Healthcare Task Force OB Services Sub Committee Recommendations

In continuing with my commitment to give you information on the issues that I am working on please note the following document.


Draft
Assemblyman Green’s Healthcare Task Force
OB Services Sub Committee
Recommendations

Muhlenberg Regional Medical Center in Plainfield provides an array of medical and clinical service in Plainfield and the surrounding community as an acute care hospital. One of their primary services is obstetrics and gynecology (OB) delivering approximately 1200 babies annually. With the impending closure of the hospital there is an urgent need to systemically address the need for service in this community and assure that no single hospital is overburden with filling the gap in these services.

This sub-committee has been charged with identifying ways and resources to assist patients and caregivers in the delivery of OB services in this region.

The sub-committee on obstetrics and gynecology (OB) consisted of representation from the following surrounding institutions:

Solaris Health System
Somerset Health Center
Robert Wood Johnson University Hospital
Saint Peter’s Healthcare System
Atlantic Health System
Plainfield Rescue Squad
Plainfield Neighborhood Health Center

The delivery of OB services in this community is centered on the Neighbor Health
Center, their Midwife Program and a collaboration agreement with Muhlenberg Regional
Hospital. It was critical to the discussion to have a clear understanding of how the health
center and the hospital carried out their respective responsibilities.

We learned that the health center accounts for approximately 800 of the 1200 births at Muhlenberg and employs midwives to deliver regular births and OB physicians to deliver high risk babies. Robert Wood Johnson provides 21 hours of weekly onsite services to the center and 24/7 back-up supervisory coverage at Muhlenberg. The Midwives Program is not a contractual agreement with Muhlenberg, but they are credentialed and have privileges. It was also noted that the program has been successful.

It was recommended by the health center that JKF accept the majority of the center’s patients and the remainder be picked-up by the remaining hospitals. At this point it was estimated that individual hospital capacity ranged from a low of 200 to a high of 400 and we confirmed that none of the participating hospitals use midwives. This led to many other questions so we proposed that a list of question be prepared and shared in order to move the process forward. (List of questions and responses attached)

After discussing the responses to the questions it was concluded that the midwives model was not conducive to multi-hospital participation and not all hospitals were interested in a
midwives program. Additionally we were able to further define each hospitals capacity as follows: JFK has capacity for 150, Overlook has capacity for 150, Saint Peter’s has capacity for 200 with a concentration on high risk), RWJ has capacity for 200-300 of the 800 births coming from the health center and Somerset has no capacity. After further discussion there was consensus on the following issues for which recommendations are being presented.

o There needs to be developed a model for distribution of patient coming from the health center.
Recommendation — Conceptually assign patients to hospital on a calendar format. Where hospitals will be assigned a day and patients seen on that day will go there. Maintaining flexibility for hospitals reaching capacity and being able to shift assignments accordingly

o Uniform process of information for patients, physicians and hospitals.
Recommendation — Develop an electronic system that would enable the sharing of information between the health center and participating hospitals to include patient record, protocols and processes.

o In order to develop a distribution model and a system for the exchange of information and uniform protocols the committee
Recommends — Creating a committee with clinical representation of all participating hospital and the health center to create a workable model for all.

It is critical to understand that while we can create the model to address the gaps in OB services to this community we first and foremost must address the issue of compensation for the services deliver. While all of the hospitals on the task force are willing partners one issue must be abundantly clear - no hospital will engage in any model that does not make economic sense or threatens the financial stability of its institution.

Therefore we future recommend the following:

Ø Charity Care must be restored at minimum to cover services provided for this community
Ø We must seek assurances for presumptive Medicaid eligibility for mothers to cover cost of birth.
Ø Assemblyman Green should draft legislation that would make these services eligible as part of the criteria for the Governor’s proposed Hospital Stabilization Fund.


List of questions submitted on behalf of NHSC to the sub-committee on OB services of the Muhlenberg Taskforce for the discussion of the potential transition of our OB program.

