City eyes closure's effect on OB care

City health leaders believe the closure of Chestnut Hill Hospital's maternity unit will not endanger Philadelphia's pregnant women, but some fear problems could grow and hope a new monitoring effort will alert them to trouble.

Kate Maus, the Philadelphia Department of Public Health's director of maternal, child and family health, described the current situation for pregnant women as "uncomfortable and inconvenient, yep, but not dangerous."

Women may not be able to have their babies as close to home as they would like, she said, but they are able to find a hospital bed when they're in labor.

She said other hospitals near Chestnut Hill - Albert Einstein Medical Center and Abington Memorial Hospital are the closest - will be able to absorb the 1,000 babies a year that Chestnut Hill Hospital has been delivering.

"I believe at this point there is still capacity, but we're monitoring that very closely," said Maus, a Mount Airy resident who was born at Chestnut Hill Hospital.

In June 2007, the city helped establish a task force on obstetrical services that includes representatives from the government, hospitals, insurance companies and advocacy groups. The group is only now beginning to collect data on hospital usage and financial problems in obstetrics. It will begin gathering detailed information about deliveries from the city's maternity hospitals next week.

Maus said she believes the initiative has moved remarkably quickly, given the complexity of the situation - the hospitals are competitors, after all, and payment information has been secret - and the workload of the doctors who run Philadelphia's obstetrical programs.

"The sensitivities here are fairly massive," she said. "People's bottom lines are on the line."

Chestnut Hill announced this week that it is closing its maternity unit, saying that the relatively small size of the program could not financially support the required services. It said it would lay off 70 staff members while expanding gynecological services to older women.

It will be the 15th hospital in the region to shutter its maternity ward since 1997. Hospitals have said that a combination of low insurance payments, especially from Medicaid, and high malpractice insurance expenses make obstetrics a money loser.

Pam Clark, a member of the OB task force and vice president of health-care finance and managed care for the Delaware Valley Healthcare Council, said the closure trend is the big issue.

"The concern is that this is the third hospital in three years," Clark said. "We're on the brink of potentially being unable to manage the babies that people want to deliver in the region."

The task force is examining obstetrical costs and revenue, malpractice expenses and capacity. The costs are difficult because different hospitals measure expenses in different ways. Revenue is thorny because most Medicaid patients now are covered by managed care plans that refuse to divulge what they pay providers, even though they are funded by the public.

As a result, the task force will have to look at aggregate financial data.

The state this year stopped subsidizing part of the malpractice expenses for obstetricians, Clark said, and that has increased financial pressure.

The state and federal government this year are giving an extra $10 million to hospitals that have a disproportionate share of poor, pregnant patients, Clark said. Chestnut Hill did not qualify for that funding.

Starting next week, the task force will be collecting data on where women are having babies and whether they arrive at the hospital with prenatal care records. If the hospital that delivers the baby can't access a woman's medical records, it often has to perform extra tests, Maus and Clark said. The city also will be looking at "sentinel events" like how many women give birth in ambulances.

JoAnne Fischer, executive director of the Maternity Care Coalition and a member of the OB task force, said she believes the state will have to step in because the closure trend transcends this region. Either the state needs to pay enough for maternity care to make it profitable or it needs to regulate hospitals to ensure that enough are providing obstetrical services, she said.

Holli Senior, a spokeswoman for the Pennsylvania Department of Health, said the state's only role in the Chestnut Hill closure was to make sure that the hospital gave the required 60-day notice and that it does a good job of transitioning its patients to other facilities.

"This appears to be a business decision by the hospital," she said. "The Department of Health has no authority to make hospitals stay in business if they don't want to."

The task force expects to make recommendations in November, Maus said.