Rural Tennesseans already have limited access to labor and delivery services, and a recent study shows the problem could get worse.
Fewer than half of Tennessee’s rural hospitals — 24 facilities — offer obstetrics care. Of those, five are considering dropping the service. That’s according to a new report from the Center for Health Care Quality and Payment Reform, a national health policy think tank.
Labor and delivery is one of the first services to get cut at struggling rural hospitals.
Regardless of location delivery wings need a big staff working 24 hours — nurses, doctors, anesthesiologists and more. But the rural hospitals are going to handle fewer babies — which means fewer payments.
Decreasing birth rates contribute to the lack of payments. The Centers for Disease Control and Prevention released its latest national birth data this week. It found that 2024 was near the record-breaking low that took place in 2023.
The CDC notes one of the major reasons for the decline has been the decrease in teen pregnancies in recent decades — more than 70% since 1991.
Across the country, Medicaid programs like TennCare pay for about half of the births in a given hospital, and the report’s authors say that Medicaid rates need to be higher. The report’s authors say that Medicaid rates need to be higher.
But the report notes that private insurance companies cover about 40% of all births, and those low payments also add to the problem. The paper offers a recommendation to employers who offer their workers health insurance coverage, saying they should require insurers to prove their rates for labor and delivery care are adequate.
It also argues that low payments for other services contribute to overall financial struggles for rural hospitals. This threatens obstetrics care because it is one of the first services to be cut when margins are narrow.
Tennessee, like other rural states, struggles to get enough health workers into its rural communities. The report explains that those labor shortages further decrease access to labor and delivery care; often it’s difficult to ensure every shift is fully staffed. The report recommends finding new ways to address this problem, like getting rid of lengthy on-call shifts — which have been common — to make jobs more appealing.
In November, the March of Dimes gave Tennessee a D- grade for its performance on pre-term births. That figure is generally seen as a proxy for the quality of maternity care in the state. The advocacy group said it also considered the state’s high maternal mortality rate — the number of people who died of pregnancy-related causes up to a year after delivery. Tennessee’s rate was more than 41 out of every 100,000 births, ranking it second to worst in the country.
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