The purpose of this study was to identify any change in the provision of obstetrical services by CAHs and to determine whether any changes could be explained by particular factors facing CAHs. Medicare Cost Report data on nursery patient days were used as a measure of provision of obstetrical services.

Key Findings:

• The percent of CAHs with at least one nursery day increased markedly between 2000 and 2006 and only a small decrease occurred after 2007. However, this was due to substantial changes in the number of CAHs, the average number of CAH beds, and the average daily census of CAHs over the ten-year period.
• Among hospitals that were or would become CAHs, the percent with at least one nursery day decreased from 64.0 percent preconversion to 55.5 percent within three years after conversion.
• No similar change in OB service provision occurred among rural hospitals that did not convert from PPS to CAH during the same time period Thus, reduction of OB services cannot be readily explained by other factors facing rural hospitals generally, such as OB provider shortages or malpractice rates.
• Despite the reduction in the number of CAHs with nursery days, there was little change in the total number of nursery days in CAHs. Hospitals that continued to offer OB services experienced a roughly 20 percent increase in their average number of annual nursery days.