aviv, did a residency at Cohen Children's Medical Center, a fellowship at the Women and Infants Hospital in Neonatology. He is double board certified in pediatrics and neonatal perinatal medicine. Currently, he is the neonatologist at Nicholas Children's in Florida. Welcome, Ross. Thanks for having me, Tim. So I'm gonna kick it off. Like, what motivated you to start this venture you call first health?

SPEAKER_01 1:07

Yeah, so first day health care is really a passion. I love what I do as a new natologist, but I saw this huge gap in trying to get former premature infants home from a NICU. You know, the NICU is probably the only field in healthcare where patients are regularly going from an ICU to home the next day without any transitionary models of care. And I saw that parents were really struggling and weren't ready to take this, you know, two-pound baby, not even at their due date, often going home with hospital-level services such as oxygen home as a caregiver of their child medical complexity. And I felt like we were often misleading them when we said that they're ready to go home. But from the other standpoint, uh I can't keep them forever. And uh I saw you know this explosion of digital health tools for adults with chronic conditions, uh, but I didn't see anything being built for the specific needs of the pediatric population. Uh and I saw it as a you know a personal mission as well as as an opportunity because um uh a day in the hospital in the NICU could be very costly, and a lot of it is could be preventable with better and more timely and technology and oversight of care in the home for these parents.

SPEAKER_00 2:27

Maybe uh so it's not everyone that listens to this is a neonatologist. Maybe take us through a story or two of what what the challenge is for a parent, as you just pointed out, and maybe the challenge for the neonatologists themselves. So yeah.

SPEAKER_01 2:42

So one of the biggest challenges is that we're saving infants of younger gestational age, every it seems like we're constantly pushing the limit. You know, when I was in training, my predecessors said it was like, you know, 27 weeks, then it was 25 weeks, now it's like 23 weeks. And there are, you know, some babies, not all, of very small babies, being saved, and they have more and more complications that take longer and longer to recover from. So a lot of these morbidities of prematurity, such as still requiring a little bit of oxygen or needing the help from a feeding tube because they're not able to eat all their feeds from a bottle, these morbidities that they have of prematurity take a very long time to recover from. Uh sometimes they may not recover even fully, but um the the problem is is that we're having more and more very, very premature infants who have more and more severe morbidities that take longer and longer to recover from. And the NICU wasn't intended to be a place for them to rehabilitate and you know get over these morbidities, but it has become that facility because we have no other place to send them. So that's what I've been trying to do is that noticing that we're already sort of halfway there sending these parents home with hospital-level tools like oxygen, um, that there's this opportunity because while babies do go home from the Nikki on oxygen, it's very, you know, not standard between hospitals. Um, overall, we're sending about 50% of our ex-small babies who are still requiring oxygen home with oxygen, but it may vary from 7% to 95% between hospitals. So there's no standard of care when trying to get a former premature infant home and sending them home with these hospital-level tools. And that's the the dilemma I've, you know, I, my colleagues, face is that we are sending them home to the unknown with these tools. And, you know, so my theory is that hospitals will be more towards those 90% numbers if they knew that there was a service like first aid healthcare that was able to help oversee the vital signs and the weaning off of these therapies that they're still dependent on, and not just sort of sending them home with a graduation cap and a good luck and uh a lot of unknowns, which is currently what we're doing right now.

SPEAKER_00 5:23

Actually, you touched on graduation cap. Is there some standard for graduation?

SPEAKER_01 5:28

Or it's just kind of so sort of every NICU has these different criteria. We say these, it's not based on a specific age, but more when they meet certain criteria. And some of them meaning that you have to have stable vital signs, that they're not having unstable vital signs, they're able to keep their temperature, and they're able to eat all of their feeds from a bottle. So these sort of were like the three pillars that we say that parents need to have for, but slowly, slowly we're sort of changing that because now there are several children's hospitals that are offering home NG tube feeding programs. So the sort of criteria basis is sort of elusive, and and and that's why there really does lack standardizations. I mean, we try our best, the AEP has recommendations, but again, it's very, very challenging because we don't know the environment and what we're sending them out to and the unknowns. So we could build all of these criteria as much as we want. The reality is that a readmission rate for a NICU graduate going home on oxygen could be as high as 30%. So clearly these recommendations and sort of criteria are just it's not working. And and it's because, as I said earlier, that huge leap that parents have to make of going home with nothing, not having all this support mechanism, you know, you're scared, you don't know what to do. You it's two in the morning, your baby's coughing, you can't get your PTS on the phone. And I I could understand them, their natural reflexes just to go to the ER, and you know, that hospital closed its pediatric floor during COVID and never reopened it, and you're seeing an adult ER doctor and etc. So there's high ongoing readmissions rates, and we just want to know as neonatologists that we're able to send the baby home and there's care a care plan and care delivery in place. And unfortunately, right now, I have no additional tools for these families than if I sent the baby home from the normal newborn nursery as a normal child, which is you know an appointment with a pediatrician in an office who you probably never even met before. So, understandably, me and my colleagues are concerned because you know, we want what's best for this child, and we we don't want to be the one that discharges a baby and readmit it or God forbid even dies in the home. But they also can't stay forever. So, my whole goal has been to create more alternative options when discharging a baby, because the reality is these so-called guidelines are changing all the time, and to really create a new field of medicine where these guidelines are gonna be well, if you have the ability to provide first-day health care tools with monitoring management of the baby in the home, then you know it's different because we're gonna prove with our outcomes that babies have less readmissions and less adverse outcomes when being discharged into our home model care.

