Harris Regional Hospital is a powerhouse when it comes to delivering babies in the mountains, a legacy it has pledged to maintain with the symbolic merger of the hospital’s OB doctors into a single practice under the hospital’s umbrella.
Before the merger late last year, two OB practices handled deliveries at Harris. One was the privately owned practice of Smoky Mountain OB GYN. The other was the hospital-owned practice of Harris’ Women’s Care.
Last fall, the hospital acquired Smoky Mountain OB GYN and brought their providers into the fold of Harris Women’s Care.
“The staff and patients have made a great transition,” said Dr. Mila Shah-Bruce, a founding provider in Harris Women’s Care.
It’s the first time in history that all the providers delivering babies at Harris are under one roof, in the same practice, and affiliated with the hospital.
And that provides for a seamless patient experience and care, according to Harris CEO Steve Heatherly.
It also dovetails with the evolution of Harris Pediatric Care.
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Until six years ago, all the pediatricians and OB doctors practicing at Harris operated standalone, private practices. Now, all four pediatricians and all three OB providers who practice at Harris are in Harris-owned practices.
“I think going forward we are going to continue to invest heavily in these two practices,” Heatherly said.
The women’s care and pediatric care providers are now more easily able to work together to provide seamless care for a mother during pregnancy and her babies once they’re born, despite mother and baby technically being patients of different practices. A new childbirth class series is one example.
“Brand new parents, who are just really kind of groping around in the dark, the classes really help them sort things out beforehand,” said Dr. Charles Toledo, the founding doctor of Harris Pediatrics.
Toledo said benefits are also realized in the hand-off of a newborn’s care from the OB provider at the time of delivery to a pediatrician.
“There is consistency. They understand us, they know us, they know our styles,” Toledo said. “There is no second guessing. They know what we can do and how we are going to do it. There are efficiencies there that have truly improved things.”
Even once a woman and her baby are discharged, it’s the pediatrician doing the one-week check-up for a newborn who first notices things like post-partum depression or breast-feeding difficulties with the mom.
“We can just pick up the phone and say, ‘Hey can you check in to this?’” Toledo said.
“It is very integrated in that aspect,” Shah-Bruce agreed. “It is becoming more cohesive.”
Evolution of hospital-owned practices
The trend of doctors moving from standalone private practices to hospital-owned practices isn’t uncommon. Nationally, the transition has been playing out since the early 2000s.
“Physicians integrating with hospitals is a theme,” Heatherly said.
That theme was somewhat later coming to Harris.
Heatherly said the hospital didn’t push doctors to affiliate, because to him, the structure was secondary to the larger goal.
“We still believe the highest form of integration is local physicians providing high quality care closer to home,” Heatherly said.
While Harris hasn’t pressured private physician practices into affiliating or selling out to the hospital, it has launched its own practices on the side, even in service lines where there was an existing private practice.
That was the case with Harris Women’s Care and Harris Pediatrics, both of which were launched by the hospital alongside existing stand-alone practices.
The hospital wasn’t trying to compete or force them out of the market, but rather wanted to ensure that the service line was meeting the demand and needs of the community, Heatherly said.
“A private practice will at times make decisions that are perfectly rationale in the context of their business, which may or may not be the best thing for the entire service line,” Heatherly said. “The benefit of this level of integration is there doesn’t have to be a disconnect between those two things.”
Dr. Janine Keever, the owner of Smoky Mountain OBGYN wasn’t pressured to sell out to Harris, Heatherly said. Rather the hospital was there to support her in whatever decision she made.
“We were not aggressive in going to Keever and saying, ‘We have to acquire your practice,’” Heatherly said. “But we were aggressive in the idea that we wanted to be her partner in making that change, whatever change she wanted that to be.”
In fact, Keever came to Harris first.
“She was trying to figure out what she wanted to do in the long term,” Heatherly recalled. “A couple months into the discussion, she decided what was best for her was to sell the practice to the hospital to create continuity of care for her patients and for her to pursue opportunities elsewhere.”
