A Perinatal Care Quality and Safety Initiative: Are There Financial Rewards for Improved Quality?

Abstract

Background There is increasing national focus on hospital initiatives to improve obstetric and neonatal outcomes. While costs of providing care may decrease with improved quality, the accompanying reduced adverse outcomes may impact hospital revenues. The purpose of this study was to estimate, from a hospital perspective, the financial impacts of implementing a perinatal quality and safety initiative. Methods In 2008, a Minnesota-based health system (Fairview Health Services) launched the Zero Birth Injury (ZBI) initiative, which uses evidence-based care bundles to guide management of obstetric services. We conducted a pre-post analysis of financial impacts of ZBI, using hospital administrative records to measure costs and revenues associated with changes in maternal and neonatal birth injuries before (2008) and after (2009–11) the initiative. Results After adjusting for relevant covariates, implementation of ZBI was associated with an 11% decrease in the rate of maternal and neonatal adverse outcomes between 2008 and 2011 (AOR=0.89, p=0.076). As a result of the adverse events avoided, the hospital system saved $284,985 in costs but earned $324,333 less revenue, which produced a net financial decrease of $39,348 (or a $305 net financial loss per adverse event avoided) in 2011, compared with 2008. Conclusions Adoption of a perinatal quality and safety initiative that reduced birth injuries had little net financial impact on the hospital. ZBI produced better clinical results at a lower cost, which represents potential savings for payers, but the hospital system offering increased quality reaped no clear financial rewards. These results highlight the important role for shared-savings collaborations (among patients, providers, government and third-party payers, and employers) to incentivize quality improvement. Widespread adoption of perinatal safety initiatives combined with innovative payment models may contribute to better health at reduced cost.

Medicaid Accountable Care Organizations and Childbirth Outcomes

“…One health system established a perinatal safety and quality initiative to reduce birth injuries that included standardized processes for childbirth and continuous quality-improvement methods. It experienced an 11% decrease in perinatal adverse events and a modest reduction in costs (Kozhimannil et al, 2013). Medicaid ACOs also could work with outpatient providers to identify high-risk patients and reduce the risk of preterm labor using available treatments (Simmons, Rubens, Darmstadt, & Gravett, 2010).…”

“…Medicaid ACOs also are positioned to reduce the cost of childbirth. Under the traditional fee-for-service reimbursement system, hospitals may lose money by improving birth outcomes (Kozhimannil et al, 2013). However, ACO contracting has the potential to align financial incentives with quality improvement.…”

Navigating the Perinatal Quality Landscape

“…The most notable accomplishments in perinatal care of the last decade relate to the endorsement of quality measures by the NQF that provide unified goals and the quality improvement frameworks provided by the Institute for Healthcare Improvement that help systems create action and change through education, team building, process improvement, and structure. 37 Fourteen perinatal quality measures are currently endorsed by the NQF, 5 of which are mandated by The Joint Commission and required for accreditation. Nurses have been actively involved with the national quality movement serving as measure developers, experts on the NQF perinatal task force, leading regional perinatal collaborative, and most notably on the institutional level as leaders and bedside care providers.…”

Estimating the Financial Impact of Reducing Primary Cesareans

“…A model was developed to determine the estimated average dollar cost of the reduction in NTSV cesareans at Baystate. [18][19][20][21][22][23][24] We considered the actual total costs, not charges or payments, of hospital care at our institution for a woman's first and second births and the associated newborn care. To offset these costs from a systems perspective, we included payments to the maternal health care provider (midwife or physician) and to the pediatric provider.…”