Rural Hospital Closures Prompt Maternal and Infant Mortality Concerns

Close to 200 rural hospitals have closed over the past 16 years, and another 20 percent are at risk of closure.

The country’s smallest hospitals continue to be in peril, as are the patients who rely on them.

This continues to be the reality for rural health, with major challenges arising for patients and providers in those regions. A total of 7.4 percent of babies born in the U.S. are birthed at hospitals handling 10 to 500 births a year, or “low-volume” hospitals. In the context of our industry’s fiscal focus, that number seems relatively low.

Yet so much for the value-versus-volume culture shift. For the women and families enduring these pregnancies, this dearth in care becomes a major quality area of concern, not to mention the fight against morbidity and mortality.

Here are the facts:

• Over one-third of hospitals with obstetrics units in the U.S. are referred to as “low volume,” meaning they have 10 to 500 births annually. This is compared to those facilities of 501-1,000 births, 1,001-2,000 births, or those with more than 2,000 births annually.
• A total of 18.9 percent of low-volume facilities are not within 30 miles of any other obstetric hospital.
• A total of 23.9 percent were within 30 miles of a hospital with more than 2,000 deliveries per year.
• The most isolated hospitals were frequently low-volume, with 58.4 percent located in very rural areas.

Close to 200 rural hospitals have closed over the past 16 years, and another 20 percent are at risk of closure. Of those remaining facilities, less than half have an obstetrics unit. The end result means greater risks for mother and baby, as well as increased potential for considerable trauma. Studies already show a close connection between maternal or psychological birth trauma and post-traumatic stress disorder (PTSD) in regions (e.g., urban hospitals) where appropriate specialty services are available: that’s upwards of 34 percent of women. The concerns in rural regions lacking such services are massive:

• Births in hospitals without obstetrics specialists or necessary care carry unique risk; neonatal intensive care units for preterm births are even less available.
• Under 50 percent of rural counties have a practicing OB/GYN, which increases the likelihood by three to four times of maternal and infant mortality; women are 30 percent more likely to hemorrhage after delivery in rural hospitals with the lowest number of deliveries.
• Decreased access to OB/GYN providers and clinics encompasses another issue: fewer women accessing prenatal care means lack of awareness specific to critical factors that can complicate the pregnancy and compromise a health delivery, such as anemia, gestational diabetes, blood pressure, or a baby in the breech position.
• A dearth of post-partum care yields increased concern for proper assessment and intervention for factors such as post-partum depression.

Finances are a major player in the decision-making to maintain necessary specialty services for patients in any region. Let’s keep in mind that half of all rural births are paid for by Medicaid, which provides far less reimbursement than commercial insurers.

Ceasing these critical hospital services is not the answer. Expanding funding has been among the recommendations. Something must shift before limited access to care becomes even more of an unacceptable co-morbidity for residing in a rural community.

Our Monitor Monday Listeners’ Survey recently asked how much our listeners are concerned about access to appropriate care (whether inpatient or outpatient) for their patient populations; the answers appear here.

Programming Note: Listen to Ellen Fink-Samnick’s live reports on SDoH every Monday on Monitor Mondays 10 Eastern.