When Alejandro Quiroga, MD, describes the more than $1 billion acute care tower Children’s Mercy is building in Kansas City, Mo., he frames it less as an expansion than a necessity.
The tower, planned for the system’s flagship Adele Hall campus downtown, will expand total capacity by 25% to 30%, with a new home for the pediatric and neonatal intensive care units, an expanded emergency department and a surgical center built for robotics. Enabling work is expected to begin this fall, with completion targeted for 2031. It comes amid a wave of large capital projects across health systems, with Children’s Mercy among 14 health system projects worth $500 million or more in 2026. Third-party assessments by Deloitte and HDR found that within five years, the system’s existing footprint would meet only 67% of projected bed needs and 40% of projected NICU demand, according to a health system news release.
The math made the decision easy to validate for Dr. Quiroga, president and CEO of Children’s Mercy.
“When we analyze where we’re going to be five years from today, if we don’t expand our capacity, we will not be able to fulfill the needs of our community and the growth that comes with that,” he told Becker’s. “Even when I was interviewing for this role, it was easy to see: from the financials, from our position, from talking to the team. And once I got into the role, it was fairly easy to validate those assumptions.”
A capacity squeeze pediatric hospitals can’t dodge
Children’s Mercy is one of 28 freestanding pediatric hospitals in the U.S., and Dr. Quiroga describes it as the only academic pediatric health resource within roughly 200 miles, a footprint that, as he sees it, turns demand into responsibility.
The pressure is not unique to Kansas City. Between 2008 and 2022, U.S. hospitals closed nearly 30% of their inpatient pediatric units, according to a study published in JAMA Pediatrics, and Dr. Quiroga sees that contraction accelerating as aging baby boomers absorb adult inpatient capacity and general systems retreat from pediatric care.
“It’s a very difficult point for pediatrics,” he said. “The [baby] boomers are in, and there is not enough capacity in the adult world to take care of the needs of the boomers. Some of that price is being paid by pediatric units, and adult healthcare systems will continue to divest of pediatric care.”
Whether that is good or bad depends on what is being divested, he said.
“If you are just dipping your toes in pediatric care, maybe this is not bad. But if you have some sort of robust pediatric platform that you’re divesting, then someone really has to absorb that,” he said. “I think that trend will just accelerate at the same time that it’s going to be met by lower numbers of pediatric specialists. Those two worlds are going to collide.”
For an operator, the result is a recruiting and retention challenge as much as a real estate one. For that reason, the physical build and talent strategy have to be aligned, Dr. Quiroga said.
‘The era of complex pediatric care’
The patients arriving at Children’s Mercy are sicker and more complicated than they used to be, a shift Dr. Quiroga calls “the era of complex pediatric care.” Children who once would not have survived now live with chronic, layered conditions. New treatments add their own demands: A recently announced gene therapy partnership, he noted, is not a single clinic visit but a series of difficult admissions and long follow-up.
“New therapies are emerging. Recently, we made a big announcement about gene therapy. Gene therapy takes multiple admissions for very difficult periods of time,” he said. “This is the right time to expand capacity so we can care for the kids who need us.”
That acuity is also reshaping where families seek care. Parents will travel for the highest-stakes treatment, Dr. Quiroga said, and the system is leaning into being a destination for that treatment while pushing lower-acuity care back into the community.
“No one’s traveling for ear tubes; people are going to travel for the right heart transplant,” he said. “There’s going to be very few pediatric heart programs with our quality.”
He pointed to the program’s three-year graft survival in pediatric heart transplant, citing an observed-to-expected mortality ratio of 0.52, or about half the expected rate.
He offered genomics as another example of the destination thesis. Citing a case the system published in Nature Medicine about a year ago, Dr. Quiroga described a patient with an intractable seizure disorder whose whole-genome sequencing revealed a calcium channel mutation. The team grew a brain organoid from the patient’s own cells, confirmed the abnormal phenotype, and tested medications on it before treating the child, moving from genomic sequence to a working therapy in about six weeks.
“That is the future of pediatric medicine,” he said. “We’re developing a chassis where answers can happen in a really fast period of time, not only a diagnostic answer, but a treatment answer.”
When bigger makes a system better, and when it just makes it bigger
Becker’s has been putting a question to CEOs across the industry: When does getting bigger actually make a health system better? For Dr. Quiroga, the distinction lies between scale for its own sake and scale a community needs.
“I’ve not seen very strong literature showing that these megamergers of healthcare systems necessarily improve the quality of care,” he said. “I don’t think bigger is better. I think right size is better.”
For Children’s Mercy, he said the case for growth is grounded in chronic capacity strain.
“We are constantly at capacity, and we know we won’t be able to fulfill the needs of our community. When you’re in that position, and ideally a little bit ahead of it, that is the right time to be bigger,” he said. “If not bigger for the sake of vanity or ego, just to provide the right care for the community. That’s not always the type of bigger the industry pursues, and that’s how some of those issues have come about.”
Dr. Quiroga ties Children’s Mercy’s new tower to a broader argument he has made in print, including an opinion piece in NEJM Catalyst: that healthcare leaders too often think in straight lines about a system that does not behave that way.
“There’s a lot of linear thinking in the industry and a lack of embracement of complexity,” he said. “One of the things we’re trying to do here is lead in complexity theory. When you look at our capital project, it’s moving faster than any other in the U.S., and that’s about enabling a mindset that is not linear.”
It is also a bet on geography. Children’s Mercy sits within a three-hour flight of roughly 80% of the U.S. population, and Dr. Quiroga expects more families to travel for the level of care the system’s new tower is designed to deliver.
“If I were to create a chassis that is very good at those things, I’d put it in Kansas City,” he said. “We foresee that more and more people are going to have to travel for that level of care, so we are thinking through that lens.”
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