To solve an urgent issue caused by an increasing OB-GYN desert, New Mexico Hospital Association and New Mexico Human Services Department are proposing to establish a telehealth prenatal and postpartum program for rural patients.
Troy Clark, executive director of NMHA, told NM Political Report that OB-GYN services are being lost across the country as well as in New Mexico. He said rural hospitals are struggling to maintain labor and delivery services in hospitals and that affects all women patients.
“It affects women’s health care in those [rural] communities,” Clark said.
Timothy Fowler, public relations coordinator for HSD, said the proposal is still in development and that there are many elements still to be finalized.
“This proposal will be submitted to the Center for Medicare and Medicaid Services this year. Upon approval from CMS, HSD will formally announce the new program,” Fowler said via email.
Fowler said it is too early to tell if the proposal will impact labor and delivery services and rural hospitals.
“The primary intent of this proposal is to allow perinatal Medicaid customers to access services near their homes, hopefully increasing their number of prenatal and postpartum visits and leading to healthier parents and infants across New Mexico,” Fowler said.
Clark said most OB-GYN doctors provide labor and delivery services in addition to handling regular patient visits. He said the exception would be nurse practitioners who provide OB-GYN visits but who do not offer labor and delivery services.
“I use the word OB-GYN as opposed to labor and delivery because it’s integral,” he said.
Clark said that within the past year and a half, two rural hospitals in New Mexico have closed their labor and delivery services due to workforce issues and the cost of keeping the services available. He said declining birth rates and the cost and quality burdens to maintain labor and delivery in a hospital are too great for many rural hospitals.
“Currently, we have four hospitals that deliver fewer than 100 babies a year,” Clark said.
He said there are eight hospitals that deliver 200 to 400 babies a year.
Clark said that maintaining labor and delivery services is similar to maintaining an emergency room.
Clark gave an example of a rural hospital that averaged 10 deliveries a month and one month the hospital had six deliveries in one day and the other four came a few weeks later.
He said that for that one day, the hospital experienced pandemonium to manage six newborns and new parents but for most the rest of the month, there were almost no deliveries. But, the hospital has to maintain staff ready for delivery three shifts a day, seven days a week.
“You have a greater than 50 percent chance of not being involved in a delivery for the entire month. It’s a component most people don’t understand. The hospital has to bear the cost of keeping people there. They don’t know when the mothers are going to come to deliver,” he said.
The problem isn’t just cost but keeping staff up-to-date on their skills. If they are routinely not delivering, then they are not maintaining the level of experience in the event of an emergency, Clark said.
Clark said the problem doesn’t just impact rural hospitals and patients. It has a ripple effect on urban hospitals because rural patients wind up in urban hospitals.
“It’s part of the cog of a bigger issue but it’s not the driver of that. It’s not the driver of the pressure on urban hospitals. It contributes but it’s not the driver,” Clark said.
But Clark said it is still an urgent problem. In addition to the two hospitals that closed their labor and delivery in the last year, he said another rural hospital is considering closing its labor and delivery.
“Right now we need to keep them open,” he said.
Clark said the way it would work is a rural patient would go to the nearby hospital, which would provide a room and a nurse. The patient would have their routine prenatal and postpartum visits with the OB-GYN through telehealth with the local nurse taking vitals and providing any on-the ground work needed for the patient.
“ We can’t afford our current hospitals to stop labor and delivery,” Clark said.