Kelly Stevenson’s active-duty military husband was deployed when she went into labor at 28 weeks into the pregnancy in March 2019, and the couple’s identical twins, Caleb and Joshua, made an early earthly debut at UCHealth Memorial Hospital Central in Colorado Springs.

After 70 days of being tended to in Memorial’s neonatal intensive-care unit, the premature twins had their first 15 minutes of fame in life when they were whisked by ambulance to Children’s Hospital Colorado in Colorado Springs, becoming among the new facility’s first patients.

“We’re just so grateful for what they did for our kids — you wouldn’t look at them now and know they were 28-week babies,” Stevenson said. “They’re thriving, and that says a lot about the care they received at Children’s Hospital.”

Five years after Children’s Hospital Colorado opened a full-service location in Colorado Springs, more than 108,000 kids have had their small “ow-ies” and large ailments treated, as demand has far exceeded projections of use and need.

“We’ve seen a significant amount of growth,” said Children’s Hospital Colorado’s Southern Region President Greg Raymond.

Leaders had forecast 15,000 emergency department visits in the first year, which brought 12,000. But the pandemic arriving in March 2020, followed by a triple-demic of the novel coronavirus, a tough flu season and the RSV respiratory virus, combined for “extreme utilization,” he said.

“Almost overnight, our volumes exploded,” Raymond said. “We went from 12,000 emergency visits a year to 20,000 visits, and in 2022 we exceeded 40,600. We had projected 28,000 that year.”

After adding 16 beds in 2020, less than a year after opening, and two years ago creating a separate partial-hospitalization behavioral health and psychiatric outpatient facility, patient load has ballooned so much that elective pediatric surgeries — such as inserting ear tubes or club foot reconstruction — are being postponed, and in-patient beds can be hard to come by at times.

Despite the volume, operations in the southern Colorado region have posted operating margin losses in each of the past five years, ranging from minus-29% to minus-5%, according to Raymond.

This year is looking more promising: the balance sheet is heading out of the red and toward black and could see revenue cover expenses for hospital’s services but not at the ancillary clinics, he said.

Emergency services

Despite sustained demand, Raymond said the local campus is always prepared to meet pressing needs in children’s health care.

“When we think about the variables in availability, we always have urgent availability, with access to a pediatric specialist that will provide a procedure in a timely manner,” he said.

The Colorado Springs hospital — one of four acute-care Children’s Hospitals in the network, which also includes campuses in Aurora at the Anschutz Medical Campus, a north metro location in Broomfield and a south metro location in Highlands Ranch — is tracking to handle 38,000 emergency department visits this year, he said.

Some emergencies require surgery, others do not. Overall, the hospital performed 2,400 surgeries in its first year and now conducts 5,600 annually.

While wait times for non-emergency surgeries are generally not long, families also have the option of scheduling elective services, such as ear, nose and throat operations, orthopedic procedures, addressing congenital anomalies and some neurological issues, at other Children’s campuses, Raymond said.

“While they’re acute and critical and complex surgeries, they’re not as critical as appendicitis,” Raymond said.

Orthopedic injuries sustained on a playground or while playing sports most often require surgical intervention.

But certain childhood mishaps can be more dangerous than others. Button-battery ingestion, for example, can be deadly.

Cases are infrequent but have the potential to escalate quickly, said Dr. David Listman, director of the emergency department in Colorado Springs.

The small shiny batteries that kids sometimes mistake for candy can erode through the esophagus, get stuck or cause bleeding and require immediate thoracic surgery, he said.

All-terrain vehicle crashes also can be serious for children, Listman said. Although the number of ATV accidents is “moderate,” he said, “They are some of the worst injuries we see with many fractures and head injuries.”

Adults and children can hit a bump in the trail or mistakenly run into fencing and fall off or be thrown from the seat. ATVs also can roll on top of ejected passengers, Listman said.

“The speed and weight of the ATV makes these among our most severe injuries as a group,” he said.

The most common reasons children visit the emergency department at Children’s Hospital in Colorado Springs are:

• Respiratory infections

• Fevers

• Vomiting

• Abdominal pain

• GI issues

• Closed head injuries

• Suicidal ideations

Mental health crises

Another repercussion of the pandemic led Children’s Hospital Colorado to declare a “Pediatric Mental Health State of Emergency” in May 2021, as officials announced its hospitals were overrun with mental crises, with children as young as 8 displaying severe psychiatric problems.

