Have you seen this? - Mothering Forums

Forum Jump: 
 
Thread Tools
#1 of 16 Old 08-13-2009, 01:28 PM - Thread Starter
 
kypovan's Avatar
 
Join Date: Jul 2009
Posts: 59
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
Washington State Medicaid to pay same rate for C-section or vaginal birth

Very interesting! I applaud Washington state. There are still some issues I see. Even though a doctor will still be paid the same amount for a cesarean or a vaginal delivery, I think there still needs to be more incentive to do the vaginal delivery. Because, well, let's face it...a cesarean still takes less time and is more convenient for an OB.

So, midwives...what do you think? Do you think a change will take place, or do you think it will effect your practice (assuming it becomes a nationwide thing)?
kypovan is offline  
#2 of 16 Old 08-14-2009, 12:10 PM
 
DocsNemesis's Avatar
 
Join Date: Dec 2005
Location: I make milk..whats your superpower?
Posts: 3,025
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
Thats interesting. Now if only they'd pay for VBAC homebirth

Cari-mama to Eriq, Lile, Paikea, Kaidyn, and Mieke is here!! 2/9/10
DocsNemesis is offline  
#3 of 16 Old 08-15-2009, 01:23 AM
 
sevenkids's Avatar
 
Join Date: Dec 2002
Location: Concrete Jungle
Posts: 2,628
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
it won't make any difference, except to perhaps INCREASE the c-section rates. Fl medicaid pays the same for c-sections and vaginal births, and our c-section rates are pathetic.
sevenkids is offline  
#4 of 16 Old 08-15-2009, 08:51 AM - Thread Starter
 
kypovan's Avatar
 
Join Date: Jul 2009
Posts: 59
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
why do you think the rates will increase from it?
kypovan is offline  
#5 of 16 Old 08-15-2009, 09:55 AM
 
mwherbs's Avatar
 
Join Date: Oct 2004
Location: Tucson, AZ
Posts: 5,575
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 1 Post(s)
there are more payment issues than just the doc's fees- we are talking OR and OR staff and recovery and the supplies used in a section and a longer hospital stay these are billing issues that have more to do with the hospital profits - so if they are paying the same for either type of birth C-sections would amount to a loss- and that would be incentive
mwherbs is offline  
#6 of 16 Old 08-15-2009, 12:08 PM
 
sevenkids's Avatar
 
Join Date: Dec 2002
Location: Concrete Jungle
Posts: 2,628
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
What mwherbs said, there's more money to be made from a c-section, besides dr fees. Hospital stay, anesthesia, OR staff, pain meds, nursing care, newborn exams and nursery stay, potentially the NICU stay, post-op recovery staff, are all billed as seperate items. If you're talking about a time investment, c-sections still pay more. An average vaginal birth may take 12+ hours, an uncomplicated c-section takes 30 minutes. Medicaid (FL)pays 800 for a birth. at 12 hours, that's $66 an hour. A c-section pays $800 for 30 minutes. Which is why we have Dr.s offices scheduling 50-80% of their patients for c-sections, which also allows them to see 25-30 patients a day in office without worrying too much about having to reschedule them all for a pesky unpredictable vaginal birth.They can reserve the OR ahead of time, and section a goodly percentage of their patients on Monday and have the rest of the week to see patients in office.
sevenkids is offline  
#7 of 16 Old 08-15-2009, 12:15 PM - Thread Starter
 
kypovan's Avatar
 
Join Date: Jul 2009
Posts: 59
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
That's exactly what I suspected. But, I wanted to hear what you all thought.
kypovan is offline  
#8 of 16 Old 08-15-2009, 12:20 PM
 
sevenkids's Avatar
 
Join Date: Dec 2002
Location: Concrete Jungle
Posts: 2,628
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
At least, Medicaid here does pay for home VBAC, and quite a few of my clients are VBACs. And I'm expecting that number to increase along with the rising c-section rates. If we could just get the stupid ban on birth center VBACs rescinded we'd be good to go.
sevenkids is offline  
#9 of 16 Old 08-15-2009, 01:25 PM
 
SeaDoula's Avatar
 
Join Date: Jan 2006
Location: Portland, OR
Posts: 275
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
Wait...I am confused. Wouldn't a cesarean birth INCLUDE anesthesia, 3 day recovery, OR staff, etc because without atleast the staff and anesthesia you are not having a cesarean?

