What It Will Take To Save Obstetrics
Update: Sonoma Valley Hospital announces it will continue its Obstetrics service. More information is available here.
As you may know from the recent coverage in our local newspapers, SVH Administration recommended to the Sonoma Valley Health Care District Board at its January 2014 meeting that we close our Obstetrics service. This was not a recommendation we made lightly, but Medicare funding that helps to pay for this service was eliminated at the end of September 2013, making what was a difficult financial situation for SVH much worse.
I recently wrote an op-ed explaining why we decided to withdraw that recommendation, at least temporarily, and what it will take to continue the service beyond 2014. I’d like to share that piece with you, which I have expanded slightly. If you wish to see our recommendation to the Board, a link to it can be found on the home page of the SVH website: www.sonomavalleyhospital.org. My article follows.
Many in our community have made it clear that they want to save the Obstetrics program at SVH. I truly share this sentiment, but the question remains, at what cost and for how long?
We gained some breathing room recently when the Medicare funds that help us pay for the program were restored. These funds had been cut in September, increasing our annual loss on Obstetrics from $500,000 to $1 million. That cut is what forced us to re-examine the situation. But even now we still have decisions to make.
We have been working conscientiously to give Sonoma the Hospital it needs and wants, even while the health care industry undergoes profound change. As costs increase and government compensation continues to be cut, the Hospital has reduced expenses while strengthening those services the community sees as a priority. Our new ER is a great example of this.
We understand that our mission is to serve the community. But ours is a very small community, which means that some services have low use, making them financially challenging, if not unsustainable.
We would prefer not to close OB, but we have to face the reality that there are few births in our Valley, and that many prenatal patients choose to deliver elsewhere.
Let me share some facts about our Obstetrics service:
- Our monthly average for OB patients has dropped from 21 in 2000 to 12 currently. This is consistent with national and county demographic trends.
- The Hospital needs at least 25 deliveries monthly to cover program costs.
- We have recently had periods of up to two weeks when there were no patients in OB, yet regulations require us to have a nurse on duty 24/7 and another on call.
- Our turnover rate among OB nurses is high (30 percent) and satisfaction is low because, understandably, they don’t like sitting around. It’s difficult to give them other tasks because they can be pulled away suddenly.
Several years ago we remodeled our Birth Center to make it more intimate and comfortable. With so few patients, mothers get individualized, unrushed care. Most women who deliver there consider it a “gem,” but we need more of them. If you exclude those families who belong to Kaiser, there are around 300 births in the Sonoma Valley annually, of which about half come to SVH. To become viable, the program requires that many more of those births come here. (If our OB program received the same market share our ER has – nearly 80% – it would be a sustainable program.)
The question has been raised, can we do a better job of marketing the service? For years we have tried to recruit a female OB to increase volumes. All of the candidates declined because they see that there is not sufficient demand in this area. Marketing is not an answer when the total number of potential patients is so small.
There are many good reasons to maintain OB services, including preserving the jobs of our OB nurses, building relationships with families who will use other Hospital services, working with the Community Center to meet the needs of Latino families, and continuing the tradition of having generations born here in town.
We are willing to assess the situation further, especially given the restored Medicare funds. But even then we are still on course to lose a half-million dollars annually. If we are to continue to offer OB services beyond 2014, two things need to happen.
The Hospital must further reduce program costs, which is challenging because the service is heavily regulated. In the months ahead, I intend to discuss all the options to reduce direct costs with the physicians and nurses who are part of our OB program. This may result in some changes to the way OB services are provided at SVH. We also will actively explore new sources of funding for OB, from philanthropy to governmental subsidies, but these are long shots at best.
The real answer lies in community use. We need the community to come forward and use our OB services. Certainly, we will continue to tell the community about our wonderful Birthing Center, and encourage mothers to share their experiences. But we also need local employers to offer health care plans that provide access to the Hospital, and community members to choose plans that allow them to use our medical services, including the many wonderful physicians and specialists affiliated with the Hospital.
Sonoma has an outstanding Hospital, one that addresses almost all of the health care needs of the community, and meets and exceeds national benchmarks for hospital quality of care in doing so. Community use is the only way we can guarantee that Obstetrics and other services the Hospital currently offers will continue to be available in the future.
In good health,
President and Chief Executive Officer
Sonoma Valley Hospital