Florida has become the first state to allow doctors to perform cesarean sections outside of hospitals, siding with a private equity-owned physicians group that says the change will lower costs and give pregnant women the homier birthing atmosphere that many desire.
But the hospital industry and the nation’s leading obstetricians’ association say that even though some Florida hospitals have closed their maternity wards in recent years, performing C-sections in doctor-run clinics will increase the risks for women and babies when complications arise.
“A pregnant patient that is considered low-risk in one moment can suddenly need lifesaving care in the next,” Cole Greves, an Orlando perinatologist who chairs the Florida chapter of the American College of Obstetricians and Gynecologists, said in an email to KFF Health News. The new birth clinics, “even with increased regulation, cannot guarantee the level of safety patients would receive within a hospital.”
This spring, a law was enacted allowing “advanced birth centers,” where physicians can deliver babies vaginally or by C-section to women deemed at low risk of complications. Women would be able to stay overnight at the clinics.
Women’s Care Enterprises, a private equity-owned physicians group with locations mostly in Florida along with California and Kentucky, lobbied the state legislature to make the change. BC Partners, a London-based investment firm, bought Women’s Care in 2020.
“We have patients who don’t want to deliver in a hospital, and that breaks our heart,” said Stephen Snow, who recently retired as an OB-GYN with Women’s Care and testified before the Florida Legislature advocating for the change in 2018.
Brittany Miller, vice president of strategic initiatives with Women’s Care, said the group would not comment on the issue.
Health experts are leery.
“What this looks like is a poor substitute for quality obstetrical care effectively being billed as something that gives people more choices,” said Alice Abernathy, an assistant professor of obstetrics and gynecology at the University of Pennsylvania Perelman School of Medicine. “This feels like a bad band-aid on a chronic issue that will make outcomes worse rather than better,” Abernathy said.
Nearly one-third of U.S. births occur via C-section, the surgical delivery of a baby through an incision in the mother’s abdomen and uterus. Generally, doctors use the procedure when they believe it is safer than vaginal delivery for the parent, the baby, or both. Such medical decisions can take place months before birth, or in an emergency.
Florida state Sen. Gayle Harrell, the Republican who sponsored the birth center bill, said having a C-section outside of a hospital may seem like a radical change, but so was the opening of outpatient surgery centers in the late 1980s.
Harrell, who managed her husband’s OB-GYN practice, said birth centers will have to meet the same high standards for staffing, infection control, and other aspects as those at outpatient surgery centers.
“Given where we are with the need, and maternity deserts across the state, this is something that will help us and help moms get the best care,” she said.
Seventeen hospitals in the state have closed their maternity units since 2019, with many citing low insurance reimbursement and high malpractice costs, according to the Florida Hospital Association.
Mary Mayhew, CEO of the Florida Hospital Association, said it is wrong to compare birth centers to ambulatory surgery centers because of the many risks associated with C-sections, such as hemorrhaging.
The Florida law requires advanced birth centers to have a transfer agreement with a hospital, but it does not dictate where the facilities can open nor their proximity to a hospital.
“We have serious concerns about the impact this model has on our collective efforts to improve maternal and infant health,” Mayhew said. “Our hospitals do not see this in the best interest of providing quality and safety in labor and delivery.”
Despite its opposition to the new birth centers, the Florida Hospital Association did not fight passage of the overall bill because it also included a major increase in the amount Medicaid pays hospitals for maternity care.
Mayhew said it is unlikely that the birth centers would help address care shortages. Hospitals are already struggling with a shortage of OB-GYNs, she said, and it is unrealistic to expect advanced birth centers to open in rural areas with a large proportion of people on Medicaid, which pays the lowest reimbursement for labor and delivery care.
It is unclear whether insurers will cover the advanced birth centers, though most insurers and Medicaid cover care at midwife-run birth centers. The advanced birth centers will not accept emergency walk-ins and will treat only patients whose insurance contracts with the facilities, making them in-network.
Snow, the retired OB-GYN with Women’s Care, said the group plans to open an advanced birth center in the Tampa or Orlando area.
The advanced birth center concept is an improvement on midwife care that enables deliveries outside of hospitals, he said, as the centers allow women to stay overnight and, if necessary, offer anesthesia and C-sections.
Snow acknowledged that, with a private equity firm invested in Women’s Care, the birth center idea is also about making money. But he said hospitals have the same profit incentive and, like midwives, likely oppose the idea of centers that can provide C-sections because they could cut into hospital revenue.