I guess I am understanding it as the whole package would be the same price as the vaginal birth. In this case there wouldn't be the same incentive to do cesareans because although the actual surgery is only 30-60min the recovery period is longer. and thus you would be getting paid less than for a vaginal birth in the actual hourly outlook.

Cortney Mama to Lyra 1-20-08 and future midwife through Birthingway College of Midwifery
SeaDoula is offline  
#10 of 16 Old 08-15-2009, 03:38 PM
 
mwherbs's Avatar
 
Join Date: Oct 2004
Location: Tucson, AZ
Posts: 5,575
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 1 Post(s)
I don't know a doc or midwife charges a global fee- and that includes prenatals and the birth fee for their services- but the hospital has it's own charges for the services they offer- I think that is why locally they have switched to surgery tecs having training and and provider number I think that they are going to try and seperate the charges even more so the tecs have to get their own pay from medicaid instead of through the hospital
mwherbs is offline  
#11 of 16 Old 08-15-2009, 05:25 PM
 
sevenkids's Avatar
 
Join Date: Dec 2002
Location: Concrete Jungle
Posts: 2,628
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
No, Medicaid, at least in Fl, is not billed a global fee. For example, if I bill Medicaid for a birth, the prenatals are EACH billed seperately, the birth fee is seperate, the immediate PP care is seperate, the newborn exam is seperate, the follow up home visit is seperate, if I administer an IV or IM pitocin it is a seperate item, if I administer Vit K it's seperate, if I adminster O2, every single little thing is seperate with a different CPT code. Some of the reimbursment rates are a joke, it costs me more to administer a Vit K injection to a baby than what Medicaid pays me, for example, but in general, the services and fees add up.

Private insurance is global, or a Medicaid HMO, but straight Pregnant Woman Medicaid is billed per item/service.

In a hospital, each service or item, even supplies used in the care of the patient, is billed seperate. So, if a woman comes into labor at a hospital, and she gets an IV of Nubain, then decides on an epidural later on, both items are billed and paid seperate. If you look at the medicaid fee schedule for a hospital it is PAGES long with hundreds of items, compared to the fee schedule for a provider. The more procedures/meds/staff/days stayed added, the more a hospital gets paid.

And, Medicaid paying the OB the same fee for either type of birth in Florida, which it has done for years, has done nothing to reduce the c-section rates, if anything, they have skyrocketed. We're right now second in the nation as far as c-section rates go, with a large number of pregnant women receiving benefits.
sevenkids is offline  
#12 of 16 Old 08-15-2009, 11:22 PM
 
AcuMom's Avatar
 
Join Date: Mar 2009
Posts: 12
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
Though they are emphasizing the rate equalization is in part to improve patient safety by reducing the number of unnecessary cesareans, a large part of the decision is aimed at reducing the expenditures of Medicaid. Washington's healthcare system, just like many other states, is feeling the effects of the current economic situation and scrambling to find ways to keep coverage available for as many residents as possible, especially pregnant momma's and children. I will be very interested to see what comes of the plan to increase patient and physician education about the proper place for surgical birth.

From the 2009 DSHS Fact Sheet:
"The 2009 Legislature is looking at the increased C-section rate with an eye toward savings, patient safety
and good evidence-based practice. Legislation (ES2992) would allow for patient decision aids, helping
educate patients, physicians and hospital birth centers about the need to control C-section
recommendations and to understand the role of surgical deliveries. This educational approach will help
new mothers understand their stake in vaginal delivery, improving patient voice, lower provider liability,
and reducing costs to the state."
AcuMom is offline  
#13 of 16 Old 08-16-2009, 10:51 PM
 
DocsNemesis's Avatar
 
Join Date: Dec 2005
Location: I make milk..whats your superpower?
Posts: 3,025
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
Yeah, VBACs arnt allowed in birth centers here either, which I never really understood (I'm near Seattle too). And medicaid doesnt cover HBACs-which again, makes little sense, since they'd be saving thousands on each birth.

Oddly though, medicaid did just start paying for nitrous (sp?) at dentists for children again very recently. I found this out because my 6 year old dd has 8 cavaties (ACK!) and they were saying it was going to be $60 out of pocket for each use, but they just changed it to start covering it again. Now if only the UW dental clinic didnt have a waitlist for my 3 year old

Sorry, went off on a tangent. :P I do agree though, they want to cut costs where they can-which sucks, since its getting harder and harder to find providers that take it-but is understandable at the same time.

Cari-mama to Eriq, Lile, Paikea, Kaidyn, and Mieke is here!! 2/9/10
DocsNemesis is offline  
#14 of 16 Old 08-16-2009, 11:15 PM
 
MaryMelissa's Avatar
 
Join Date: Aug 2009
Posts: 3
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
I think it's a great first step to reimburse care providers the same fee whether it's vaginal or surgical.
However if you are a doctor that has a high cesarean rate you can actually accept a higher number of clients (and thus make more money) as the surgery can be scheduled.
MaryMelissa is offline  
#15 of 16 Old 08-17-2009, 10:33 AM
 
cileag's Avatar
 
Join Date: Aug 2008
Posts: 603
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
I am not optimistic about this at all. As an L and D nurse, I just see it as a way for the hospitals to be even more cash strapped than they are, which puts more pressure on a couple of areas:
1. Individual floor budgets get cut and trimmed, which usually means an increase in nurse to patient ratio. Right now we're barely keeping our head above the water and they are gradually increasing our active labor patient ration from 1:1 to 2:1. This makes it incredibly difficult for me to support an unmedicated mom.
2. More incentive to get people out of the door faster. We also see this--yes, there are mandates put forth by insurance, but already we have most c/s moms out the door by 36 hours, and vaginal deliveries by about 30.

I applaud Washington State for trying, but I think much better incentives would be for a salaried pay system like the Mayo has to start with, and more insurance and government funded out of hospital birth.

Mama to P. born at home 10/09, and W. born in the hospital 2/13

cileag is offline  
#16 of 16 Old 08-17-2009, 11:00 AM
 
mwherbs's Avatar
 
Join Date: Oct 2004
Location: Tucson, AZ
Posts: 5,575
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 1 Post(s)
Quote:
Originally Posted by cileag View Post
I am not optimistic about this at all. As an L and D nurse, I just see it as a way for the hospitals to be even more cash strapped than they are, which puts more pressure on a couple of areas:
1. Individual floor budgets get cut and trimmed, which usually means an increase in nurse to patient ratio. Right now we're barely keeping our head above the water and they are gradually increasing our active labor patient ration from 1:1 to 2:1. This makes it incredibly difficult for me to support an unmedicated mom.
2. More incentive to get people out of the door faster. We also see this--yes, there are mandates put forth by insurance, but already we have most c/s moms out the door by 36 hours, and vaginal deliveries by about 30.

I applaud Washington State for trying, but I think much better incentives would be for a salaried pay system like the Mayo has to start with, and more insurance and government funded out of hospital birth.
these are some excellent points and something fairly important to consider because we have already had the HMO handling of birth and how they control the monies -- and here in AZ we were the model child of HMO/medicad budgeting and it is a mess- but I do remember years ago that the first HMO I came across- Kaiser that the doc was salaried and did not get paid more for complications I think that they may have even had a bonus if there were less complexity to a case so it may be a much better way to manage the monies--- the thing is that it seems that cost is going up to provide medical care but a huge part of that budget is now going to different types of administration--- all those insurance companies handling the money - when we had simpler payment systems where docs were actually paid directly for services the insurance companies were much smaller and administration costs were far lower--- I wonder just how many people each provider has riding on their backs..
mwherbs is offline  
Reply

Quick Reply
Message:
Drag and Drop File Upload
Drag files here to attach!
Upload Progress: 0
Options

Register Now

In order to be able to post messages on the Mothering Forums forums, you must first register.
Please enter your desired user name, your email address and other required details in the form below.
User Name:
If you do not want to register, fill this field only and the name will be used as user name for your post.
Password
Please enter a password for your user account. Note that passwords are case-sensitive.
Password:
Confirm Password:
Email Address
Please enter a valid email address for yourself.
Email Address:

Log-in

Human Verification

In order to verify that you are a human and not a spam bot, please enter the answer into the following box below based on the instructions contained in the graphic.



User Tag List

Thread Tools
Show Printable Version Show Printable Version
Email this Page Email this Page


Forum Jump: 

Posting Rules  
You may post new threads
You may post replies
You may not post attachments
You may not edit your posts

BB code is On
Smilies are On
[IMG] code is On
HTML code is Off
Trackbacks are On
Pingbacks are On
Refbacks are Off