Distance from qualified care can literally mean life or death for a pregnant woman living in a rural area.
EDITOR’S NOTE: Leslie Marsh reported this story during a recent episode of Monitor Mondays. The following is an edited transcript of her reporting.
While rural healthcare is grappling with increasing financial and regulatory pressures that have led to 120 rural hospital closures over the past decade, it is also dealing with the creation and expansion of obstetrics deserts, as more providers retreat from providing obstetrical services.
Technology, information gains, and improved practice have led to gains in overall quality of life and longevity for the country at large. Maternal care is a devastating exception to this trend. The Centers for Disease Control and Prevention (CDC) begin collecting data on pregnancy-related deaths in 1986. During the 20th century, maternal mortality rates declined significantly; however, these rates have been steadily increasing since 1987, from a rate of 7.2 deaths per 100,000 live births back then to 16.9 deaths per 100,000 live births in 2016. If you are a black, non-Hispanic woman, the data indicates that you have roughly three times the average risk of maternal mortality.
Childbirth is the most common reason for hospitalizations; however, rural hospitals are increasingly electing to discontinue these services. Access to maternity care is of particular concern because roughly 18 million women of reproductive age live in rural areas. A report from the University of Minnesota’s rural research team indicates that mothers who live in rural areas are 9 percent more likely to die or nearly die in childbirth, compared to their urban counterparts.
A study published in the Journal of the American Medical Association (AMA) indicated that between 2004 and 2014, a total of 179 rural counties lost hospital-based obstetric services. By 2014, a Health Affairs study noted, more than half of all rural counties had no hospital that offered maternity care. Although these hospitals are closing down their obstetrical units, the hospitals still deliver babies, but these deliveries occur in an emergency room, with less-prepared providers.
The lack of access to high-quality care and obstetrical services close to home is an alarming trend that is putting rural moms at greater risk. Climate and geography can lead to disastrous results for mom and baby. Hemorrhage is a risk even in the hospital setting; it becomes a death sentence if you are 30 miles away from a hospital.
The data and implications for young women of child-bearing age are troubling; however, the national attention this situation is receiving has led to efforts to reduce maternal mortality, and to find solutions for both practitioners and women giving birth in rural communities without hospital-based obstetrical services. Legislators are paying attention, too – the Rural Maternal and Obstetrical Modernization of Services Act (Rural MOMs Act) would offer grants to train physicians and fellows to practice obstetrics in rural communities; it would also expand the use of telehealth services.
Identifying the problem and the underlying causes is the first step in finding solutions. All moms should have access to high-quality maternal care, regardless of where they live. Incorporating best practices for maternal care, pregnancy-related complications, and sufficient training are essential next steps. Working together, we can and will do better – our nation’s moms and babies deserve the best care, regardless of their ZIP code. Access to quality obstetric care is a matter of life and death.
It’s no secret to any of us that there has been quite a bit of recent disagreement between the opposing sides of the political aisle
I’m going to skip over the topic of the hour with the government shutdown and address two actions the federal government has taken in the
Please log in to your account to comment on this article.
Sepsis sequencing continues to challenge even experienced coding and CDI professionals, with evolving guidelines, documentation gaps, and payer scrutiny driving denials and data inconsistencies. In this webcast, Payal Sinha, MBA, RHIA, CCDS, CDIP, CCS, CCS-P, CCDS-O, CRC, CRCR, provides clear guideline-based strategies to accurately code sepsis, severe sepsis, and septic shock, assign POA indicators, clarify the relationship between infection and organ dysfunction, and align documentation across teams. Attendees will gain practical tools to strengthen audit defensibility, improve first-pass accuracy, support appeal success, reduce denials, and ensure accurate quality reporting, empowering organizations to achieve consistent, compliant sepsis coding outcomes.
Expert presenters Kathy Pride, RHIT, CPC, CCS-P, CPMA, and Brandi Russell, RHIA, CCS, COC, CPMA, break down complex fracture care coding rules, walk through correct modifier application (-25, -57, 54, 55), and clarify sequencing for initial and subsequent encounters. Attendees will gain the practical knowledge needed to submit clean claims, ensure compliance, and stay one step ahead of payer audits in 2026.
Accurately determining the principal diagnosis is critical for compliant billing, appropriate reimbursement, and valid quality reporting — yet it remains one of the most subjective and error-prone areas in inpatient coding. In this expert-led session, Cheryl Ericson, RN, MS, CCDS, CDIP, demystifies the complexities of principal diagnosis assignment, bridging the gap between coding rules and clinical reality. Learn how to strengthen your organization’s coding accuracy, reduce denials, and ensure your documentation supports true medical necessity.
Denials continue to delay reimbursement, increase administrative burden, and threaten financial stability across healthcare organizations. This essential webcast tackles the root causes—rising payer scrutiny, fragmented workflows, inconsistent documentation, and underused analytics—and offers proven, data-driven strategies to prevent and overturn denials. Attendees will gain practical tools to strengthen documentation and coding accuracy, engage clinicians effectively, and leverage predictive analytics and AI to identify risks before they impact revenue. Through real-world case examples and actionable guidance, this session empowers coding, CDI, and revenue cycle professionals to shift from reactive appeals to proactive denial prevention and revenue protection.
In this timely session, Stacey Shillito, CDIP, CPMA, CCS, CCS-P, CPEDC, COPC, breaks down the complexities of Medical Decision Making (MDM) documentation so providers can confidently capture the true complexity of their care. Attendees will learn practical, efficient strategies to ensure documentation aligns with current E/M guidelines, supports accurate coding, and reduces audit risk, all without adding to charting time.
Join Ronald Hirsch, MD, FACP, CHCQM for The PEPPER Returns – Risk and Opportunity at Your Fingertips, a practical webcast that demystifies the PEPPER and shows you how to turn complex claims data into actionable insights. Dr. Hirsch will explain how to interpret key measures, identify compliance risks, uncover missed revenue opportunities, and understand new updates in the PEPPER, all to help your organization stay ahead of audits and use this powerful data proactively.
Stay ahead of the 2026-2027 audit surge with “Top 10 Audit Targets for 2026-2027 for Hospitals & Physicians: Protect Your Revenue,” a high-impact webcast led by Michael Calahan, PA, MBA. This concise session gives hospitals and physicians clear insight into the most likely federal audit targets, such as E/M services, split/shared and critical care, observation and admissions, device credits, and Two-Midnight Rule changes, and shows how to tighten documentation, coding, and internal processes to reduce denials, recoupments, and penalties. Attendees walk away with practical best practices to protect revenue, strengthen compliance, and better prepare their teams for inevitable audits.
As AI reshapes healthcare compliance, the risk of biased outputs and opaque decision-making grows. This webcast, led by Frank Cohen, delivers a practical Four-Pillar Governance Framework—Transparency, Accountability, Fairness, and Explainability—to help you govern AI-driven claim auditing with confidence. Learn how to identify and mitigate bias, implement robust human oversight, and document defensible AI review processes that regulators and auditors will accept. Discover concrete remedies, from rotation protocols to uncertainty scoring, and actionable steps to evaluate vendors before contracts are signed. In a regulatory landscape that moves faster than ever, gain the tools to stay compliant, defend your processes, and reduce liability while maintaining operational effectiveness.
Happy National Doctor’s Day! Learn how to get a complimentary webcast on ‘Decoding Social Admissions’ as a token of our heartfelt appreciation! Click here to learn more →
CYBER WEEK IS HERE! Don’t miss your chance to get 20% off now until Dec. 1 with code CYBER25
CYBER WEEK IS HERE! Don’t miss your chance to get 20% off now until Dec. 2 with code CYBER24