“We are trying to reduce the cost of medicine, and this would be more cost-effective and more pleasant for patients,” he said.
Kate Bauer, executive director of the American Association of Birth Centers, said patients could confuse advanced birth centers with the existing, free-standing birth centers for low-risk births that have been run by midwives for decades. There are currently 31 licensed birth centers in Florida and 411 free-standing birth centers in the United States, she said.
“This is a radical departure from the standard of care,” Bauer said. “It’s a bad idea,” she said, because it could increase risks to mom and baby.
No other state allows C-sections outside of hospitals. The only facility that offers similar care is a birth clinic in Wichita, Kansas, which is connected by a short walkway to a hospital, Wesley Medical Center.
The clinic provides “hotel-like” maternity suites where staffers deliver about 100 babies a month, compared with 500 per month in the hospital itself.
Morgan Tracy, a maternity nurse navigator at the center, said the concept works largely because the hospital and birthing suites can share staff and pharmacy access, plus patients can be quickly transferred to the main hospital if complications arise.
“The beauty is there are team members on both sides of the street,” Tracy said.
Banner Health president and incoming CEO Amy Perry joins HealthLeaders CEO editor Jay Asser to talk about the transition in replacing the retiring Peter Fine, ushering the health system into the future, and solving for the biggest pain points facing hospital leaders.
As health systems shift more care services to the patient's home, they're looking at drones to solve key supply chain challenges
Health systems and hospitals are turning to drones to address supply chain care gaps—including challenges that both providers and patients face in accessing drugs and other medical supplies.
In the latest example, the Mayo Clinic has announced a partnership with Zipline to integrate drone deliveries into its Advanced Care at Home program. The deal aims to improve care management for the home-based acute care program by giving providers quick access to medical supplies. Mass General Brigham unveiled similar plans in January when it announced a partnership with Canadian drone company Draganfly.
Just last month, Houston’s Memorial Hermann Health System announced a partnership with Zipline to deliver specialty prescriptions and medical supplies to patients’ homes beginning in 2026.
“As a system, we are continuously seeking ways to improve the patient experience and bring greater health and value to the communities we serve,” Alec King, Memorial Hermann’s executive vice president and chief financial officer, said in a press release. “Zipline provides an innovative solution to helping our patients access the medications they need, quickly and conveniently, at no added cost to them.”
Drones have been on the fringe of the healthcare space for several years, usually showing up in small pilot programs aimed at improving delivery of time-sensitive supplies between two health system sites or from a health system to a patient’s home and vice versa. The use case aims to address delays or slow deliveries caused by geography, weather, traffic, or transportation issues as well as giving patients access to tests, medicine, and vaccines in their homes rather than making them travel to a hospital or clinic.
In January, Axios called 2024 a “breakout year for delivery drones,” noting that the Federal Aviation Administration eased the rules last fall to allow some companies to fly drones beyond the visual lines of sight, called BVLOS. That opened the door to companies like Zipline, Amazon, and Wing (part of the Alphabet stable) expanding their services. The FAA is expected to create standards for BVLOS operations in the near future.
The Mass General Brigham and Mayo Clinic programs represent a different use case. Both health systems plan to use drones to transport medical supplies to and from the homes of patients in acute hospital at home programs. Those programs, which have gained traction since the pandemic, require hospitals to combine digital health and telehealth services with in-person care for patients in their homes, as an alternative to in-patient care.
The complexity of the program might mean that drones would be used almost every day to send medical supplies to the patient’s home and/or transport tests and specimens from the home back to the hospital.
“At Mass General Brigham, we are looking at the future of healthcare, and part of that vision is taking care of patients in the comfort of their homes,” David Levine, MD, MPH, MA, clinical director of research and development for the Mass General Brigham Healthcare at Home program, said in a press release. “In accomplishing this at scale, we understand that we need to continue to evolve our processes to support home-based care. These types of technological solutions allow us the opportunity to create a paradigm shift in our care delivery.”
Geisinger is leveraging virtual nursing technology to improve quality of care.
On this week’s episode of HL Shorts, we hear from Rebecca Stametz, vice president for digital innovation at Geisinger, about the virtual nursing models at Geisinger. Tune in to hear her insights.
The HealthLeaders Mastermind series is an exclusive series of calls and events with healthcare executives. This Virtual Nursing Mastermind series features ideas, solutions, and insights on excelling your virtual nursing program. Please join the community at our LinkedIn page.
