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Pediatricians are being overwhelmed by "NICU graduates"

by Sally Ginsburg, MD

In case you missed it, a new report from the Health Care Cost Institute found that health care spending on children covered by employer-sponsored health insurance (ESI) rose faster than the overall average spending, increasing 5.7% per year from 2010-2013 compared to 3.9% for the entire ESI population. The Institute attributed much of it to big increases in hospital admissions for newborns within the first 18 days of birth, separate from the costs of delivery. 

More and more premature and critically ill newborns are being treated in neonatal intensive-care units (NICUs) across the country, and while on the surface that may seem like a good thing, for pediatricians like me, it is causing us a serious case of unintended harm. But before I jump into that, I wanted to explore why children’s health care costs are rising faster than average.

During the time of the study, the CDC reported that most states saw an increase in the age of new mothers, an age group that has more high-risk issues and neo-natal complications. Another factor may be the C-section rate. According to the CDC, 32.7% of all births are delivered via C-section, almost at an all-time high and a likely contributor to additional long(er) term stays for newborns. Gestational diabetes can also add to the expense and, sometimes, duration of stay.

But to me, the biggest cause in the spike in child health care costs is the increase in mothers with substance abuse problems. Other studies from the same period of time show an increased use of opiates by mothers at the time of delivery. But it’s not just opiates. Once pregnant, many of these mothers are placed on medications like methadone and Subutex, which have their own costly repercussions.

The babies of substance-dependent mothers spend weeks or months in the hospital. They are often premature. These infants need to be weaned off medications carefully, requiring prolonged and costly highly skilled inpatient care.

When these infants are released from the hospital, they are typically beset with neurological, nutritional, respiratory and social problems. The results of these intrauterine and neonatal insults include developmental delays, ADHD, behavioral problems and other nuanced diagnoses for which we do not yet even have names.

And here is what makes my blood boil. Once these infants and mothers leave the hospital, there are very few services or resources available to help them. So it falls on us, the pediatricians. And we are not well prepared to deal with this onslaught.

I have been a practicing pediatrician for 17 years. When I started, this was not a major issue. Now, not a day goes by that my office doesn’t have at least one parent pleading with us to help them manage their child. It is about as bad as it has ever been.

And there are fewer resources than ever. There aren’t enough pediatric mental health specialists, and schools don’t have the budgets for services to help manage this ever-growing population. The problem has reached the tipping point.

We are trying to figure out ways to get properly trained to manage these complex patients, and often have to call a child psychiatrist or psychologist to see how we can best help these struggling families. Many of pediatricians went into pediatrics to deal with medical issues we could help fix, but you can’t really “fix” a child with neurological and developmental deficits. You can help ease the transitions and medicate the behavioral problems, but you cannot “heal” the patient. These are children with chronic problems and no concrete answers.

One of the primary issues is money. NICUs are the financial saviors for many a children’s hospital system, but treating these kids when they leave the hospital is just not a moneymaker. In fact, it is a bottomless money pit. We make sure these babies get everything they need as preemies – all the fancy technology, the expensive medications, the highly specialized care – but then, when they graduate from the intensive care unit, we send them off into a world without the support they need – with pediatricians and primary care physicians left to catch the fallout. Developmental and mental/behavioral health services are just not available everywhere. Those resources that do exist are stretched so thin.

Pediatricians are pretty burned out. Not all of us, of course, but in my personal opinion, many of us. From my little corner of the Northeast, this is what I see: an explosion of children with challenging behavioral and mental health conditions, overburdened doctors and dwindling resources.

Anyone out there with a solution to this problem? I do not have one.


Dr. Ginsburg is a pediatrician at Pioneer Valley Pediatrics.

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Comments

Submitted by Denise Terry - Sunday, November 15, 2015

Dr. Ginsburg, please let's connect - we aim to address some of these issues through EmbraceFamily Health to improve maternal-child health, prenatal care and education of moms, reduction of preterm labor, parental support postpartum - to complement that care that moms receive (or don't always receive) from their OBGYNs and pediatricians. We're building medical-grade digital health solutions in collaboration with clinicians. Would love to talk some more. - Denise Terry, CEO EmbraceFamily Health

Submitted by Katie - Wednesday, October 14, 2015

My daughter spent a week in the NICU and it cost about $200k. Thankfully, she had insurance and it covered the cost.

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