Costs – Charges – Value

From the TMC blog: 5 reasons birth centers have met their moment

Childbirth Connection has been advocating for greater access to birth centers for much of our 95 year history. We opened the first urban birth center in 1975 and helped found the organization that would later become the American Association of Birth Centers (AABC). Our director from 1970 to 1995, Ruth Lubic, went on to win a MacArthur “Genius” Award for her pioneering work in birth center innovation. Although the number of birth centers has increased in the intervening decades, birth centers remain a very small segment of the health care system. Just 0.3% of U.S. births take place in birth centers.

But a new study out today and a congressional briefing next week are sure to heighten attention to this high-quality, high-value care option. Added to other trends and recent developments, we anticipate this new study will trigger rapid growth in birth centers, and more focused and innovative efforts to integrate birth centers into the health care system. Here are 5 reasons birth centers have met their moment.

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Filed in Blog, Clinicians, Consumers, Costs - Charges - Value, Hospitals and Health Systems, New Reports and Resources on Thu., Jan 31, 2013

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From the TMC blog: Fixing persistent liability concerns in maternity care: We can do it!

One of most commonly cited barriers to improving maternity care is the risk of providers and hospitals being held liable for bad outcomes. Whether it is reining in overuse of tests and procedures, honoring women’s preferences, or increasing interdisciplinary collaboration, good ideas often cannot move forward once the issue of liability is raised.

If we cannot make progress toward more evidence-based, woman-centered care because of liability concerns, then the liability system is functioning poorly. But what are the aims of a high-functioning liability system? Is it just to avoid lawsuits and hold liability insurance premiums down?

In our new report, Maternity Care and Liability, we hold 25 possible liability reforms up to a framework that addresses the needs and interests of all of the system stakeholders: those who deliver care, those who pay for care, and most importantly, the women and newborns who receive care. We developed this framework based on maternity care and liability studies and with the input of clinicians, legal scholars, consumer advocates, policy makers, and others.

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Filed in Blog, Clinicians, Consumers, Costs - Charges - Value, Hospitals and Health Systems, New Reports and Resources on Wed., Jan 9, 2013

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From the TMC blog: Overuse of c-sections: bad for women, babies, and the bottom line

Last month, Childbirth Connection issued Cesarean or Vaginal Birth: What Is At Stake for Mothers and Babies, a best evidence review cataloging dozens of adverse outcomes made more common by cesarean surgery. Maternal infections, prolonged pain, life-threatening complications, and childhood chronic illnesses – evidence demonstrates cesarean increases the likelihood of each of these. These risks are appropriate tradeoffs in some circumstances when cesarean offers a clear benefit. But a growing chorus of obstetric leaders and maternity care reformers are warning that the c-section rate is too high. For the benefit of public health – for the 4 million women who give birth every year and their 4 million babies – we must work to safely rein in the overuse of c-sections.

Today, we learn the extent to which c-section overuse is driving up health care costs, too. Together with Catalyst for Payment Reform and the Center for Healthcare Quality and Payment Reform, we have issued The Cost of Having a Baby in the United States, prepared by Truven Health Analytics.

What is at stake for payers? Not only do unwarranted c-sections create greater health risks for women and babies, this study shows that they also dramatically increase costs for employers and, through Medicaid programs, state and federal budgets.

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Filed in Blog, Costs - Charges - Value, New Reports and Resources on Mon., Jan 7, 2013

From the TMC blog: Help is on the Way: Breastfeeding Support for Healthier Moms and Babies

This year, World Breastfeeding Week coincides with a major milestone for mothers: on August 1, the women’s preventive health provisions of the Affordable Care Act (ACA) go into full effect. Every new insurance policy will now begin covering breastfeeding equipment and lactation support services without co-pays.

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Filed in Blog, Consumers, Costs - Charges - Value on Sat., Jul 28, 2012

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From the TMC blog: Technical report on NQF quality measures now available.

Back in April, Carol Sakala wrote about the new and continuing perinatal and reproductive health quality measures endorsed by the National Quality Forum. The final Technical Report on the set of NQF-endorsed measures is now available.

