Last year, Burke Medical Center faced some tough math in trying to keep its childbirth services going.
The 40-bed hospital in Waynesboro, in rural east Georgia, was losing more than $1 million per year on its obstetrical services.
Given the high overhead, a hospital must deliver 500 babies or more a year to break even on that service, says Stephen Shepherd, CEO of Burke Medical Center. “In rural areas, getting up to 500 babies is tough.’’
And last summer, the hospital’s lone pediatrician retired from the medical staff.
Burke Medical sought to replace him, and while it was doing so, its sole OB/GYN left to practice in Augusta.
So in December, with no OB on board, Burke Medical Center closed its obstetrics program. Unless a birth is considered so imminent that it’s an emergency — in which case the delivery is performed in Burke’s ER — pregnant women must travel 25 miles or so to Augusta to have their babies.
The hospital’s decision to close its labor and delivery service continues a trend in Georgia and elsewhere.
Many rural hospitals in the state have given up on offering obstetric services over the past decade. One reason is that it’s difficult to maintain a high-cost service with low reimbursement rates; another is that many rural hospitals struggle to recruit physicians to run such a program.
Among Georgia’s “critical access” hospitals –- rural facilities with no more than 25 inpatient beds –- 32 of 34 have given up maternity services, according to Jimmy Lewis of HomeTown Health, a rural hospital organization.
About 60 percent of births in Georgia every year are covered by Medicaid, and Georgia physicians and hospitals say the government insurance program generally does not pay them enough to make up for the costs of the care. Georgia OB/GYNs have not had a Medicaid pay increase in more than a decade.
“Payments don’t cover deliveries and follow-up care,’’ says Lewis. And if there’s only one OB in an area, that doctor is always “on call,’’ he adds.
A shortage that just keeps growing
Pat Cota, executive director of the Georgia OBGyn Society, says roughly 40 counties in Georgia –- one in every four –- has no OB/GYN. “Between Athens and Augusta, there’s no delivery hospital.’’ Cota says. “It continues to get worse and worse.”
There are only five obstetrics residency program in the state -– two in Atlanta and one each in Augusta, Macon and Savannah.
“We’ve got to look at some kind of model to provide access to OB for women in rural areas,’’ Cota says. “It involves adequate payment.’’
Obstetricians will not be getting a Medicaid pay raise this year from the federal Affordable Care Act, unlike pediatricians, internists and family practice doctors. In fact, OB/GYNs could take a slight pay cut under Gov. Nathan Deal’s proposed budget.
Cota also says recent legislation in Georgia is a deterrent for some OB/GYNs to practice in the state. Last year, the Georgia General Assembly passed a bill that generally bans abortion after 20 weeks of pregnancy, reducing by about six weeks the length of time during which women in Georgia may have elective abortion. Critics of the law say it puts doctors at risk who work with difficult pregnancies.
Burke Medical Center, the sole hospital in Burke County, has been losing money for several years. The remaining doctors, though, are providing good care in the area, Shepherd says. “There is still excellent care available in Burke County,’’ he says.
Women in the county — many of them teenagers — get prenatal care through family medicine physicians and nurse practitioners in the area. Shepherd says, “If the mother is in active labor, we do [the delivery] in the ER.’’ The hospital has retained its OB nurses, he adds.
A lot of time in the car
The drive from Waynesboro to an Augusta hospital takes about 45 minutes, says Dr. Paul Browne, director of maternal-fetal medicine at Georgia Regents University in Augusta, which is helping Burke County with its prenatal care.
A long car ride to the delivery room can raise the chance of a bad health outcome for the baby or the mother, Browne adds.
Infant mortality is improving in the state, though Georgia still ranks in the bottom 10 states on that measure, Browne says. But he also says the maternal death rate in the state is getting worse.
One positive development, Browne notes, is that the Ronald McDonald House in Augusta, run by an international charity that helps ailing children and their families, has provided lodging to at-risk expectant mothers. That allows them to stay close to a hospital before delivering.
In rural areas, helicopter and ambulance transfers to a large hospital are available when there are serious medical complications for mothers and infants.
Increased reimbursement for this emergency transportation, as well as for physicians, is a critical need, Browne says. But he acknowledges that it’s hard to persuade budget makers to include such funds given the state’s financial crunch.
The big question, he says, is: “Will the state subsidize rural health care in Georgia?”