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Issue Summary

Many payers are revising their reimbursement systems to reward quality, as opposed to the quantity or type of care provided.  For example, within Medicare, quality measurement has been incorporated into payment systems related to hospitals, physicians, ESRD facilities, Medicare Advantage plans, and Accountable Care Organizations.  Many private payers and Medicaid programs are following suit.  In general, providers delivering higher quality care receive incentive payments, while those delivering low quality (and/or high cost) care, are penalized.

In addition to using quality measurement to determine payment, payers and government entities are making these data available to the public to help guide their choices of insurers or providers.  For example, the state of Virginia provides data on risk-adjusted cesarean section rates for every obstetrician in the state.  CMS has long posted quality data related to Medicare Advantage of Medicare Prescription Drug Plans and those data do impact which plans that people choose to enroll into.  The Health Insurance Marketplaces will also be posting information on the quality ratings of plans offered through that program.

The development and use of quality measures is a critical issue and will only become more so in the future.

Available Literature and Resources

  • Perinatal Quality Measures endorsed by the National Quality Forum
  • The Joint Commission's Perinatal Care Quality Measures
  • Strong Start for Mothers and Newborns Initiative, run by the Centers for Medicare and Medicaid Services
  • Childbirth Connections - source for significant amount of information related to quality outcomes around birth
  • Birth by the Numbers - Data analysis related to birth in the U.S.
  • Evidence-Based Maternity Care: What It Is and What It Can Achieve. The Milbank Report.

  • 2014 March of Dimes Report on Preterm Birth:
    The state-specific summaries include state preterm birth rates and grade the states on prevention strategies like rates of uninsured women, late preterm birth, and maternal smoking. Affiliates could consider using this data juxtaposed against midwifery outcomes and associated cost savings as a compelling talking point for the benefits of increased access to midwifery care.

  • National Vital Statistics Reports, "Trends in Low Risk Cesarean Delivery in the United States, 1990-2013," November 2014.
    A new National Vital Statistics Report describes trends in low-risk cesarean delivery rates in the United States from 1990 through 2013. Trends in low-risk cesarean delivery by state of residence, gestational age, age of mother, race, and Hispanic origin of mother are examined. Importantly, the report finds that the overall cesarean rate increased 60% from 1996 to 2009, with only a slight decline since that time.



American College of Nurse-Midwives
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