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Wednesday, April 05, 2000
The ability to hold conflicting thoughts simultaneously is supposed to be a mark of intelligence. So I am trying to be intelligent about Allegheny General Hospital's announcement that it will close the Midwife Center for Birth and Women's Health.
I am trying to understand how this closing can be happening at a time when the less institutional, more personal, lower-cost, noninvasive, family-oriented services of nurse-midwives are more in demand than ever; when wellness and prevention are the mantra of health care experts nationwide; when the "fetal vessel" view of pregnant women is supposed to be on its way out; when more hospitals are establishing complementary care centers offering alternatives to the drug-and-cut mentality of Western medicine; when the excellent outcomes of midwifery have been documented and published in the Journal of the American Medical Association.
Turns out there is a way to make sense of these two colliding realities, but it requires getting over the quaint and outmoded notion that the top priority of health care institutions lies in meeting basic human needs.
In this health care climate, with managed care bean-counters breathing down providers' necks, insurance companies using their enrollment numbers to negotiate cutthroat reimbursement rates, and hospital systems competing to see whose edifice complex is the biggest -- well, there's not a lot of room for something as low-cost and low-tech as a free-standing midwife center.
This is especially true at Allegheny General -- which, you no doubt recall, was driven to its knees by the spectacularly wrongheaded, profligate, possibly criminal "stewardship" of its leaders, three of whom were recently charged by the state attorney general with illegally spending $52 million in endowment funds.
One program the hospital acquired before its house of debt came tumbling down was the midwife practice, formerly affiliated with The Western Pennsylvania Hospital. AGH spent at least $500,000 to place the new facility in a building adjoining AGH and it was a dream come true for the midwives and their clients.
Women responded, too. The midwifery program went from 117 births in 1997 to 244 in 1999. It has about 1,000 clients at the moment, including women who continue to go there for gynecological care.
No one is claiming that AGH's midwife center was losing money -- or at least not enough to force its closure. It just wasn't making enough money. And given the hospital's struggle to recover from bankruptcy, AGH wants to use the midwife space for some other kind of program that will bring the maximum return in the most efficient manner possible.
In other words, it's an institutional priority to go after big reimbursements. If that means leaving the midwifery program behind, then so be it.
AGH spokesman Tom Chakurda insisted yesterday that the hospital felt awful about jettisoning the midwife center and said it would do everything possible to help the practice survive in some other form.
Indeed, with all the non-patient-related forces coming to bear on hospitals these days, spinning off the midwife center may be the best route to go. Who wants to stay where they're not wanted anyway? Newborn babies have enough baggage in their futures; no sense adding "drag on institutional priorities" to the list.
Sally Kalson's e-mail is:skalson@post-gazette.com