Shifting OB landscape
For most of the past decade, Keever’s practice had a virtual monopoly on the OB service line. At its peak, Smoky Mountain OB GYN had seven doctors and midwives on staff, delivering more than 650 babies a year at Harris, and bringing in patients from a five-county area.
Keever built a spacious and well-appointed new office on a hill overlooking the hospital to serve the seemingly indefatigable demand for women’s health and OB care coming her way.
But Keever’s empire collapsed abruptly 18 months ago.
Half her staff left en masse to join a competing practice being launched by Mission.
Meanwhile, Harris had just launched its own women’s care practice, and she lost another physician to them, leaving her practice with only one other provider beside herself.
Her patient load dropped substantially and her new state-of-the-art OB office sat half empty.
Keever’s long-standing cooperative relationship with Harris remained strong, however, even during the upheaval. She joined forces with the doctors in the new Harris Women’s Care, forging an alliance to serve patients delivering at Harris, despite being separate practices.
But the long-term viability of her standalone practice amid the competition playing out between Harris and Mission prompted soul searching in her part.
She ultimately chose a life-changing path: to close her practice here, move back home to be closer to family and spend more time as a mom.
“After eleven years spent building the practice and the new facility, I have decided to focus more time on raising my son and teaching,” Keever wrote in a letter sent to existing patients last year. “I will greatly miss the relationships that I have built with my patients over the last decade. I would like to thank you for trusting me to care for you over the years.”
Harris acquired Keever’s posh medical office building and moved Women’s Care into it following the merger.
“We really needed the additional space, and everything is state-of-the-art,” Shah-Bruce said.
Harris Women’s Care is now comprised of three OB doctors and a nurse practitioner. But only the OB doctors can deliver babies. They don’t currently have a midwife, which is one distinction with the Mission Women’s practice serving in the western counties.
Shah-Bruce said that Harris’ OB doctors are all women, however, and can provide the same type of natural, personal connection and natural birth options midwifes are known for.
“You can be as invasive or as least invasive as an OB as you feel comfortable,” Shah-Bruce said.
“The presence or absence of midwives for us doesn’t’ expand or contract the scope of services,” Heatherly said. “They offer the full gamut of care that has been offered in the community for years.”
Mission Women’s Care in western counties
Angel Medical Center in Franklin has seen major gains in the delivery of babies at its hospital in the past year following the launch of an expanded OB and women’s care service line under the umbrella of Mission Health in late 2014.
Angel Medical Center saw a 70 percent increase in newborn deliveries from 2014 to 2015. It marks a major shift in the OB landscape in the western counties.
Harris Regional Hospital in Sylva has historically been the go-to hospital for having babies across the four western counties. But after Mission Health acquired Angel, it began investing substantially in the build-up of its women’s health and OB service line.
Mission Women’s Care brought six doctors and midwives on board and opened new offices in Sylva and Bryson City, in addition to its home base in Franklin — making a major foray into the territory once dominated by Harris.
“The feedback we’ve been receiving has been very positive. Women seem to appreciate having a choice in care providers,” said Kellett Letson, vice president and chief of women’s health for Mission Health.
“It is important for women to have a choice and choose what is right for them,” added Dr. Elizabeth England, with Mission Women’s Care in Sylva, Bryson City and Franklin. “Why a woman chooses one physician or office over another is a very personal decision often dependent on several factors important to them and their family.”
The increase in deliveries at Angel has led to a decrease in the volume of deliveries at Harris Regional Hospital in Sylva. Deliveries at Harris dropped from more than 600 a year on average to 490 in 2015.
But Harris is not daunted by the new competition from the Mission practice.
“We will continue to be the dominant provider of women’s and children’s services. We feel like we are in a better position to do that,” Harris CEO Steve Heatherly said.
Heatherly added that competition is not bad.
“Choice is not bad for patients,” Heatherly said.
That’s one thing both provider practices agree on.
“We believe it is good for Western North Carolina to have so many great obstetric and gynecologic providers from which to choose,” England said.
— By Staff writer Becky Johnson