Be Well. Get Well. Stay Well.

Changes to OB/GYN Program at Angel Medical Center

ABOUT THE CHANGE


In April, Angel Medical Center (AMC) announced plans to modify our OB/GYN program with the goal of sustaining women’s health services and hospital services at our not-for-profit Critical Access Hospital in Macon County. AMC will discontinue labor and delivery services but will continue to provide prenatal and postnatal services, gynecological services, surgical procedures as well as preventive, routine and complex care for women of all ages.

  • AMC is in the process of exploring several options for transitioning these services to Mission Hospital in Asheville, where a quarter of all Macon, Jackson and Swain county women already choose to deliver their babies, or alternatively to DLP Harris Hospital in Sylva to ensure that patients have access to needed care.
  •  A final plan will be in place before June, and July 14, 2017 will be the last date for the labor and delivery component of Women’s Services at Angel Medical Center.
  • The decision to discontinue labor and delivery services was made after an extensive analysis of AMC’s Women’s and Children’s services. Based on an assessment of the medical center’s clinical services, OB-GYN and pediatric practice stability and fiscal sustainability, AMC and Mission Health determined that discontinuing labor and delivery services at AMC is the responsible decision for the sustainable future of Macon County’s community health, wellness and inpatient services.

AMC and Mission Health remain fully committed to providing outstanding local care for Macon County patients, families and community partners and plan for continued growth and investments in its dedicated caregivers and communities.


ANGEL MEDICAL CENTER
PRESS CONFERENCE



 
“Our final decision will ensure that we have excellent labor and delivery services for our moms and babies combined with full-time, local pre- and post-natal care, gynecology services and other women’s health services in Franklin."

--Karen Gorby, RN, President and Chief Nursing Officer

FREQUENTLY ASKED QUESTIONS


General Introduction:

As Angel Medical Center and Mission Health leaders we understand and greatly appreciate the understandable community interest in women's and children's health, an interest that we share and that has been a primary focus of our professional lives. We are always interested in how AMC can continue to provide vital services to the residents of Macon County and we continuously seek to provide open, honest and timely information. To that end, we would like to share answers to questions that we believe may be raised by our decision and announcement to modify our OB/GYN services at AMC.

Can you clarify the hospital's stance on C-Sections? Will AMC perform emergency C-sections?

  • Preparing for a safe and effective emergency C-section takes time and coordination. Mission hospital has specialized Neonatal Intensive Care Unit (NICU) staff present 24/7/365 to handle neonatal emergencies and so in the time that it would take to call in our surgical team, gather supplies and prepare the room any patient could have already been transported to Mission where they have that staff in house at all times. It is critical to address the care of both the mother and newborn, and only Mission Hospital has that staff and those skills.

What about women who must deliver on the way to the hospital?

  • The labor process for most women typically allows for time to travel, even very extended travel times, to a hospital. In very rare cases, women do give birth on the way to the hospital. In such a circumstance, Angel Medical Center has a full-service emergency department staffed with Board Certified Emergency physicians who are ready to stabilize, treat and triage emergency cases. If any expectant mother is deemed too far advanced in labor to travel to another regional hospital’s women’s unit or to Mission Hospital by EMS, then the baby would be delivered at AMC within the ED and both Mom and baby would be stabilized prior to transport to Mission Hospital. Equally important, if any baby required specialized equipment for the transport, as was sometimes the case even with deliveries at Angel, Mission Hospital would send a neonatology team with all of the necessary equipment by helicopter to transport the very sick baby quickly to Mission’s Level III Neonatal Intensive Care Unit (the only Level III NICU in western North Carolina).

Angel/Mission made the decision to discontinue deliveries based on finances.

