LAUSR

While there are many publications on cost effectiveness of neonatal therapies in preventing disease complications, the dollars and cents of staffing a financially healthy neonatal system with quality outcomes are not transparent [1–5]. Strategies for subsidizing regionalized care, however, remain sequestered in administrative board meetings and may exclude neonatal health care providers entirely. Navigating the economics of regionalization involves balancing the needs of community hospitals with “balancing the books” as well as mitigating the workload and salary tensions between academic and clinical faculty. In this Commentary, our goal is to share the financial design of a system of neonatal care whose clinical outcomes are described in this issue [6]. Regionalization of perinatal care has been the standard of obstetric and pediatric services for nearly five decades [7]. Risk-appropriate stratified services have resulted in improved neonatal outcomes, including reduced mortality and short term morbidities—particularly for the most premature infants [8–10]. This strategy benefits from centralizing rare and uncommon health care problems in one location which enables higher levels of experience and presumably, expertise for healthcare personnel [11–13]. Increasingly, economic factors influence decisions which erode the strength of regionalized care [14, 15]. Given the movement toward value-based payment mechanisms and the myriad of pressures currently faced by neonatal health care systems, it may be instructive to understand the business structure for a specific model of regionalization.