Enhancing Neonatal Care in Underserved Areas

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Doc makes it his mission to bring subspecialists to rural southeastern North Carolina.

By Taylor Sisk

Fernando Moya, requires little sleep – which is fortunate, given that his days are stretched pretty thin.

Moya, a neonatologist, is founder, president, and CEO of Coastal Children’s Services, a pediatric subspecialty group. The practice is based in Wilmington, but, by design, has no stand-alone offices of its own. Moya’s objective in creating Coastal Children’s Services was to enhance quality neonatal care in Wilmington and then reach out into the largely rural southeast, placing neonatologists and other pediatric subspecialists where they’re needed most.

In additional to its offices at Wilmington’s New Hanover Regional Medical Center, the practice now has pediatric specialists in four hospitals in the region: Onslow Memorial Hospital, Camp Lejeune Naval Hospital, Southeastern Regional Medical Center, and Columbus Regional Healthcare System.

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Fernando Moya’s objective was to enhance quality neonatal care in Wilmington and then reach out into largely rural southeastern North Carolina.

On a recent Tuesday morning at Southeastern Regional in Lumberton, Moya is clutching an extra-large cup of Dunkin’ Donuts coffee and sporting a day’s growth of stubble. He’s just had, he allows, “a rough night” in the neonatal ICU. But he’s eager to discuss his ambitions for pediatric care here in Robeson County, a county with the state’s lowest median household income, at $30,248, and some of its worst health indicators.

Coastal Children’s Services has been providing care at Southeastern Regional since August of last year. Moya hasn’t yet hired someone to oversee operations here, so he’s still very hands-on. But that’s his modus operandi anyway: right in the thick of things. He spends a few days each month practicing throughout the region.

“I like to be here because I like to try to bring the enthusiasm of what we’re trying to do,” Moya says. “I enjoy it.”

An opportunity to make a difference

A native of Chile, Moya began his pediatric training there and completed it at Yale. He remained on faculty at Yale for 6 years, served as associate director of neonatology at Louisiana State University and then chief of the division of neonatal-perinatal medicine at the University of Texas McGovern Medical School in Houston.

In 2005, he was recruited to come to Wilmington. Negotiations had begun to build a children’s hospital at New Hanover Regional, and Moya was attracted by the opportunity to bolster neonatal care in the area. He now serves as associate director of neonatology at New Hanover Regional and medical director of the Betty Cameron Children’s Hospital.

At the time of his arrival, the nearest NICU was in Fayetteville, nearly 100 miles away. Moya began to plot a regional strategy, with New Hanover Regional as the hub and Level 2 NICUs in the surrounding more rural areas.

Alan Stiles, UNC Health Care system’s vice president for Network Development and Strategic Affiliation and former chair of pediatrics at the N.C. Children’s Hospital, says that what Moya is providing was much needed.

“The southeastern region of North Carolina mainly has smaller rural hospitals with limited capacity to do more than stabilize and send premature or sick newborns to larger hospitals, often at great distances from their families and home,” Stiles says.

According to research conducted by NC Child, in Orange County — home of the UNC Health Care system — there are 3.4 infant deaths per 1,000 live births and life expectancy at birth is 81.7 years. In Robeson County, only a 2-hour drive away, there are 13.4 infant deaths per 1,000 live births and life expectancy at birth is 74.2 years.

Providing care where most needed

Moya founded Coastal Carolina Neonatology in 2009. His first regional alliance was with Onslow Memorial in Jacksonville, an hour from Wilmington.

In May 2010, he launched a broader initiative, Coastal Children’s Services, an LLC, which today employs 25 physicians and about the same number of advanced practice clinicians. Pediatric subspecialists now practice either in the hospitals or in already established practices throughout the region.

“Our vision has been to bring the care to [the hospitals], help them elevate the level of care, and keep as many patients as they can there,” Moya says. “We’ll support them locally. Whatever cannot be managed there will go either to Wilmington or elsewhere, with the appropriate triaging.”

Stiles, who calls Moya a “highly accomplished neonatologist and academic leader,” emphasizes the importance of the relationships with academic medical centers that Moya has forged to ease transfers when necessary.

Joann Anderson, president and CEO of Southeastern Regional and past president of the American Hospital Association’s Small and Rural Hospital Council, has embraced Moya’s initiative: “With Dr. Moya’s help, our staff is learning to care for more complex health care issues in neonates.

“By doing this, we’re hoping to be able to keep the infant near its support family while potentially improving outcomes because care is more readily accessible.”

Results take time. But according to NC Child data, the number of children up in Onslow County (where Moya formed his first alliance) receiving early-intervention services in their first 3 years rose by 45 percent from 2009 to 2013.

How it works

Making this work, Moya says, entails several critical elements.

First, “we recruit extraordinary people who can multitask.” That means, for example, that Janet Hoffer, who handles marketing and PR, also assists with education initiatives. It also means an all-hands approach to administrative duties.

Second is keeping overhead low. Being based in hospitals and established practices helps considerably in that effort.

Moya says he negotiates “reasonable contracts” with the hospitals, providing a number of services at cost. “It would be very hard to try to milk a lot of resources out of hospitals that are struggling,” he says.

Education and research

Coastal Children’s Services is also cultivating alliances beyond the region. The University of Chicago Medicine Celiac Disease Center, for example, has provided training, and Moya hopes to establish his practice as an affiliate.

He and his colleagues host three annual conferences, offering “world-class” speakers, Moya says. A recent symposium speaker was Richard Polin, MD, a member of the American Academy of Pediatrics’ Committee on Fetus and Newborn and co-author of the widely used Workbook in Practical Neonatology.

Hosting such events, Moya says, is central to the mission: “We have the connections, we have the insight, we have the motivation. And we also learn ourselves.”

The practice also conducts clinical research — both its own and in multi-center trials — and New Hanover Regional is now a member of the Pediatric Trials Network.

Unacceptable outcomes

North Carolina’s infant mortality rate (in 2014, 7.1 deaths per 1,000 live births) has consistently been among the nation’s highest. It’s considerably worse in the southeastern region of the state.

Moya believes that in an area so close to nationally recognized medical centers, including UNC and Duke, such outcomes are unacceptable.

“We hope to be a vehicle to summon that collective strength,” he says. For that to happen, “We need to partner with others, improve access to general care, then some specialty care. And then let’s try to recognize the time needed to interact, educate, and improve quality — and then see where those rewards go.”

“When he approached me about collaborating, he described his vision and reasons for it,” Southeastern Regional’s Joann Anderson says. “He told me he believed a regional approach to issues related to infant mortality was needed.

“I fully support that vision.”