by Max Brantley
How is it that you can save money in the Medicaid program by paying bonuses for more efficient medicine?
Maybe this will give you an idea.
The state Human Services Department says it is paying bonuses to 25 hospitals for taking steps to insure elective early childbirth is medically necessary. A longer time in utero is good for babies and can reduce the cost of expensive neo-natal care.
More than 25 hospitals were awarded bonus payments from Arkansas Medicaid this week for improving the quality of care patients receive, most notably by working to ensure there is a medical reason for women to give birth before 39 weeks of pregnancy.
“Clinical evidence shows that delivering a baby before 39 weeks increases the risks for complications and possible developmental delays,” said Dr. William Golden, Arkansas Medicaid Medical Director. “While some early deliveries are unavoidable because of medical issues, experts now strongly discourage elective deliveries at 37 or 38 weeks as being too risky for the newborn baby.”
Working with the Arkansas Foundation for Medical Care and the Arkansas Hospital Association, Medicaid added measurement of early, elective deliveries to its hospital pay-for-performance program, known as the Inpatient Quality Incentive program (IQI), in 2009. That year, 33.6 percent of all births happened in weeks 37 or 38 of pregnancy. Of those early deliveries that were not natural labor, over 60 percent were elective. The most recent data available shows that in 2011, only 27 percent of all births were in weeks 37 or 38. Of those early deliveries in women without natural labor, only 17 percent were elective. That means nearly 3,000 babies spent one to two weeks longer in utero before birth.
“Hospitals have really taken this issue seriously,” Golden said. “As a result, newborns in our state are having better health outcomes, there is less use of neonatal intensive care units and the health care system is more efficient.”
Janalyn Williams, Arkansas State Director for the March of Dimes, said she is thankful that Arkansas Medicaid included early, elective deliveries as one of the areas it would measure under IQI.
“The best chance a baby has to start a long and healthy life is to be carried to full-term. We know a baby’s brain will increase in size by 33 percent the last 4 weeks of pregnancy as those weeks are vital for organ growth and development,” Williams said. “March of Dimes is elated to see measureable improvement in recent years as it relates to medically unnecessary inductions prior to 39 weeks. This initiative is something we support and urge all birthing hospitals in Arkansas to adopt the stance of no elective inductions prior to 39 weeks.”
Vince Leist, CEO of North Arkansas Regional Medical Center, said he is proud of the work his hospital, physicians and the nursing and obstetrics staff has done as part of IQI.
“We’re well aware that deliveries pre-term create situations or medical conditions that, in most cases, are unnecessary,” Leist said. “We worked very very hard with our doctors and staff to educate the community, and it paid off.”
Now in its sixth year, the IQI program has provided more than $26 million in bonus payments to Arkansas hospitals, and has earned national recognition for its innovation and health care community involvement.
“This initiative represents a growing national trend toward rewarding hospitals and other providers for their commitment to providing high-quality, efficient and evidence-based care to their patients,” said Andy Allison, Arkansas Medicaid Director. “We are encouraged by the improvements since the program began.”
WASHINGTON REGIONAL MEDICAL CENTER
ST. VINCENT INFIRMARY MEDICAL CENTER
WHITE COUNTY MEDICAL CENTER
NORTH ARKANSAS REGIONAL MEDICAL CENTER
ST. BERNARDS MEDICAL CENTER
NW MEDICAL CENTER
ST. JOSEPH'S MERCY HEALTH CENTER
BAXTER REGIONAL MEDICAL CENTER
BAPTIST HEALTH MEDICAL CENTER NLR
ARKANSAS METHODIST MEDICAL CENTER
ST. MARY'S REGIONAL MEDICAL CENTER
CRITTENDEN REGIONAL HOSPITAL
DREW MEMORIAL HOSPITAL
SPARKS REGIONAL MEDICAL CENTER
GREAT RIVER MEDICAL CENTER
JEFFERSON REGIONAL MEDICAL CENTER
BAPTIST HEALTH MEDICAL CENTER — STUTTGART
SALINE MEMORIAL HOSPITAL
HELENA REGIONAL MEDICAL CENTER
MEDICAL CENTER OF SOUTH ARKANSAS
BAPTIST HEALTH MEDICAL CENTER — LR
NEA BAPTIST MEMORIAL HOSPITAL
ST. VINCENT MEDICAL CENTER — NORTH
FORREST CITY MEDICAL CENTER