SPEAKER_00 8:43

So that clearly leads to so what's first day health gonna do? How are you addressing this? What's the service provided?

SPEAKER_01 8:51

Yeah. So, in the model of first day health care delivery, babies don't graduate from the NICU, they transition into our whole model of care. And we're able to, with our technology, provide an extension of the care babies are currently receiving in the NICU. So we built our own uh proprietary remote patient monitoring system with wireless sensors for vital sign data acquisition. So a remote command center team staffed by new native nurse practitioners and the same providers who were taking care of these babies in the NICU are constantly monitoring the vital signs. We also utilize third-party AI-derived algorithms based on heart rate variability, that we're not just waiting for bad things to happen. We're actually trying to predict and prevent and see future issues. And then we combine that remote monitoring with the care providers who are overseeing the care that the parents are being uh, you know, already burdened with responsible. So if they're going home on oxygen, we're overseeing with our evidence-based protocols the weaning of that oxygen into room air. If they're going home with a nasal gouvage tube, we help oversee the increasing of the oral feeds and the weaning of the nasal gouvage tube. And they basically receive a similar level of cares if they're in a NICU, but from the comfort of the home. And we provide a more weaning, gradual weaning and better oversight of the weaning of these therapies. So you don't need to stay in a NICU in the future to be weaned off these therapies. You could have it being done in the home with our oversight remotely, as well as in the additional of hands in the home, if the baby pulls out the NG tube, for instance, that you don't need to rush back to the hospital's ER or the hospital to have it replaced. So a combination of technology, remote expertise providers in neonatal care, and hands in the home to do a procedure like replacing NG tube or deliver a therapeutics or to do point-of-care testing to obtain better data to provide more alternatives than what we currently offer right now.

SPEAKER_00 10:58

So I know you're early. Uh so where where are you in the journey right now? Is this running in a couple of homes? Or yeah. Talk to me about that.

SPEAKER_01 11:08

We've done already initial validation studies with development hospital partners, which is about demonstrating the reliability of our wireless or remote patient monitoring. Uh, and now the biggest step is we're going to be launching clinical trials with hospital children partners. We're going to be launching at Cleveland Clinic in Ohio with new natologists there, uh IRB-approved NICUTA home wireless monitoring uh trial that is going to be demonstrating the benefits of extended monitoring and management in the home in a population of former, you know, premature infants. Um and it's really going to be exciting because we're going to be able to then demonstrate, you know, what is that parent satisfaction, what is that length of stay reduction, uh and and uh that's gonna be a you know a big inflection point that we're gonna be launching this year.

SPEAKER_00 12:06

Uh just out of curiosity, I mean, just pick on Cleveland Clinic. Are they gonna send this home with 10 kids or what what's the scope of the case?

SPEAKER_01 12:14

So the the trial, the study trial design is actually interesting. It's gonna be a randomized control trial, it's not blinded, but they're gonna be randomized between families who get a wireless remote patient monitoring offering in the home and those who don't. And the reason is is they're not gonna be the babies who are the highest risk, like ones going home on oxygen. There are gonna be the entry criteria of only 32 weeks and above. So these are sort of the late preterm infants uh who uh still have issues, but they're not as severe as obviously a 25 or 24, 23 week infant. But being randomized, they could now have a comparative group and see what was the you know, parent satisfaction and you know, feeling empowered about discharge readiness, uh, as well as length of stay reduction. Um a lot of these babies, even if they're not going home on oxygen and they're late preterm, a lot of babies are sort of having prolonged Nick use days because, as I mentioned, one of those discharge criteria is having stable vital signs. And what this means to one neonatologist may be different from another. And this question occurs like, because you have these babies on continuous monitoring, you see a desaturation episode, right? What do you do? What does it mean? You know, was it while they were feeding from a bottle, while is it while they were asleep, did it bounce right back up without intervening? How long did it last? So there's all this, like, you know, a way of deeply analyzing the significance of these episodes. And the reality is, is if you were to have a saturation probe on all normal newborn infants, you'll see a lot of babies who have desaturation episodes when feeding from bottles. Just we don't know because they're not on a monitor, but here they are. So every doctor sort of and hospital has their own sort of you know criteria for this. But uh, what I'm seeing is, and what he believes is that doctors will allow babies and parents to go home sooner if they knew they had this safety net mechanism in place that the baby's still on a monitor, whereas if they didn't have it in place. Um, and that's gonna be really interesting to demonstrate that even in babies 32 weeks and above, a home remote patient monitoring program could decrease length of stay, will be significant because then we could we'll our goal, our plan in we're designing another trial with a with another hospital on a payer partner would be pushing the you know the gestational age to lower infants and infants who actually are still requiring oxygen and the more complexities. So uh a late preterm infant, we may show we could decrease length of stay by two days with a statistical significance, and you know, okay, it's just two days, but the potential for length reduction is limited when you know you're at 32, but when you're at 24, 25 weeks, it's like literally weeks to months that could be decreased from a NICU stay with a a program like ours.

