A new report from the Center for Healthcare Quality & Payment Reform reveals a startling reality for families in rural America: more than half of rural hospitals in this country (55%) do not offer labor and delivery services.
That disturbing figure is emblematic of a worsening trend at the nexus of rising costs and labor shortages that affects medical facilities across the country and requires immediate attention.
Between 2011 and 2021, 267 rural hospitals – a quarter of all rural obstetrics units – stopped providing maternity services, leaving pregnant women in rural areas with few options at a critical time for their mental and physical health.
Solving Healthcare’s Provider Data Problem Starts with Interoperability
Break down the silos. Take control of your provider data.
Some facilities have alleviated their acute short-term staffing needs with locum tenens practitioners, traveling medical professionals who can step in to maintain a continuum of care for a temporary period of time.
Systemic problems remain, however. Despite spending a higher percentage of our GDP on healthcare than any other wealthy nation, the United States is grappling with the highest maternal mortality rate in the developed world, and the growing lack of obstetric care in rural areas will only contribute to the crisis.
Pregnant women in rural communities were vulnerable even before the uptick in obstetrics closures. A 2021 report from the US Government Accountability Office showed that the maternal mortality rate in the most rural counties was 23.8 deaths per 100,000 live births – more than 60% higher than the 14.6 deaths per 100,000 live births in large metropolitan counties.
Multiple factors are converging to create this crisis
The Role of Consultants in Tackling Healthcare Expenses
To ensure effective cost mitigation, employers can’t wait for the market to adjust — they have to punch first.
Rural hospitals often struggle to maintain adequate staff, which can lead to closures of labor and delivery units. In 12 states, the majority of hospitals that provide maternity care are losing money. The problem is even worse for smaller rural hospitals, two-thirds of which are in the red on patient services.
Combined with rising costs, these shortfalls make it harder to attract and retain staff, despite the necessity of maternity care. It’s not the hospitals’ fault; the cost to deliver a baby is now nearly $20,000, but Medicaid reimbursements haven’t kept up.
Understaffed facilities can turn to locum tenens providers for vital short-term relief. A birthing center on Michigan’s rural Upper Peninsula recently faced closure after the departure of two OB/GYNs, but was able to use locum tenens providers to keep the center open. This model is replicable anywhere but requires health systems to continue to invest in serving locations that may not be profitable for them.
The financial burden on rural healthcare systems partially stems from the fact that rural women are less likely to be insured than their urban counterparts. A Michigan Medicine study, published in the journal Obstetrics & Gynecology, showed that 15.4% of women in rural areas were uninsured before pregnancy, 27% higher than the 12.1% uninsurance rate of women in urban areas.
The federal government has made some encouraging recent moves in that direction. In 2019, the US Health Resources & Services Administration created the Rural Maternity and Obstetrics Management Strategies (RMOMS) Program to increase access to maternal and obstetrics care in rural communities. It now funds programs run by 14 awardees in 11 states to test innovative programs targeted at addressing their residents’ maternal health needs.
Aside from providing grants, RMOMS says it also collects data on rural hospital obstetric services, builds networks to coordinate a continuum of care, leverages telehealth and specialty care, and improves financial sustainability with its partners.
On the private side, training and payments are the top issues
When rural residents are trained in obstetrics, there’s no guarantee that they’ll remain in rural communities to deliver care. Hospitals and medical schools in rural areas need to recruit and train doctors, nurses, and midwives specifically to practice in those areas, however there needs to be a reason for these medical providers to stay, such as through the use of incentive programs.
These efforts may require government subsidies, which would be a worthy investment. The State of New York recently provided a $5 million emergency grant to sustain a birthing center that otherwise would have closed, a move that delighted the surrounding community.
Until more subsidies are approved, private philanthropy can pick up some of the slack. Ruth Gottesman’s $1 billion donation to the Bronx’s Albert Einstein College of Medicine made tuition free for all students; I’d encourage philanthropists to take a closer look at more rural medical schools where their money could make an even bigger impact.
Addressing America’s maternal health crisis will be complicated and nuanced; we’re starting in negative territory. The above solutions are just a few that have been proposed, and innovation will surely play a role moving forward, but there is one clear thing: we need to start now. In the meantime, rural hospitals can utilize locum tenens agencies to provide continuity of care for patients in their communities.
Photo: asiseeit, Getty Images
Stacy Cyr is the Director of Marketing at Barton Associates, one of the leading locum staffing agencies in the United States specializing in sourcing locum tenens physicians, nurse practitioners, physician assistants, dentists, and other healthcare specialists across the U.S.
This post appears through the MedCity Influencers program. Anyone can publish their perspective on business and innovation in healthcare on MedCity News through MedCity Influencers. Click here to find out how.