Seven months after North Central Family Medical Center said it would drop its prenatal program because it could no longer afford it, the center has reached an agreement with Piedmont Medical Center and Rock Hill GYN/OB to continue the program indefinitely.
The move means uninsured and underinsured expectant mothers across York County will continue to have access to prenatal care, preventing an influx of nearly 1,000 new patients at local OB/GYN offices that health officials say would've strained area practices to the breaking point.
Last summer, North Central -- the only local medical office to offer prenatal care to those without insurance -- announced it would fold the program at the end of September 2009 because its contract with PMC for five midwives to administer care had become too expensive. Shortly thereafter, PMC and York County each provided $35,000 grants to keep the prenatal program going until a permanent solution was found.
Now, to help the center increase revenue and offset the cost of providing care to the uninsured, doctors from Rock Hill GYN/OB will be on site at the center for a half-day each week. The doctors will be paid a small fee, but the center will still get money from Medicaid and other third-party sources. The doctors also will supervise two midwives hired by North Central and care for any high-risk patients or those needing C-sections. PMC will continue to provider labor and delivery services for the patients.
The arrangement not only continues a needed service but makes for a "much smoother operation," said Ernest Brown, North Central's executive director.
Essentially, he said, it keeps the program completely in-house. Before, high-risk patients had to travel to physicians to be evaluated.
"We'll be able to serve prenatal patients ... in a much more efficient and professional manner than we did in the past," Brown said. "Overall, it's much, much better."
North Central relies on federal money to provide care for its uninsured and underinsured patients and the prenatal program accounts for a large portion of that.
The program's financial struggles were mainly because of a significant decrease in patients with Medicaid and an increase in patients without medical coverage. When the program started in 1993, 95 percent of its patients qualified for Medicaid. Now only half qualify.
The program treated 963 patients last year.
The center's clientele runs the gamut from single mothers on Medicaid to people who are employed and have health insurance provided to them but can't afford to have it deducted from their paycheck.
"They're the working poor," said Frances Carney, the center's newest midwife. "They're the ones who will fall through the cracks."
News that North Central would stop the program led some heath officials to fear an increase in South Carolina's high infant mortality rate.
The state had an infant mortality rate of 9.4 deaths per 1,000 live births in 2005, the latest data available, according to the National Center for Health Statistics. That ranks as the third-highest in the country, behind Louisiana and Mississippi.
The women who use North Central's prenatal program are thankful to still have the option.
"It's real good for me," said Rosalba Perez, 22, of Lancaster, who doesn't have insurance and is 20 weeks pregnant with her second child. "You can't get this in Lancaster."
Without North Central, Perez's next closest option is a center in Sumter -- 90 minutes away.
"It's only 30 minutes away," she said of North Central. "I feel so good about it."
Not all are happy
Despite the relief the new arrangement brings many, not everyone is happy with how things played out.
The midwives who North Central had contracted through PMC to administer the prenatal program are no longer needed. They feel patients will lose continuity of care because they're likely to see different doctors during visits, and say patients are losing the choice of midwife care, among other concerns.
The midwives assumed they would be part of any solution to keep the program going because the existing relationship they already have with many patients, said Norma Ramirez, who was a midwife at the center for 15 years.
"They know about our quality of care and feel comfortable coming to us," Ramirez said.
The new arrangement brings a new routine of care for the patients, which could lead to confusion for some.
"Usually, when you have fragmented care like that, you lose something," Ramirez said. "There will be some cracks.
"The benefit is at least there's prenatal care there."
Brown disputes that patient care will be lacking under the new arrangement.
"I see it being even better," he said.
Charlie Miller, PMC's president and CEO, said he understands the former midwives' frustration, but that the decisions were made with the patients' best interests in mind. The solution is one "we have every reason to believe will sustain itself over a long period of time," he said.
The midwives had a representative present during the discussions, Miller said.
"This was a very transparent process," he said. "If you do it well and put the focus on all the right pieces ... it doesn't always work out to everyone's benefit the way they want it to."
Care for everyone
Dr. Norman Taylor, president of Rock Hill GYN/OB, said the arrangement took sacrifice and compromise from all parties.
"It was a big deal," Taylor said. "I was impressed that so many people took the time to do it. It would've been a mess if we didn't have a place for these ladies to go."
But now, prenatal care is available to any woman who chooses to use it, Taylor said.
"We'll see how it works. With everything going on (with health care), who knows," he said. "But we feel good about what we've got."