There is a lot of uncertainty in Maryland surrounding how we deliver care to sick patients in hospitals because of looming federal cuts to Medicare and Medicaid and the the possibility that the new federal administration might end the state’s current waiver payment system. Hospitals also face higher costs for labor, supplies and pharmaceuticals and no sign of increasing revenue. In this uncertain time, the governor and legislature will need to assure access to care for the most vulnerable of our citizens, our children.

While there has been an increase in closures of pediatric hospital inpatient units nationally, Maryland’s unique payer system creates an environment in which hospitals face challenges in preserving pediatric inpatient services. Multiple hospitals have closed their inpatient pediatric units, and next month Upper Chesapeake Hospital will close theirs.

As pediatric hospital patients are only a small fraction of any acute-care hospital, the state needs to consider how to incentivize and fund pediatric inpatient care to ensure that these patients continue to have access to critical care when needed.

Families who now may have to travel long distances to be with their sick child in the hospital will face numerous challenges, including longer trips to and from the hospital and costs like tolls and parking.

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Prior research has demonstrated that low levels of pediatric readiness lead to worse outcomes for sick children. Additionally, there are risks to transporting children long distances, including possible motor vehicle crashes and deterioration of a child’s condition if transport is delayed, as is common in the busy winter months.

Now is the time for the state to engage in careful discussion and planning to create a future where children with acute illnesses can be cared for safely in their community. Similar to the work being done this year to address children with behavioral issues stuck in emergency departments, engagement with key stakeholder groups including pediatricians, hospitals and families who have experience with being sent out of state for care can hopefully lead to a sustainable solution and improvements.

Dr. Scott D. Krugman is senior associate dean for LifeBridge Health/George Washington School of Medicine and Health Sciences