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
- National Vital Statistics Reports, "Trends in Low Risk Cesarean Delivery in the United States, 1990-2013," November 2014.
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.
- On October 17, 2014, the Coalition for Quality Maternity Care (CQMC), led by ACNM, submitted comments to The Joint Commission in response to a revised draft of their Perinatal Care Certification Program, which had been revised with input from the CQMC and others, provided in March of 2012.
- On March 26, 2014, the Coalition for Quality Maternity Care (CQMC), led by ACNM, submitted comments to The Joint Commission in response to their proposed Perinatal Care Certification Program.
- On January 21, 2014, the Coalition for Quality Maternity Care (CQMC), led by ACNM, submitted a comment letter to CMS regarding proposed plans for a Quality Rating System to be used to evaluate health plans offered through the Health Insurance Marketplace.
- In April of 2011, ACNM led in the creation of the Coalition for Quality Maternal Care (CQMC), a group of organizations dedicated to ensuring affordable, high quality maternity care for all women and infants. It seeks to remove barriers to optimal maternal health practice, promote models of care that are evidence-based, improve maternity care choices for women and reduce disparities in maternal and newborn health outcomes.
- MOMS for the 21st Century Legislation - A bill to address various issues related to maternity care
- Quality Care for Moms and Babies Act of 2013 - A bill to support creation of maternity quality measures and their use and dissemination
- ACNM Signs onto Letter of Support for Preemie Reauthorization Act (February 4, 2013)
- ACNM and AWHONN Urge MACPAC to Make Recommendations to the Congress for Improving the Quality of Medicaid Maternity Care (October 15, 2012)
- ACNM comments on proposed measures for perinatal and reproductive health care (2011)
- ACNM Comments on the AMA Physician Consortium for Performance Improvement (PCPI) Maternity Care Work Group on the Maternity Care Performance Measures Set
- Midwifery: Evidence Based Practice