Special Announcement for OB Patients


Updates Concerning OB Services at IU Health Paoli Hospital

January 26, 2018

OB services are back at IU Health Paoli Hospital!!

"Best Kept Secret, No Longer a Secret" Part 1

On January 26, IU Health announced the reversal of a previous decision to close OB services at IU Health Paoli Hospital. That announcement follows a week of meetings and learning together what the lack of local OB care could mean. From the beginning, IU Health's senior leadership struggled with the decision as they weighed the importance of rural OB services against the financial burden of keeping it going. They were very clear in their desire to "get this right".

One factor for the reversal of their decision, is likely the success of Southern Indiana Community Health Care (SICHC) recruiting a physician to help ease the C-section call and obstetrics for the population we serve.

An even more compelling factor that weighed heavily into the decision was the collaborative priority of Governor Holcomb, State Health Commissioner Dr. Kristina Box, and IU Health to focus on lowering the state's infant death rate. Indiana Infant mortality is higher than all other northern states and that’s a puzzle many are looking to solve. Prioritizing safe, easy to access prenatal care and delivery sites for Indiana’s babies is a small critical piece of that puzzle.

As a FQHC Look-alike community health center, SICHC offers that comprehensive pregnancy, birth, infant and family care that can make all the difference.

If nothing else, these last 2 weeks have made us acutely aware of the value of our community’s health resources. We are exceedingly grateful that IU Health system decided to lead the way by choosing to advocate for equitable health care over cost considerations.

Now it’s up to us to find ways to work with them for improved outcomes across the spectrum. And let’s work together to impact public policy so that other small communities without the strength of IU Health have a chance to be heard as well.

The next step for all of us is to speak up loudly for national funding to cover the cost of maternity care and other health services in disadvantaged communities. Healthy babies come from healthy pregnancies. It’s that simple.

Contact your Senators and House of Reps today to add your voice for equitable care. 

Want to know more?

A lot of information has been flying around over the past few weeks concerning the needs and challenges to OB health in Orange and Crawford counties. While ensuring the health of mothers and babies was our primary concern, we found that there are a lot of other issues tied up with this goal: Indiana's high infant mortality rates,  transportation and health equity issues, and the important relationship between a robust health care system and a community's fiscal health. We urge you to take a look and follow through the links to discover a wealth of information about health care and community vitality.

 This brief offers a rundown of the facts you need to know.  

This extract contains many of the letters of support we received. We are honored by the outpouring of support from patients, medical and social services colleagues, and members o the community.

This infographic summarizes some facts about infant mortality in our region.

We would love to share with you the outpouring of support we received via letters sent in by our patients and concerned citizens. We are compiling those now (without names or identifying details) because we think they give a lot of insight into the wide spectrum of concern about health equity in our region. Please check back in a few days!


We want to extend our special thanks to the dedicated physicians who have staffed the OB department for over two years while we were without a permanent C-section doctor in Orange County. Doctors Stauffer, Bruneau, and Sneed, we could not have done it without you!


"The Best Kept Secret, No Longer a Secret!" Part II

Now it’s time to thank the OB crew who work hard to make rural OB care what it should be!

We’ve heard that "best kept secret" comment from many a happy mother when describing their experience delivering at Paoli's childbirth facility. They also say, "If I had known it was like this, I would have had all of my babies here".

They go on to describe: 
- The attentive care from the nurses with one-on-one focused staffing; like they’re part of our family.
- The facility's laboring hot tub, birthing ball and family friendly environment
- Flexibility of the OB staff that support and encourage birth plans unique to each couple
- The consistent care offered by the midwife or doctor who they get to know during their prenatal care
- And the same midwife or doctor who attends their delivery, rather than having an “on call doctor” do the delivery

- The low C-section rate in part due to patient, supportive staff who support natural labor and your body's own timing.
- Exceptionally qualified anesthetists who perform high quality epidurals for pain control
- Highly trained C-section doctors who stay in Orange County round-the-clock because they believe in the value of 
critical access to vulnerable populations.

Shout out to Dr. Stauffer, our best advocate ever!

- Encouraging nurses and lactation consultants who help get breast feeding off to a good start 
-The value of having the delivering doctor also manage the baby's care both in the hospital and in the office for years to come.

