The Crisis of Pediatric Healthcare: The Cost of Neglecting Our Children's Health Services
The time to act is now
As the saying goes, the children are our future. Yet, we are facing a concerning trend in the United States that threatens to undermine the health and well-being of our youngest generation. The decline in the payment for pediatric healthcare services is causing an alarming number of pediatric emergency rooms and hospital wards to close their doors. Simultaneously, access to subspecialists is dwindling, and practices that provide essential care to children nationwide are shutting down.
In Michigan, a troubled health system terminated all of its employee pediatricians. In Rochester, NY, a long-standing private practice with 3,000 children and three clinicians is closing. In Northern Virginia, practices have been closing offices or closing the whole practice as the owner retires, and no one wants to take on the risk and complexity of managing an office that cares for children when payment for services keeps decreasing and costs keeps increasing.
In a recent Wall Street Journal article (1), the spotlight was shone on the lack of pediatric emergency room competency for children. This issue is not isolated but is part of a more significant, systemic problem eroding pediatric healthcare infrastructure in the U.S. I urge you to read and share the article with your legislatures.
Pediatric emergency rooms are often the first line of defense when a child's health is in peril. They are equipped with specialized equipment and staff trained to handle the unique needs of children. Yet, the dwindling payments for pediatric services are causing these critical facilities to close. This trend reduces the availability of immediate care and means that children may have to be treated in general emergency rooms, which may not be equipped or staffed to handle pediatric emergencies effectively.
In 1995, I came to Manassas, Virginia. With my adult emergency medicine partners, a group of 5 pediatricians, and the support of the pediatricians in the community, we built the first hospitalist program and emergency room program for children in a community hospital. The quality of care improved, and the community regained trust in the hospital after many years of poor quality. Today, the hospital is owned by the University of Va Health System. It has closed all pediatric care to the community. The other hospitals, Sentera-Woodbridge, Reston-HCA, Stone Springs-HCA, and Haymartket-HCA, have followed their example.
For other lines of services, the hospitals have sought trauma designation. This allows them to charge for activating their trauma teams even in minor automobile accidents: "The median cost for the encounter in the activation group was $36,761 versus $624 in the non-activation group." (2). So you can make $37,000 for a single visit or $1,200 for child care if they have insurance. It is easy to follow the money.
Similarly, the decreasing payments for pediatric healthcare are causing hospital wards dedicated to children's health to close. These specialized wards are vital as they offer an environment tailored to children's unique needs, from physical health to emotional well-being.
Moreover, the decline in payment for pediatric services is causing a decrease in access to subspecialists. These experts are crucial for diagnosing and treating complex health issues in children. Fewer subspecialists mean longer appointment wait times and potentially delayed diagnoses and treatments.
We can access Fairfax Children's Hospital, Children's National, John Hopkins, and MCV Children's Hospital in Northern Virginia. Their EDs are filled with mental health patients with no inpatient beds and no neurology consults left; developmental consults are years out, and psychiatry consults are two years out. We have two of the most affluent counties in the country, Loudoun and Fairfax. Prince William, considered underserved, has a median income of $114,000 (3) Imagine the struggles of rural communities, Native American communities, and urban communities where access is more limited and resources less plentiful.
Lastly, the impact of reduced payments for pediatric services is leading to the closing of practices that provide care and access to children across the U.S. These practices often serve as a child's primary healthcare provider, offering regular check-ups, immunizations, and other preventive care. The closing of these practices means fewer healthcare access points for children, particularly in rural and underserved areas.
The consequences of this trend are far-reaching and potentially devastating. Children are not simply small adults; they have unique health needs and require specialized care. The decline in payment for pediatric services is not just a financial issue; it is a public health crisis that threatens the future health of our nation.
The time to act is now. We, as a society, along with our policy-makers, must recognize the importance of investing in pediatric healthcare. The health and well-being of our children, and by extension, our future, depend on it.
Herbert Bravo, MD
References:
Children Are Dying in Ill-Prepared Emergency Rooms Across America, By Liz Essley Whyte and Melanie Evans.
The Cost of Trauma Team Activation for Low-Risk Pediatric Motor Vehicle CollisionsMatthew Wilkinson, MD, MPH, FAAP, FACEP;Pediatrics (2019) 144 (2_MeetingAbstract): 417. https://doi.org/10.1542/peds.144.2MA5.417
https://www.census.gov/quickfacts/fact/table/princewilliamcountyvirginia,US/PST045221