This viewpoint in JAMA argues for regionalizing care and  instituting accompanying payment reform to improve quality and reduce the costs of caring for children with complex healthcare needs.

It summarizes:

“A recent report in the national media raised an important question: Who is monitoring and safeguarding the care of children with complex healthcare needs? The article reported on a hospital alleged to have a mortality rate for children undergoing heart surgery more than 3 times higher than the national average, prompting an investigation by the Joint Commission and the Centers for Medicare & Medicaid Services. In August of 2015, the hospital voluntarily closed its congenital heart surgery program. Although many details remain unclear, this investigation has stimulated a long overdue discussion regarding the optimal care of these and other children requiring complex, resource-intensive care.”