Bundled payments may be coming for maternity care

Bundled payments are being considered for many different episodes of care with hospitals. The most notable bundled payment model is the joint replacement model created by the Centers for Medicare & Medicaid Services (CMS). But other models are generating interest as well – including a potential bundled payment model for maternity care. 

Bundling payments for live birthsA growing number of facilities and payors are exploring the idea of bundling payments for services rendered after a mother gives birth. The feds are on board, too, so this could be the next big trend with value-based care.

According to an article published in Hospitals & Health Networks, the Health Care Payment Learning and Action Network, a federally affiliated network of both public and private healthcare shareholders, has identified maternity care as one of its top priorities for implementing bundled payments.

Maternity and newborn care is a significant contributor to the nation’s healthcare costs. Statistics from the Agency for Healthcare Research and Quality (AHRQ) indicate that hospitalizations resulting in live births make up at least 10% of total hospital stays.

In addition, over 30% of U.S. births occur via cesarean section, according to numbers from the Centers for Disease Control and Prevention (CDC), and C-sections are typically more expensive than natural deliveries. While there’s medical necessity for some cesarean births, that’s not the case for all of them.

Positive impact

To reduce unnecessary surgeries and lower all costs associated with maternity care, some health systems have already started using a bundled payment approach.

Pennsylvania’s Geisinger Health System is one of them – its hospitals have received bundled payments for maternity care for six years, according to the Hospitals & Health Networks piece.

During that time, not only have C-sections dropped because Gesinger’s hospitals perform fewer early elective deliveries, but fewer babies have been sent to the NICU due to the system’s increased focus on standardizing processes of care throughout birth and delivery. Overall, costs are down and satisfaction is up, since mothers and babies are healthier and happier.

Gesinger’s episode-based maternity care only includes the mother’s prenatal, labor and delivery care – not the newborn’s. And it’s only available for those with low-risk pregnancies to protect the health of patients.

Other hospitals and payors have yet to follow Geisinger’s lead with bundled maternity care payments, but it’s only a matter of time before the practice becomes more common – especially as more focus shifts toward controlling costs and boosting value.

Future of maternity bundling

One of the hurdles to clear before bundled payments become the norm for maternity care is figuring out exactly how long an “episode” should last.

While some believe the bundle should just include the mother’s care, as with Geisinger’s program, others think it should be expanded to include the first 30 days of newborn care.

However, once payors get these specifics set in stone, it’s only a matter of time before maternity care is added to the list of conditions for which hospitals must accept bundled payments. So it’s critical to start preparing now by taking a look at what your facility can do to lower the likelihood of C-sections and other costly medical interventions for expectant mothers.