Most rural hospitals aren't offering labor and delivery services, forcing mothers to travel

Over half of the country’s rural hospitals aren’t offering labor and delivery services, and many of those that are could soon be forced to end maternity care due to financial losses, according to the Center for Healthcare Quality and Payment Reform (CHQPR).

The center wrote in a new report that over 200 rural hospitals across the U.S. stopped delivering babies in the past decade. As of this month, 55% of rural hospitals don’t offer these services, and in 10 states more than two-thirds don’t.

CHQPR noted that it can be financially difficult for hospitals to staff for 24/7 maternity care and that private and Medicare payments often fail to break even.

Per hospital cost reports for 2022, over a third of rural hospitals that still provide maternity care logged an overall loss on patient care services, “so their ability to continue delivering maternity care is at risk,” CHQPR wrote in the report. Within 12 states, more than half of rural maternity care hospitals posted patient care losses.

“Smaller rural communities are at greater risk, both because their losses on maternity care are higher and because they are more likely to experience large losses on other patient services,” CHQPR wrote in the report. “More than half of small [less than $21 million in total annual expenses) rural maternity care hospitals lost money on patient services overall in 2022.”

The sparse availability of maternity care hospitals forces pregnant women to travel further for a delivery and incur a higher risk of complications and death for the mother and baby alike, the center wrote. Whereas travel time to a hospital with labor and delivery services is often under 20 minutes for those in urban areas, in rural areas “the travel time is likely to be at least 30 minutes, and it is often 40 minutes or more,” according to the report.

Halting the drop-off in rural maternity care will require stakeholders to address these facilities’ recruitment and payment difficulties, CHQPR wrote.

The former reflects a widespread issue that will require a national solution, “otherwise, filling a position at one small rural hospital may simply create or extend a vacancy at another hospital” at the expense of lower resource facilities, the center wrote. However, any strategy to bolster the rural maternity workforce will also require targeted clinician training, remote specialty support and new staffing models for on-call coverage, according to the report.

To address the financial roadblock, CHQPR urged employers to put pressure on their health insurance plans “to demonstrate that they are paying amounts that are adequate to cover the cost of maternity care services. Similarly, states should require Medicaid plans to pay adequate amounts for maternity care services.”

At the same time, rural hospitals are still sustaining losses across the rest of their service lines that threaten their continued operation. CHQPR stressed that, per hospital cost reports, the shortcomings are primarily caused by insufficient payments from commercial and Medicare Advantage plans. As such, the group again called on stakeholders to pressure private insurers by only choosing plans that pay rural hospitals adequately across the board.

“It is not an exaggeration to say that rural maternity care is in a state of crisis, and a crisis demands immediate action,” CHQPR wrote. “Every day that steps are not taken to implement the changes in workforce recruitment and payments described above increases the likelihood that more women and babies will die unnecessarily.”