Dr. Roslyn Banks-Jackson worries about what will happen to many women of Emanuel County when the local hospital shuts its labor and delivery unit.
She’s the only ob/gyn currently practicing in the east-central Georgia county. And the practice, Emanuel OB/GYN Clinic, owned by the hospital, will soon be closing as well.
Many of her low-income patients have no transportation, and they either walk or have to get rides from friends or relatives to get to their appointments.
When the closures come, those of Banks-Jackson’s patients who do have cars will be driving 30 to 40 minutes to other counties to deliver their babies, said her office manager, Ashley Williamson. Some patients may wind up delivering in the local emergency room, Williamson added.
Emanuel Medical Center, citing high costs and low reimbursements, decided last month to close the hospital’s obstetrical program June 30.
“I’m 100 percent positive we’ll have worsening [patient] outcomes as a county,’’ Banks-Jackson said Monday. For patients without a car, “I seriously doubt they’ll get prenatal care.’’
The shuttering of the labor and delivery unit follows similar actions by other hospitals across the state. The obstetrical closures have hit especially hard in rural Georgia, where health care has been imperiled by doctor shortages and shaky hospital finances.
More than 40 Georgia counties lack obstetrical providers, and fewer than 75 of 180 hospitals in the state have labor and delivery units, Pat Cota of the Georgia OB/GYN Society said.
Cota said that when access to obstetrical services is reduced, women have to travel greater distances for prenatal care and deliveries. That increases the chances for a pre-term delivery, she said.
One reason for the obstetrical closures is that it’s difficult to maintain a high-cost service with low reimbursement rates from Medicaid. The government insurance program covers about 60 percent of all Georgia births, and the rate is even higher in rural areas.
Georgia OB/GYNs finally received a Medicaid pay increase – the first in more than a decade – under the recently approved state budget. Yet that won’t increase the reimbursements to a hospital itself, which deals with the high costs of staffing in its birthing program.
And Georgia’s rural hospitals, unlike those in some other states, are not getting a revenue boost from Medicaid expansion under the Affordable Care Act. Expansion would extend Medicaid coverage to more low-income patients, meaning the hospitals that treat them would get more revenue. But Georgia is among the states that have rejected Medicaid expansion, saying it’s too costly.
The two sides of mobility
Besides Emanuel Medical, another Georgia hospital recently announced a July closing of a labor and delivery unit: Barrow Regional Medical Center in Winder.
Located between populous Gwinnett County and Athens-Clarke County, Barrow is much less rural than Emanuel County. It’s also more affluent, with most people having access to transportation.
Chad Conner, Barrow Regional’s marketing director, said the hospital has delivered fewer than 115 babies per year for the past three years. Most of Barrow County’s pregnant women are instead going to neighboring counties for delivery, he said.
“We made this decision [to close the delivery unit] so we can focus on other areas that are doing well and will benefit the community more,’’ Conner said, citing emergency services, primary care and orthopedics.
A hospital needs at least 350 deliveries a year to break even in its obstetrical service, according to Jimmy Lewis, CEO of HomeTown Health, an organization of rural hospitals in the state.
That’s a difficult number to reach in a rural county, he added.
“When a labor and delivery unit closes, there is little prenatal or postnatal care,’’ Lewis said. There’s a much higher probability of a birth problem, he added.
Georgia’s preterm birth rate has improved in recent years, but the state has the highest maternal mortality rate in the nation.
Emanuel looks to the future
Emanuel Medical officials, in announcing the obstetrical closure, said that over the past four years, there has been an average of 326 births annually to Emanuel County women.
About two-thirds of these births have been delivered out of the county in larger neighboring hospitals. “As a result, the small number of deliveries at Emanuel Medical Center is not sustainable,” the hospital said in a news release.
Still, Mel Pyne, regional CEO for Emanuel Medical, said in a statement that the hospital has seen “significant growth in ER services, outpatient procedures, and other medical services.”
And he noted that the hospital was selected as one of four hospitals to participate in Gov. Nathan Deal’s pilot project that will use telemedicine and other techniques to bolster rural health care in Georgia.
But to fill obstetrical gaps, Lewis of HomeTown Health suggests that counties subsidize that service, or that the state sets up regional birthing centers.
Cota of the OB/GYN Society said that once a hospital closes its obstetrical program, “it’s almost impossible to reopen it.”
More hospitals in the states may eventually close these units, Cota said.
She said she would like to see a statewide group of experts formed to put together a plan to retain labor and delivery services “so we can preserve access to health care for women.”