Lessons Learned From Philadelphia Obstetrics Closures

Marcia Frellick

December 10, 2014

Researchers examining how consolidations and mergers can affect the surrounding facilities looked to Philadelphia, Pennsylvania, where 13 of 19 obstetrics units closed between 1997 and 2012.

Scott A. Lorch, MD, MSCE, a neonatologist and researcher in the Center for Outcomes Research at The Children's Hospital of Philadelphia, and colleagues interviewed 23 people from 11 hospitals whose obstetrics units were still open to find out how the closures had affected them. Results were published in the December issue of Health Affairs.

The authors reported sharp increases in delivery volume (on average, 57.7%, and more than 70% at some county hospitals) and noted that the closures also abruptly changed the mix of patients and insurance status. For instance, obstetric units that remained open saw an average increase of 216% in women with public or no insurance between 1995 and 2009.

People interviewed said the new mix of patients brought on financial concerns, which in turn decreased job satisfaction of providers. Potential solutions, they say, may include adding specific personnel, such as social workers, to help patients and providers adapt to the changes.

In addition, the informants said care became fractured. More patients received prenatal care outside of the place they delivered the child, and as a result, many informants said they were seeing people with no prenatal care, and care became more inefficient.

The study also suggests a need for coordination and communication across county lines and among hospital systems and public health departments in the case of closures.

Because the problems were most prominent when the closures were abrupt, the authors conclude that public health officials should work to identify hospitals and specific units at risk of closing.

The authors said Philadelphia units were hit particularly hard because the community has high malpractice rates, which pushed hospitals to employ obstetricians directly, as well as high overall personnel costs to run a labor and delivery floor.

"While the degree of obstetric unit closures was larger in Philadelphia than in any other metropolitan area, analyzing the situation may provide useful lessons for other areas as hospital consolidations, closures and mergers have accelerated since the enactment of the Affordable Care Act," Dr Lorch said in a hospital news release.

The authors have disclosed no relevant financial relationships.

Health Aff. 2014;33:2162-2169. Abstract

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