The Arkansas Center for Health Improvement in Little Rock is a nonprofit healthcare think tank that gathers and studies data, analyzes policy, and conducts research about ways to improve health outcomes in the state.
It has performed much of each activity regarding the recent trend of Arkansas hospitals closing their labor and delivery units. Arkansas Money & Politics visited with ACHI President and CEO Craig Wilson about the shortage.
Arkansas Money & Politics: Has the shortage of labor and delivery units in Arkansas reached crisis stage?
Craig Wilson: In the absence of a crisis, you get the status quo. Compared to where we were several years ago, we don’t have the status quo. In response to poor maternal and infant outcomes compared to the nation and other economically developed countries — and the closure of roughly 25 percent of labor and delivery units across the state since 2019 — there was a real sense of urgency and focused attention on the maternal and infant health challenges we faced as a state. That galvanized action by the executive and legislative branches, community leaders, philanthropy, and the healthcare community. We did have a crisis that saw a concerted response, and we continue to have a crisis that will require a continued sense of urgency and collective action.
AMP: What can be done in the short term?
Wilson: A lot has been done already with enactment of state policy changes and federal- and state-funded programmatic efforts supporting regionalization of care, but those actions take time to implement and see the impact. There are other efforts, such as safety bundles to reduce C-section rates by the Arkansas Perinatal Quality of Care Collaborative and the postpartum call center through the Arkansas Center for Women and Infants’ Health, that early data show are supporting improved outcomes and patient experience.
The closure of labor and delivery units is largely a math problem — lower delivery volume means less revenue to support services that require an obstetrical workforce that is on-call 24/7. We should borrow from models like the rural emergency hospital, which provides standby payments from Medicare that support those 24/7 necessities to maintain a point of access to care.
AMP: Do you expect any more closures in Arkansas?
Wilson: My hope is that there’s not, but there is a patient volume threshold below which other hospital service lines can’t offset the revenue loss for providing labor and delivery services. In many of these rural areas, younger populations of birthing age are out-migrating. More women are not having children, and for those who do, they are waiting until later in life. Those factors have a slower impact that can result in the decision to cease labor and delivery services. A more immediate decision must be made when you lose a delivering provider, as has been the case in several of these situations.
AMP: What are the prospects of a hospital reopening its unit or a new unit being opened?
Wilson: As is the case with any line of service, patient volume, workforce supply and sufficient reimbursement for services will have to be a certainty. I think it’s more likely that hospitals will partner to develop regional models to support care throughout the birthing journey.
AMP: Is the demand for midwives about to skyrocket?
Wilson: Increasing the supply of certified nurse midwives will certainly expand the workforce for providing care throughout the birthing journey, including deliveries. Arkansas heavily relies on physicians and, in particular, OB-GYNs to deliver babies. Our analysis has shown that OB-GYNs deliver more than 95 percent of babies in Arkansas. Developing team-based approaches to delivering care throughout the birthing journey will be critical as more certified nurse midwives are introduced into the workforce, particularly in rural areas where high-risk pregnancies are more prevalent and travel time to specialist care is greater.
Expanding obstetrics fellowships for family medicine physicians is also critical in the development of a maternal care workforce. Family practice physicians are already highly trained in the work that they do, and a one-year fellowship offers a shortened pipeline to equip those physicians with surgical skills and obstetrical expertise to extend clinical capacity in rural areas.
AMP: What are the missing incentives attracting new doctors to practice in rural areas?
Wilson: They have the same lack of incentives to practice in rural areas as any other healthcare provider. There must be enough patient volume and sufficient reimbursement to support their practicing in rural areas. They also need the help of at least one other colleague — and ideally more than one — to support the 24/7 nature of these types of specialty services. Otherwise, there’s quick burnout.
Patient volume in rural areas is also a challenge for training OB-GYNs, which requires a sufficient number of deliveries and a training physician. Many rural areas can’t support these residency programs due to those challenges. Physicians are more likely to practice where they trained, and the training opportunities for this specialty and many others are concentrated in urban areas.
READ ALSO: Owner of Lauderdale Outdoor Services Not Slowing Down Soon
