LABOR LIFELINE: Maternity care remains in focus despite hardships

MARINETTE — No financial benefits await hospitals operating in more rural areas, according to an official.

“Some things do not make financial sense to still provide,” said Dr. Scott Voskuil, chief medical officer at Aurora Medical Center — Bay Area in Marinette.

Other than tax breaks that any nonprofit organization receives, the hospital is operating out of a commitment to partnership, he said.

“With us, we’re able to look at it and say, ‘You know what, our patients really need us.’ It’s probably a bad financial decision, but it’s part of being a part of the community, a part of being not for profit and so forth, so that’s really what it comes down to,” Voskuil said. “We’re not a business; we’re here to take care of patients and communities.”

The hospital was recently given two recognitions — “Best Hospital for Maternity Care” and “Maternity Care Access Hospital” — the latter being a designation that 73 hospitals in the U.S. received.

The award highlighted the concept of maternity care deserts, a problem that affects 2.2 million women, according to the March of Dimes.

A maternity desert is an area without a birth center or obstetric care and where no obstetric providers work. Marinette and Menominee counties are not maternity deserts, but counties surrounding Marinette are.

Often, financial factors make it unsustainable for a hospital to provide care in the community.

“That’s why we’re super proud of being able to keep that service, especially in Wisconsin, when we’re starting to see the effects of these pressures upon other organizations with closures and so forth,” Voskuil said.

He said Aurora Bay Area can weather the storm by having a presence elsewhere to take on the financial loss for the patients who need help.

Aurora Health Care is the largest health system in Wisconsin and the state’s largest private employer.

“Now our hope is we can continue to spread the word a little bit and reach those folks that think that their only option is to travel long distances to get good care,” Voskuil said.

Not only are families getting quality care from their “home base” providers — those who live and work at hospitals in the area — but that care is also being bolstered by support from Green Bay, which may supplement the maternal care or provide part of it altogether.

He highlighted the integrated healthcare between Aurora BayCare Medical Center in Green Bay and the communication with Aurora Bay Area in Marinette. When someone needs to see the maternal fetal specialist in Green Bay, the teams work together.

“Between Marinette and Green Bay, we’re a bit unique because we have shared physicians from Green Bay that come up and see both clinic, surgery patients and OB in Marinette,” Voskuil said.

Bellin Health Marinette also provides care for expectant mothers, who can deliver through Bellin in Green Bay or Aurora Bay Area in Marinette. (Bellin does not have a delivery room in Marinette.)

Dr. Alyssa Nycz, a pediatrician with Bellin Health, said Bellin doesn’t have OB-GYNs that deliver in Marinette, but they offer prenatal and postnatal care with their two OB-GYNs on staff.

“I see plenty of families in clinic in Marinette who don’t have the ability to make the trip to Green Bay,” Nycz said. “If it’s best for a family dynamic, a Bellin provider is absolutely going to support that the mom stays in Marinette.”

Nycz does a lot of baby care in the Aurora Bay Area hospital with another physician colleague. She said the two hospitals’ goals are similar: to provide the same standards of care.

“I think the shared pediatric call group between Bellin and Aurora is pretty unique,” Nycz said. “Everyone I’ve worked with has been fantastic.”

She did note that the Marinette area does not have a Neonatal Intensive Care Unit (NICU), which is a big difference between why someone would want to deliver in Green Bay vs. Marinette.

If a family ends up in Marinette or delivers in Marinette, I trust the OBs in the hospital … I trust the pediatricians, no matter who we work for. We are going to make sure mom and baby are safe,” Nycz said.

UP Health System Marquette has the only NICU in the U.P. They see an average of 700 deliveries per year, compared to Marinette’s average of 200.

Although the hospital is not considered a rural access site, it serves rural areas and maternity deserts surrounding parts of Marquette County.

“If we didn’t have our NICU, I don’t know what our moms would do,” said Dr. Jorrie Houle, OB-GYN and D.O. at UP Health System and member of the OBGYN Associates of Marquette.

They see people from Gwinn, Ishpeming, Escanaba and Houghton. Houghton is almost a two-hour drive to Marquette, where the hospital is located.

“The NICU ultimately allows us to be able to have patients safely delivered in the Upper Peninsula and avoid them having to travel downstate within Michigan or across into Wisconsin,” Houle said.

Houle said they perform all high-risk deliveries or anything outside of routine care. For example, patients with gestational diabetes or those delivering twins and triplets are transferred from rural areas to Marquette.

Houle said the Upper Peninsula Health Plan (UPHP), a program similar to Medicaid, can reimburse travel for patients from Escanaba or Houghton.

She said they have an adequate number of providers, but some hospitals may need help keeping people hired. That factor can make care difficult for patients, who may have to travel longer distances to see someone.

“The distance from the hospital can sometimes complicate things,” Houle said. “If they choose not to receive prenatal care, then they do put themselves at higher risk for a poor outcome for them and their baby.”

She said that UP Health System has a 1-to-1 staffing ratio, which is the standard practice for the Association of Women’s Health, Obstetric and Neonatal Nurses.

“We are always asking for more staffing,” Houle said. “Our outcomes are good because patients have access to board-certified OBGYNs as well as a maternal fetal medicine specialist along with NICU.”

Voskuil said it’s not as common for health professionals to be interested in living in a more rural area.

“We have less and less doctors available, so the competition for the spaces that provide the ideal practice for them is pretty rough,” Voskuil said.

“Staffing becomes a huge problem,” he said.

Coupled with a declining reimbursement for services, it becomes a hardship for organizations to take on, he said.

“I don’t have an easy answer on how small community hospitals can make a go of it, honestly, it’s a tough thing,” Voskuil said.

Ultimately, women’s and children’s care has to be provided — it is typically subsidized by the hospitals. This makes it all the more important that patients learn to advocate for themselves, Houle said.

“Obstetrics does not make hospitals money,” she said.