Costs prompt hospitals to rethink birthing services

Several issues have prompted St. Luke Hospital in Marion to evaluate the viability of its obstetrical services in the near future.

“It is unknown at this point” if St. Luke will discontinue obstetrical services, said Doug Newman, chief executive officer of St. Luke Hospital and Living Center.

“All hospitals are required to be capable of providing emergency delivery or care services as per federal EMTALA (Emergency Medical Treatment Active Labor Act) laws.”

According to published hospital board minutes, some of the recent issues of concern faced by St. Luke are as follows:

n By the end of 2004, Banner Health Systems, the hospital management group, will no longer lease the facility. And the hospital board will be responsible for management. At a December board meeting, members discussed and approved a contract with a hospital consultation service.

n Physicians Don Dodson and Kim Hall, with Marion Family Physicians LLC, have contacted the hospital board with concerns about the lack of a full-time or part-time certified registered nurse anesthetist to cover anesthesia cases when full-time CRNA Bruce Skiles is on vacation.

At the meeting, Newman reported that it would cost about $200,000 to $250,000 a year to hire a part-time CRNA.

It was also reported that Banner officials do not feel it is cost effective to provide additional CRNA coverage, and the family physicians are concerned about continuing to operate without additional CRNA staff.

n The Marion family physicians have also notified the board that they do not plan to accept new obstetric patients until issues about hiring a part-time or full-time CRNA are resolved and do not plan to deliver any more babies at St. Luke after March.

At the board meeting, Newman also spoke about an additional issue-the cost of having babies has risen in recent years because of rising insurance costs. And those rising costs have had an impact on the feasibility of offering obstetric care at the facility.

St. Luke currently has three bassinets in its nursery and handles between 18 to 22 births a year.

The physicians and the board reportedly plan to meet in the near future to continue to work through the aforementioned issues.

“It is never an easy thing to accept losing a service-as it is both an emotional as well as a business issue,” Newman said.

Mike Ryan, chief executive officer for Hillsboro Community Medical Center was contacted concerning the possibility of discontinued obstetrical services at St. Luke and how that would affect the obstetrical unit at HCMC.

“If they don’t perform obstetrical services or do births, that’s going to probably mean that some of those mothers might want to come this way for those services,” Ryan said.

St. Luke is not alone as it faces the possibility of closing its obstetrical services in the near future.

“Marion is not the first nor the last rural facility not to have physicians delivering babies,” Newman said. “It is a widespread trend that has been occurring for years.”

Ryan agreed and said, “It’s a common trend in rural hospitals, at least in Kansas. I think, certainly, the liability insurance market is a driver of that.”

Hospitals and physicians purchase liability insurance, and those premiums have risen considerably since the 9/11 terrorists’ attacks, Ryan said.

“When insurance companies were making money in the stock market, et cetera, there wasn’t a lot of pressure to increase their rates,
he said.

“But when they were losing money in the stock market, just like you and I were, then they’re looking at their rates to make their bottom line.”

Ryan also listed other health-care pressures faced by physicians and hospitals today as follows:

n Increased costs due to recently imposed government regulations, such as the Health Insurance Portability Accountability Act and the Emergency Medical Treatment Active Labor Act.

n Reduced reimbursement from health plans, such as Medicare, Medicaid and Blue Cross Blue Shield.

n Shortages in the hospital work force.

n The increasing trend of un-insured and under-insured patients using the facility and not meeting financial obligations for health care.

n An increased use of hospitals by the large population of the aging Baby Boomer Generation.

At HCMC, Ryan said one Hillsboro physician offers obstetrical care-delivering babies. The HCMC nursery contains five bassinets, and about 20 births were handled last year at the facility.

“That’s pretty stable-a pretty typical year,” Ryan said.

In the past, a number of area women have chosen to give birth in larger hospitals, Ryan said. But he questions the rationale to choose to drive the distance when services are available locally.

“Many people feel that you have to have a specialist for everything associated with your health care,” Ryan said.

“I certainly agree that when there are complications, a specialist may be required. But 99 percent of them are going to do just fine. Most births are very appropriately cared for by a family-practice physician who is well trained in this part of family care.”

And if there are unforeseen complications, HCMC has emergency transportation and transfer agreements in place to make sure the mother and baby get all the care they need, Ryan said.

If St. Luke does close its obstetrical services in the near future, women in Marion County will be forced to look to other facilities for their obstetrical care, such as Hillsboro, Newton, McPherson and Wichita.

“If a family is considering HCMC for their family experience, we would be happy to show them our birthing room and the resources we have to insure their well being,” Ryan said.

“Our team of well-trained nurses and physicians can provide a wonderful birth experience for most mothers.”

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