BEMIDJI — U.S. Sen. Tina Smith visited leaders within Sanford Health of Northern Minnesota Thursday, Aug. 17, for a roundtable discussion on improving rural maternal outcomes.
"We have a very diverse population with many challenges and if we really want to reduce the disparate outcomes that exist, we need the resources to do so."Dr. Johnna Nynas, OB-GYN
Smith introduced the Rural MOMS Act on the Senate floor in 2021, with the bill language requiring the Health Resource and Services Administration to establish rural obstetric networks, fostering collaboration to improve birth outcomes and reduce maternal morbidity.
“The idea behind the Rural MOMS Act was to be able to continue this kind of partnership and collaboration that had been started here in Bemidji,” Smith said. “And to be able to see it be replicated and happening in other parts of the country.
“Last year I was successful in getting more funding for these kind of collaboratives and we need to kind of keep that push going.”
The bill also has language for grants to medical schools and health professional training programs to support education and training on maternal health in rural areas, as well as incorporating maternal health services in certain telehealth grant programs.
"We have to also just acknowledge and understand that too often our health care systems undervalue women and undercount their health care needs and their health care experiences."Sen. Tina Smith
Telehealth services, and their reimbursement rates, were a primary focus of discussion, as many rural hospitals have closed maternity units due to high costs.
Essentia Health Fosston shuttered its maternity unit just last year, with 18 births reported at the clinic during 2022.
“It's about coordination of care. For example, I may get a phone call from an outlying hospital, where they have a patient who might be in labor, have another complication, but they don't have OB-GYN services available,” said Dr. Johnna Nynas, OB-GYN at Sanford Bemidji.
“I am supporting hospitals as far as way as Baudette, International Falls and Warroad. Just with information, but that's where we can really dig in and lean into this program and
grow it.”
Nynas said the program is also partnering with Cass Lake and Red Lake Indian Health Service hospitals, coordinating care through telehealth.
“By expanding virtual OB hospital programs and having them available at other smaller hospitals,” said Nynas, “not only would those providers feel supported, but the patients are getting evidence based-care that they need from a board surgeon.”
“What we do with our other women’s health care provider is stabilize the patients and improve their outcomes,” Nynas said. “It's got to be reimbursed though, and with the change of the pandemic, that funding is at risk.”
With the waning of the emergency around COVID-19, telehealth service reimbursements for Medicaid have changed, with Nynas explaining telehealth visit rates for a complicated pregnancy — that may include other factors such as pre-eclampsia or gestational diabetes — are reimbursed the same as a relatively uncomplicated pregnancy.
“Overall, reimbursements for women's health care services are generally lower and certainly don't recoup the amount of cost and risk that go into taking care of some of these patients in rural areas,” Nynas said. “We have a very diverse population with many challenges and if we really want to reduce the disparate outcomes that exist, we need the resources to do so.”
While American Indians constitute about 2% of the nation’s population, 22% of Beltrami County’s population identifies as Native American.
Susan Ninham, administrative officer at Red Lake Comprehensive Health, said the collaborative is making a difference in removing patients’ barriers to care, such as transportation.
“I think it really has increased the quality of care that our patients are needing and wanting,” Ninham said. “It has eliminated some of those barriers to have to travel to take time off from work, to find child care and to spend a day, you know, just traveling and getting to an appointment that can be done virtually.”
The Rural MOMS Act has bipartisan support, with a House companion bill introduced by Rep. Dan Newhouse (R-WA), and with four Republican Senators joining colleagues across the aisle in sponsoring Smith’s Senate version. The bill is currently in committee.
“We have to also just acknowledge and understand that too often our health care systems undervalue women and undercount their health care needs and their health care experiences,” Smith said. “And what you see happening here is the opposite of that. It's putting real value on helping women and moms and babies, and I think that’s one of the strengths that I hope can come out of Rural MOMS.”
