DOUGLAS — The hospital in Evanston recently cut its obstetrics program, joining Kemmerer on the west side of the Cowboy State to abandon the expensive and — in a state with low birth numbers – unsustainable medical service.
That OB desert will force pregnant women to seek treatment in facilities 100 or more miles away — a challenging task when a woman is in labor or, worse, facing an emergency for the newborn.
OB deserts, as they are being called these days, are cropping up across the country, especially in rural areas where hospitals and clinics in many cases can barely afford to keep basic services, as federal reimbursements for Medicaid and Medicare and private insurance payments don’t keep up the real costs.
Another factor, according to those who, like Memorial Hospital of Converse County CEO Matt Dammeyer, track such things, is the desire for health care professionals trained to handle OB to practice their specialty rather than emergency room duties or other tasks.
That is because, as Dammeyer explained recently, there simply aren’t enough births to keep a maternity ward functioning and financially viable in many rural markets.
And that’s what’s happening in Wyoming, prompting state officials and legislators to seek answers – though many don’t like some of the obvious solutions, such as subsidizing care in the smallest counties.
The MHCC administration has been similarly faced with a decision whether to continue OB services in Converse County as it looked at services that were losing money.
Obstetrics, with only 6 to 11 births in Douglas and extremely high costs, was among those at the top of the list.
The administration and board made the hard decision to not only keep the OB services but to expand them.
Growing OB
Yes, you read that correctly. Expand them in a time when other hospitals are gutting or eliminating their costly programs.
In fact, on Nov. 16, MHCC purchased Women’s Health Associates of Wyoming in Casper, the practice of the late Dr. Samuel J. Vigneri.
“We don’t seem to have quite the problem it looked like we were going to have a year ago or two years ago” when discussions of ending OB services were on the table, Dammeyer said prior to the purchase. “(But still) volumes are not great.”
Not including the new practice in Casper, MHCC has four OBGYN/pediatric providers: Dr. Mark Campbell (an OB-GYN who said he is trying to cut back to semi-retirement soon), Dr. Deeanne Engle and Dr. Regg Hagge. The latter two combine family medicine/pediatrics with obstetrics.
MHCC added the fourth more recently. Dr. Chanel Ostrem joined MHCC a few months ago and is a doctor of osteopathic medicine who is currently rotating through different departments at MHCC but can handle maternity care when needed.
Dammeyer said he calculated the cost of having a full-service OB-GYN program at the hospital as a massive money loser, but like offering milk at cost in a grocery store to get people in the door, he recognized that it not only was a critical service to provide the community but a gateway to having patients in the future.
OB was worth saving here, but to do that, it has to expand, he reasoned.
The OB department, because of what it does, has to be staffed 24/7.
Dammeyer’s analysis shows that means a full crew of specially trained nurses and a top-notch OBGYN physician must fill 44 shifts per month.
With 6 to 11 babies born at the Douglas hospital in any given month (numbers provided for October 2023 to September 2024 fit into that range per month), that leaves upwards of 30 shifts every month with no babies.
MHCC’s solution so far has been to assign those nurses and doctors to other duties in the hospital, something Dammeyer said they are upfront about when hiring OB staff.
Many potential providers and others who are highly trained don’t agree to come here with such low birthing numbers. It’s cost MHCC some good hires, but administrators aren’t dissuaded.
Instead, the board and administration made the commitment to expand OB, but as Dammeyer explained it, that means getting pregnant mothers from other counties to have their babies in Douglas.
Where will more babies come from?
It is slowly working, at least anecdotally. Dammeyer said the hospital is starting to see patients from neighboring counties, primarily Natrona County, come to MHCC rather than to the larger, Banner Health-owned Wyoming Medical Center in Casper.
Whether it’s for the more homey atmosphere of a smaller hospital, the quality of OB-GYN staff or some other reason, he hopes the increasing numbers continues as MHCC tries to recruit more OB staff.
A key to that may be in the works.
With its larger population base, the obvious direction to look for more patients and expecting mothers is Natrona County. Dammeyer smiled at that obvious observation.
MHCC on Sunday confirmed the acquisition of Women’s Health Associates, which will expand the OB options in Converse County significantly by providing OB services in Casper but having the babies born in Douglas.
“I think the experience we can give our ladies here is a much different experience (than many places, including WMC), so I think you’re going to see that” part of MHCC grow as people from Natrona County start coming to Douglas to have their babies, he said.
“But it’s another ‘back to the Evanston’ story,” Dammeyer said. “That’s a big deal because, you know, Kemmerer which is about 50 minutes to the north, they already whacked their obstetrics program.
“So now you have to go all the way over to Rock Springs, which is an hour and a half, or more likely, you’re going to go to Park City, which is an hour, hour-and-a-half (or) you’re going to go all the way to Salt Lake.”
Dammeyer said MHCC doesn’t want that situation to happen in Converse County or elsewhere in eastern Wyoming. And that means expanding.
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