As the controversy between Norton Healthcare and the University of Louisville over control of Norton Kosair Children’s Hospital continues to unfold, our colleagues at Insider Louisville have emphasized a central role that control of neonatal intensive care unit (NICU) beds is playing. Every hospital that delivers babies will have a nursery, but not all are qualified to run the NICUs that take care of the very sickest and most vulnerable infants. Aside from providing necessary care, it is no state secret that NICUs are one of the very most profitable services in a children’s hospital.
The number of NICU beds in individual acute care hospitals is regulated by Kentucky’s certificate of need (CON) process. There are four possible levels of NICU beds ranging from Level I for routine infant care, to level IV for institutions capable of caring for virtually any sophisticated need, including surgery. Kentucky’s continuingly updated State Health Plan addresses the criteria and requirements for each level. On May 31, 2013, the Plan was revised to bring it more into line with the most recent “Guidelines for Perinatal Care” of the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists. The Plan now includes specific requirements for a new state designation of Level IV. You can download the NICU-related pages of the 2013 State Health Plan here.
The new regulations make it possible for a level II facility to care for sicker babies if it has a written affiliation agreement with a Level IV facility. Similarly, a Level III facility must now also have a formal collaborative relationship with a Level IV facility for consultation and transfers. This puts hospitals with Level IV NICUs at the top of networks of care and referrals. In medical terms, this is also referred to as guaranteed income streams. You can see where this might be going. Continue reading “The Quest for Neonatal Intensive Care Beds. A Statewide Phenomena.”