There is comfort in having a doctor who knows the family.

The factors above all help contribute to quality numbers at IU Health Paoli Hospital that are recognized by the whole IU Health Hospital System

1. Avoiding elective induction of labor before 39 weeks which is shown to positively impact infant outcomes. 
Recognized by the March of Dimes and tied for best overall within IU Health

2. Primary C section rate
Second best overall with a 13 % average over the last 3 years. (IU's goal is to be lower than 29%)

3. Breast feeding rate – Third highest within IU Health

4. Absence of hospital associated infant infections and mother’s urinary tract infections related to catheters- 
Best overall within IU Health

What makes these numbers even more compelling are mother's health risk factors that can lead to complications.

--30% are smokers (National average is 17%)
--15% are teenagers (National average is 8%)
--26% start their prenatal care after the first trimester (National average is 16%)

Early care can identify problems to help avoid complications.
-- Amish women with large families are at risk of heavy bleeding at delivery. 91% of them start their prenatal care after first trimester, with 70 % in the last 2 months

SO.....many thanks to the IU Health Paoli OB team who provides attentive care in a competent manner that is reflected in quality numbers, despite risk factors. And thank you to IU Health System for taking the progressive lead for health equities in Indiana.

The final outcome says it all.......healthy mothers and babies. And that’s no secret!


January 25, 2018

Update:

Today SICHC had a meeting with management and physician representatives from IU Health Bedford and Bloomington.

The obstetric's situation has opened up the opportunity to have a conversation about many other areas of health care services including inpatient admissions, emergency room care, outpatient surgery, diagnostic services and visiting specialist clinics. We were encouraged by their willingness to drive down and to be receptive to hear our experience. We had the chance to describe our organization, represent some of the concerns of the community, and explore opportunities to enhance care locally.

With open doorways of communication between SICHC and IU Health, we believe there will be more opportunities to partner for effective care. Though we have always had strong relationships locally, we now recognize the larger IU Health system as an ally. IU administrators and Southern Indiana Physicians have identified potential resources, projects and workforce support, and are actively involved in finding solutions to difficulties within the local and larger health system. They are eager to grasp the challenges this community faces, and ready to be part of the team that seeks healthful solutions.

SICHC is guided by community needs, interests and voices. We want to thank you for your support, engagement, and trust in us. As we walk this path together, we encourage participation in community driven efforts to address the health concerns of the whole community so our strong relationships can continue to be rooted in shared values, shared decision making, and intentionally listening and learning.

If you haven't already done so, go to Orange County Health Coalition's Facebook page and click "follow".


Many thanks to the many people who have sent letters of support. It is clear that you are concerned about health care access.

Despite the government shut down in Washington earlier this week, Indiana's Senators have been advocating for health care concerns. You can view US Senator Joe Donnelly's speech here.

US Senator Todd Young's staff met locally last Thursday making copious notes regarding the need for urgent funding:

Todd Young's staff heard SICHC board and community members ask for action on these key issues:

  1. To prioritize funding to cover costs for hospitals who see a disproportionate share of low income women for OB care (Medicaid reimburses 1/4 of what commercial insurance does).
  2. To fund the CHIP program that covers health care for millions of children.
  3. To fund the National Health Service Corp that helps health providers choose to serve in undeserved areas.
  4. To fund Community Health Centers adequately so that they can cover costs (This doesn't help SICHC since we are an FQHC look-alike, not a full fledged FQHC. It's complicated. But we still support other Centers with our voice.)
  5. Join the Governor's priority of decreasing Indiana's unacceptably high infant death rate by sending health care dollars to Indiana. http://www.nwitimes.com/…/article_b2a0bd92-5235-11e7-9892-b…

Add your voice to advocate for funding to maintain critical programs in our rural community. Write to your Senators and House Reps or go to their web pages: 

https://hollingsworth.house.gov/
https://www.young.senate.gov/contact/email-todd
https://www.donnelly.senate.gov/contact/email-joe/

A reminder that no matter the outcome of hospital delivery services and government stalemates, we are a community health center ready to provide the spectrum of primary health care to your family. We will continue to provide prenatal care in our practice. It's our commitment to you to be there for your family.