To inquire about participating in an upcoming Mastermind series or attending a HealthLeaders Exchange event, email us at exchange@healthleadersmedia.com.
Mount Sinai is using several pieces of technology to improve care coordination.
As more virtual nursing programs pop up throughout healthcare, more technology is integrated into health system workflows, and it's important that nurse leaders understand the capabilities and potential applications.
Clair Lunt, senior director of nursing informatics at the Mount Sinai Health System, outlined how the New York-based health system uses technology in its virtual nursing program, and how they plan to expand the program in the future.
Ms. Lunt is a part of the HealthLeaders Virtual Nursing Mastermind program, in which several health systems are discussing the ins and outs of their virtual nursing programs and what their goals are for implementing this new strategy.
Technology
According to Ms. Lunt, Mount Sinai uses virtual nursing for admission and discharge documentation and patient education. They are using several pieces of technology including TVs and cameras.
"There is what's called a bridge, which is the platform where the virtual nurses can actually log into [their] systems and see [their] patients," Lunt said.
The cameras are placed above the TV in the patient’s room and paired with a high-resolution zoom camera next to the TV.
"Those cameras are used to home or zoom right in on wounds or medications or blood products that you need a second set of eyes on if needed," Ms. Lunt said.
There are also pillow speakers with microphones that patients can use to call the nurse.
"They can speak through it, and they just talk to the pillow speaker when they're answering," Ms. Lunt said, "and the virtual nurses can hear them."
Future applications
Over time, Ms. Lunt believes the program will go beyond virtual nursing.
"Other platforms will want to be able to use the technology to be able to care for patients at a multiple number of sites," Ms. Lunt said, "rather than have people based at each site."
For instance, someone from the MRI department could use the virtual platform to help patients complete -questionnaires, rather than having a bedside nurse dothem. Pharmacists could also use the platform to go over new medication information with patients.
Ms. Lunt said the platform could also be used for home rehab programs, with virtual nurses working with patients at home to complete physical assessments prior to pre-authorization, freeing up the clinician to work with the patient.
"They can just pop in and just talk to the family and the patient," Ms. Lunt said, "you can actually pull the patient's family members into a call without them actually having to be in the room with the patient."
The idea is that virtual nursing will expand to improve patient care overall, Ms. Lunt explained.
"So that care coordination piece, I think will become favorable for a lot of different disciplines," Ms. Lunt said, "not just virtual nursing."
The HealthLeaders Mastermind seriesis an exclusive series of calls and events with healthcare executives. This Virtual NursingMastermind series features ideas, solutions, and insights onexcelling your virtual nursing program.Please join the community at our LinkedIn page.
To inquire about participating in an upcoming Mastermind series or attending a HealthLeaders Exchange event, email us at exchange@healthleadersmedia.com.
A not-so-new feud between NewYork-Presbyterian Hospital and union health fund 32BJ has reached a fever pitch. The union fund was on the cusp of signing with Aetna to cover its 210,000 members when a hospital-sized roadblock popped up.
Due to the hospital's prices, 32BJ wanted to exclude it in its new contract. However, Aetna’s contract requires the insurer to get a signoff from the hospital in order to omit it from a client's plan.
According to New York Presbyterian, 32BJ owes the health system over $25 million in medical service bills and is barring 32BJ from signing with Aetna until those bills are covered. Without the payment, Aetna can’t offer the plan the union fund wants.
32BJ says it has no current plans to pay the hospital.
“We were totally shocked. That’s just not how business is done,” said Peter Goldberger, executive director of the union’s benefit funds, speaking to the Wall Street Journal. He added that NewYork-Presbyterian never brought up the charges prior to the union fund attempting to sign with Aetna.
The union health plan spends about $1.5 billion a year covering members—who typically hold occupations such as cleaners, maintenance workers and airport staffers—and their families.
Last year the union health fund spent roughly $22.5 million on care at NewYork-Presbyterian alone.
This led 32BJ to call off signing with Aetna, who they said they do not blame for the situation.
The union fund will continue with its current partner Elevance’s Anthem, which has not included NewYork-Presbyterian in its network since 2022.
The Price Problem
NewYork-Presbyterian’s prices reflect those of big hospitals that command premium rates with private insurers. These demands are high, and sometimes guarantee that the health system will be included in all of an insurer’s networks, even if a client doesn’t want them.
