DHH Announces steps to reduce rate of premature births

DHH Announces steps to reduce rate of premature births
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POSTED: Wednesday, November 17, 2010 - 5:46pm

UPDATED: Friday, November 19, 2010 - 12:05pm

BATON ROUGE, La (WVLA) -- Louisiana Department of Health and Hospitals Secretary Bruce D. Greenstein today joined the March of Dimes, Rep. Regina Barrow and other key stakeholders for prematurity awareness day to announce steps the Department is taking to reduce the rate of premature births in Louisiana.

"Today, I join with the March of Dimes in honoring prematurity awareness day, but for me it's really prematurity 'what are you going to do about it' day. The March of Dimes' grade of 'F' issued today is a stark reminder that we must act and we must act now. Typically with these kinds of things, we study and we talk and we study some more. Today, we are taking action," Secretary Greenstein said. "We can no longer accept results that leave too many of our babies hooked up to tubes for weeks and sometimes months, or in the most devastating cases, leave families grieving the loss of a precious child.

"Medicaid - that is taxpayers - pay for 70 percent of births in Louisiana, so we know we can work on fixing the system through payment reform and best practices to have a tremendous impact on birth outcomes. These first steps we are announcing today are critical reforms in how Medicaid operates to incent and demand better outcomes for the investments we make."

Louisiana consistently has ranked 49th in infant mortality, and premature births are a significant factor in infant deaths. The initiative announced today addresses prematurity through three primary methods.

First, Louisiana Medicaid will reform its payment structure for obstetricians to reduce the number of elective inductions and C-sections prior to 39 weeks gestation. A key part of this initiative is reducing c-sections and the circumstances that often lead to preventable c-sections, such as early induction. Currently, vaginal births and c-sections are paid at the same rate of 80 percent of Medicare. Under the new system, vaginal births will be paid at 90 percent of that rate, while c-sections will be paid at the 80 percent rate. Louisiana ranks 4th in the country in the number of c-sections per live births growing from 25.4 percent in 1997 to 36 percent in 2007.

Further, Secretary Greenstein is asking a group of key stakeholders, doctors and experts from around the state to study and recommend additional payment reform or policy changes that will reduce elective births prior to 39 weeks of gestation. The group will consider simply not paying for those elective inductions or c-sections, requiring prior authorization, and building a shared-cost savings model where hospitals share in the savings created when costly NICU admissions are reduced.

"We know it can be done because we've seen it working at some of the largest birthing hospitals here in the state," Greenstein said citing 39th week initiatives at Woman's and East Jefferson hospitals. "With no new investments, these hospitals dramatically decreased elective early births. At East Jefferson, the number went from more than 500 to 18. Since implementing the initiative at Woman's, the admissions into the neo-natal intensive care unit dropped 20 percent. We need to replicate those results using the tools we have in Medicaid to make it work. I have directed the action team working on this project to work collaboratively and report back to me within two months with solutions we can implement immediately."

Secondly, Louisiana Medicaid will significantly enhance screening for smoking in pregnant women. By maximizing state general fund dollars currently being used in a pilot screening program through Medicaid matches, screening incentives can be built in for physicians. The Department is also aligning already available resources in the Tobacco Control program and in the Office of Behavioral Health to ensure once screened, pregnant women have access to services to help them quit on a priority basis.

"Smoking is an important determinant of health status and a major contributor to prematurity and low birth weight. In Louisiana in 2009, 22.1 percent of women ages 18-44 reported smoking, compared to 19.6 percent overall in the U.S.," said Medicaid Medical Director Dr. Rodney Wise, OB-GYN. "The March of Dimes rightly points out in its recommendations today that this is a key indicator that is moving in the wrong direction. These are relatively easy steps we can take to help women kick the habit to ensure healthier, full-term babies."

Lastly, the Department has authorized the use of the drug 17-Hydroxyprogesterone to decrease the incidence of repeat pre-term births.

"The most significant risk factor for a preterm birth for a mother is having had a preterm birth previously," Dr. Wise said. "Treatment with the hormone progesterone (17P) dramatically reduces the risk of a repeat premature birth. There is strong and well-established evidence base for this treatment, which is recommended by the American Congress of Obstetricians and Gynecologists. We are proud to be one of only a handful of states to include 17P in its panel of covered prescription drugs. Now, we will be working with doctors to promote the appropriate use of 17P in the Medicaid population."

Following the press conference today, action teams assembled by the Department and led by director of the birth outcomes initiative Dr. Rebekah Gee and head of the governor's Commission on Perinatal Care Dr. Alfred Robichaux are meeting to work on implementation of the strategies announced. These teams, made up of physicians, nurses, academicians, advocates and grass-roots community organization representatives, will also be studying and making recommendations in the next several months on other key indicators leading to infant mortality.

Additionally, Secretary Greenstein is asking these stakeholders to develop a report card for physician groups and hospitals to measure key indicators of birth outcomes. The groups will make recommendations for what will be included in those report cards by February, and the Department will issue the first set of report cards by next summer.

"If you don't measure it, you can't manage it," Greenstein said. "Some people aren't going to like this, we know that. But those at the top will serve as examples to help everyone find solutions that will work. We have to know what's happening to fix it.

"I want to make it clear that we are focusing on results and moving this dial, not tomorrow or next month or next year, but starting today. And we're taking very real steps so we're not standing here year after year talking about yet another 'F'," Greenstein said.

Comments News Comments

I'm glad DHH is taking a very public and proactive approach to addressing poor birth outcomes in our state. These three policy recommendations on late pre term birth, smoking cessation and the approval of 17P on its panel of covered prescription drugs-should contribute to a steady decrease in our prematurity rates. I look forward to working closely with DHH and other stakeholders to improve our rates and lives of our babies and families.

These sound like practical and evidence-based steps toward reducing premature birth. Reducing the epidemic of elective inductions and encouraging vaginal birth through payment structure will assist to preserve normal birth and healthy outcomes in this state.

Brenda Broussard CNM - Certified Nurse-Midwife

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