New Hampton hospital stopping delivering babies; still a priority at FCMC

By Bob Fenske, editor@nhtrib.com

and Bob Steenson, bsteenson@charlescitypress.com

It wasn’t hard to sense a little ire in the air as MercyOne New Hampton Medical Center CEO and President Aaron Flugum lead a discussion earlier this month about the New Hampton hospital’s decision to “pause” labor and delivery services next summer.

“I could feel it,” Flugum said, “but I also appreciated the passion and honesty people brought to the meetings. I think, for the most part, they have a much better understanding on why we have to do this.”

MercyOne announced last month that it would pause services, beginning July 1, 2020, for a variety of reasons, including two doctors leaving the New Hampton area and the remaining doctors deciding to no longer provide OB services.

And Flugum also told focus group members that two other physicians, Drs. Nathan and Heather Harms, have opted to leave MercyOne to focus on mission work full-time.

“We need two doctors on call,” Flugum said, “and even now, that means they’re giving up more than half their days and nights where they have to be ready to come into the hospital.”

Hospitals across the county, especially in smaller communities, have been electing to stop delivering babies, because of a severe shortage of OB/GYN physicians and family doctors who practice obstetrics.

Add to that a shrinking and graying rural population and Medicaid reimbursement rates that are so low that some hospitals can’t afford to provide the service.

Since 2000, 34 of Iowa’s 118 community hospitals have closed their birthing units, according to the Iowa Department of Public Health. There have been two so far this year, down from eight closures last year — the most in a single year.

It’s a significant concern, Rod Nordeng, administrator of the Floyd County Medical Center, told the Press previously in a story on the medical center’s physician recruitment efforts.

Nordeng said it’s important to the Floyd County hospital and clinic to have physicians who will deliver babies, but fewer doctors want to do that.

“Many physicians in family medicine want to be in a clinic setting, Monday through Friday, 8 to 5, and that’s it,” he said. “If you’re delivering babies you’re on call.”

There are also increased liability concerns with delivering babies, he said.

The Floyd County Medical Center has made it a priority to keep its maternity department open, including hiring a certified nurse midwife, Judi Halbach, who joined the medical staff last April, and hiring another family practice doctor, Dr. Michelle Im, who will make deliveries and will join the staff when she finishes her residency in September.

Nordeng said some health care centers have gone to systems where expectant mothers rotate through a group of physicians for their care and whoever is working when she delivers is the doctor she gets. Others have doctors who work exclusively in the hospital, and a patient’s primary care physician never sees them outside the clinic.

“Our physicians and our nurse midwife want to deliver their patients’ babies, even when they’re not on call. That’s not the norm in health care any more,” Nordeng said. “We’re fortunate that we’re still focusing on the mom’s desires whenever we can.”

In New Hampton, people at two recent focus groups wanted to know if the decision on obstetrics would be repeated in other departments at the hospital.

Flugum said the hospital has invested heavily in its facility and people, pointing out that MercyOne has invested more than $19 million in infrastructure in recent years.

“We’re not going anywhere,” he said and pointed out that the hospital is implanting a new eCARE Emergency service that will provide extra support to MercyOne New Hampton’s clinicians when they need it. “And we’re not on an island when it comes to OB. This is happening everywhere.”

Iowa ranks 50th in the nation when it comes to OB/GYN providers per capita, and the issue is even more pressing in rural counties like Chickasaw.

And the trends don’t look good, either. According to Dr. Stephen K. Hunter, the Vice Cahhir for Obstetrics at the University of Iowa Hospitals and Clinics, 66 percent of those completing their family medicine in 1988 planned to have obstetrics in their practices.

Thirty years later, only 18 percent of those who completed their family medicine residencies planned to offer OB services.

Not only is there the shortage of doctors who deliver babies, but MercyOne New Hampton’s “volume” and the low reimbursement for Medicaid patients also makes it difficult for the hospital to make the OB program financially viable.

Over the past years, the average number of annual Chickasaw County births is around 130, yet MercyOne has averaged 51 births a year during that time and not all those are from its “home” county.

Yet, Flugum was adamant that if the hospital had doctors willing to work in OB, it would continue to do so.

“We have great people here,” Flugum said, “and that includes not only the physicians but also our nurses and our entire staff. They do a great job … it’s just really challenging right now.”

As one of the recent New Hampton focus groups broke up, one of the last comments came from a woman who will deliver her second baby at MercyOne sometime next month.

“I’m sad, I’m not going to lie,” she said, “but I think sitting through this has helped me realize how hard it is going to be to ‘unpause’ this.”