Kristen Karl has nothing against the Bellevue Medical Center or Papillion's Midlands Hospital.
Two of the Bellevue resident's four kids have been treated in both hospitals' emergency rooms. Her father-in-law has had surgery at Midlands. Her sister had a baby at the Bellevue hospital.
But a month ago Wednesday, Karl delivered her youngest son, Daniel, at Omaha's Bergan Mercy Medical Center. She delivered 4-year-old Kaelin at Bergan, too.
Karl is among the many Sarpy County residents who drive past the hospitals in their own county to deliver babies in Douglas County. The practice is one of the factors that has led officials in the Alegent Creighton Health system to decide it will close Midlands' inpatient obstetrics unit sometime this fall. Obstetrics units will remain at Bergan Mercy and the system's four other metro-area hospitals.
Consumers can expect to see more hospital systems weighing which services to offer at which locations as they try to curb expenses and become more efficient in the face of reduced reimbursements from the federal government.
Just over half the metro area's deliveries in 2012 were at two hospitals: Bergan, with 3,316 deliveries, and Methodist Women's Hospital, with 3,607.
In 2012, Midlands reported just 283 deliveries, which is down from previous years. Bellevue Medical Center has seen increases in its number of deliveries since it opened in May 2010, with 176 in 2010 and 683 in 2012. Bellevue's numbers are lower than those at five other area hospitals, but its CEO projects a double-digit percentage increase in births next year.
Moms “like to deliver at places where we have a full neonatal intensive care unit, anesthesia 24/7, all of those full-service capabilities,” said Cindy Alloway, an Alegent Creighton Health vice president who oversees OB services at the system's hospitals. In order to offer the full range of services, she said, “we will no longer be able to offer all services at all locations.”
An Alegent Creighton Health spokeswoman said no other closures are in the works. “We are always looking to see where duplications are,” said Kelly Grinnell. “That's just kind of the business of health care these days.”
Two Omaha hospitals, Children's Hospital & Medical Center and the Nebraska Medical Center, operate Level 4 neonatal intensive care units, which can take care of the smallest and sickest babies. Bergan, Creighton University Medical Center and Methodist Women's Hospital have Level 3 NICUs, a less-intensive level. Lakeside Hospital and Bellevue Medical Center operate Level 2 NICUs. Mercy and Jennie Edmundson hospitals in Council Bluffs, Midlands and Immanuel Medical Center provide basic neonatal care.
Dr. John Moore, an Omaha pediatrician who sees his young patients at Methodist Women's Hospital, Bergan and Lakeside, said NICUs are expensive to operate, and the quality of care suffers with the duplication of efforts. “You can't have NICUs all over the city and have all of them being supported equally,” he said.
Dr. Guy Schropp, an obstetrician/gynecologist, understands that. But Schropp has been delivering babies at Midlands for 24 years, as of Wednesday, and his office in the medical building next to Midlands is on the same floor as Midlands' labor and delivery unit.
“A lot of patients come to us out in that area because that's where they live,” he said. “So from our standpoint, we're disappointed. Not that we don't understand why it has to be done, but we're disappointed.”
Some patients, Schropp said, prefer “that more laid-back, one-to-one care” they get at Midlands. “But you've got to be realistic. There's a lot of changes in medicine these days.”
Alwyn Cassil, a spokeswoman for the Washington, D.C.-based Center for Studying Health System Change, said hospitals are facing a lot of financial pressures.
“You cannot fault hospitals for trying to increase their efficiency and hold down costs,” she said. “Hospital spending is a huge piece of the health care dollar. They are getting very strong messages from all directions that they need to do a better job of holding down costs.”
One source of the pressure, she said, is the federal Affordable Care Act, which will constrain the growth of Medicare payment rates.
In addition, payments that hospitals get for serving a disproportionate share of low-income people will be reduced, she said, with the idea that the expansion of health care coverage will generate more paying patients.
“Consolidating expensive services into arrangements that allow (cost controls) is going to be, probably, a priority for hospitals,” Cassil said.
Expectant mothers who head to hospitals with more services as a result of consolidations shouldn't see any increase in their costs, unless they also take advantage of those increased options.
Delivering babies is a competitive business among hospitals because it creates a pipeline for future patients. Metro-area hospitals, with that goal in mind, have poured millions of dollars into their labor and delivery operations in recent years, expanding the size of the patient rooms to accommodate more visitors and improving the rooms' looks and sleeping accommodations for spouses.
But Cassil said that's not the only way to secure patients.
A mom's experience is important for repeat business for another baby, Cassil said, but more important in her view is the experience someone has in a hospital's emergency department, which she said often is considered the hospital's front door. “A broader group of people are going to have experiences (in the ER) than just people with maternity needs.”
Midlands had about 8 percent of the deliveries of Sarpy County children in 2012, Alloway said. That number, she said, compares to Bergan Mercy's 64 percent share of the year's Sarpy deliveries. In 2009, she said, 18 percent of Sarpy babies were delivered at Midlands; 55 percent were at Bergan.
On average, Midlands has about two patients a day in its OB unit, Alloway said.
Closing the unit will affect about 20 registered nurses, OB technicians and certified nursing assistants, she said.
“We will try to find positions within our system to offer employees affected by this,” Alloway said. “If we cannot find positions, we may have to let some go, but that is not our intent.”
Bellevue Medical Center has 11 obstetrician/gynecologists on staff, with another 15 family medicine physicians who deliver babies for their OB patients there, plus a midwife. An additional four OB-GYNs have applied to join the staff, said Paulette Davidson, the hospital's CEO.
Methodist Women's had 14 percent of its deliveries from Sarpy County residents and 19 percent from outside Sarpy and Douglas counties, hospital officials said.
Susie Engebretson, who lives in a southwest suburb south of the Douglas County line, is due to deliver her second child, a son, at the Women's Hospital next month. She had daughter Ellie, now 3, at Methodist Hospital in March 2010. (Methodist Hospital, in central Omaha, stopped delivering babies when the Women's Hospital opened.)
After her daughter was born, Engebretson said, she worked as a volunteer with Methodist's breastfeeding and new mother support group, so she felt most comfortable with the Methodist crew.
“I guess mostly I like the Methodist name brand attached to it,” Engebretson said. “I started going to my OB-GYN way before I had kids, and so it was nice when I became pregnant that I already had an OB I trusted.”
The drive from home to the Women's Hospital takes about 15 minutes, she said.
Schropp, the OB-GYN said it takes him about 15 minutes to get to Bergan, where more than half of his practice's babies are born. He said he still will perform hysterectomies and laparoscopies at Midlands.
Karl said driving from her Bellevue home to Bergan takes her about 25 minutes. She said the care she received last month was “excellent at Bergan, even more so the second time than the first time. They've renovated, and the rooms were a lot nicer, bigger.”
Bergan opened a new maternity center in January 2010 to provide more and bigger rooms.
The way the delivery was handled also was better, said Karl, whose 11-year-old twin sons were born in Georgia. “When I had the boys and Kaelin, they were all C-sections,” she said. “The minute they pulled the kids, they were gone to the nursery.”
With Daniel, she said, he was handed to her husband, Paul, and he held the baby until he handed him off to her in the recovery area.
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