Special Announcement for OB Patients

Updates Concerning OB Services at IU Health Paoli Hospital

January 18, 2018

Realities affecting the decision about OB care in Paoli (known before wednesday's meeting):
1. The IUHealth 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 Csection 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 Csection 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. IUHealth 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 Csection 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:

Posted 1/18/2017

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 here or via the www.sichc.org website.
Soon we will 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 mean time please "share" these posts with your friends to broaden communication out to the whole community. We need all hands on deck

Posted 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!

Posted 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!

Posted January 16, 2018 at 4:01 pm

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!