Frisbie Memorial Hospital in Rochester recently announced plans to close its birth center, citing financial problems.
The move is on hold pending a review from the New Hampshire Attorney General, which said the hospital promised to keep its birthing center open for at least five years after it was acquired by HCA Healthcare in 2020. But if the closure does move forward, Frisbie would join at least nine other Granite State hospitals that have shut down their labor and delivery units since 2000, according to a 2021 study by the Urban Institute.
Additional reporting from Vox has found that maternity ward closures accelerated across the nation during the COVID-19 pandemic. And here in New Hampshire, one of the state’s top health officials is concerned about how these local closures are affecting patients.
“What we've seen is that there are increased drive times for families to get to a hospital that provides comprehensive prenatal care and labor and delivery services,” said Patricia Tilley, director of Public Health Services for New Hampshire’s Department of Health and Human Services. “And that drive time has been increasing over time as hospitals continue to close.”
If Frisbie’s birthing center closes as planned, hospital officials said existing patients would be sent to Portsmouth Regional Hospital, which is about 30 minutes away.
The Urban Institute’s 2021 study found that this increased travel time for expecting parents is becoming more common. In 2000, about 20% of pregnant people in New Hampshire lived more than 30 minutes from a hospital with a birthing center; by 2018, that figure increased to more than 27%.
Tilley said longer drive times have led to more unplanned deliveries at hospitals without labor and delivery units, or en route to larger hospitals with these services.
“We've seen concurrently an overall reduction in the number of women that go to all of their prenatal care appointments,” she said.
In a statement provided to NHPR, Frisbie’s parent company HCA Healthcare said they plan to continue to offer pre- and post-natal care even if the birthing center closes.
“We remain committed to women’s health in Rochester and will partner with local OB-GYN providers to offer pre- and post-natal care for women in the current birthing center space, and will continue offering all gynecological surgery at FMH,” HCA Healthcare spokeswoman Ellen Miller wrote.
Hospitals often cite staffing shortages and financial problems as part of the rationale for closing their birthing units. New Hampshire’s low birth rate means it's costly to allocate specialized labor and delivery staff to a unit that’s not receiving many patients, according to Tilley. But she noted New Hampshire’s 7% birth rate increase in 2021.
Lakes Region General Hospital in Laconia closed its maternity ward in 2018 in part due to low reimbursement rates from Medicaid. In New Hampshire, only 24% of births are covered by Medicaid compared to a 42% national average.
Tilley said Frisbie Memorial Hospital’s decision to close its birth center could limit choices for patients who already have limited access to care.
“We certainly know, in that part of the state, as we think of the [Route] 16 Corridor, individuals don't really have many choices around them.” Tilley said, noting that Huggins Hospital in Wolfeboro, also on that same route, closed its birth center in 2009.
Tilley said there are strategies that can encourage other hospitals to keep their birth centers open, like increasing Medicaid reimbursement rates to small hospitals, which are set by the state.
She said a hub-and-spoke model of healthcare employed by other states is also an option. This would entail a larger regional hospital having stronger relationships with and providing resources to smaller hospitals farther out of their community so that they can help each other.
Attorney General John Formella launched a review of Frisbie’s plans Monday. Formella said hospital officials did not show the required evidence of financial distress to shutter their birth center.
The Attorney General’s Charitable Trusts Unit is investigating whether the hospital made a “good faith effort” to keep services going and if it misused federal COVID pandemic relief funding.
“We are particularly interested in whether [Frisbie Memorial Hospital] took advantage of CARES Act funds and whether [the hospital] has already begun referring its prenatal patients to Portsmouth Hospital,” Charitable Trusts Unit Director Diane Murphy Quinlan wrote in an Aug. 8 letter to the hospital.
The Attorney General’s office declined to comment further, saying they’re still in the early phases of their review.
