St. Charles Health System is considering shutting down the family birthing center in Redmond, sending women in labor to the Bend hospital instead. Hospital officials say the move would help limit the high costs of delivery in Central Oregon and critics worry the added travel time could put some women and babies at risk.
“The biggest impact is going to be time and safety,” said Amber Loredo, a nurse in the Redmond birthing center. “This is not good for our community.”
The proposal came from a group of hospital officials, doctors and other women’s health providers in the community who have been meeting over the past six months to discuss ways to lower delivery costs in the region.
“Delivering a baby at St. Charles is very expensive. We’re one of the most expensive places to have a baby in Oregon,” said Iman Simmons, chief operating officer at St. Charles. “It’s made us realize we can no longer continue to do the same thing in the same way.”
In 2016, insurance plans paid an average of $11,720 for a normal delivery at St. Charles Bend, the second highest rate in the state, according to data reported to the Oregon Health Authority. St. Charles Redmond was paid $10,560 for a normal delivery, well above the $8,057 state average and more than twice the amount of the lowest-cost hospital in the state.
“We have great transparency now across the state,” Simmons said. “So commercial payers are understanding that they’re paying one hospital that looks similar half of what they’re paying us. And they have a lot of questions about that.”
Closing the Redmond center would reduce overhead costs and staffing challenges, providing some economies of scale, she said.
The group was charged with reducing the increase in delivery costs by 15 percent over the next five years. That could lower the cost for consumers, who often face high deductibles and other out-of-pocket costs when having a baby.
The closure could mean that women in labor have to drive an additional 15 to 30 minutes to the Bend hospital. That could push the travel time for those in more remote parts of the region to over an hour, or longer with winter weather.
“We have moms who come from Warm Springs, who come from Post, who come from Spray,” said Loredo, who lives in Culver and has had seven children at the Redmond birthing center. “When you’re working on your fourth, fifth, sixth baby, you barely make it in time.”
The hospital in Prineville stopped delivering babies in 2009, forcing women to drive an extra half hour to Redmond. Shifting those deliveries to Bend would put travel times to 45 minutes or longer.
While medical societies have no formal recommendation on safe travel times to the hospital, research suggests that the farther women have to go, the higher the risk of problems for mothers and babies.
“Labor and delivery are really a process that is time sensitive,” said Dr. Stefan Grzybowski, co-director of the Centre for Rural Health Research at the University of British Columbia in Vancouver, Canada. “There’s risk associated with more time.”
Grzybowski led an oft-cited 2011 study that looked at the relationship between travel time and delivery outcomes for more than 49,000 women in rural British Columbia.
While complications remained rare, the researchers found a statistically significant differences in newborn deaths and neonatal intensive care unit use depending on their travel time.
Women who had to travel more than an hour, they found, were more likely to stay at home until the start of labor, particularly if they had other children at home, and so were more likely to deliver en route to the hospital.
“Most of the time, this whole process works fine,” he said. “But the trouble with stressing women by increasing their getting to services for something that should be pretty safe, you’re just amplifying the risk.”
Grzybowski said it’s hard to set a safe cutoff for travel time.
“An hour is a reasonable threshold,” he said. “I can’t say that that’s a hard line. It’s not like the risk jumps up at a certain point.”
Hospital officials counter that some women could go to the Madras hospital instead of coming to Bend, and that women with high-risk pregnancies throughout the region are already directed to Bend, which has the region’s only neonatal intensive care unit.
Access to obstetric services is increasingly becoming a major issue for women living in remote areas of the country. Many rural hospitals have stopped delivering babies as the relatively low number of births makes it hard for hospitals to cover their costs. A recent study found that more than half of rural counties in the U.S. now lack obstetric services.
The 12-bed birthing center in Redmond is on pace for more than 500 births this year but is operating at a 43 percent occupancy rate, meaning on average, the center is less than half full. The center in Bend has 28 beds and handles about 1,700 births per year, at a 48 percent occupancy rate. Shifting the Redmond births to Bend would raise that occupancy rate to 62 percent, and into the 60 to 75 percent occupancy range that hospitals target.
Loredo questioned those occupancy numbers, saying the birthing centers sometime hit their capacity and patients must be redirected from one center to the other when things get busy.
“I don’t know where they get their numbers or how that’s developed, but it doesn’t seem like that on the floor,” Loredo said.
Simmons said capacity issues often reflect staffing levels rather than a shortage of beds at the centers, and that combining the staff at one center could reduce those challenges.
Central Oregon has seen steady growth in its population, but Simmons said those trends are driven by retirees and older people who are not having babies. Nationwide, birth rates have been declining for decades and in 2016 hit their lowest mark since government agencies started collecting the data.
Simmons said closing the birthing center in Redmond would free up an additional 12 beds at the hospital that could be used for other health services in high demand.
The task force considered two other proposals, including one that would also close the Redmond Center for Women’s Health, and one that would maintain limited birthing services in Redmond. Simmons felt the proposal to shift deliveries to Bend was most likely to move forward.
The St. Charles executive committee will consider the options on Oct. 17 and make a recommendation to the hospital’s Board of Directors. Simmons said there was no firm timeline for making a decision or for closing the Redmond birthing center if they decide to go that route.
Hospital officials pledged no nurses would lose their jobs if the birthing center were closed.
Simmons said the hospital’s priority would be to shift those nurses to the birthing center in Bend and allowed that some nurses might opt for a hospital-funding training program to become operating room nurses instead.
The Oregon Nurses Association, which negotiates contracts on behalf of the St. Charles nurses in Bend and Redmond, is opposing the potential closure and has scheduled an informative meeting at Redmond library at 6:30 p.m. Monday for the public. A union spokesman said the hospital system has not taken into account the views of the nurses or the public in coming up with their plan.
Loredo said she’s heard from many people in the Redmond community concerned about the proposal.
“Everywhere I go, people are asking me about it and are very concerned about the care for themselves or their children,” she said. “We should table this.”
— Reporter: 541-633-2162, firstname.lastname@example.org