Greene County Medical Center is leaving the delivery business. The medical center board of trustees voted unanimously Thursday morning to begin a 60- to 90-day transition period closing obstetric services at the medical center and at the Advanced Women’s Care clinic.
The move comes less than three weeks after the sudden resignation of Dr David Jaskey, OB/GYN, and less than nine months after the new inpatient portion of the medical center opened, complete with two private labor/delivery/post-partum rooms and a nursery.
Chairman of the board Jim Schleisman justified the decision, saying it is necessary to allow the medical center to be financially viable.
Schleisman said that eight or nine years ago when McFarland Clinic doctors decided not to deliver babies, he pushed for hiring an OB/GYN at the medical center. “I have to say, it hasn’t been very successful…. I hate to see it go away, but I’ve spent 40 years in business and in business you’ve got to make some real tough decisions… We’re seeing patients here, we provide healthcare, but we’re still a business…. We have to make sure this place is successful. Otherwise we’re not going to be seeing any patients, not the people with heart attacks or strokes…. I think we need to move on.”
Discussion of obstetrics services lasted 90 minutes. Medical center chief financial officer Mark Vander Linden and chief executive officer Carl Behne prepared information about the number of deliveries over the past eight years and the financial impact of obstetrical services on the medical center’s bottom line.
Over the past eight years, women who reside in Greene County delivered an average of 97 babies per year. The eight-year average of births at the medical center is 51; that includes residents and those coming from other counties.
In 2015, 48 babies were born at the medical center. Twenty-seven of the births were to Greene County residents; the remaining mothers came from nearby counties.
The 27 Greene County women who gave birth in Jefferson is less than one-fourth of the total who had babies. In 2015, there were 113 babies born to Greene County residents. Mothers went to Ames, Fort Dodge, Carroll, Lake City, Boone, Manning and Des Moines to deliver their babies.
Greene County Medical Center is one of 82 critical access hospitals (CAH) in Iowa; there were births at 44 of them. Behne said he thinks only 34 CAHs have OB departments; the other 10 babies were born in emergency rooms.
Obstetrics incurs net loss to medical center: Vander Linden’s financial information included all obstetric-related revenue and expenses (imaging, newborn nursery, supplies, etc) for the medical center and Advanced Womens’ Care.
The total charges at Advanced Womens’ Care for obstetric care were $517,000. Of that, including a 35 percent realization rate (insurance carriers’ allowed charges), only $182,000 came in as payments. Expenses (salaries, benefits, supplies) totaled $628,000. The bottom line is a $439,000 loss.
The inpatient obstetric department showed an estimated loss of $111,000.
The newborn nursery, labor/delivery, imaging, and lab showed net ‘profit.’
The “total picture” shows a net loss of $370,400 in obstetric services annualized for the fiscal year that ends June 30. The net loss for fiscal year 2015 was $289,000.
Valerie Martin, advanced nurse practitioner and certified nurse midwife at Advanced Women’s Care, prepared a lengthy list of services she can provide. She is willing to add credentials.
Her skills are a factor in Behne’s recommendation to the board that the medical center remove itself from providing obstetric services but continue to offer gynecological services. Quality services that are cost effective for the medical center can be offered, he said.
In discontinuing obstetrics, medical center trustee David Hoyt said, “The message is we need to take care of our people. We need to take care of tens of thousands of people that need our service lines other than OB. We need to take care of those 30 or 40 or 50 women who are going to be having babies by helping them get somewhere else, but we’re not letting the community down. It’s just the opposite.”
Trustee Bill Raney said delivering babies “is something a rural hospital isn’t going to be able to provide compared to what the big metro hospitals do.” Young parents rely on having fast access to all services that could be necessary should something be amiss, to include a neonatal intensive care unit. Critical access hospitals can’t provide them.
Behne explained the role of a critical access hospital is not to offer all services. “We have to look at over the next several years, to be financially viable, what are we good at, what should we be providing for our community, and those things we can’t and shouldn’t be doing. How do we facilitate safe and efficient access for our people to those things, wherever they are.
“Our duty, as a county hospital, is not to be the end-all do-all for everybody, but to be the safety net at this level with the best patient experience we can provide, and when we can’t do that, to be the feeder system for wherever the patient chooses to go. We help with that access. That has to be our goal as a board and as an institution if we want to survive.”
All obstetric patients of Advanced Women’s Care have already received notification and assistance in finding care with the resignation of Dr Jaskey. That resignation was effective May 9.
The labor/delivery/post-partum rooms and the nursery can be put to other uses. Designated rooms for those admitted through the emergency room “for observation” and space for acute patients who need more skilled care than others were suggested. According to community relations director Carla Offenburger, there was very little new equipment purchased.
