Dear Gov. Phil Scott, Secretary Jenney Samuelson, Commissioner DeShawn Groves, Director Jill Mazza Olson, and Director Julio Cespedes,
As another Vermont hospital considers closing its birthing center because of financial distress, we urge the administration to increase funding for obstetric care statewide by aligning Medicaid reimbursement rates with what Vermont already pays for other primary care services.
In Windham County, more than 45% of births are covered by Medicaid, higher than the state average. Most families in the county choose to get obstetric care at Brattleboro Memorial Hospital, where leaders have reported nearly $4 million in annual losses on labor and delivery services. These deficits exist because reimbursement does not cover the true cost of obstetric care: The hospital collects less than 50 cents for every dollar billed.
Policy solutions
Increasing Medicaid rates for prenatal, labor and delivery, and postpartum services would make a meaningful difference to support obstetric care throughout Vermont and ensure that hospital-level care can be financially viable. While some obstetrical services are already classified as primary care under Medicaid’s enhanced primary care professional fee schedule, labor and delivery services are not included in the enhanced primary care rates.
The Department of Vermont Health Access has the authority to increase reimbursement for these services immediately and the backing of state and federal lawmakers to more sustainably reimburse providers for labor and delivery services.
Federal lawmakers have proposed additional policy measures to address the financial challenges rural hospitals face in providing obstetrical care, including the Keep Obstetrics Local Act. In addition to increasing Medicaid payment rates for targeted obstetric services, this legislation would provide “standby” payments to cover a portion of the fixed costs of staffing and maintaining an obstetric unit, and adjust payments for labor and delivery services at hospitals with low birth volumes. Vermont does not need to wait for Congress to adopt similar policies.
Risks to maternity care access
Without changes to the financing of obstetric care, researchers warn that labor and delivery units will continue to close, forcing pregnant patients to travel farther for care. Already, many families in southern Vermont live more than a 30-minute drive from hospital-based obstetrical care, and the closure of any birthing center in Vermont would significantly increase travel times.
It’s well documented that longer travel times and emergency department births are associated with increased risks of maternal morbidity and adverse infant outcomes. Families in rural counties without birthing centers also have fewer options for outpatient maternal health services, including lactation support, doula care, and childbirth education.
While the Scott administration has said there are alternatives to birthing services for Windham County residents seeking maternity care, we want to stress the precarity of all rural obstetric services in the region. We have heard reports that staffing shortages and revenue shortfalls are also a challenge for nearby hospitals, including Cheshire Medical Center in Keene, N.H., and Baystate Franklin Medical Center in Greenfield, Mass.
We are also concerned about patients’ access to affordable care at out-of-state hospitals. Because Vermont’s Medicaid reimbursement rates for delivery services are substantially lower than rates in Massachusetts and New Hampshire, 12 out-of-state hospitals have less financial incentive to accept Vermont Medicaid patients.
Safe, quality care in Vermont
We believe Vermont should guarantee access to safe maternity care at the state’s hospitals, rather than relying on obstetric services across state lines, where we have less transparency and regulatory control over costs, access, and quality.
Even at Vermont’s smallest hospitals, obstetrical care consistently exceeds national safety and quality benchmarks. This is not by chance. Clinicians at community hospitals receive support from specialists at tertiary care facilities through 24-hour consultation services and routinely participate in obstetric training sessions to support ongoing quality improvement.
Finally, we want to emphasize that OB-GYNs and certified nurse-midwives provide comprehensive primary care beyond obstetrics, including cancer screenings, routine gynecological care, contraception, and menopause care. If hospital-based obstetric services close, other primary care clinicians may not be able to meet community needs for these essential services.
As the Agency of Human Services continues its statewide health care transformation efforts, clinicians stand ready to contribute with our expertise. We respectfully request that our organizations be included in regional planning. Thank you for your attention to these urgent issues and for your commitment to ensuring that safe, equitable maternity care remains accessible to all Vermonters.
Sincerely,
Naiim Ali, president, Vermont Medical Society
Lauren MacAfee, chair, American College of Obstetricians and Gynecologists Vermont Section; president-elect, Vermont Medical Society
Tracy Tyson, president, American Academy of Pediatrics Vermont Chapter
Michelle Dorwart, president, Vermont Academy of Family Physicians
Emily Zolten, president, Vermont Affiliate of the American College of Nurse-Midwives
Michelle Wade, president, Vermont Nurse Practitioners Association
Nicole Clegg, president, Planned Parenthood of Northern New England