1. What is the hospitals capacity?
(SPUH) 200 births annually with a focus on high risk
(OH) We are expecting 200-250 deliveries from Newark based Obstetricians. Any increase in an unassigned patient population would be cared for by the OH OB/Gyn hospitalists. Their volume has exceeded our initial expectations and this would therefore require hiring of additional staff. Basically, the capacity issue would be directly related to this work group along with the Healthstart nursing and administrative staff. Our present Healthstart Clinic space is not adequate to support any further increase.

2. Is the hospital willing to continue the current midwife model?
(SPUH) Saint Peter’s University Hospital is not in a position to take on the responsibility of the midwife program. We are of the opinion that the midwife program model does not work with multiple hospitals.
(OH) AH and OH are familiar with midwivery models. We don’t believe that is a hindrance and is worthy of consideration if appropriate on site board certified OB/Gyn physician coverage is in place at the Health Center. The larger issue is that OH cannot accept the volume discussed during our phone meeting or half of the present volume.

3. If no to (2) above, what would the hospital propose?
(SPUH) Saint Peter’s proposes that the center assign patients to hospitals after patients have been given the opportunity to select, by assigning hospitals according to the day of the week (i.e.: Monday — hospital A, Tuesday — hospital B, Wednesday — hospital C etc.)
(OH) We would be interested in learning what JFK proposes as an alternative.

4. Where will services be done: prenatal, L&D, post partum?
(SPUH) Saint Peter’s proposes that the center continue to provide prenatal and post partum services. L&D would be provided by the assigned hospital.
(OH) At OH indigent or unassigned care starts in our Healthstart clinic and then follows the appropriate path. We would not suggest that OH could in any way absorb this volume.

5. Who will be the collaborative physician for the midwives?
(SPUH) Saint Peter’s is not in a position to provide these services but believes they need to be provided.
(OH) If the Health Center were to remain then we would suggest that the collaborating physicians be those board certified OB/Gyn on site working with them.

6. If the hospital continues the midwife model: will the midwifes deliver?
(SPUH) Not at Saint Peter’s
(OH) We don’t see how this would be productive and or a good use of their time as it is not our impression that any one hospital can take this on for this collaboration to be effective.

7. How does your residency program work with any model of care?
(SPUH) Actively involved.
(OH) AH residency program initiates this July so too early to comment

8. How do they handle abortion and tubal ligation and IUD requests?
(SPUH) Not performed at Saint Peter’s University Hospital.
(OH) These requests in our clinic environment, JUD’s are accomplished through our clinic, tubal ligations are performed by the hospitalists and they will do them during c/section or electively, abortions have been sent to outside agencies.

9. Do we change the model of care on this side if they are the collaborative provider?
(SPUH) This needs further clarification.
(OH) Please clarify this question.

10. Can we see their midwife and OB/GYN protocol books?
(SPUH) Saint Peter’s does not have a midwife program. However, we propose that a monitoring committee be established with representation from each hospital willing to participate in providing 05 services along with the health center to establish best practices and protocols. The goal would be that protocols would be uniform in all locations.
(OH) If a working relationship is established we would be happy to share protocols.

11. How do we get around the 15 minutes to care’ for women in trouble at the MRMC satellite ER? If the satellite ER is not there? If the patient gets in trouble here at NHC Plainfield or Elizabeth?
(SPUH) Patient should go to nearest emergency department.
(OH) Excellent question and one to be answered by senior leadership for the health care system.

12. How quickly can the switch occur and will they be able to get current prenatal records from MRMC?
(SPUH) Saint Peter’s suggest patients be given updated medical records. We also suggest that the use of Electronic Medical Records should be considered at all with the monitoring committee in charge of its development.’
(OH) NO ANSWER

13. Will they have a doc onsite here for dcc only visits?
(SPUH) Saint Peter’s is not in a position to provide this service.
(OH) NO ANSWER

14. What is the process for addressing risk management cases?
(SPUH) The issue of risk management should be addressed by the monitoring committee.
(OH) NO ANSWER


--------------------------
(SPUH) Saint Peter’s University Hospital
(OH) Overlook Hospital