Indian Hospital cuts the cord on childbirth services.
The best things in life may be free, but the miracle of childbirth comes with a high price tag.
SFR has learned that price is a major reason why, come October, the Santa Fe Indian Hospital (SFIH) will no longer provide labor and delivery (L&D) services to expectant American Indian mothers.
According to hospital CEO Jim Lyon, each delivery at SFIH costs the hospital around $10,000, no small chunk of change
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for a facility subsisting on a meager allowance from the federal government.
"It's both a budgetary decision and an effort to beef up the quality of other services that we can provide to our patients," Lyon says.
The decision to shutter the program underscores the harsh realities of operating a facility in the Indian Health Service (IHS) system, the federal program that provides health care for American Indians and Alaska natives. Unlike, say, the Veteran's Administration, IHS funding is discretionary.
"Congress funds it at their pleasure," says Roxane Spruce Bly, coordinator for the Native Health Care Council of New Mexico. "In the past I think that was seen as an advantage because funding could grow. It wasn't a finite amount each year. But the downside is that in recent years the increases have been minimal."
In fact, the IHS lags far behind other federal programs when it comes to funding for health care. According to the US Commission on Civil Rights, the government typically spends twice as much per capita on health care for federal prisoners as it does for American Indians. And the money allocated to IHS falls far short of the demand.
"The main problem that we face and will continue to face is a lack of available funding," says James Toya, director of the Albuquerque Area IHS division, a region that covers New Mexico, southern Colorado and El Paso, Texas. "Nationally, the IHS is funded at about 60 percent of what our overall need is."
Lyon says that number is even less for the Santa Fe Service Unit, one of nine units under the umbrella of the Albuquerque Area, which handles some 110,000 outpatient visits a year at SFIH and four field clinics in the Santa Clara, Cochiti, Santo Domingo and San Felipe pueblos. But despite the high volume of patients, Lyon says that childbirths represent only a small fraction of the annual workload at SFIH.
According to Lyon, the hospital had 198 total deliveries last year with 132 of those births coming from members of the nine northern pueblos that specifically fall under the hospital's jurisdiction. Conversely, there were more than 1,500 births last year at St. Vincent Regional Medical Center, one of several area facilities that Lyon expects will absorb mothers transferred from SFIH.
"We're already diverting some of those deliveries to other facilities based on when the patient is scheduled to deliver," Lyon says. "Right now we're contracting with staff to keep our program open until we get all our patients transferred to other facilities."
Toya cautions that SFIH is not getting rid of its maternity capabilities altogether, but will continue to handle patients up to and after a birth.
"It's not the whole realm of maternity care, it's just the actual delivery of the baby," Toya says. "We still want the mothers to come for prenatal care up to the delivery, and then we want to have both the mother and the baby back in the hospital for their postpartum care so that there's a real continuity of care."
Lyon expects the L&D program to be completely phased out at SFIH by the end of October. Given the expansive area that the Santa Fe Service Unit covers, he anticipates the deliveries will be spread out evenly among hospitals in Santa Fe, Española, Los Alamos and Albuquerque.
"Our total amount of deliveries is tiny in comparison to bigger hospitals," Lyon says. "Even if all 198 of our deliveries went to Presbyterian alone, that wouldn't be a dent in the number of deliveries they do in a year."
But the bottom line, literal and figurative, isn't about the volume of patients as much as their health care qualifications. The vast majority of expectant mothers who delivered at SFIH last year were on Medicaid (as many as 99 percent, Lyon says). That means SFIH can easily transfer the care of its pregnant patients to other institutions.
The cost to those hospitals is another matter. Lyon estimates that an individual delivery at SFIH costs the hospital around $10,000, only a third of which is covered by Medicaid. Lyon says the decision to disband L&D services at SFIH will save the hospital roughly $1.3 million a year, but most of those funds will simply be used to bolster other cash-strapped hospital programs.
"We're not exactly saving all of that cost," Lyon says. "It's just a matter of shifting out resources so that we can better serve more patients."
Shifting those resources at SFIH also results in the transfer of financial and workload burdens onto other institutions, although Arturo Delgado, spokesman for St. Vincent Regional Medical Center, says the repercussions of the SFIH decision have thus far been minimal.
"There will probably eventually be an impact," Delgado says, "but it probably won't be as severe for us, considering we handle a much higher volume of patients."
L&D is the second program (the first was allergy treatment) to be discontinued at SFIH since Lyon took over as CEO in January 2004. Up to six positions (four of which were already vacant) will eventually be eliminated along with the L&D program. Lyon says that will free up space to strengthen other areas, such as the hospital's surgical unit. In the end, Lyon says, the L&D decision is a matter of trying to do the most with the available resources.
"We are always working with our tribes to look at how we can serve the largest number of patients and the biggest needs," Lyon says. "We constantly try to focus on doing those things that we do the best and that can serve the most patients."