  • That is partly true. While we don’t focus on whether a profit is generated on any particular service and operate many that do not, our overarching goal is to provide the best and most care for all of western North Carolina while remaining viable. We must ensure that essential care remains available over the long run, so we do have to consider the sustainability of any service offering. Based on an extensive and careful assessment of the medical center’s clinical services, practice stability and financials, Mission Health determined that discontinuing labor and delivery services at AMC is the responsible decision for the sustainable future of Macon County’s community health, wellness and inpatient services. Like much of the rest of the region, the counties served by Angel Medical Center are aging and mostly not growing. At the same time, the way that care is delivered is changing rapidly. We are increasingly able to care for patients without an overnight hospital stay. In line with our community’s needs and future trends in health care, Mission Health’s future regional investments will focus on primary care, state-of-the-art testing services, virtual care, ambulatory care, emergency care and transport while retaining essential inpatient care.
  • As a team of leaders and care providers we explored several options, including continuing birthing services at AMC. Significant facility upgrades were required to provide state-of-the-art technology, facilities and staffing for the safest birthing experience for moms and babies. We also considered the possibility of a free-standing birthing center, but that proved not to be viable.
  • Additionally, what may not be immediately apparent to someone outside the medical profession, is the significant financial investment required to provide these particular services to support an entire TEAM of those who provide this care. This not only includes the physicians (in this case, primarily the OB-GYN and Pediatricians) but also the supporting staff of advanced practitioners, nurses, techs, and numerous other associated personnel. The ability to support an entire team is far from just a financial one. Most importantly, it requires attracting and retaining those individuals who choose this work as their core interest. For these reason we believe that discontinuing deliveries at AMC is simply the right decision for our patients. We will continue to provide holistic pre- and post-natal care, gynecologic care and many other Women’s services in our office in Franklin and at AMC.

What equipment does AMC have on hand to assist birthing mothers who may find themselves at AMC for any reason?

  • Importantly, all of the equipment from the existing Women’s Unit will be relocated to the ED so that we are fully prepared for emergency deliveries after July 14, 2017. The staff there is trained in OB care and neonatal resuscitation and care and the OB and Pediatric doctors are on call at all times to come in for these emergencies. Angel Medical Center is a full-service, Top 20 Critical Access Hospital, offering comprehensive services through more than 188 active, consulting and courtesy physicians representing a full spectrum of specialties. Those physicians have immediate access to numerous specialists and subspecialists at Mission Hospital, by phone or through virtually assisted video and examination.

What about mothers who come in and have substance abuse issues? What equipment does AMC have to handle a situation like that?

  • This is an extremely sad but unfortunately all too real situation as the use of methamphetamines and opioids in pregnancy has been increasing significantly as part of the tragic, widespread drug epidemic in America today. We work very hard during prenatal care to get any mother-to-be with a substance-abuse problem into appropriate treatment programs to support and stabilize them prior to delivery. These babies often go into withdrawal after birth and this can be a life threatening condition for the baby.
  • Angel Medical Center has the appropriate equipment to triage and treat emergency cases. This was a key consideration in transitioning deliveries from AMC to another local provider along with a far better equipped and specialized regional partner, like Mission Hospital, that offers the safest possible care for all mothers and babies, including those who are suffering from the tragedy of substance abuse. It is dramatically safer for both mother and baby - to receive care in Asheville where specialized expertise and support systems are available. As a health system, we have to plan for all aspects of the birth and post-delivery process and for any and all range of complications. Substance abuse is just one of many such considerations. It is not possible for a very small hospital to have all of those resources available whether in Macon or any other part of the nation. What’s fortunate for our community, is that ALL of those resources are available within the regional system of care provided by Mission Health. That’s one of many reasons Mission Health has been named a Top 15 Health System in the US in five of the past six years – something never achieved by any other health system in America.

Why didn’t the hospital conduct a poll, or at least ask the women in the community, how they felt about discontinuing deliveries at Angel Medical Center?

  • It is very important to understand that our decision was reached after a very thorough and careful assessment of AMC’s Women’s and Children’s services. No decision to discontinue a service comes easily or is made lightly, but rather represents our commitment to providing the highest level of the most essential care to the communities we serve. Program assessments are made based on the safety of our patients, clinical best practice, practice stability and financial data to ensure we are delivering the appropriate level of care in the most appropriate location. As part of Mission Health, AMC is supported by our nationally-ranked network of care, which provides resources across the system and allows us to best perform analysis in determining appropriate program locations. Please rest assured that our decision was based on evidenced-based clinical and quality data, as well as difficult but responsible financial accountability, to ensure the sustainable future of Macon County’s health, wellness and inpatient care services continue to be available.
  • While we value the opinions and feedback from our community members, and understand that more broadly, gathering opinions is often helpful input for many decisions, in some decisions “opinions” can be counter to what is in the public’s interest (as an example, public resistance to vaccination - one of the most safe, evidence-based and impactful practices ever made available). We also know that nearly many local women already are choosing to deliver at Harris Hospital or Mission Hospital today. AMC and Mission Health always respect the right of each individual to make a decision and choose a healthcare provider that they believe serves them best. Our responsibility is to make sure that we offer to the region and reliably provide a system of care that is evidence-based, reliable and provides safe and effective care close to home.

