RD328 - Annual Report on the Impact and Effectiveness of the Pilot Programs to Expand Access to Obstetric, Perinatal and Pediatric Services.


Executive Summary:
Over the past several years, many rural, underserved areas throughout the Commonwealth have experienced challenges brought about by the lack of obstetric (OB) providers and the closings of hospital OB units. In response to this health care crisis, in 2004, Governor Warner formed a Workgroup to develop and make recommendations to improve access to prenatal, obstetric, and pediatric care thus helping to ensure healthy babies. This Workgroup, chaired by the Secretary of Health and Human Resources presented a series of recommendations in six key policy areas; reimbursement, insurance, evidence-based practice and licensure, birth injury and access to care. Measures to expand access to prenatal care using a new practice paradigm were suggested. Subsequently, the 2005 General Assembly passed HB 2656 authorizing the State Board of Health to approve pilot projects to improve access to OB care.

Work began in August 2005 when a group of OB Pilot stakeholders and representatives from the Virginia Department of Health (VDH) met to discuss developing one or more pilot sites capable of providing high quality pregnancy related care. Stakeholders determined that two areas emerged as having the greatest need. Low income women and their families from the Northern Neck and Emporia-Greensville areas were negatively impacted by the lack of readily accessible obstetrical care, requiring greater distances to travel to obtain care, thus contributing to the increasing probability of poor birth outcomes. The stakeholder group continued to meet numerous times over the past 12 months to develop strategies to establish a birthing center utilizing the services of certified nurse midwives (CNMs). In April 2006, the stakeholders presented their business proposal to the Board of Health. The Board reviewed the proposal and requested the stakeholders respond to six items required either in HB 2656 or that the Board considered integral to patient safety.

During this same time the legislature continued to provide essential support needed to improve access to OB care. The Code of Virginia was amended to allow CNMs to practice with physician collaboration thus eliminating the requirement for physician supervision of CNMs. In addition, the General Assembly appropriated $150,000 in 2006 to support start-up costs of the pilots. VDH has drafted a Memorandum of Agreement (MOA) with Virginia Commonwealth University (VCU) to administer these funds and provide managerial oversight of the pilot projects. The Department agreed that it would be best to hire contractors within each community to serve as project coordinators to continue the work of building community partnerships and developing the birthing center plan. A workplan identifying the tasks and subtasks that are required of each project coordinator based upon predetermined goals within a given timeframe will be used to assess progress over the next year. Each project coordinator is expected to establish programs and develop services leading to a fully operational birthing center in their respective areas by 2008.

VDH will serve as a primary contact for the purposes of collaborating on the implementation of project tasks and priorities and will provide technical assistance for the purpose of expediting the project. VDH will continue to monitor the progress of the pilot projects, and report on the impact and effectiveness of the pilot projects in meeting the program goals.