Contract terms like these negatively affect insurer’s clients, usually employers and unions, making it harder for them to guide patients to lower-priced health systems. Employers end up staying in them, despite not knowing what they are paying, and services potentially costing double what the government would pay.
Hospital prices have been a major pain point lately, and data shows they usually pay far more than Medicare rates. There’s also been pushback from other groups that say Medicare rates are far too low and don’t cover the cost of care. Regardless of where the numbers fall, employers need access to pricing data for their health plans.
Fellows is CEO of Beacon Therapeutics, which is developing several potential treatments for patients with a range of prevalent and rare retinal diseases such as the treatment for X-linked retinitis pigmentosa (XLRP).
"These patients, mostly young boys and men, will eventually go blind, and generally the symptoms start when they're in their early teens," he says. "By the time they're in their fourth decade of life, they're down to pinhole vision, and ultimately they lose their vision completely."
Fellows, who has worked in the ophthalmology field for more than 40 years, has a passion for finding a solution for this condition that stems from the many patients and families he has met who are affected by XLRP. He remembers one such experience in the UK, when he looked on as a physician met with a family whose young son was slowly going blind from XLRP.
The doctor, Fellows says, was explaining to the parents that one of the first symptoms of retinitis pigmentosa is losing night vision. The boy chimed in that he was already experiencing night vision loss. He said that had been playing tag with his friends in the evening and had run into a bench that he couldn't see. At that point, the boy said, he quit playing the game.
The boy then explained how the disease is affecting him.
“The thought that I might not be able to get a driver's license is devastating,” the boy said, according to Fellows, “but the biggest fear for me is I'm going to come to that point where I meet my date with darkness. That's the day I wake up and everything is black.”
"It's devastating for these kids because they're concerned that they will never be able to get their driver's license," Fellows says. "They're concerned they won't be able to get accepted into college. They're concerned that they won't be able to choose the career they want because of the limitations to their sight."
A Mission to Prevent Blindness
That incident and many more like it have inspired Fellows and his colleagues to be at the forefront of finding ways to manage XLRP. And interacting with patients is the key to pursuing that goal.
"We reach out to our patient support groups and work directly with them, and we also talk to the patients and families," Fellows says. "Our employees meet with patients because I firmly believe that you really have to get to know [them] to understand the journey that they're on. It really helps connect us to what we're trying to do on a day-to-day basis."
There are no current treatments for XLRP, which affects approximately 17,000 people in the U.S. and Europe.
"The most important thing for us is to find a way to get treatments to patients quickly because these people are all going blind," Fellows says. "They are living with the prospect of blindness their whole life. And now we have something that not only will save the vision, but potentially improve it."
David Fellows, CEO of Beacon Therapeutics. Photo courtesy Beacon Therapeutics.
Beacon recently presented robust 12-month data from its Phase 2 SKYLINE trial. According to researchers, males with XLRP demonstrated a response rate of 63% in eyes treated with a high dose of AGTC-501. Response rates in patients’ eyes treated with a low dose of AGTC-501 were similar to the untreated eyes in the high dose cohort. In addition, patients treated with a high dose demonstrated a robust improvement in visual function, including mean retinal sensitivity. Finally, according to the researchers, AGTC-501 was generally well tolerated, with no clinically significant safety events associated with treatment, and any treatment-related adverse events were mostly non-serious and mild to moderate in severity.
Beacon's second program focuses on an intravitreally (IVT) delivered novel AAV-based gene therapy for dry Age-related Macular Degeneration (Dry AMD), a leading cause of irreversible vision loss in people over 60. IVT delivery is less invasive, requires less clinician training and can be delivered in a clinic rather than via surgery.
"We're injecting the drug into the vitreous in the eye,” Fellows says. “And we're using an AAV capsid as the delivery vehicle, [which] will allow the complement factors to be expressed in the retina and presumably be able to affect the course of this disease and prevent the loss of vision.”
Leadership Begins With Listening
Fellows began his career as a sales rep, and discovered early on that a key element to success is listening. He says he listened to what the doctors were saying, identified their needs, and converted that into something that he could act on to solve a problem.
"From a leadership standpoint, listening to what people are telling you about what their needs are, and then trying to find a way that you can address those needs, builds successful relationships with physicians, patients, and employees," he says. "As long as you have your two ears open and you're listening, you're processing and acting, I think that's a good guide to leadership."
