Indirect Care Utilization Among Children with Medical Complexity

Purpose of ReviewChildren with medical complexity (CMC) account for 1% of the US pediatric population and 35% of healthcare costs. Comprehensive care for CMC requires high amounts of indirect care time (ICT). We describe the value of ICT for CMC in a mature, consultative, subspecialty complex care program.Recent FindingsNine hundred five CMC in our Comprehensive Care Program over a 2-year period received an average of 1283 h of ICT and 640 h of direct visit time per year. Provider costs/year were $93,977 for ICT and $62,848 for direct care provision. The odds of incurring hospital costs increased by 43% among CMC who used ICT.SummaryCMC utilize substantial, costly, and unreimbursed amounts of ICT, yet ICT is associated with increased hospital costs. Perhaps ICT might be a proxy indicator of rising clinical acuity and should prompt escalation of ambulatory care plans; further studies are needed.