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Filed in Blog, Clinicians, Consumers, Costs - Charges - Value, Hospitals and Health Systems, New Reports and Resources, Quality Collaboratives on Wed., Jun 27, 2012

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From the TMC blog: Hospital charges still all over the map

You can get from New Jersey to Maryland in less than an hour, but despite the proximity, New Jersey hospitals, on average, charge 3-4 times more than Maryland hospitals for both vaginal and cesarean births. This is just one of the notable facts gleaned from Childbirth Connection’s analyses of the latest maternity charges data. Although the data do not show whether higher charges reflect better care, researchers who look at price variation generally find no relation between prices and the quality of care, complexity of patient care needs, or costs of actually delivering care. Such unwarranted price variation amounts to billions in wasted spending across the health care system, according to a February report from Thomson Reuters that looked at various hospital procedures.

New charts compiled by Childbirth Connection (PDF) show the significant price variation across states that report average labor and birth hospital charges to the Healthcare Cost and Utilization Project (HCUP). The chart set also includes average prices charged by birth centers, which fall well below charges for uncomplicated vaginal births in hospitals. State-by-state analyses (PDF) show charges increasing year-to-year, and reveal differences by mode of birth and presence or absence of complications.

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Filed in Blog, Costs - Charges - Value on Wed., May 9, 2012

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From the TMC blog: Update on Nationally Endorsed Maternity Care Performance Measures

At Childbirth Connection, we know that performance measurement is an essential element for moving toward the maternity care system that women and families deserve — one that meets the Triple Aim of better care, better outcomes, and better value. Performance measurement is central to our 2020 Vision for a High-Quality, High-Value Maternity Care System and companion Blueprint for Action consensus reports. So, we are thrilled that the National Quality Forum (NQF) has approved for endorsement 12 continuing and 2 new maternity care performance measures.
Pending a 30-day appeal period, these will continue to be available or be newly available as nationally endorsed performance measures for both quality improvement and public reporting. I am pleased to offer this update as co-chair of the multi-stakeholder Steering Committee that evaluated measures submitted by developers within the formal NQF consensus development process with explicit criteria for endorsement.

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Filed in Blog, Clinicians, Consumers, Costs - Charges - Value, Hospitals and Health Systems, New Reports and Resources, Quality Collaboratives on Wed., Apr 11, 2012

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From the TMC blog: Caesar’s Ghost: National Health Policy Forum Focuses on Cesareans

On March 31, the eve of Cesarean Awareness Month, the National Health Policy Forum addressed the rising rate of cesarean section in the United States. The Forum is a non-partisan organization that offers educational programming and other health policy resources to congressional and federal agency staff.

Caesar’s Ghost: The Effect of the Rising Rate of C-Sections on Health Care Costs and Quality, explored the drivers and consequences of the increasing c-section rate and public- and private-sector initiatives to achieve a more optimal rate. Forum presenters included:

More information about the program and the full slide set from each presenter are available from the National Health Policy Forum.


Filed in Blog, Clinicians, Costs - Charges - Value, Hospitals and Health Systems on Tue., Apr 3, 2012

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From the TMC blog: What is a Maternity Care Home?

Earlier this year, the Center for Medicare and Medicaid Innovation (CMMI) announced Strong Start, a major federal initiative to improve birth outcomes among Medicaid enrollees. (Letters of Intent are now due May 11, 2012.) The initiative includes a funding opportunity for three innovative models of prenatal care delivery that show promise for reducing preterm births. Two of the three models have national organizations that define and promote them: group prenatal care models like CenteringPregnancy and prenatal care in birth centers, a model promoted by the American Association of Birth Centers. The third model has left some people scratching their heads: Maternity Care Homes. What is a Maternity Care Home and, more importantly, what changes do practices have to make to become one?

The purpose of this article is to foster awareness and discussion about Maternity Care Homes and to encourage Strong Start applicants to advance this model. The article will answer common questions about Maternity Care Homes, with an emphasis on implementation. If you have other questions, please leave them in the comments.

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Filed in Blog, Clinicians, Costs - Charges - Value, Funding Announcements, Hospitals and Health Systems on Wed., Mar 28, 2012

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From the TMC blog: Early Elective Deliveries Are Decreasing

One year ago, the Leapfrog Group released results of their annual Hospital Survey, for the first time publicly reporting rates of early elective deliveries (inductions or planned c-sections occurring before 39 weeks without a medical reason). The results were shocking, with hospitals varying from virtually zero to well over half of elective deliveries occurring before 39 completed weeks. Last week, we partnered again with the Leapfrog Group and other organizations to publicize the release of this year’s survey results, and we’re pleased that the data show rates moving in the right direction.

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Filed in Blog, Clinicians, Consumers, Costs - Charges - Value, Hospitals and Health Systems, New Reports and Resources on Tue., Jan 31, 2012

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