Wednesday, May 16, 2012

Illinois Midwives Medicaid Proposal: How it Stacks-up

The table at the end of this post illustrates where the Midwife Medicaid Proposal (shaded blue) ranks in comparison with the line items in Governor Quinn's proposed FY13 Medicaid Liability and Spending Reduction plan.  The purple shaded line item illustrates cost-savings that would be gained from fully integrating Certified Professional Midwives into Illinois' health care delivery system.

Compared with the Governor's 58 line items of "proposed elimination and reduction of human service programs, " the Midwife Proposal's focus on cost-effective care is refreshing. The table is reported in thousands. Each line item should be multiplied by $1,000 to get the total savings. For comparison, think $2,500 for the Midwife Proposal ($2.5 million/1000). 

The Midwife Medicaid Proposal (pilot project) reduces Medicaid charges by $5 million. (Reduction in charges typically translates to a 50% reduction in expenditures, since health insurance programs don't pay 100% of the amount charged). Fully integrating CPMs would double the savings.

The difference between the pilot project and full integration is the number of Certified Professional Midwives allowed to practice. The pilot project puts a cap on the number of licenses issued, and thus puts a cap on Medicaid savings. Without a cap, we can expect a 2% utilization rate and a  conservatively estimated $5 million of annual savings to Illinois' Medicaid budget.

Fully integrating Certified Professional Midwives is a good idea. It is the trend of the national. Home birth is rising in popularityTwenty-seven states already legally authorize the practice of Certified Professional Midwives. None of these states restrict the number of midwives allowed to practice.

Let's look to our neighbor to the north. In 2006, Wisconsin enacted licensure of Certified Professional Midwives. Today, Wisconsin has one of the highest rates of home birth in the nation  which effectively curbs run-away maternity care costs for the state. Home birth with Certified Professional Midwives is extremely cost efficient because this type of care virtually eliminates costly facility fees and drastically reduces costly and unnecessary medical interventions. Even low utilization rates significantly reduce maternity care costs and expenditures.
"Within the first year of licensure, the number of Certified Professional Midwives serving Wisconsin doubled. Now every corner of the state, even the most remote areas are covered by at least one licensed home birth provider." -- Katherin Prown, PhD, Legislative Chair for the Wisconsin Guild of Midwives
Most importantly for women, the Wisconsin Guild of Midwives actually can publish a geographically diverse list of licensed home birth providers. The simple of act of compiling a statewide comprehensive directory of home providers is the envy of Illinois women, particularly women in rural Illinois. Illinois families looking for home birth providers struggle and often end up paying for more expensive hospital care or delivering without the assistance of a licensed provider. 

With Governor Quinn's call for a comprehensive plan to reduce Medicaid expenditures, there has never been a better time for Illinois to capitalize on the home birth wave.  Washington State, another lead state in terms of home birth popularity, has been saving Medicaid money through integrating CPM home birth services since 1999. The program is so effective in terms of both saving money and improving birth outcomes that the Jeff Thompson, MD, MPH, Chief Medical Director,  has included increase utilization of Certified Professional Midwives into his long-term strategic plan.
"Midwives have a central focus in our strategic plan. We are hoping Washington State can double out-of-facility births in the next two or three years."  -- Jeff Thompson, M.D., MPH, Chief Medical Officer, Washington State Department of Health. 

