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
- 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