I recently sat down with Stina Sieg to discuss why the struggle birth centers face in getting AHCCCS coverage for our services. Ms. Sieg also interviewed AHCCCS spokesperson Heidi Capriotti. According to AHCCCS:
“We haven’t heard directly from members that that’s their preference,” said AHCCCS spokesperson Heidi Capriotti.
Capriotti explained that if you’re a mom-to-be on AHCCCS and a birthing center experience is something you want, you should definitely contact her agency. But that’s probably not enough.
You’ve got to contact managed care provider – your health-care plan. They’re the ones who set the reimbursement rates. And Capriotti said they’re the ones who ultimately choose whether or not to include birthing centers in their coverage.
“But we are actively working with our managed care providers to explore options to expand the number of birthing centers available to our members,” she said.
If you are a member – do you agree? It’s time to call AHCCCS and let them know that you do want birth center care! Let’s actively work together for the change we want to see.
When I first experienced the birth center model of care as a client, I was so focused on the excellent prenatal care and different model for birth that I did not realize “birth center” encompasses so much more. As we explored the model of care in our start-up phase looking at other birth centers, the depth of the community support and access point for the medical system was our goal.
The Business of Being Born recently featured the Health Foundations Birth Center in Minnesota, who has beautifully achieved this “birth center” model of care with the depth of services that have come to define the birth center experience. Amy Johnson-Grass, the birth center’s founder and the current President of the American Association of Birth Centers explains:
We are unique because we are a lot more than just a birth center and midwifery practice. We are truly an integrative practice with a huge spectrum of offerings on-site. We are not only familiar with herbs, homeopathy, nutrition, and counseling, but we are also prescribers. Plus, we have other providers that work with us too, like chiropractors and acupuncturists. We’re a lactation center. We’re an education center with lots of different class offerings. And, we offer quite a few services for women, outside of maternity care, like annual exams, problem visits, and contraception offerings. This continuity of care (even extending to their kids with our Pediatricians!) really allows for us to focus on community building, which is so important because so many of us lack it. So we hold many events to continue and build those connections ranging from larger gatherings like Every Woman Can to smaller retreats, family picnics, and annual Valentine’s Day party…during Christmas we have about 100 kids come through to see Santa!
A fascinating case study and exploration of the WHY behind the delay in evidence to implementation in health care. Although the article does not address maternal health care, the philosophy is clear – does this sound familiar?
David Epstein/ProPublica writes:
“Most of my colleagues,” Christoforetti says, “will say: ‘Look, save yourself the headache, just do the surgery. None of us are going to be upset with you for doing the surgery. Your bank account’s not going to be upset with you for doing the surgery. Just do the surgery.’”
The first case study in the article looked at two patients with very different outcomes. Neither one needed a stent. The patient who got one did not survive. The article explains:
Stents for stable patients prevent zero heart attacks and extend the lives of patients a grand total of not at all.What the patients in both stories had in common was that neither needed a stent. By dint of an inquiring mind and a smartphone, one escaped with his life intact. The greater concern is: How can a procedure so contraindicated by research be so common?
When you visit a doctor, you probably assume the treatment you receive is backed by evidence from medical research. Surely, the drug you’re prescribed or the surgery you’ll undergo wouldn’t be so common if it didn’t work, right?
For all the truly wondrous developments of modern medicine—imaging technologies that enable precision surgery, routine organ transplants, care that transforms premature infants into perfectly healthy kids, and remarkable chemotherapy treatments, to name a few—it is distressingly ordinary for patients to get treatments that research has shown are ineffective or even dangerous. Sometimes doctors simply haven’t kept up with the science. Other times doctors know the state of play perfectly well but continue to deliver these treatments because it’s profitable—or even because they’re popular and patients demand them. Some procedures are implemented based on studies that did not prove whether they really worked in the first place. Others were initially supported by evidence but then were contradicted by better evidence, and yet these procedures have remained the standards of care for years, or decades.
The entire article contains several case studies and a thorough look at the research. It is a great read! What are your thoughts relating to maternal health care?