SPEAKER_00 15:16

Right. Um, just touching on it, probably not all the way there, but you mentioned payer. How how do you see this being paid for?

SPEAKER_01 15:25

Yeah, that's a really good question. Yeah. So the way that first aid healthcare is gonna be paid for is really through risk-based arrangements with payers and hospitals as partners, because obviously a payer wants to save in this expensive NICU population. And if we're able to manage that condition of oxygen weaning or Nasal Govaj tube weaning, so they could not have to be in the NICU but be in the home, then we could make contract with the payer for managing that condition, whether it may take a baby uh 10 days to get off the oxygen or or even up to three months or a set time period. Uh, the reason hospitals want this, are gonna want this, is that first of all, many hospitals have capitated rates or DRG payments or models where they may not be getting paid anymore if it reaches capitation, or they get a bundle payment for a code, and then like they're incentivized actually to want a decreased length of stay. So uh in some scenarios, it actually may be the hospital if they're at risk, because uh there are children's hospitals who have even accountable care organizations, or children's hospitals who have um uh you know capitated rates, but I've never had a scenario where a hospital administrator tells me as a doctor to get a you know discharge a baby. What it's really also about is also there's many children's hospitals who have difficulty managing bed capacity of neonatal beds. And despite the fact that we have 60% more NICU beds today than 15 years ago, there's still children's hospitals who are over census because they're they don't have room for all these feeding grower babies. So what we're doing is we're really solving a problem for them by getting these feeder growers out sooner so they could actually provide more higher acuity patient care, where even if they're getting paid for every day of you know service until day of discharge, the higher acuity kids are the ones who you know pay higher. And I've seen firsthand scenarios where children's hospitals are closed for referral of transports of newborns because they're just 110% capacity, you know, and now they call a different, they have to call a different hospital, for instance. So uh the real goal is to align the interests of hospitals and payers, and for hospitals to want us to take these, you know, former premature infants out in a more timely manner, uh, because it allows them to do what they do best, which is taking care of the higher acuity patients and what the care was intended for. And the trickle-down effect is enormous because now this is the kind of hospital women are going to want to have their babies at because nowadays women are consumers of you know where they want to have their baby. And it's common for families to want to have their baby at a hospital that has a NICU versus a smaller hospital that may not have one in case you know they have a baby and they don't want to be transferred. But if they are in a NICU, they definitely don't want to be there longer than necessary. And if they knew that, God forbid their baby was in a NICU at a hospital that worked with First Day Healthier, then they would be able to know that they would be able to go home not by themselves and with support mechanism in place. So um, it's really about creating this new line of greatly needed service that is going to align the interests of all parties involved and really provide savings for this niche costly population. You know, people aren't necessarily aware that we're having about three and a half million births per year. About 10 to 12% are coming through a NICU. It's about 350,000 patients that are costing about 30 to 40 billion dollars per year. And it's just a enormous amount of expenditure. And it's a huge expenditure also on our tax dollars because Medicaid covers a majority of NICU care, and Medicaid is paying for a majority of NICU care. So I really feel strongly that as we grow, there's going to be more pressure from Medicaid and states to work with first-day healthcare because the status quo is just unsustainable about this tremendous amount of expenditure on such a small population.

SPEAKER_00 19:49

Yeah. Amazing, amazing work you're doing, Ross. You know, let's let's wind it down. If if people want to know more uh about the internet, yeah, first day healthcare. Yeah, what do we say?

SPEAKER_01 20:01

Go on. Yeah, if you're interested, you know, come to our website wwwfirstday.health. I'm found on LinkedIn. I'm there a lot and happy to share more information.

SPEAKER_00 20:12

Well, again, uh thanks for the work you're doing, and uh thanks for being on our podcast.

SPEAKER_01 20:17

Thanks, Tim.