What it will take to save obstetrics

By Kelly Mather

Many in our community have made it clear they want to save the obstetrics program at Sonoma Valley Hospital. 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 this program were restored. These funds had been cut in September, increasing our annual loss on obstetrics from $500,000 to $1 million. That’s what forced us to re-examine the situation. But we still have decisions to make.

For several years, 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 a month 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 to our hospital. (If our OB program received the same market share our ER has – nearly 80 percent – it would easily be a sustainable program.)

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 SVH services, working with the Community Health 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 the costs of the program. As I noted, this is challenging because the service is heavily regulated, but we will continue to examine all costs, including those of our medical staff.

More importantly, we need the community to use our OB services. This means that we need local employers to offer health care plans that include the hospital, and community members to choose plans that provide access to 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. Community use is the only way we can guarantee that obstetrics, and other services the hospital currently offers, will be available in the future.

• • •

Kelly Mather is CEO of Sonoma Valley Hospital.