The statistics on maternal health outcomes are sobering. According to the CDC, about 700 women in the US die annually in pregnancy or within the first year after pregnancy, and another 50,000 women experience complications with short or long-term impacts.
It is a problem that persists despite fairly widespread media attention. In April 2022, for example, in a personal story in which she chronicled the complications she suffered during her own pregnancy, tennis star Serena Williams shone a light on maternal mortality rates among women of color and outcomes for the Black community generally, which has mortality rates nearly three times higher than that of White women. Yet despite the attention and focus, the US’s mortality rates remain high and rose yet again during the course of the pandemic.
Federal Quality Initiatives
The Biden-Harris administration is focused on addressing the maternal health crisis and racial disparities with a series of quality-focused initiatives, such as:
- The designation of Black Maternal Health Week.
- Medicaid expansion opportunities.
- Expansion of telehealth best practices.
- Investments in home-visit services.
- Public health measures.
Among the administration’s quality initiatives is the creation of the new Birthing-Friendly designation, which publicly identifies hospitals meeting certain criteria related to their maternal health programs and introduces new quality measures that will ultimately be tied to hospital payments.
Birthing Friendly
The concept of identifying hospital maternity care services in accordance with quality capabilities is not new or unique, and ECG has reported on this phenomenon in the past. More than 15 states have implemented voluntary or required levels of maternal care, where birth centers must meet certain criteria to care for patients at different complexity levels.
The Birthing-Friendly initiative broadens these efforts and helps the public identify sites that are actively engaged in maternal quality initiatives. CMS officially began collecting data in May (for the period from October to December 2021), when hospitals had to attest to the following Maternal Morbidity Structural Measure question:
“‘Does your hospital or health system participate in a Statewide and/or National Perinatal Quality Improvement Collaborative Program aimed at improving maternal outcomes during inpatient labor, delivery and post-partum care, and has implemented patient safety practices or bundles related to maternal morbidity to address complications, including, but not limited to, hemorrhage, severe hypertension/preeclampsia or sepsis?”
Hospitals that answer yes to the question will be designated “Birthing Friendly” and will be identified as such on Care Compare, where the maternity quality measure on elective early C-sections is published. While today it starts with only attestation of quality efforts, the Birthing-Friendly program will evolve over time as reporting is required on additional clinical quality measures. Right now, the draft Inpatient Prospective Payment System (IPPS) rule for 2023 includes measures on severe obstetric complications and cesarean birth. The measures will change over time, but ECG expects the increasing transparency on maternal outcomes and related quality results to be a permanent fixture in obstetric services.
Why Does This Matter?
The new designation gives patients and providers another important data point with which to evaluate and compare birth centers in their area. The Birthing-Friendly designation signals that hospital teams are actively working on quality and safety initiatives and are dedicated to ensuring that each patient gets the very best care.
As the program matures and requires more reporting of perinatal quality measures, it will also make public more information about obstetric centers, and it is important to consider how organizations will prepare for that—especially as those measures begin to impact payment levels in future years.
Is Your Organization Ready to Be Birthing Friendly?
Now that your organization has submitted its Birthing-Friendly attestation, here are a few ways to prepare for the final IPPS rules and new quality metrics.
- Align with Evolving Quality Reporting Requirements: The Birthing-Friendly attestation will be reported on in the fall. The IPPS Final Rule will be released later in 2022, and CMS has indicated that the Birthing-Friendly measures will evolve. Keep a close watch for changes.
- Become a Force for Change in Your Community: Assessing policies and procedures for unintended bias, analyzing your quality data by patient characteristics such as race or ethnicity, and evaluating systemic bias are important first steps for change.
- Assess Your Quality of Care and Your Quality Infrastructure: The maternal health crisis is driving the need for a closer look at quality programming and structures in obstetric care. Is your hospital poised to not only report on quality outcomes but also to meaningfully assess quality and drive change across your diverse patient populations? Now is the time to conduct a gap assessment.
- Develop an Action Plan: Depending on the results of your facility’s gap assessment, consider the infrastructure and resources your organization needs to achieve the desired results. Areas of opportunity may include clinical and administrative leadership organization, roles, and responsibilities; quality committee structures; policies and procedures; and staffing mix.
- Critically Evaluate Your Women’s Health Strategy: Step back and evaluate whether your system has a solid strategy to navigate the complex women’s health landscape. As you examine your maternity program structure, consider the bigger women’s health picture. A strong strategic plan will ensure that the women in your community not only have a safe and healthy birth experience but also stay with your system for future care needs.
Published July 28, 2022