Congress's auditing arm says states could keep more rural delivery rooms open by raising Medicaid reimbursements

Increasing state Medicaid reimbursement rates for rural hospitals could help them keep their obstetric units open, the Government Accountability Office said in a report Wednesday.

More than half of rural counties "did not have such services in 2018, according to the most recent data available," the report notes. "Studies showed that closures were focused in rural counties that were sparsely populated, had a majority of Black or African American residents, and were considered low income."

The GAO, the auditing arm of Congress, interviewed stakeholders, who said Medicaid reimbursement and physician recruitment and retention are the most important factors in keeping delivery rooms open. "Stakeholders said Medicaid reimbursement rates set by states do not cover the full cost of providing obstetric services. This may mean particular financial losses for hospitals providing these services in rural areas, where a higher proportion of births are covered by Medicaid. Medicaid covered 50 percent of rural births in 2018, compared to 43 percent of births for the United States as a whole."

"Recruiting and retaining providers is particularly challenging for rural areas, as they must compete with urban areas for a limited pool of providers to staff obstetric units that require a full range of maternal health providers, such as physicians and nurses, as well as anesthesiologists." The report said obstetric services would also benefit from more remote consultations, such as videoconferencing, to {ensure that rural patients who live longer distances from higher levels of obstetric care have access to such care through their own clinicians in their communities."

The report also suggests "establishing regional partnerships—such as a hub-and-spoke model where a larger hospital partners with smaller rural hospitals for care coordination and to provide training and other resources. . . . For example, a specialist from the hub hospital could help manage a rural patient's high-risk condition as needed and support the rural clinician for planning delivery at the local hospital."