'Advanced' Birth Centers Get Backing In House

The Florida House continues to move ahead with a proposal that would allow “advanced” birth centers where women could go as an alternative to hospitals to deliver babies.

The House Health Care Appropriations Subcommittee unanimously approved the bill (HB 1099) on Tuesday, with assurances that it will soon be changed to address some safety and quality concerns raised by hospitals that potentially could lose patients to the new facilities.

The bill, filed by Rep. MaryLynn Magar, R-Tequesta, would allow “advanced” birth centers that would be able to perform cesarean sections and epidurals. The centers also would be allowed to keep women up to 48 hours following vaginal deliveries and 72 hours following C-sections.

Under current law, women in Florida can plan to have babies at three types of locations: home, a licensed birth center or a hospital. Birth centers are not authorized to keep patients beyond 24 hours or to provide epidurals or cesarean sections. They also are limited to treating only women who are considered to have low-risk pregnancies.

The state had 221,038 births at hospitals in 2016 and another 1,724 births at birth centers, according to the Florida Department of Health. Another 2,050 births were planned at home.

Magar’s proposal is the second bill that has moved forward in the House that would expand the ability of non-hospital providers to treat low-risk patients.

The House has passed a proposal (HB 23) that would allow patients to stay in ambulatory surgical centers for up to 24 hours, ending a long-standing prohibition on overnight stays. The bill also would authorize so-called “recovery care centers,” where patients could stay up to 72 hours after undergoing surgical procedures.

Rep. David Richardson, D-Miami Beach, supported the advanced birth-center bill on Tuesday but says he had a “huge concern” with the future of the state’s hospitals and how they would fare in an environment where more health-care providers can compete for patients.

Richardson says that people “all want the best hospital care available at a moment’s notice” but added the policy of carving out patients who can be treated at other facilities puts hospitals at risk of losing paying patients.

“They are not going to be able to make a living,” he says.

But Rep. James Grant, R-Tampa, disagreed, saying “the problem is the absence of business in health care” and said that competition for pregnant women is good for hospitals.

Though the bill would establish “advanced” birthing centers and allow them to offer surgeries and anesthesia, safety requirements would be the same as for traditional birth centers. Those requirements include arranging with local ambulance services for the transportation of emergency patients.

Robert Yelverton, a physician with Women’s Care Florida, which has 67 outpatient centers across the state and delivers more 13,000 babies annually, says his group is working on a proposal to add some requirements to the bill, such as a mandate that advanced birth centers be located within a certain proximity of hospitals in case of emergencies.

But the move could preclude advanced birth centers from being established in rural areas.                                 

Lori Boardman, administrator and chief medical officer for women’s services at Florida Hospital in Orlando, raised several concerns with the bill. She said advanced birth centers would be required to have just one surgical suite, which wouldn’t be adequate if more than one cesarean section occurs at the same time. Additionally, she noted that there are no requirements for the centers to have arrangements with blood banks in case transfusions are necessary.

Boardman said she isn’t being an administrator “alarmist.” She said that while in Rhode Island, she chose to deliver her second child with a midwife at a birth center-type facility that was in the basement of a hospital.

During the delivery, she said, her uterus ruptured, and she required an emergency hysterectomy. She said she was rolled out of the birthing facility and into an elevator and taken to a surgical floor. She never left the hospital, and the transfer took moments.

“I was happy I was in a hospital when that occurred,” she said.

Magar, R-Tequesta, has touted the bill as a potential cost saver to the state, but it would not require the facilities to treat Medicaid patients, which also was a concern for Boardman. A Senate version of the bill (SB 1564) has not been heard in committees.

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