I have several fair, valid points to be considered in HCMC’s OB crisis

To the editor:

By now, many of your readers are aware of the crisis in Henry County regarding obstetric services.

With advanced obstetric and neonatology services, Henry County Medical Center serves Henry and four other counties as their primary hospital.

Benton, Carroll, and Stewart have no obstetric (OB) capabilities. Weakley has one obstetrician supported periodically by out-of-county physicians. Other counties are served to a lesser degree.

Obstetrics is the most central and critical of all services that any hospital provides. A patient with almost any other medical or surgical condition can be transported for care elsewhere without undue harm.

This is not true of obstetrics and is of such importance that it cannot be done legally unless the patient or her advocate requests it and the treating physician considers it safest to do so.

Premature deliveries, placental abruptions, septic newborns and newborns of diabetic mothers (all routine situations) in our area likely will suffer expensive, lifelong consequences and perhaps death if unable to access a facility with capable obstetrics prior to delivery.

The least equipped obstetric unit is better equipped to deliver a baby than any ER in Tennessee.

HCMC serves in an obstetric desert in an area that already experiences one of the highest infant and maternal mortality rates in the nation. Imagine the escalation of these issues if this service is no longer available to these five counties.

Imagine also the escalation in cost when these babies, born in our ER are transported, some by helicopter, to a facility that does what we already do.

A contingent from Henry County, including an obstetrician, a pediatrician (myself), the HCMC CEO and a minister met with our legislators, the TennCare director and his CFO on June 14. Our primary effort was to point out the unfair payment schemes related to TennCare reimbursement.

Currently, BlueCare, the monopolizing Managed Care Organization (MCO) in Northwest Tennessee, reimburses about one-fifth the cost of caring for the least-complicated deliveries — less than $10 an hour. This is all that is paid to cover 24-hour nursing, medication, nutrition, lab and more.

Even more frustrating, individual TennCare MCOs reimburse more for the same service at different Tennessee hospitals. Not only that, one TennCare insurance type varies in payment by as much as three-fold for these same services compared to the lowest-paying TennCare brand within our own hospital.

Imagine our anger when the TennCare director (who should be our advocate) explained away that unfair system as "proprietary," then claimed that if our rates are increased, other hospitals also must be increased.

Shouldn't this tax-supported and federally matched program pay exactly the same at every hospital in Tennessee?

HCMC's rates are negotiated and, while we might be criticized for our current contracts, the process of "negotiating" with these multi-billion dollar companies is not a two-sided process. Wouldn't you think that the state's TennCare official's very existence should be to support this effort?

Another inarguable point that seems to be ignored is this: babies will be born whether we provide their OB care or it is provided elsewhere. Therefore, TennCare (MCOs) will spend more on those babies than if they assisted HCMC OB unit by simply paying a fair reimbursement. Why?

If the HCMC OB closes, babies [with TennCare] in our five-county area will be born in Jackson, Union City, Clarksville, Nashville and the HCMC ER. All of these facilities will be paid far more than our current OB unit receives for the exact same service.

In a logical world, TennCare MCOs, such as BlueCare, would be thrilled to accept what we've requested rather than pay significantly more elsewhere. It is incomprehensible that the TennCare Oversight Division would not emphatically make this point to those same parties.

I have lived in this community for more than 25 years and have never seen the groundswell of activism that has developed around this issue. These concerned people are educated on this topic, asking hard questions, and are contacting our government officials.

Our governor has made meaningful efforts to recognize the issues of rural Tennesseans. It would be a tragedy for him not to address this issue just as diligently. HCMC has asked our governor and state legislators to exercise any influence they have with BlueCare.

Our hospital administrator made a request to BlueCare that, if met, will be a large step toward the improvement of our obstetric services finances. This request only seeks to break even and reveals the importance that we place on this matter — health above all other considerations.

My points are fair and valid; they should be given consideration at the highest levels of government and public engagement.

SCOTT WHITBY of Paris is a medical doctor, specializing in pediatrics, a Fellow of the American College of Physicians, and a member and former chairman of the HCMC Board of Trustees. Susan Jones of Paris is launching a website this afternoon offering grassroots ways to help keep the HCMC OB open. The website is nwtncares.org.