From Private to Public, And Vice Versa
Fellows has also had the unusual opportunity of both leading a company through an IPO and taking a public company private.
"Most people don't get the opportunity to do that," he says.
The publicly traded company going private was the Applied Genetic Technologies Corporation (AGTC), a clinical-stage biotechnology company focused on the development and commercialization of adeno-associated virus (AAV)-based gene therapies for the treatment of rare and debilitating diseases. AGTCwas one of the original gene therapy companiesand had been in businessfor more than 20 years.
"AGTC was purchased in November of 2022 by Syncona, one of the leading European investors, and that's when they asked me to take over the company and take it private," Fellows says. "I'm used to the other way around: taking a private company public. It's been a really interesting experience from that standpoint."
He says the biggest challenge in the privatization process is finding new funding sources after losing public financing.
"We've been in the process of raising money, and we anticipate we will be very successful,” he says. “But it is challenging, especially in this environment in the biotech world."
Another challenge involved orchestrating change management in an operation that had been in business for more than a decade.
"Asking people to unlearn behaviors and processes and convincing them there are different ways to do that" is difficult, Fellows says. "I spent a lot of time coaching people that it was now acceptable to stand up and give their opinion and to work new solutions."
Outside the Office
Creating a new work environment for more than 100 employees while driving several programs forward that may help prevent blindness keeps Fellows busy. For relaxation, he enjoys his collection of classic cars, especially his black 1969 280SL Mercedes.
But everyday his focus is on the patients.
"There's only one reason to be in the drug development business and that's to get something to the market that's going to help patients,” he says. “And if you're not interested in that, then I think you're in the wrong career.”
Carefirst Blue Cross Blue Shield Vice President of Clinical Services Piyush Khanna discusses what is top of mind for payers and providers in contract negotiations this year. From the influences of last year's healthcare events to the importance of meaningful data, don’t miss this episode of the HealthLeaders podcast.
NewYork-Presbyterian is partnering with March of Dimes to launch a mobile health vehicle targeting underserved communities in New York City where access to care is limited
NewYork-Presbyterian is going mobile to address maternal health disparities in New York City.
The health system is partnering with March of Dimes to roll out the Mom & Baby Mobile Health Center to underserved communities in The Big Apple. The mobile health vehicle will offer pregnancy, post-birth, and women’s health services to residents who can’t or don’t access healthcare services on a regular basis, regardless of insurance coverage.
Nationwide, hundreds of health systems and hospitals have launched mobile health programs aimed at addressing key population health concerns, targeting communities where access to care is difficult. Mobile maternal health programs are particularly vital given the nation’s high maternal mortality rate.
Locally, according to the March of Dimes, one out of every 18 births in NYC involves a woman who received little or no prenatal care.
"The Mom & Baby Mobile Health Center offers a bridge to care," Auja McDougale, MD, the mobile center's medical director and an obstetrician/ gynecologist at NewYork-Presbyterian/Weill Cornell Medical Center, said in a press release. "Bringing patients into the healthcare system so they have ongoing much-needed medical care is vital for healthy moms and healthy babies."
The 40-foot-long vehicle will be staffed by NYP providers and offer full obstetric and well-woman exams, prenatal and postpartum care, screenings for cervical cancer and sexually transmitted infections (STIs), breast exams, vaccination, laboratory testing, ultrasounds, contraceptive counseling, mental health screenings and referrals, and education about caring for a newborn with breastfeeding support for new mothers.
This health system has four goals to reach with virtual nursing, says this CNO.
The potential of virtual nursing seems promising as many health systems begin to brainstorm and implement programs of their own.
Sarah Brown, CNO at UnityPoint Health, laid out how the Iowa-based health system has set up their virtual nursing program and what their four goals are for the future.
Brown is a part of the HealthLeaders Virtual Nursing Mastermind panel, where several health systems will discuss the ins and outs of their virtual nursing programs and what their goals are for implementing this new strategy.
Here are the four phases that UnityPoint hopes to achieve with their virtual nursing program.
The HealthLeaders Mastermind seriesis an exclusive series of calls and events with healthcare executives. This Virtual NursingMastermind series features ideas, solutions, and insights onexcelling your virtual nursing program.Please join the community at our LinkedIn page.
To inquire about participating in an upcoming Mastermind series or attending a HealthLeaders Exchange event, email us at exchange@healthleadersmedia.com.