Reduce Rx costs in Long Term Care through utilization controls$150.0
Eliminate individual providers for Adult Speech Hearing and Language Therapy$411.0
Eliminate $10 Add-on Fee for Clients with Developmental Disabilities in Nursing Facilities$472.0
Rx Pilot Project - Pharmacist provide education and coordination of care$500.0
Reduce Eye Glass for Adults (1 pair every 2 years)$509.9
Eliminate individual providers for Adult Occupational Therapy$596.7
Reduce spending on Wheelchair Repairs through utilization controls$800.0
Eliminate Adult Chiropractic$884.5
Eliminate Dental Grants$1,000.0
Fees to Access HFS data$1,000.0
Reduce spending on Ambulance Services through utilization controls$1,500.0
Reduce Reimbursement Rate for Power Wheelchairs$1,900.0
Shift service to Federal VA Facilities for Veterans$2,000.0
Midwife Proposal$2,500.0
Eliminate individual providers for Adult Physical Therapy$2,544.9
Reduce spending on Transplant Rx through utilization controls$2,700.0
Eliminate scheduled c-sections prior to 39 weeks (unless medically necessary)$2,854.0
Increase Co-pays for Services in Federally Qualified Health Centers$2,919.3
Eliminate REACH Program (employer-assisted housing)$3,000.0
Reduce spending on Bariatric Surgery through utilization controls$3,000.0
Reduce spending on HIV Rx through utilization controls$3,000.0
Reduce Eligibility for Supportive Living Facilities for persons with physical disabilities$3,300.0
Reduce Eligibility for Nursing Facilities for persons with physical disabilities$4,400.0
Eliminate Pediatric Palliative Care$4,500.0
Fully Integrated CPMs$5,000.0
Reduce spending on Cancer Rx through utilization controls$5,000.0
Reduce Monthly Allotment of Incontinence Supplies (200 from 300)$5,000.0
Reduce Adult Podiatry - Limit Services to people with diabetes.$5,200.0
Eliminate Bed Holds for Long Term Care Facilities for Temporary Absence (hospitalization)$8,305.0
ER Co-pay for Non-Emergency Use$9,000.0
Reduce spending on child Rx through utilization controls (requiring certification of need for over 5 Rx/person)$10,000.0
Collect on Third Party Liabilities$10,000.0
Reduce Hospice Care spending through utilization controls$10,015.3
Reduce Home Health spending through utilization controls$11,000.0
Reduce spending on Hemophilia Rx through utilization controls$11,995.3
Require Managed Care Organization to pay full costs at Federally Qualified Health Centers$13,200.0
Eliminate Excellence in Academic Medicine Program (payments to teaching hospitals)$13,800.0
Eliminate Group psychotherpy for nursing home residents & related transportation costs$14,256.1
$1 Co-Pay for Generic Rx$14,300.0
Reduce Home Services for Children in Medically Fragile/Tech Dependent Medicaid Waiver$15,000.0
Reduce Durable Medical Equipment spending through utilization controls$15,008.8
Reduce Inefficiencies through Care Coordination Initiatives$16,075.0
Eliminate Adult General Assistance$16,681.3
Collection of Rebates on Hospital Outpatient Rx$20,000.0
Eliminate Automatic Rate Increase for Supportive Living Facilities$20,800.0
Implement Audits to Providers consistent with Affordable Care Act Rules$21,875.0
Improve Birth Outcomes through replication of MI Model Program$25,000.0
Reduce Detox Services - No re-admission w/in 30 days$25,492.4
Eliminate New Admits to Institutions for Mental Illness$36,851.2
Reduce Reimbursement Rate or Long Term Acute Care for Patients Dependent on Ventilators$39,600.0
Reduce Hospital Re-admissions through prevention$40,000.0
Reduce Rx spending when patient has 3rd party payer not billed as primary$40,000.0
Reduce Eligibility - Family Care for Adults$49,884.7
Eliminate Adult Dental$51,428.2
Reduce Return on Investment Percentage in the Capital Portion of Nursing Facility Rate$71,125.5
Eliminate IL Cares Prescription Program$72,154.0
Eliminate New Admits to Intermediate Care Nursing Facilities (mostly impacts people with mental illness)$114,100.0
Enhanced eligibility verification$120,000.0
Reduce spending on adult Rx through utilization controls (requiring certification of need for over 5 Rx/person)$136,000.0
Reform Private Insurance Market for Children with Special Needs$250,000.0

Note: This post is a revision. The original post misrepresented the Governor's table by not recognizing numbers are published as thousands. Apology extended to Governor Quinn and his staff.

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