Does Mission Health plan to build a new hospital in Macon County?

  • The Mission Health Board has approved an unprecedented, $45 million investment in Macon County to build a brand new, replacement hospital for Angel Medical Center. We anticipate that the new hospital will include all of the existing services available at AMC, other than Labor and Delivery. Importantly, the new facility will address long-standing problems and poor design that currently make care there challenging at times. Most important of all, the completely redesigned, state-of-the-art hospital will enable us to do things that we simply cannot do today to better meet the needs of the Community.
  • Across western North Carolina, Mission Health is investing nearly one-half billion dollars in new facilities, equipment and upgrades to ensure that quality care is available close to home in each community that we serve. Most importantly, as a member of Mission Health, AMC will have connection to the new Mission Hospital for Advanced Medicine, the single largest investment in the history of western North Carolina. As the regional medical center the Hospital for Advanced Medicine will be an asset for every citizen of western North Carolina. 

COMMUNITY QUESTIONS AND ANSWERS


How do you think it is a responsible decision to make women travel an hour—to an hour- and-a-half away to deliver their babies?

  • We appreciate your concern, and we – like you – wish that this decision was not required. Our decision to eliminate Labor and Delivery services was reached after a very thorough and careful assessment. No decision to discontinue any service comes easily or is made lightly, but in view of the severe financial losses, the close availability of alternative services at Harris Regional Hospital, the challenging but within-reach availability of state-of-the-art services for high-risk mothers at Mission Hospital and the essential need to keep general hospital services available in Franklin, we made the very difficult choice that is best for the community.
  • It is important to note that the labor process for most women typically allows for time to travel, even very extended travel times, to a hospital.  Harris Regional Hospital is less than 30 minutes from Angel Medical Center.  As you note, Mission Hospital also is available at a significantly greater distance. 
  • Mission Health is committed to investing in the health and wellbeing of our communities throughout our 18-county region. Our goal is to help each and every resident of western North Carolina Be Well, Get Well and Stay Well. Our unprecedented investment in Macon County’s Angel Medical Center is just one example of our relentless commitment to delivering the best care in state-of-the-art facilities to serve the needs of our patients and families.

  • Please remember that all other Women’s Services will remain, including: pre- and post-natal care, gynecologic care, pediatric care and more.

What are your thoughts on the relationship between health care access in western North Carolina, the Affordable Care Act (ACA), our previous governor and legislature's decision to not expand Medicaid in North Carolina, and Mark Meadows’ health policy preferences and this need to rethink how healthcare resources are made available? How can community members be made aware that healthcare availability decisions and events are related to a national and local conversation on health care reform?

  • You are correct that the debate at the State and Federal levels on health policy is not just “political dialogue,” but extraordinarily impactful on millions of citizens in the most intimate and significant ways.  Mission Health is closely following – and always participating in – the ongoing healthcare debate at the State and Federal levels. We are in constant contact with local, state, and federal representatives to make sure that they understand fully the impact that their policy decisions will have – not only our facilities – but on our community.  They do not create policy just for western North Carolina and we are at times pleased and at times saddened by their decisions.
  • The Affordable Care Act (ACA) allowed for tens of millions of Americans to gain health insurance, and while North Carolina did not expand Medicaid, according to the Urban Institute, more than 500,000 people in NC are now covered who were not before. (Click here for the Urban Institute report).  For all of the good, bad and indifferent concerning the ACA, it is undeniable that it has expanded coverage dramatically and made health care coverage affordable for the very first time ever for millions of Americans.

  • The American Healthcare Act which was, unfortunately, passed, would inflict very significant harm on North Carolina and western North Carolina in particular if it ultimately becomes law. In fact, of all the states in the nation, North Carolina will be the second most harmed state (after Alaska) by this Act.  Western North Carolina is even more impacted, because of our demographics – we are older, poorer, sicker and less likely to be insured than state and national averages. The flip from an insurance subsidy model to a flat tax credit model will make care completely unaffordable for many. For example, a couple of 60-year-olds who earn $25,000 per year, currently receive an Affordable Care Act insurance subsidy of more than $32,000. Under the American Healthcare Act passed today, they will receive $8,000 in tax credits and lose more than $24,000 of their prior subsidy. They will not be able to pay the additional $24,000 out of a total $25,000 earnings for that year.

  • We strongly encourage you to learn more about these critical decisions being made that will impact all of us.  To do so, please visit the Kaiser Family Foundation’s non-partisan website includes break-downs by state and the cost of different proposals.

Where are you putting the new Hospital in Franklin, North Carolina?

  • We are looking at a few locations that are in Franklin, including a property adjacent to our current facility but a final decision has not been made. Because this facility will need to meet the needs of the community for more than 30 years, we must conduct deep due diligence in the assessment of all potential properties. Final decisions resulting from our ongoing evaluations will be communicated directly to our communities, partners and team members.

Bad move! This is supposed to be a general hospital and should provide all normal services. Perhaps moving the helicopter back to Asheville or moving things such as knee and hip replacements to Asheville would allow keeping the general in the Angel General Hospital. This move may make it a lot tougher to get people to support future Certificates of Need for Mission or Angel equipment.

  • While we appreciate your concerns regarding the services provided by a general hospital with respect to the upcoming elimination of Labor & Delivery services, it is important to understand that all other Women’s and related services will remain, including: pre- and post-natal care, gynecologic care, pediatric care and more. It is also important to remember that the health needs of the overwhelming majority of women are also shared with men – heart disease, cancer, diabetes, lung disease and so many other important illnesses. In fact, it was a detailed study of what those needs are for the community as a whole that led to this difficult decision.

  • We too wish that we could maintain Labor & Delivery services. Our choice was a hard, but thoughtful decision reached after a very thorough and careful assessment of AMC’s Women’s and Children’s services. No decision to discontinue a service comes easily or is made lightly, but rather represents our commitment to providing the highest level of the most essential care to the communities we serve. Program assessments are made based on the safety of our patients, clinical best practice, practice stability and financial data to ensure we are delivering the appropriate level of care in the most appropriate location.

  • In regard to your point of Certificates of Need and hospital equipment, please rest assured that our decision was based on evidenced-based clinical and demographic data, as well as difficult but responsible financial stewardship, to ensure the sustainable future of Macon County’s health, wellness and inpatient care services remain available for the community. A Certificate of Need, by definition, affirms that the plan is required to fulfill the needs of a community – which the new facility clearly and unmistakably does.

I am an older woman that has already had all my children and I would love to know why you are taking the labor and delivery out when you have so many women counting on the Franklin hospital. The nurses are great up there and the midwives are wonderful. I have had to travel 30+ miles to have my baby, and trust me when I say it was no fun. You guys don't care about all the jobs being lost from people that truly love being in labor and delivery not to mention the women in danger of driving that far away putting themselves and baby in danger. It is just not right what greed does to one’s self. I hope you rethink this situation before you act on it. I thought Mission was a great hospital until this.

  • We couldn’t agree more that the nurses (and other team members at Angel and all Mission facilities) are simply terrific. On the point of our wonderful staff and their jobs, we completely share your concern. We have a very successful history of placing team members in new jobs within Mission Health, and in fact, there are numerous open positions at both Angel Medical Center and Highlands-Cashiers Hospital that are available for application. Mission Health also operates a Career Development Center that assists with those who experience a transition in role. We are dedicated to helping and supporting each team member to the greatest extent possible.

  • It is important to appreciate that the labor process for most women typically allows for time to travel, even very extended travel times, to a hospital.  Harris Regional Hospital is less than 30 minutes from Angel Medical Center.  As you note, Mission Hospital also is available at a significantly greater distance. 

  • In very rare event of a true emergency, Angel Medical Center has a full-service emergency department staffed with Board Certified Emergency physicians who are ready to stabilize, treat and triage emergency cases. If any expectant mother is deemed too far advanced in labor to travel to another regional hospital’s women’s unit or to Mission Hospital by EMS, then the baby would be delivered at AMC within the ED and both Mom and baby would be stabilized prior to transport to Mission Hospital. Equally important, if any baby required specialized equipment for the transport, as was sometimes the case even with deliveries at Angel, Mission Hospital would send a neonatology team with all of the necessary equipment by helicopter to transport the very sick baby quickly to Mission’s Level III Neonatal Intensive Care Unit (the only Level III NICU in western North Carolina).

  • Regarding the issue of “greed” you raised, while we understand the emotion behind that comment, it also indicates that you may not understand the reality of healthcare today. The root cause of our collective problem is that both Medicare and Medicaid reimburse health systems less than their actual cost of providing care and far too many rural Americans are under- or uninsured.  The combination of Medicare, Medicaid and the uninsured – 77% of all patients at Angel Medical Center – that makes rural healthcare so incredibly difficult.

  • Even before Mission came to help keep the hospital open, Mission loaned Angel money with no requirements so that it could remain open. In the year prior to Mission beginning to manage Angel, the hospital lost $4 million, was in default of its debt obligations and was on the verge of bankruptcy. Since then, we have reduced and restructured the hospital’s debt by assuming responsibility for it, improved operations and dramatically improved clinical quality and outcomes. We’ve never required that Angel “make money” but out of necessity it does need to break even.

  • Unfortunately, the Labor & Delivery program has been losing as much as $2 million per year. We simply can’t allow any one program to put all programs in jeopardy. At the same time, that is a program that is not growing, while so many other programs – particularly those catering to our rapidly growing elderly population are growing and will require increasing support.  In addition, The American Healthcare Act which was unfortunately passed today, would inflict very significant harm on North Carolina and western North Carolina in particular if it ultimately becomes law.  In fact, of all the states in the nation, North Carolina will be the second most harmed state (after Alaska) by this Act. Western North Carolina is even more impacted, because of our demographics – we are older, poorer, sicker and less likely to be insured than state and national averages. The flip from an insurance subsidy model to a flat tax credit model will make care completely unaffordable for many. For example, a couple of 60 year olds who earn $25,000 per year, currently receive an Affordable Care Act insurance subsidy of more than $32,000.  Under the American Healthcare Act passed today, they will receive $8,000 in tax credits and lose more than $24,000 of their prior subsidy. They will not be able to pay the additional $24,000 out of a total $25,000 earnings for that year.

  • We strongly encourage you to learn more about these critical decisions being made that will impact all of us.  To do so, please visit the Kaiser Family Foundation’s non-partisan website includes break-downs by state and the cost of different proposals.

Angel Medical Center and Ronald Paulus from Mission Health need to let Franklin citizens know that if Jim Davis and Kevin Corbin would vote and get Medicaid expanded in North Carolina, there would be plenty of money to keep OB services in Franklin.

  • We certainly agree that it is very important for citizens to understand the implications of healthcare policy decisions that elected officials make, and Mission Health strongly supports Medicaid expansion.  Unfortunately, the issue is even more complicated than that change alone. While Medicaid expansion would improve our ability to provide care to everyone without regard to their ability to pay, that alone would not be sufficient to resolve our challenges.
  • The root cause is that both Medicare and Medicaid reimburse health systems significantly less than the actual cost of providing care; at the same time, far too many rural Americans are under- or uninsured.  Our Medicaid problem is not unique to North Carolina and in fact, North Carolina has a more effective program than many other states.  It’s really the combination of Medicare, Medicaid, the uninsured and relatively low volumes that makes rural healthcare so incredibly difficult to provide and manage.

  • Please know that Mission Health has an active and ongoing relationships with our state and federal legislators and that we regularly share the many issues that impact the delivery of healthcare in our region. Mission Health is committed to investing in the health and wellbeing of our communities throughout our 18-county region.

  • Our goal is to do our very best to help each and every resident of western North Carolina Be Well, Get Well and Stay Well. Our unprecedented investment in Macon County’s Angel Medical Center is just one example of our relentless commitment to serve the needs of our patients and families across western North Carolina.

 

“As the largest healthcare provider in the region, Mission Health is committed to investing in the health and wellbeing of our communities throughout our 18-county region.  Our goal is to help each and every resident of western North Carolina Be Well, Get Well and Stay Well.  Our unprecedented investment in Macon County’s Angel Medical Center is just one example of our relentless commitment to delivering the best care in state-of-the-art facilities to serve the needs of our patients and families.”

--Ronald A. Paulus, MD, President and CEO of Mission Health