OB services will be provided by Mid-Valley Hospital
In less than nine months, Three Rivers Hospital in Brewster will no longer deliver babies. Starting April 1, 2020, all hospital births in Okanogan County will be centralized at Mid-Valley Hospital in Omak.
The Three Rivers board of commissioners made the decision Oct. 30 after learning that Family Health Centers (FHC) intends to move obstetrics services to Mid-Valley, Jennifer Best, business development coordinator for Three Rivers, said this week.
Because Three Rivers doesn’t have any of its own providers for obstetrics — they’re all employed by FHC — the board felt it had no choice but to end the obstetrics (OB) program, Best said. Three Rivers announced the decision on Friday (Nov. 15).
“We completely understand Family Health Centers’ decision. They’re trying to keep OB in the county,” Best said. “Overall, we support the decision, but we’re really sad to see it go.”
The Three Rivers board discussed recruiting the hospital’s own providers — ideally, family-practice doctors certified to do C-sections, Best said. But hiring a minimum of four practitioners would exceed Three River’s financial capacity, she said.
The decision by Three Rivers’ board of commissioners comes just three months after North Valley Hospital in Tonasket discontinued its OB services.
North Valley stopped doing deliveries as of Aug. 1 because Confluence Health could no longer meet the minimum staffing requirements — a decision reached after years of trying to recruit providers, according to John McReynolds, North Valley’s operating officer.
All three county hospitals — like rural hospitals across the country — struggled to recruit enough medical providers certified to do C-sections. Three of the FHC providers who worked at Three Rivers had the certification, Best said.
FHC’s CEO Jesús Hernández signaled the organization’s intentions in a column published in area newspapers at the end of August, Best said.
“We must act with some urgency to save OB from disappearing from our county altogether. If we don’t, we risk losing more providers…. FHC’s response is to immediately implement a plan to move our OB hospital services to one hospital and work with that hospital’s leadership to create an OB Center of Excellence to better serve Okanogan County,” Hernandez wrote.
FHC initially planned to stop delivering babies at Three Rivers at the end of January 2020, but the hospital negotiated two extra months to ensure coverage of other patient care, Best said. With an average of just 90 births a year, OB practitioners spend most of their time caring for other hospital patients, Best said.
Childbirths at Mid-Valley and North Valley have declined by 30% in recent years, but have been more stable at Three Rivers. At Three Rivers, there were 92 births in 2017, 90 in 2018, and the hospital expects 80 to 90 this year, Best said.
For years, the Three Rivers board has evaluated the hospital’s services with an eye toward what to cut or expand. They had considered eliminating OB care, but heard “loud and clear” from the community that people wanted childbirth and OB, so they kept it going, Best said.
Three-fourths of Three Rivers’ OB patients are covered by Medicaid. Reimbursement rates for childbirth are lower than for other procedures and OB has never broken even, Best said.
Still, cost wasn’t a factor in the decision to end the OB program. “Three Rivers Hospital was committed to supporting obstetrics regardless of how much revenue it generated. At the end of the day, without physicians, we can’t provide OB,” she said by email.
Three Rivers will still deliver babies for women who come to the emergency room about to give birth, she said.
The three hospitals in the county relied on different combinations of providers, including family practitioners, obstetrician/gynecologists, and midwives to deliver babies. But all needed a back-up provider certified to do C-sections.
All three hospitals have been grappling with this issue for several years. They need to strike a balance between having enough work to keep doctors busy — and keep their C-section skills fresh — but not burn them out with an overwhelming 24/7 on-call schedule. Centralizing OB care means doctors will be busier, delivering about 400 babies a year.
The number of family-practice providers in the United States who perform C-sections has plummeted, going from 44% in 1982 to 17% last year, according to numbers from North Valley. There are only about 1,000 such doctors in the entire country considering these career opportunities, North Valley’s McReynolds said. “It’s already difficult to get providers to come to this area,” Best said.
Recruiting a practitioner takes two to three years and costs about $100,000, Mid-Valley CEO Alan Fisher said at a health care summit this summer.
Executives at all three hospitals have been meeting for about two years to devise a solution for OB care and look for ways to collaborate on a variety of medical services.
The hospitals were reluctant to centralize OB care. Family-practice physicians have a commitment to providing cradle-to-grave care. “OB is the only happy thing people do at a hospital, so it’s a special thing for people who work there,” said McReynolds.
Provider shortages have affected all hospitals in the county. Earlier this year, Mid-Valley had to send all women to other hospitals for obstetrics care when one of their physicians was on leave for a month.
Three Rivers has been one of about 10 hospitals in Washington — and the only one in eastern Washington — to earn the Baby-Friendly USA designation, which emphasizes support for breastfeeding.
The designation, earned in 2004, needs to be renewed every five years. Once the board learned about FHC’s decision, they elected not to renew in 2020 because of the expense, Best said. The hospital is required to pay for the inspectors, including their travel costs, she said.
Three Rivers’ labor and delivery department offered water births, nitrous gas as an alternative to epidurals, and welcomed doulas and midwives. “It was an investment we wanted to make — it fit our philosophy” Best said. Three Rivers still has gold certification through a state program called Breastfeeding Friendly Washington, Best said.
Mid-Valley offers lactation consultants and immediate post-delivery skin-to-skin contact for mother and baby.
Since making the formal announcement last week, Three Rivers hasn’t heard any reaction from patients or the community, Best said.
Staff at Mid-Valley Hospital and Family Health Centers could not be reached for comment.