To a sick child, it probably doesn't mean much. But to hospital marketers, it's the world.
A battle is brewing over which facility has the right to call itself a children's hospital: a stand-alone facility solely devoted to children's services or a unit within an acute-care hospital for pediatric care.
One battleground is Miami, where Miami Children's Hospital is telling people about itself through an extensive advertising campaign on radio, television, newspapers, magazines and billboards.
The 268-bed hospital is a freestanding specialty facility.
In a recent ad in the Miami Herald, the hospital posed the following question: "Does your health plan include a real children's hospital?"
The ad says that while other South Florida hospitals claim to " specialize" in treating children, Miami Children's is the only one licensed by the state as a specialty hospital exclusively for children.
"There was some confusion," said Marcia Diaz de Villegas, the hospital's director of marketing.
The marketing blitz is an attempt to counteract a trend among general hospitals to advertise their pediatric units as children's hospitals. The aggressive advertising campaign also showcases the industry angst over which facilities should be called children's hospitals.
Miami Children's launched its ad campaign after nearby Baptist Hospital of Miami announced in April it was opening a seven-bed Level III neonatal intensive-care unit. Soon afterward, Baptist, a 392-bed acute-care facility, began calling its wide range of pediatric services a "children's hospital."
But Diaz de Villegas said Miami Children's isn't targeting Baptist specifically with its ads. Instead, it aims to address all South Florida hospitals that have collected their pediatric services under a children's hospital moniker, including 1,422-bed Jackson Memorial Hospital, a public hospital in Miami, and Joe DiMaggio Children's Hospital, part of 792-bed Memorial Regional Hospital in Hollywood, Fla.
Traditional children's hospitals "think they're doing what they need to do to preserve their role or what they perceive to be their role," said Fred Messing, chief executive officer of Baptist.
Messing said once Baptist received permission from the state for its neonatal ICU, designating a part of the facility as a children's hospital helped it to centralize children's services.
"I think we're just sort of raising our hand and saying, `This is who we are, and this is an important part of what we do,'*" Messing said. Baptist has more than 100 beds designated for children.
Florida has only four hospitals licensed as specialty hospitals for children, said Lisa Jacques, a spokeswoman for the state Agency for Health Care Administration. Besides Miami Children's, they are 168-bed All Children's Hospital in St. Petersburg, 100-bed Florida Elks Children's Hospital in Umatilla and 60-bed Shriners Hospital in Tampa.
In Florida, at least 10 other hospitals are calling themselves children's hospitals, said J. Dennis Sexton, CEO of All Children's.
"It is our enormous concern that everybody uses it," he said.
Last year, after 883-bed St. Joseph's Hospital in Tampa, part of Allegany Health System, said it was opening a children's hospital, All Children's and Miami Children's filed an administrative complaint with the state.
The hospitals complained the state healthcare agency didn't follow proper rulemaking procedures and was wrongly allowing general hospitals to advertise themselves as children's hospitals. A hearing was held late last year, and an administrative law judge dismissed the complaint in April.
Rick Ellis, an attorney for the state agency, said the agency lacks "delegated legislative authority" to prohibit general hospitals from advertising their pediatric units as children's hospitals.
Two years ago the state healthcare agency proposed a rule to restrict hospital advertising. South Florida hospitals challenged the proposal, and the agency ultimately withdrew it, Ellis said.
Michael Aubin, administrator of St. Joseph's new children's hospital, said the potential to lose fund-raising dollars is why children's hospitals, such as All Children's, don't want others using the name.
Acute-care hospitals are marketing themselves as children's hospitals around the country.
Lawrence McAndrews, president of the National Association of Children's Hospitals and Related Institutions, said acute-care hospitals generally use the children's hospital name for several reasons.
According to McAndrews, there is an element of institutional pride for hospitals and a push by managed-care companies to create competitive alternatives that encourage acute-care hospitals to have pediatric units. The trend is also motivated by marketing, so general hospitals can fulfill the need for "one-stop shopping," McAndrews said.
But fragmenting the market could erode the patient base at children's hospitals. He also said pediatric centers can be a way for adult hospitals to lose money. Without the volume of a full children's hospital, acute-care hospitals will end up subsidizing their pediatric units, he said.
Leading to the confusion in all this is the lack of a real definition of who can say they are a children's hospital and who can't.
McAndrews said states need to lead the way in developing standards for facilities that call themselves children's hospitals before there is a federal movement. Without those standards, "I think it has the potential of misleading the public," McAndrews said.
In Florida, the state agency has a committee working to develop standards for children's facilities.
Sexton of All Children's said other hospitals might consider calling themselves "children's centers."
"It's not a floor we're going to call a children's hospital," Sexton said. "The bottom line is that it trivializes what a children's hospital is."