The Wyoming Department of Health has identified the southwest portion of Fremont County as a potentially emerging maternal healthcare desert.
“In Lander we’ve noticed a bit of a concerning decline (in births) in the last year,” WDH senior policy analyst Franz Fuchs told the Wyoming Legislature’s Joint Labor, Health and Social Services Committee during a meeting this week. “Their previous baseline was around 35 births per month, and that’s gone down significantly to 20 just recently. … So we put Lander on the warning map. (There’s) a little bit of a cause for concern there.”
The east side of Fremont County is already a maternity desert, Fuchs noted, “because Riverton stopped doing births back in 2016.”
“But even Lander is now seeing sort of a decline (in) births … as well as a decrease in providers,” he said. “That’s worth keeping an eye on.”
‘A conundrum’
Wyoming Rep. Sarah Penn, R-Lander, who works as a nurse practitioner in Fremont County, offered some insight into the local issues that have contributed to the decrease in births and maternal healthcare providers in Lander, calling the situation “multi-factorial.”
For example, she said, one local provider recently experienced a “major health event and didn’t really come back from that.”
Meanwhile, other providers are experiencing “burnout” because “they’ve been doing this for a long time and feeling like other providers weren’t pulling their weight,” Penn said, while still others have “concerns (about) management there at the hospital.”
“There are lots of things going on, (and) it all kind of happened at once, unfortunately,” Penn said. “And then all of a sudden you have this drop in providers.”
The hospital is working on hiring more providers, she noted, but “the reimbursement is not great, because the medical malpractice (insurance) to deliver babies is astronomical.”
“There’s a lot of factors that are playing a part here in why we’re facing what we’re facing,” Penn said. “Low numbers and high operating costs and malpractice and burnout, (it’s) all these things. It’s a conundrum.”
Fuchs agreed that multiple factors have likely contributed to the recent decrease in maternal healthcare providers in Fremont County, but he also framed the issue as “primarily a hospital liability problem.”
“Hospital and management challenges (have) really caused some of these issues,” he said, pointing to increasing costs and post-COVID nursing shortages that have affected hospital operations in recent years. “It’s not just about the fundamentals – there have been potentially poor decisions made by management that have caused some of these situations that lead to the labor and delivery closures.”
The question, Fuchs said, is what role the state should play – if any – in addressing those hospital issues.
For example, Fuchs said, the state could “increase Medicaid payment rates” in Wyoming to bring them “closer to parity with at least Medicare.”
“Reducing that gap slightly could make it less of a loss later and help some of these hospitals keep their financial picture in better shape,” he said, noting that about 30 percent of births in Wyoming are covered by Medicaid.
Other options for state involvement Fuchs mentioned include:
-helping distressed hospitals with management and financial operations
-creating a malpractice “risk pool” that could “reduce the risk of malpractice (to) providers in exchange for participating in quality improvement activities”
For their next meeting, the committee asked legislative staffers to provide more information about Medicaid reimbursement rates for labor and delivery services in other states, and about strategies other states have used to address malpractice insurance costs.
The committee also requested more information about the potential to develop midwifery programs at community colleges in maternal health deserts in Wyoming, and about the relationship between midwives and obstetrician-gynecologists in the state.
Earlier, Penn had talked about the “statutory requirement” that says midwives in Wyoming have to have “oversight by a physician.”
Those requirements can cause complications, Penn said.
“I know that to be a situation within our community within the clinic where I work,” she said. “And I experienced that situation when I was pregnant with my baby. I had a nurse midwife who was able and ready and willing to deliver if I were to have this baby on the weekend. And her overseeing physician was headed to Europe about the time my baby was due.”
At the time, Penn said, there were “four other delivering providers in our community and at this hospital, but none of them were willing to be the overseeing physician.”
She said she would be interested in finding ways to “increase (the) ability” for midwives to have “more autonomy” in the state.
The Labor Committee’s next meeting is scheduled to take place June 20-21 in Pinedale.