MONTPELIER — Health care policy and services for births have long been at issue in our smaller Vermont communities. When I was on the Board at Copley Hospital, now more than a decade ago, I supported Copley taking over births from Lamoille Health Partners (LHP). At the time, LHP gave up births primarily because of poor reimbursement rates. While we face some of the same issues as we did then, today the issues related to keeping a birthing center going are even more complex.
Copley is a great facility and a great place for young families to access their healthcare and to have their kids. The questions for Copley are many. Not only is reimbursement an issue but also the area has experienced a declining number of births. Recently there have been less than 200 births per year in our service area. The vital stats report from the health department paint a concerning picture: quality of the service, staffing, insurance and the structure of the organization offering any service like births all have to be considered when discussing this basic health care service.
With increased regulatory control from the state and ever-tighter budget constraints on hospitals it’s becoming harder for organizations like Copley to maintain services that aren’t profitable.
Owen Foster, the chair of the Green Mountain Care Board, has been quoted as saying that the discussion about closing birthing centers shouldn’t come as a surprise.
“Any hospital, the most immediate thing they’ll do is cut a service that’s low margin: if they’re in financial trouble, that’s where you go,” he said. “But that might not create the health care system we really need as a state.”
So, what do we want from our local Health Care system? Personally, I think primary care is a vital service. Lamoille Health Partners has been having issues and has been going through changes that are affecting services in the county. LHP is the leading employer of doctors in primary care in the area and the organization needs to be stable. A birth is, in my view, also part of the primary care system and just as I hope we can keep a strong group of primary care doctors here I hope that we can maintain the ability for children to be born here in the area.
In the Legislature this week, in the Senate, we did pass S.18, which would establish a licensing structure for freestanding birth centers. S.18 would help deal with the complications related to the structure of the organization offering birth services. In other words, it would allow for an organization to perform birthing services outside the review of the Green Mountain Care Board. It would also require prenatal, maternity, postpartum, and newborn coverage under Medicaid and health insurance plans. Birthing centers could be created without being subject to the Green Mountain Care Board’s Certificate of Need process. The attempt is to make it easier to create independent organizations outside of hospitals, which would allow for birthing services outside of the regulatory process.
Funding for these services also remains an issue we all need to grapple with. We all know Medicaid doesn’t come close to covering the cost of births in any setting. But in addition, for small hospitals, the disparity in the rates that private insurers pay for the delivery of a baby is even more of an issue. For example, the University of Vermont Medical Center receives $17,100 for the delivery of a baby while a community hospital like Copley receives $6,904 from a private insurer like Blue Cross Blue Shield. That disparity alone makes it untenable for small hospitals to offer births. That said, if hospitals like Copley go out of the business of births and everyone goes to Burlington it will cost all of healthcare in Vermont a huge amount more.
The Administration and Board at Copley are facing the unenviable task of weighing the future of the Birthing Center at Copley. It’s not cut and dried and I only have limited influence on the situation. I’ve offered my opinion to members of the board and the hospital administration. I do hope we can all figure something out to keep births in the community whether at Copley or maybe under a stand-alone birthing center model. Whatever happens this isn’t easy.
Richard Westman represents the Caledonia District in the Vermont Senate, including the towns of Barnet, Danville, Groton, Hardwick, Peacham, Ryegate, St. Johnsbury and Stannard.
