The Children’s Hospital Association examined the distribution of pediatric health care services, care delivery, and pediatric care utilization to help inform policy decisions related to network adequacy standards that would require the inclusion of specialized pediatric providers in provider networks. Specifically, the analysis addresses policies related to the inclusion of essential community providers (ECPs) in networks and the use of distance standards as a metric of network adequacy.
- Children’s hospitals in the study provide, on average, more than six-fold the number of selected pediatric services than seen in non-children’s hospitals, and have more than 25-fold the number of pediatric designated beds
- Children’s hospitals in the study provide more than 80 percent of inpatient care to pediatric patients in need of cardiac surgery, bone marrow transplants and solid organ transplants and more than 50 percent of the inpatient care to children in need of rheumatology services, otolaryngology surgery, surgical neuroscience services, oncology care, and six additional specialties
- Only 49.9 percent of children ages 0-19 would have access to an acute care children’s hospital when commonly used adult distance metrics to assess network adequacy are applied to those hospitals
- Children’s hospitals, unlike other hospitals, have the clinical expertise and capacity necessary to ensure children receive appropriate and high quality care that meets their unique needs
- Distance standards should not be used to assess a provider network’s adequacy in relation to pediatric specialty care given the regional nature of that care, particularly tertiary and quaternary pediatric care
Association Contacts: Jan Kaplan, (202) 753-5384 or Alex Rothenburger, (202) 753-5370