Birthing center hearing: Opposition makes its case

FRANKFORT — Focusing heavily on estimated volume in the business plan, attorneys representing three hospitals concluded arguments Thursday explaining opposition to state authorization of the Visitation Birth & Family Wellness Center.

Opponents honed in on a perceived lack of need for the facility while reiterating potential safety hazards during the second day of arguments in downtown Frankfort.

Chicago-based health care consultant Richard Baehr said the center’s methodology is flawed because it expects to lure nearly all home births from a handful of counties, projecting anywhere from 75 to 90 percent of the market share in about 24 counties of its proposed service area.

Baehr revealed his firm has been paid $15,000 to date to thoroughly analyze and critique the center’s business model and utilization projections as outlined in its certificate of need application.

The center, which hopes to build at 2813 Ring Road in Elizabethtown, projected half or more of its patients will come from Louisville and Jefferson County while only 7 percent of its patients will be generated from Hardin County. Hardin Memorial Health filed formal opposition to the certificate of need request and has been joined in opposition by Twin Lakes Regional Medical Center in Leitchfield and Flaget Memorial Hospital in Bardstown.

Baehr described the presumptions as unrealistic because obstetrics is a compact and local industry. He testified that between 50 and 60 percent of obstetrics patients at the three hospitals opposing the center are generated from each hospital’s home county. Furthermore, Baehr said, around 99 percent of Jefferson County patients give birth in their home county, which makes unlikely any notion they will drive roughly 50 miles south to Elizabethtown.

Likewise, the projection by the center that home births will triple in Jefferson County from 2009 to 2014 has no data to support it, he said.

Baehr maintained the spike in home births from 2007 to 2009 likely was fueled by the economic downturn, but J. Guthrie True, the proposed facility’s attorney, asked what statistics he had to support this argument.

“I don’t have any statistical evidence to prove it,” Baehr said.

Baehr provided modified assessments, drastically lowering the anticipated market share in the counties targeted by the center. Based on his projections, the center is likely to attract no more than 26 to 46 births in its first few years, far lower than the 150 to 200 or so projected, he said. Those figures will not generate enough revenue to cover expenses and will make the center financially unfeasible, Baehr said.

True argued the center has a pool of 9,500 eligible, low-risk births in the service area, but Baehr said the number shrinks dramatically once Medicaid patients are removed. The center does not plan to accept Medicaid payments.

Baehr said the facility is a location for “women of means” who have commercial insurance or can afford to pay for the services out of pocket.

True said Medicaid payments for birth centers are low, presenting an all-inclusive payment of no more than $365 per birth, which cannot cover costs.

True asked Baehr if he researched the volume, patient origins or service areas of birth centers during his analysis. Baehr said he did not because they were not featured in the application, which could have strengthened the argument for the center if the numbers were positive.

Baehr said the center’s model might be more reasonable had it not relied entirely on the home birth market.

Dr. David Hamilton, an OB/GYN at Elizabethtown Physicians for Women, said he supports midwives but has a strong moral opposition against any birth center that claims to offer medical services for mothers but cannot perform emergent care.

“I find it very unsettling,” he said.

All 10 of the obstetricians who have privileges at HMH refused to enter collaboration with the center because of those concerns. Attorneys asked several witnesses if HMH “poisoned the well” by stoking physician opposition against the center. Hamilton said he volunteered to testify and share his concerns.

Hamilton said any birth is a potential emergency and “inherently unpredictable,” Being more than a stretcher ride from emergency care, he said, poses problems, specifically when complications arise or an emergency Caesarean section is required. For instance, Hamilton said a suppressed heart rate in an infant could drop blood pH to dangerous levels in a matter of 12 to 14 minutes and put the neurological outcome of the child at risk.

Hamilton said he does not question the competency of midwives at birth centers or their motivation to help others, but he opposes the location and its distance from an ER.

“It’s an inherently flawed system, I’m sorry,” he said.

Marty Finley can be reached at (270) 505-1762 or mfinley@thenewsenterprise.com.