Redefining Children’s Partnerships: Developing Strategic Alternatives to Traditional Models

Access to pediatric specialty care has been a growing issue in many parts of the country for some time—as one recent study shows, there was a 19% decline in inpatient pediatric units between 2008 and 2018.^[1] But when the New York Times ran a story about the challenges one family faced when trying to find specialty care for their chronically ill child, the issue finally caught the attention of the general public.

While the article highlights a pervasive and critical issue, its attribution of cause—that is, to boost profit margins—is reductive. There are many components beyond just profitability impacting how and where pediatric care is being delivered now and where it will be delivered in the future:

• Pediatrics operates at a structural financial deficit due to a disproportionate reliance on Medicaid reimbursement, which typically lags behind Medicare and commercial payment levels and is insufficient to cover the cost of care.
• Birth rates and the overall pediatric population have declined nationally, reducing demand for some services.
• Lower-acuity care has moved to ambulatory settings, thereby reducing the demand for inpatient beds at community hospitals. Moreover, children who do require inpatient care often have complex needs that community hospitals are not equipped to manage.
• There are not enough pediatric specialists to operate pediatric programs, and many specialists gravitate to working in large academic centers, leaving smaller markets and rural areas underserved.
• Quality and safety in pediatric specialty care decline when volumes are low, and it is challenging for physicians to maintain their skills if they don’t have a full patient roster.
• Recruiting and retaining trained pediatric nurses and other clinical support staff is a challenge, and provider shortages in the post-COVID-19 era are limiting organizations’ ability to safely keep units operational.
• When the choice is available, families are often willing to bypass community hospitals and travel to children’s hospitals offering access to a greater breadth and depth of specialties and pediatric expertise.
• Adult-focused healthcare systems are facing tremendous financial challenges, forcing them to make difficult resource allocation and operational choices across all service lines, including pediatrics.2 COVID-19 surges in 2019 and 2020 exposed the adult healthcare system as ill-equipped to handle increased bed demand, which in some cases led to pediatric units being reassigned for adult patients.

This has caused an inflection point with regard to their pediatric programs: do they (a) invest and grow to make programs sustainable, (b) shutter their services entirely to focus investment on core adult programs, or (c) attempt to partner more closely with children’s hospitals to deliver pediatric care in innovative ways?

More and more often, we are seeing option c prevail. Health systems are increasingly looking for new ways to partner with children’s hospitals—knowing that many prior collaboration efforts have had mixed results.

_{Edited by: Emily Johnson
Designed by: Mary Anne Akhouzine}

Published August 16, 2023