January 18, 2018

Realities affecting the decision about OB care in Paoli (known before Wednesday's meeting):

  1. The IU Health System has done a tremendous job in financially supporting the recruitment of new doctors and covering ob services over the years including a significant outlay of money to keep highly qualified C-section trained doctors in town at all times after we lost the SICHC doctors who did our C-sections a year ago. This was to be a stop-gap measure until we could find an OB/GYN or family practice doctor with C-section training to join the OB team. IU could not sustain this cost indefinitely.
  2. This community has lost 4 physicians in the last 2 years. That means patients have found other doctors for their pregnancy care and general medical care...sometimes out of town. That also means the hospital has received less business, thus making it more challenging financially. This hospital is staffed 24 hours a day with OB nurses ready for someone to walk in with an urgent pregnancy need, an on-call surgical team and anesthesia staff, a fully equipped emergency department and ambulance crews, a state of the art radiology department and lab, ER doctors that are highly trained, along with numerous support staff that keep the place going round the clock (kitchen staff, cleaning services, respiratory therapists, radiology technicians, IT staff and billing). All of that overhead is very challenging to cover if the payments decrease due to low patient volumes. Utilizing the hospital is one way of investing in its future so that it's healthy when you aren't.
  3. IU Health Paoli has a high proportion of Medicaid deliveries. Medicaid pays the hospital 1/4 of what a private insurance pays. That low reimbursement makes it very difficult to cover the overhead.

The 3 realities above: (insurance challenges, decreasing patient volumes and markedly increased cost this year for paying a C-section doctor to come to town 24/7) has created a situation that didn't appear to be sustainable. This led to the difficult decision that no one wanted to make, yet there were financial realities to contend with.

One more reality:
SICHC has been struggling financially but holding to the original mission started 44 years ago of providing access to quality health care for Orange and Crawford county. We provide 38,000 visits per year on a very small budget which includes self-funding care for low-income individuals. The medical providers include 5 nurse practitioners, 2 physicians, and 1 midwife spread out over 4 offices. A very loyal staff has the stressful job of meeting increasing demands by insurance companies while also caring for the high volume of patients.

Hope: Some relief is in sight since SICHC was recognized as meeting the rigorous quality standards to become a nationally recognized FQHC "Lookalike" Community Health Center, starting 11/1/2017. FQHC's must have sliding fee scales, comprehensive services, be governed by a board and meet quality standards for care. In recognition for this, there is an increased reimbursement by Medicaid and Medicare for office visits. {Definitions: Full FQHC's get additional federal dollars to support their comprehensive services (but those are at risk with the political gridlock in Washington holding up funding for health centers to operate). "Look-alike" FQHC's don't receive additional funding].

The other opportunity that came into play is that this community just had it's "Health Provider Shortage Area" score recalculated and it's significantly higher than before so that may help us recruit doctors through the National Health Service Corp who can receive government funds to help pay off their large educational debt if they come to an area that needs doctors.. The bad news is the funding for that program is also held up in the same political stalemate in Washington.

Take home message:

  • Help recruit new doctors. Encourage students to consider medicine as career
  • Vote for candidates who care about these issues!
  • Call your National senators and House Representative to demand critical funding for :
    • Community Health Centers
    • National Health Service Corp to ease doctor's educational debt for years practicing in underserved areas
    • Covering the costs for doctors and hospitals who do a disproportion share of Medicaid deliveries. (Did I say that the money previously earmarked for hospitals doing this is being phased out?)

Here you go:
Senator Todd Young: https://www.young.senate.gov/contact/email-todd
Senator Joe Donnelly: https://www.donnelly.senate.gov/contact/email-joe
Representative Trey Hollingsworth: https://hollingsworth.house.gov/contact/


January 18, 2017

Follow up on OB services at IU Health Paoli:

It's been a productive day in Indianapolis with many opportunities to talk to person's who influence health care. Dr. Dwight Stauffer, (OB physician who has provided over 200+ days of Csection support this year), Katarina Koch (SICHC's fund development expert) and Dr. Yoder traveled to Indy to meet with lawmakers and IU Health executives.

We were received very well and had productive conversations, in the morning with legislators and in the afternoon with upper-level IU executives.

