Specialized pediatric care moves into suburbs

"We realized the need to partner with physician practices in the community to bring primary care to the people in their neighborhoods," said Lisa Helfman, Texas Children's Hospital director of real estate services. "Today we have almost 50 primary care pediatric facilities in the community."

In addition to responding to the logistical challenges parents face getting to the Medical Center, health care providers are also responding to population growth in the Greater Houston area.

According to the Health of Houston 2012 survey, the percent of children under the age of 5 in Fort Bend County increased by 60 percent between 2000 and 2010. In Montgomery County, that number grew by 46 percent, and 40 percent in Waller County. By comparison, the number in Harris County grew by only 19 percent.

New pediatric facilities

The growth has created a demand for a variety of pediatric-centered facilities in surrounding communities. Kool Kids Pediatrics opened recently in Cy-Fair, Night Light Urgent Care also has a Cy-Fair location as well as one in Sugar Land, and Urgent Care for Kids recently opened facilities in The Woodlands, Katy and West University.

In Urgent Care for Kids' case, the company expanded its offices into places where there are not as many alternatives to hospitals and free standing ERs, especially for kids, regional marketing director Emily Byrne said.

"In Houston there isn't a pediatric mix with urgent care facilities," Byrne said. "We heard complaints from many parents who had to wait with their kids behind adults in line to get treatment."

The group opened locations in West University and The Woodlands in October and Katy in September. The Katy location averages about 20 child-patients per night, some of whom come from as far as the Galleria area. The West University and The Woodlands locations, only a few weeks old, average about seven–10 children a night.

In a traditional emergency room, there is also only a small chance that a child will be seen by a pediatrician, said Connie Cazares, co-founder of NightLight Pediatric Urgent Care.

Pediatricians at NightLight, which opened a location in Sugar Land in March 2007 and one in Cy-Fair in November 2009, are also able to communicate efficiently and regularly with the patient's home doctor, Cazares said.

Challenges

The population of children—some of whom, statistically, will have complex care needs—is growing in step with the broader population in the Greater Houston area, said Ken Janda, president and CEO of Community Health Choice, a nonprofit HMO that finances health care for 220,000 of the state's children and specializes in low-income populations.

Advancements in medical technology now provide more treatment options for disabled children helping them to live more productive lives, but those resources have to be accessible to people, Janda said.

The movement of children's health care providers into places such as Katy and The Woodlands makes accessing medical resources much easier to those residents, he said. There are, however, many ZIP codes in the Greater Houston area where populations of children are growing at similar speeds to that of Katy or The Woodlands—the north and east side of Houston are two examples—where health care providers have been less eager to move. Children in these areas are largely on Medicaid and not commercial insurance, Janda said.

One additional concern children's health care professionals are watching closely is that the income level of parents—who are statistically a young group of people—is dropping, Janda said.

This trend, combined with an increase in the number of hospitals, may encourage parents to take their kids to the ER for non-emergency care. When children get sick, the only place some of these parents think to take them is the emergency room, he said.

"Too often emergency rooms have kids coming in with ear or upper respiratory infections—things that could clearly be seen in an urgent care facility or doctor's office," Janda said.

Though he understands the concerns about paying for it, the Affordable Care Act might help address this through its insurance subsidies to lower income parents, he said. Health care providers are also trying to address the problem by encouraging a single point of contact for patients and their families. Overall, such coordination yields better outcomes for the children and allows insurance companies to save money because medical providers do not repeat steps.

"It is really critical from our standpoint," Janda said. "We absolutely encourage families to find a 'medical home,' a place that care can be coordinated, so that parents aren't frustrated with the fragmented system."