Hospital Bypass Among Rural Obstetric Patients With Commercial Health Insurance

Hospital bypass by rural obstetric patients contributes to low patient volumes at rural hospitals, limiting revenues and eroding the viability of the obstetric service line. Bypass by commercially insured patients is particularly concerning for hospital finances because commercial insurers reimburse hospitals at higher rates than public insurers for obstetric services. Using commercial claims, we characterized bypass among rural obstetric patients with commercial insurance and calculated hospital payments generated by bypass admissions. Half of rural obstetric patients bypassed their nearest obstetric hospital between 2016 and 2021. Bypass rates were higher when the nearest obstetric hospital was in a noncore or urban-adjacent county, had low birth volumes, or lacked higher-level neonatal services. Bypass rates increased when patients had another nearby hospital option or higher clinical risk. However, bypass by low-risk patients was common and generated $536 million in payments to admitting hospitals, suggesting a meaningful role for obstetric bypass in influencing rural hospital finances.