We started with State Representative Steve Davisson who is a pharmacist supporting legislation to help with funding for addiction treatment services. He introduced us to Dr. Kristina Box (OB/GYN who is the newly appointed Health Commissioner leading the Indiana Department of Health's efforts to reduce Infant death rates. She has the ability to impact legislative decisions on how health care dollars are spent. She's also looking into other funding streams that could be useful for our community.

We spent over an hour with IU Health executives on numerous topics related to the decision to end OB services in Paoli. We were extremely impressed with their attentiveness as they listened with concern and were not at all defensive. They were receptive to new information and asked clarifying questions, never interrupting us as we spoke. The outcome of the conversation is unknown, but we left feeling respected and heard. And we recognize the financial realities of what they have faced this year. (Will be coming in a separate post but important to read to get the scope of the challenge they have dealt with and been generous through)

Local CEO Larry Bailey was supportive of our visit, recognizing that we could represent a community perspective. We took 100 letters of support along with us.....produced in just 24 hours by those of you who spoke with passion regarding the attentive care you have received from the IUH Paoli OB team or your concern regarding risks if local services were lost. Thank you all. It was a tremendous response. Additional letters still welcome!

Soon we'll be writing up a full description of the issue including some of the realities that this community has faced that led to IU Health's decision announced at the beginning of this week. In the meantime please "share" these posts with your friends to broaden communication out to the whole community. We need all hands on deck


January 17, 2018

Dr. Yoder and a team from Paoli are meeting with hospital administrators today to seek solutions to save our OB department at IU Health Paoli Hospital. They carry with them all of your good wishes and letters of support. While we wait to hear the outcome, Dr. Yoder asked that we share this update and call to action:

The Chief Operating Officer and Director of Mission and Values is meeting on 1/17 with a delegation from Paoli. They have been very gracious in hosting us for this, even clearing their previously booked schedule in order to meet with us. They are offering genuine conversation and a chance to speak our concerns. Many thanks for the many letters pouring in.

It's important to remember that IU Health has been very supportive over the years. They have:

  • Paid a recruiter to help find doctors for the area
  •  Helped support start-up salary for new doctors just building their patient base.
  • Paid handsomely for Csection trained doctors to stay in the community 24/7 for the last year, in order to keep OB services going while we were waiting for Dr. Hunt to arrive.. This was a huge investment in terms of money and commitment to the OB program.

Please know that the local hospital administration has been an advocate for ongoing services. Please don't trash this hospital. Use them for your medical care. Buy locally in order sustain what we do have.

The board of SICHC met on Tuesday. They recognize that this community has significant power to work together to keep our local health care system healthy. What does that teamwork look like? We need you to help us figure that out.
Who wants to be leading on this issue locally? Consider watching a webinar on 1/23 about " Building a Movement for Health Equity." You will find many resources at https://healthequityguide.org/ Lets keep this momentum and create community answers. SICHC is very busy staying afloat right now. We need others to help lead on this!
http://www.countyhealthrankings.org/…/building-a-movement-f…


January 16, 2018

Thank you all SO much or the outpouring of support regarding the planned closing of the OB unit at IU Health Paoli Hospital. We want you to know that all of your messages are going with us as we meet tomorrow with the Chief Operating Officer and Director of Mission and Values. The hospital administrators have graciously agreed to hear our case and we will keep you updated as the situation develops.

Please know that IU Health has been working with us to help recruit more physicians to the area and we hope that our newly acquired status as a Federally Qualified Health Center will aid in the recruitment process as well. We need to keep that OB unit hopping in order to prove that it can be a sustainable service to the community.
Stay tuned and by all means keep those letters of support coming!


January 16, 2018

Sadly, we have learned that Indiana University Health plans to stop offering baby delivery services at IU Health Paoli Hospital starting April 1. Becky Johnson (midwife), Dr. Yoder, and other concerned individuals are working with IU Health officials and Indiana politicians to search for solutions to help preserve OB care in our rural community.

What’s important to know:

SICHC is an independent, not-for-profit medical group that is not owned by the IU Health system.

We believe that access to prenatal care locally is critical to good outcomes for mom’s and babies. WE WILL CONTINUE TO PROVIDE REGULAR PRENATAL CARE at our offices.

Please feel free to use the comment form to the right to express your questions and concerns on this development. We hope you will support us as we strive to develop and maintain better birthing options for women in Southern Indiana.

Let us hear from you!