2010 Testimony

2009 Testimony

Thank you to Councilwoman Tasco and the Committee on Public Health and Human Services for giving Delaware Valley Healthcare Council of HAP the opportunity to testify here today.

I am Ken Braithwaite, regional executive for the Delaware Valley Healthcare Council of HAP. The Delaware Valley Healthcare Council (DVHC) of The Hospital & Healthsystem Association Pennsylvania (HAP) is a membership organization representing more than 50 acute and specialty care hospitals and health systems, over 30 facilities providing inpatient behavioral health services, and 20 facilities providing physical rehabilitation in southeastern Pennsylvania.

DVHC appreciates this opportunity to express the regional hospital community’s concerns about one of the most important issues confronting Philadelphia, the issue of infant mortality. DVHC's testimony today will cover:

• The City’s current infant mortality rates and whether the closure of hospital obstetrical (OB) units has impacted these rates.
• Current stresses on the City’s hospital-based OB services.
• DVHC’s recommendations for reducing infant mortality rates.

Impact of OB Unit Closures on Infant Mortality Rates

Philadelphia infant mortality rates have remained fairly stable. According to data from the Pennsylvania Department of Public Health from 1999 to 2007:

• The overall mortality rate for infants of all races ranged from about 10 to 12 per thousand babies born.
• The mortality rate for African American infants ranged from just below 14 to about 17.
• The mortality rate for Caucasian infants ranged from about 6 to 12.
• The mortality rate for Hispanic infants ranged from about 6 to 10.

From 1997 to 2010, the number of Philadelphia hospitals delivering babies has dropped steadily from 19 to six, increasing patient volumes at the remaining OB units. For a three-month period in the fall of 2008, DVHC collected daily utilization information from Philadelphia hospitals. At that time, DVHC found that the Philadelphia mothers and children were receiving excellent care despite the many stresses placed on hospital OB units by these increased volumes.

Stresses on Hospital-based OB Services

According to DVHC’s 2008 data collection, in aggregate, for three out of every four days of the survey period, the number of labor and delivery patients admitted exceeded 75 percent occupancy – the target occupancy rate recommended by some policy experts to allow for surges in OB patient volume. (1) 

In addition, according to DVHC’s utilization reporting system in fiscal year 2007, average annual occupancy rates in three city OB units were above 90 percent for the year. This average rate for the entire year means that on a day-to-day basis, occupancy rates were sometimes lower than 90 percent, and sometimes much higher, even, on occasions above 100 percent.

The reasons behind hospital obstetrical unit closures in the city and region have been documented by The Hospital & Healthsystem Association of Pennsylvania (HAP) and Delaware Valley Healthcare Council of HAP (DVHC). Liability insurance for obstetrical service providers, including hospitals and physicians, is one of the most costly types of medical liability insurance to purchase. For example insurance from ProAssurance, one of the insurers providing coverage to Philadelphia OB/GYNs, costs $169,336 as compared to $37,190 for internal medicine.

While medical liability insurance costs are high, hospital reimbursement rates for obstetrical (OB) services are low, especially for services provided to mothers and infants with Medical Assistance, Pennsylvania’s Medicaid health insurance for low-income individuals. On average for all types of acute care hospital services, Medical Assistance reimburses hospitals less than 80 percent of the cost of care provided.

Even with these financial challenges, the Philadelphia hospitals that continue to deliver babies devote significant resources to fulfilling this part of their mission, and continue to use other services lines to subsidize OB care.

Reducing Infant Mortality

As noted in the resolution that convened this hearing, low birth weight is a key risk factor for infant mortality.

According to the Centers for Disease Control and Prevention and many other experts, early and continuous prenatal care helps identify conditions and behaviors, such as smoking, drug and alcohol abuse, inadequate weight gain during pregnancy, and repeat pregnancy in six months or less, that can result in low birth-weight babies. Babies born to mothers who received no prenatal care are three times more likely to be born at low birth weight, and five times more likely to die, than those whose mothers received prenatal care.

Data from the Philadelphia Department of Public Health indicates that the percentage of expectant mothers residing in Philadelphia who do not receive prenatal care is higher than state and national rates. According to DVHC’s 2008 collection of hospital utilization data, for 10 percent of patients in active labor prenatal charts were unavailable, either because the patient received no prenatal care or records were not received from prenatal providers.

Philadelphia must reduce its infant mortality rate. The City must increase the percentage of expectant mothers who receive prenatal care. National health reform contains provisions that will help, including the elimination of co-pays and deductibles for pre- and post-natal care. Coverage for labor and delivery services, sometimes not included in health plans, will be part of the essential benefits package required for inclusion in state health exchanges.

But these changes are in the future, and Philadelphia must begin to act now to address the issue of high mortality rates. DVHC is supporting the National Healthy Mothers, Healthy Babies Coalition’s text4baby campaign, working as part of the coalition assembled by the Maternity Care Coalition. Via free, cell phone text messages timed to their due date or baby’s date of birth, text4baby provides pregnant women and new moms with information to help them care for their health and give their babies the best possible start in life.

To help ensure that Philadelphia has enough physicians, mid-wives, other nurse practitioners to provide the full continuum of perinatal care, DVHC supports medical liability reform to improve the medical liability environment of the state and City. DVHC urges the state legislature to evaluate all options for improving the medical liability environment, including using voluntary mediation to resolve medical liability issues and setting up health courts, with special expertise in health care, for hearing medical liability cases.

To help ensure that hospitals are compensated fairly for obstetrical services and can continue to provide these services, DVHC and HAP support the modernization of the Medical Assistance payment system. The way hospitals are compensated for health care services provided to patients with Medical Assistance is based on a 20-year old formula that no longer reflects the way these services are provided. The hospital community is proposing a new payment system that would compensate providers more fairly and allow more doctors and hospitals to be able to afford providing obstetrical services. We ask your assistance in working with the state legislature to support this Medical Assistance Modernization including ensuring adequate payment rates for obstetrical and neonatal services.

DVHC is committed to being a partner in the City’s efforts to address this important issue, and to working with the hospital community here in the region and across the state to enhance access to the entire continuum of obstetrical care. We must do all we can to ensure that the next generation of Philadelphians gets off to a healthy start.

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(1) According to a report from the School of Public Health at Drexel University, Obstetric Care for Philadelphia Residents: 1997-2004, individual hospitals must decide what occupancy level is appropriate, taking into account financial pressures, risk, and caregivers' workloads. Several states and organizations have published suggested target occupancy rates; these sometimes vary according to whether the area is urban or rural area, or whether the hospital is small or large. For example, the New York State Department of Health recommends a 75-percent occupancy rate for obstetrical units in urban areas.

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