Across Texas, rural hospitals are facing a difficult decision: Whether to continue delivering babies as the number of births falls and the cost of providing the service rises.
Letha Stokes has a “very, very heavy heart” since Medical Arts Hospital ended its labor and delivery services on Dec. 6.
The hospital CEO said it took three years of studying, penny pinching and what-ifs before she and the hospital board of directors decided the Lamesa-based facility in northwest Texas should not deliver babies anymore.
Until recently, Medical Arts Hospital delivered an average of 100 babies per year, the majority of them covered by Medicaid, the joint state-federal health care insurer for the very poor. But the hospital also lost an estimated $500,000 a year due to the program’s low reimbursement rates. That wasn’t sustainable.
Stokes said ending deliveries means Medical Arts’ patients will have to drive 40 to 60 extra miles to hospitals in places like Seminole, Snyder or Lubbock.
“This was a very difficult decision,” Stokes said. “… There is a risk either way, if you deliver babies or if you don’t deliver babies.”
Medical Arts Hospital isn’t alone. Yoakum Community Hospital in Yoakum also plans to end deliveries soon — meaning just 69 of Texas’ 163 rural hospitals will still deliver babies. That’s according to the Texas Organization of Rural and Community Hospitals, an advocacy group for rural hospitals.
Texas’ rural hospitals have struggled just to stay open; federal Medicaid reimbursements don’t fully cover the costs of services they provide, and fewer doctors and specialists have opted to practice in small towns. Since 2013, 14 rural hospitals across Texas have closed; just three were replaced with freestanding emergency rooms or urgent-care centers.
Meanwhile, the low number of births in rural areas has made it difficult for hospitals to justify the costs of staff and equipment.
Don McBeath, director of government relations for the Texas Organization of Rural and Community Hospitals, said as more rural hospitals stop delivering babies, more pregnant women may need to drive long distances to get prenatal care and give birth.
“They may be in an ambulance or the back of a pickup truck” if a rural hospital is not available nearby, McBeath said. “I do think that this decline in the number of rural hospitals providing [obstetric] services is probably going to increase prenatal and postnatal mortality.”
McBeath said rural hospitals have reduced obstetric services because of uncertainty over two major funding streams they’ve come to rely upon: the federal Disproportionate Share Hospital fund and Texas’ Medicaid 1115 waiver.
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