Maternity deserts plague rural America, with 55% of rural hospitals lacking labor and delivery services. The Center for Healthcare Quality & Payment Reform (CHQPR) highlights the dire need for reevaluating staffing and reimbursement models. This comprehensive report explores the escalating crisis, emphasizing the impact on patient access and outcomes. The proposed solutions include tailored workforce support and revamped payment models to sustain maternity care in rural areas. Urgent action is urged to prevent unnecessary maternal and infant mortality, recognizing the pressing state of rural maternity care.
Maternity deserts are escalating in the US, especially in rural hospitals, where closures of labor and delivery departments outpace urban counterparts. The Center for Healthcare Quality & Payment Reform (CHQPR) exposes a critical situation, with 55% of rural hospitals lacking essential maternity services. The report underscores the urgent need for rethinking staffing and reimbursement models to ensure sustained access to maternity care. As over 200 rural hospitals shut down labor and delivery in the past decade, patients face extended travel distances, amplifying the risk of complications. This introduction delves into the unfolding crisis and sets the stage for proposed solutions.
The Challenge of Maternity Deserts in Rural Hospitals
The report revealed a staggering statistic: 55% of rural hospitals in the US do not provide labor and delivery services. In ten states, more than two-thirds of rural hospitals lack these essential services. Over the past decade, more than 200 rural hospitals have ceased offering labor and delivery, exacerbating the problem of limited access to care.
This absence of maternity services is generating a significant care access issue. Patients in rural areas now face extended travel distances to avail themselves of essential care. Research indicates that increased travel distance correlates with a decreased likelihood of accessing timely healthcare. In urban areas, the typical travel time to a hospital with labor and delivery services is under 20 minutes. Contrastingly, in rural communities, the travel time can range between 30 to 40 minutes and, in many instances, exceed 40 minutes.
The impact is not limited to the point of labor and delivery; even accessing prenatal care becomes a challenge due to longer travel distances. This, in turn, has severe implications for both infant and maternal health outcomes, increasing the risk of complications and mortality. CHQPR emphasized, “There is a higher risk of complications and death for both mothers and babies in communities that do not have local maternity care services.”
The situation is projected to worsen because maintaining labor and delivery services and other maternity care is financially burdensome. CHQPR explained that providing safe and high-quality maternity care demands 24/7 availability of physicians and nurses, contributing to dramatically higher costs for rural hospitals. Unfortunately, payments from private insurance and Medicaid plans fall short, increasing losses for hospitals providing these services.
Many rural hospitals cannot sustain labor and delivery departments due to losses in other patient care areas. A third of rural hospitals with remaining labor and delivery services reported financial losses in overall patient services, jeopardizing the viability of maternity care departments.
The solutions proposed to tackle the maternity desert crisis revolve around two key aspects: supporting the rural workforce and designing effective payment models. To bolster the rural workforce, the report recommends creating specialized training for rural maternity care and implementing tailored clinician recruitment strategies for rural areas. Remote consultations from maternal-fetal specialists and experienced OB nurses, along with staffing models promoting sustainable on-call services, can further support the existing rural healthcare workforce.
On the payment front, CHQPR stresses the need for increased payments for maternity care. In small rural hospitals, maternity patient volumes may be lower, but the resources required to meet patient demand remain constant due to the unpredictability of visits. Consequently, reimbursements need to be more substantial to sustain staffing levels. Employers are urged to ensure that health insurance plans cover the actual cost of maternity care services, and states should mandate Medicaid plans to provide adequate coverage for maternity care services.
However, the report acknowledges that the issue extends beyond maternity care reimbursement. Many rural hospitals struggle to cover the costs of labor and delivery departments due to losses incurred in other patient services. To address this, employers in rural areas are encouraged to select payers that reimburse adequately for all hospital services, especially private payers.
One innovative proposal put forth by CHQPR is the concept of capacity payments. Currently, rural hospitals only receive payment when actively providing a service. Introducing annual capacity payments from private insurers and Medicaid would offer predictable revenue for the fixed costs of maintaining a labor and delivery department. This proactive approach aims to address the financial challenges faced by rural hospitals that need to be prepared to provide services, even on days with no deliveries.
Overall, CHQPR emphasizes that rural maternity care is in a state of crisis, requiring immediate and comprehensive action. Urgent steps are needed to implement changes in workforce recruitment and payment models to prevent unnecessary maternal and infant mortality. The report’s authors assert, “It is not an exaggeration to say that rural maternity care is in a state of crisis, and a crisis demands immediate action. Every day that steps are not taken to implement the changes in workforce recruitment and payments described above increases the likelihood that more women and babies will die unnecessarily.” Addressing the maternity desert crisis demands a multifaceted approach that combines workforce support, payment reform, and innovative strategies to ensure sustainable and accessible maternity care in rural areas.