“As a result, we’ve shed more light on the inadequate resources that exist locally, statewide and nationally, and we’ve made significant improvements — yet the need remains,” Raymond said.

Last Tuesday, 20 children sought emergency care for mental health issues at the Colorado Springs hospital, he said. “It might have been five or six kids the day before. What happened that day? I don’t have the answer.”

After being spotlighted nationally for high teen suicide rates last decade, El Paso County increased suicide prevention efforts with messages and assistance at schools, primary care providers’ offices and specialized behavioral health programs.

Now, Raymond said, “We have to ask ourselves do we have adequate community resources to keep kids from escalating to the point to where they seek emergency care to advocate for their safety?”

The hospital has rooms for psychiatric patients designed for addressing trauma, along with a freestanding Children’s Colorado Therapy Care on Telstar that opened in November 2022, which Raymond said also has seen steady high demand.

In 2022, 200 individual patients, from infants and toddlers to elementary and high school students, received outpatient treatment. The number more than tripled in 2023 with about 650 patients. To date this year, the patient load has increased to nearly 850 children.

A partial hospitalization program — in which clients attend day treatment in a classroom-style setting and go home in the evenings — grew from 30 patients in 2022 to nearly 190 last year and almost that many so far this year.

“We are often full; it’s a very popular program, and we’re having good outcomes,” Raymond said. “We’ve still got to lock arms in Colorado Springs to have more upstream prevention.”

Challenges ahead

Raymond acknowledges challenges ahead. Along with population expansion, the pediatric hospital is struggling with how to deal with changes to Tricare reimbursement, the insurance plan for active-duty and retired military and their dependents.

About 1 in 5 patients in Colorado Springs are insured by Tricare, which recently reduced reimbursements by 40% for pediatric outpatient services, Raymond said.

Another 55% of patients are covered by Medicaid, the government-funded health plan for indigent and low-income families. That leaves one-quarter of local patients paying through private insurance, which reimburses at higher rates than subsidized insurance.

“We knew that coming into Colorado Springs that the sustainability of this organization would be challenged by the financial realities of the reimbursements we receive for the care we provide,” Raymond said.

It’s not that the private nonprofit hospital system, which in addition to Colorado also serves Montana, Wyoming, South Dakota, Nebraska, Kansas and New Mexico, didn’t do its due diligence, Raymond said.

Planning for the children’s hospital on the UCHealth Memorial Hospital North campus in Briargate dates to 2012, he said.

Memorial Hospital North opened in April 2007 as a small community hospital, and development in the northeast part of the city led to its build-out and a major expansion that began in 2016 and opened in 2019.

When Children’s opened the Colorado Springs campus in May of 2019, other area hospital systems, including Memorial, closed their pediatric services.

Today, 9 of 10 kids needing in-patient care are seen at a Children’s Hospital Colorado facility; the remainder are treated at rural or outlying hospitals, largely for emergencies.

By and for the community

When a hospital falls short in revenue projections, others in the network are leveraged to make up the difference, Raymond said, which has been the case in Colorado Springs.

But while there’s a potential the local hospital will finish 2024 with a positive operating margin, off-campus locations such as a pediatric specialty clinic and the behavioral health clinic will not, Raymond said. Those losses will push overall operating margins into another year in the red.

Making a profit has not been the goal, he said: “Our hospital was built by and for the community.”

Community philanthropy has helped with bottom line. Nearly $39 million in donations to the hospital’s foundation has funded overall care, research and innovation, support for families tending to sick kids’ needs and other services, Raymond said.

Consistently ranking in the top echelon among children’s hospitals across the nation has helped the system gain respect for its work and recruit new providers, he added.

“As we think about the future … we’ll invest and support the organization ensuring sustainability and advocating for kids, to not only ensure Children’s Hospital gets reimbursed, but more importantly that patients have adequate care,” Raymond said.

“Ultimately, Children’s wants to be identified by how many kids we keep out of the hospital than how many we see.”

Because while everything at Children’s Hospital is pint-sized, even the oxygen masks, and the interior sports bright colors and whimsical artwork to perhaps ease the pain of broken bodies, it’s still not a favorite childhood destination.