Children’s Medical Center criticizes KMC nursery upgrades

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KETTERING — Local competition for the region’s tiniest, most fragile patients is intensifying, spurring a heated debate over duplication of services and health care costs.

Kettering Medical Center on Jan. 1 expanded its nursery capabilities to care for babies weighing as little as 2.2 pounds and as young as 28 weeks. Its neonatal intensive care unit (NICU) will serve very premature babies born not only at Kettering Medical Center, but at other Kettering Health Network hospitals where babies are born: Southview Medical Center, Fort Hamilton Hospital and Soin Medical Center, which will open in February in Beavercreek.

According to a Jan. 6 letter to doctors, KMC will further upgrade its NICU this summer, enabling it to go head-to-head with Miami Valley Hospital. Until now, MVH had the region’s only high-risk obstetrics unit with an associated ICU.

KMC plans to staff the NICU on or after July 1 with a neonatal team from Cincinnati Children’s Hospital Medical Center. “We would like to give moms an alternate choice for delivering at a high-risk facility,” hospital spokeswoman Elizabeth Long said. “The ultimate goal is to keep mothers and babies together.”

Kettering’s expansion, however, has drawn criticism from the Children’s Medical Center of Dayton. Dayton Children’s receives about 7 percent of the referrals to its NICU from Kettering Health Network hospitals. That’s significant because Dayton Children’s NICU is its single largest revenue source and generates a $5 million surplus that helps subsidize other pediatric specialties.

Dayton Children’s officials have publicly campaigned against the Kettering Medical Center nursery upgrades, the plans for which became public nearly three years ago.

“We are deeply disappointed that our colleagues and partners at Cincinnati Children’s along with the leadership at Kettering Health Network would take a step to establish a duplicative service that is clearly not needed in the region, and certainly not in the best interest of quality,” Dayton Children’s said in a set of talking points obtained by the Dayton Daily News.

“It’s really not good to duplicate such a high-level service. We know our clinical care and our quality are exceptional. Our data support that,” said David Kinsaul, Dayton Children’s president and CEO.

KHN’s Long said the network has grown in recent years. The addition of Greene Memorial and Fort Hamilton hospitals and the construction of Soin Medical Center have created a greater need for an in-network NICU capable of providing critical care, she said. She said delivery volume at Kettering Medical Center increased 2.7 percent to 5,000 babies from 2010 to 2011. But Miami Valley Hospital and Dayton Children’s point out that demand is not growing for Level III beds in the Dayton region. Each year, the two hospitals together care for about 700 infants that need Level III care, a number that has remained fairly constant in recent years.

And in 13 local counties, the number of preterm births (less than 37 weeks gestation) declined to 3,080 in 2010, a drop of nearly 10 percent since 2006.

Dr. Marc Belcastro, medical director of Miami Valley Hospital’s Level III NICU, said several studies have demonstrated that the fewer infants cared for in a neonatal nursery, the higher the mortality rate. He said neonatal professionals can lose their edge if they work with fewer critically ill babies.

Kettering Medical Center has 50 nursery beds, 20 of which are designated as Level IIIA. That means the nursery can provide care for a newborn that weighs at least 2.2 pounds and whose gestational age is more than 28 weeks, according to new state guidelines that took effect Jan. 1.

Miami Valley Hospital, meanwhile, has 60 beds that are designated Level IIIB, which indicates the hospital can provide comprehensive care for infants with extremely low birth weights. KHN is seeking the Level IIIB designation for its nursery as well. Dayton Children’s NICU has 41 beds that are designated Level IIIB.

If care is provided by Cincinnati-based neonatologist and subspecialists in the NICU, it could siphon future referrals for those children to Cincinnati when the same services are available in Dayton, said Dr. David Roer, a general pediatrician with Pediatric Associates of Dayton.

“This has the potential to inflict some serious damage on Dayton Children’s,” he said.

Dr. Jim Greenberg, co-director of the Perinatal Institute’s neonatology division at Cincinnati Children’s Hospital Medical Center, said it is not the intent of Cincinnati Children’s to make inroads into the Dayton market. He said Cincinnati Children’s recommended that Kettering reach out to Dayton Children’s about staffing its Level III NICU.

Greenberg said Cincinnati Children’s staff would only send babies elsewhere for care if that care wasn’t available in the Dayton area, he said.

Greenberg declined to disclose how much Kettering is paying Cincinnati Children’s to staff its NICU.

Kettering’s upgraded nursery counts some parents among its supporters.

Kari Riley-Garland of Carlisle gave birth Jan. 10 to 3-pound, 12-ounce daughter Brynn at Kettering. Riley-Garland said she appreciated knowing her daughter was right around the corner after delivery and didn’t have to be “whisked away” to another hospital. It also was more convenient for her family.

“It made everything just a whole lot easier,” Riley-Garland said as she reached into the incubator and stroked Brynn’s hair. “Once I went here, I wouldn’t go anywhere else.”