As I prepare for next week’s webinar on payment reform to align incentives with quality, I have been thinking a lot about how we pay for maternity care in this country, and the opportunities to rein in costs while improving the quality of care. I have concluded that we face both an unprecedented opportunity and an unprecedented responsibility to get serious about maternity care payment reform.
Pregnancy, childbirth, and newborn care are collectively the most common and expensive hospital conditions billed to both Medicaid and private insurers. The national hospital bill for maternity care totaled $98 billion in 2008 – and no other condition came close to this figure. (See more facts about costs on Childbirth Connection’s updated Facts and Figures page), With states across the country facing budget crises, strategies that responsibly reduce the Medicaid bill for births ought to be on the table, especially if we can do so while simultaneously improving quality. (More on that in a minute.)
What are the arguments for payment reform? They fall into a few categories:
- We’re paying too much
- Incentives and idiosyncrasies built into the current system virtually guarantee that we’ll continue to pay too much
- The payment system offers no accountability whatsoever for providing high quality care. In fact, it incents poor quality care.
Although maternity care seems to have been off the radar of those debating strategies to bend the cost curve, that seems to be changing. A flurry of recent articles and reports have demonstrated the points above: