Pennsylvania hospitals aim to tackle maternal health challenges with a new action plan from the Hospital and Healthsystem Association of Pennsylvania.
Developed by HAP's Task Force on Maternal and Child Health, the report outlines evidence-based strategies and policy recommendations to improve outcomes, expand access to care and eliminate disparities.
HAP President and CEO Nicole Stallings spoke with Becker's Hospital Review about the importance of cross-sector collaboration and innovative solutions to tackle barriers like workforce shortages, medical liability and the sustainability of labor and delivery services.
Question: Maternity care desserts are a big issue not just in Pennsylvania but nationwide, as more than 57% of rural hospitals currently do not offer labor and delivery services. Where are the key opportunities to address maternal care access at a time when many rural hospitals are cutting services or closing altogether?
Nicole Stallings: There are various reasons why labor and delivery departments face challenges in maintaining access to services, especially in rural communities. In some areas, the volume of deliveries has dropped below the level needed to maintain competencies for high-quality care. In other regions, hospitals struggle to recruit the specialized clinical teams required to keep labor and delivery units open 24/7. This difficulty in attracting providers to underserved areas is why our report focuses on policy recommendations to incentivize recruitment. These include addressing reimbursement rates for labor and delivery services and improving the medical liability climate, which has made Pennsylvania a challenging state to practice in.
Q: Across the country, more hospitals are pursuing CMS' rural emergency hospital designation, which involves eliminating inpatient care to focus on emergency and outpatient services. Does this trend raise concerns about limiting access to quality maternal care?
NS: These are incredibly difficult decisions being discussed at hospital board tables daily. Regarding rural emergency hospitals in Pennsylvania, we currently lack the ability to pursue that designation. Advocating for the necessary state legislative changes to make this option available is a priority for our association this session. While it may not be the solution for every rural hospital struggling to stay open, we believe it's an essential tool to have in our arsenal.
Q. How does HAP plan to tackle workforce shortages in maternal health? What innovative approaches are being considered?
NS: There are solutions that hospitals and policymakers can pursue. For policymakers, there are opportunities to incentivize recruitment in underserved areas, such as loan repayment programs and increasing residency slots — both of which are key priorities for us. Additionally, we want to ensure that nonclinical team members, like doulas, are eligible for reimbursement. Doulas improve care quality, enhance outcomes and significantly boost patient satisfaction. We aim to make Medicaid and private insurers cover doula services.
Additionally, it's crucial that the workforce reflects the communities they serve. Expanding and diversifying Pennsylvania's maternal health workforce is a priority. Hospitals can partner with workforce development organizations and leverage our two [Historically Black Colleges and Universities] to grow and diversify the pipeline of professionals, ensuring equitable representation and improved care.
We have several examples of hospitals partnering with county-level organizations to recruit individuals from underserved communities, using data at the zip code and neighborhood levels. These efforts aim to bring people from these communities into the healthcare workforce pipeline. We believe these initiatives can be scaled across Pennsylvania, provided we have the necessary resources and support to do so.
Q: How do you envision cross-sector collaboration improving maternal health? What role should hospitals play in fostering these partnerships?
NS: Recommendations in our report outline actionable steps that hospitals and policymakers can take to improve quality, expand access and strengthen and diversify the workforce. Traditionally, hospitals have focused on improvements within their four walls, but they are increasingly addressing complex factors outside of them that improve maternal health.
For example, social determinants of health — such as living in a food desert, lacking a safe place to exercise, or having limited transportation — can make it difficult to manage conditions like hypertension or attend prenatal visits. By screening for these social drivers and implementing programs to address them, we can make a significant difference.
Additionally, when patients are discharged, we have an opportunity to connect them with navigators or other support systems to manage ongoing needs, such as hypertension or substance use disorders. We can be more intentional and active partners in their continued care. Our report highlights this opportunity for hospitals to take a broader, more proactive role in addressing these challenges.
Q. How can hospitals address racial disparities in maternal health and strengthen their role as community anchors?
NS: Our report emphasizes the need to build deliberate structures and processes to examine data, identify disparities and develop plans to address them. Disparities may arise for various reasons — such as missed screenings, the need for implicit bias training, or stronger partnerships. It's critical to use data to guide our work and remain committed to implementing changes based on that information.
While hospitals have long been engaged in quality improvement efforts within their walls, this report highlights their commitment and leadership as community anchors. It shows their willingness to tackle more challenging issues and work toward meaningful and sustainable solutions.
Click here to download HAP's 26-page report on maternal health.