The Charleston Birth Place is an accredited birth center in South Caroline, owned and operated by Certified Nurse Midwife and former AABC President, Lesley Rathbun. Ms. Rathbun fears impending legislative process will greatly impact her ability to provide safe and appropriate clinical care. The new regulations would require a doctor to visit the birth center when an emergency takes place in order to decide if the mother and child need to be taken to the hospital. The Post and Courier explains:
Four years ago, state lawmakers passed a temporary fix that allowed birth centers to sidestep the regulations and remain open. That proviso, which has been renewed each year and will remain valid through June, allows birth centers to consult with a physician on-site or “by telecommunications or other electronic means.” It also requires the contracting physician to “be within a thirty minute drive of the birthing center or hospital.”
But a health care subcommittee of state lawmakers recently indicated it will not likely renew the proviso for another year. Rep. Murrell Smith, a Sumter Republican who chairs that subcommittee, did not return a message Friday.
Meanwhile, two bills have been introduced to permanently update the DHEC regulations, but similar laws have failed to gain traction in the past.
NORTH CHARLESTON, SC (WCSC) – A local birth center is in jeopardy of ending its services. This after a state committee deleted a temporary law this week that enables the local center to carry out natural births. Charleston Birth Place an accredited birth center provides natural births for women.
What’s happened to your health insurance premiums in 2017? Are you paying more for less? Many of our clients seem to be facing this worst-of-both-worlds scenario. Would a direct pay, or cash only system provide some relief?
Sometimes called direct pay, and closely related to concierge care, this sort of business model was once seen as the perquisite of rich folks and medical tourists from foreign lands. But nowadays many of the people seeking cash-based care are middle-class Americans with high-deductible insurance plans. For a patient with an $11,000 family deductible, for example, it might make more sense to seek out a cash-based center like the Premier Medical Imaging facility in Minneapolis, which offers a basic MRI for $499, than to cough up the several thousand dollars that the same procedure generally costs at a traditional hospital. Cash payments don’t count toward a patient’s deductible, but for some it’s worth the gamble.
This trend may accelerate nationally. With the Affordable Care Act on the chopping block, many experts expect the free-market model to take off. While congressional Republicans have yet to produce a viable replacement for the Obama Administration’s health care law, almost any change is likely to result in more Americans’ choosing high-deductible insurance plans, which would help fuel the cash-based marketplace for years to come.
This case study is persuasive, especially when you review the out-of-pocket under either scenario. Read the article and let us know – what do you think?
Weekly vaginal checks starting at 36 weeks? Frequent vaginal checks in labor? Does this policy give your provider important clinical information – or is this an obstetric ritual that exists simply because it hasn’t been questioned?
Mothers-to-be, laboring women, pregnant friends – listen to me.
You have the right to determine who – if anyone – will put his or her hand in your vagina during pregnancy and birth. You have the right to inquire about any procedure that is being suggested as part of your prenatal, labor and delivery care. You have the right to consent. You have the right to request a vaginal exam. And you have the right to refuse one. Period.
But, is this an important piece of your clinical care? Does your provider NEED this information to provide safe care?
“We look at a lot of different signs to determine progression. We do very few cervical checks. We use signs such as change in contraction pattern, how the woman is coping, physical signs such as shaking, nausea, bloody show and moaning. You can see how a woman begins to turn inward and the ability to concentrate decreases. These are the typical things we will look for and chart. We only check when women first come in, and if they refuse, we don’t worry about it. We will also check if it has been a long time without any external signs of progression or if there is a clinical need. Again, a woman’s right to refuse is acknowledged.”
Rebecca Dekker of Evidence Based Birth examined two studies that looked at the effect of weekly checks at the end of pregnancy. Her conclusion:
I think in summary the evidence really shows that there is no benefit to doing the weekly exams. It may satisfy your curiosity or your doctor or midwife’s curiosity, but it doesn’t really have an effect on your health either way. You are asking me what’s the evidence, what references can I use when I go to talk with my doctor, and I would say when it comes to a situation like this you don’t have to give your reason why. If you don’t want the vaginal exams, either because they make you uncomfortable or you just simply don’t want them or you think they’re unnecessary for whatever reason, your reason is your own and you don’t have to explain it to anybody.
Babymoon Inn is a full-scope midwifery practice and wellness center with locations in Phoenix and Tucson. Our team is committed to improving maternal outcomes and providing personalized, evidence-based care to all people.