Canvasing for Midwife Friendly Politician

Fabulous time walking today for Dee Beaubien, Independent, Illinois 52nd House District.

The weather did not cooperate but the neighbors did. People are excited about having an Independent voice for McHenry County in Springfield.

Summary of feedback I received:

• She's a great person.
• I like her. I met her when she walked through the neighborhood.
• I'm voting for her because I'm tired of extreme attitudes and people not working together.
• I knew her husband. He was a great politician.
• Dee Beaubien focuses on issues and not just sound bites.

Neighbors were impressed with Dee Beaubien's interest in constituent concerns. After all, we all want a legislator who cares enough to return our phone calls.

Oh and don't forget... Dee supports licensing home birth midwives based on the Certified Professional Midwife credential, the national standard for regulating home birth maternity care. 

Election Season

Like it or not advocating for policy change is a political endeavor;  thus the very best time to get to know your local politicians is during election season. Advocates typically are doing the asking. (Can I count on your "YES" vote on the Home Birth Safety Act?)  During election season, we have opportunity to give legislators something back. Volunteer.

Running for office is a challenge. Local candidates often are very short of resources. This is the best time to get involved. Take time to give. Put your efforts where your heart is. Find a candidate who believes in your issues and help get that person into office.

I recently took to the web to contact the candidates running for the Illinois House of Representatives in my district.  Within days of sending-off an email to Dee Beaubien, she picked up her phone and called me. In my email, I informed her of my interest in the Home Birth Safety Act.

I was pleased to learn that she already knew quite a bit about the bill. (Dee's late husband Mark, served in the House of Representatives from 1996 - 2011. Although this is her first run for office, she has years of experience meeting constituents, listening to their concerns and thinking about solutions.)

I was even more pleased that prior to calling me. She prepared..... She read the bill!

 



Talking with Dee solidified my support. She is a candidate who cares. She is an independent voice dedicated to public service and helping people one-on-one. She cares about the issues. She cares about property tax relief.  She is focused on creating jobs, fiscal responsibility, and she has even pledged to cut law-makers pay.

 

On our phone call, I also learned of Dee Beaubien's dedication to hospice care. On behalf of those who can not voice the words, thank you, Dee.  (I love hospice care as much as I love midwifery care.)

Constituents of Illinois' 52nd House District: Can I count on your "YES" vote for Dee Beaubien, Independent, for State Representative?

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Who are the 2%?

Home Birth Mothers

Mothers who birth at home with Certified Professional Midwives can save Five Million Medicaid Dollars annually even if though they represent only 2% of the population.

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 popularity. Twenty-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.

CFIM Press Release: Midwives Can Save Millions for Illinois Medicaid

Illinois Midwives Medicaid Proposal will save millions in charges to Medicaid

Coalition For Illinois Midwifery

Contact: Rachel Dolan Wickersham, President E-Mail: jiandra @ aol.com
Date: April 18, 2012
For Immediate Release

While Illinois lawmakers struggle with unpopular cuts to existing services, in order to meet Governor’s Quinn’s demand for a $2.7 billion Medicaid budget cut; the Coalition for Illinois Midwifery (CFIM) has prepared a legislative proposal that reduces expenditures by expanding the types of services available to women preparing for childbirth. The proposal integrates Certified Professional Midwives into the health care delivery system and recognizes them as Medicaid providers. CPMs are so incredibly cost-efficient that even extremely low utilization rates save millions of dollars in Medicaid expenditures. Based on extrapolations from a Washington state cost-benefit analysis, use of CPMs could save the state millions in Medicaid dollars annually without eliminating any services or reducing reimbursement rates. This sets the plan apart from many other cost-reduction strategies.

Childbirth is the most common hospital diagnosis and accounts for more than 10 percent of all hospital stays. Certified Professional Midwives, who attend the majority of home births throughout the country, are the most cost-effective providers of maternity care in the nation. Cost-savings are gained primarily through the virtual elimination of facility fees. Equally important, CPMs utilize the Midwives Model of Care, ™ providing one-on-one, community-based care focused upon keeping mothers healthy; thus preventing expensive birth complications.

The five-year pilot project proposed by the Coalition for Illinois Midwifery, will allow for limited licensing of CPMs (30 licenses per year for the first three years, expanding to 50 licenses per year for the 4th and 5th years). During the first three years, the licensed midwives would serve approximately 360 families who rely upon Medicaid, reducing charges to Medicaid by approximately $5 million per year. Cost-savings for the pilot project are based on 2009 Medicaid charge data for the State of Illinois. The full report is available by request.

Twenty-seven states allow the practice of Certified Professional Midwives. About half of these states recognize CPMs as Medicaid providers. The Illinois General Assembly has failed to license Certified Professional Midwives despite a wide-spread coalition of support and 12-years of recent concentrated-efforts to pass licensing legislation.

The percentage of births covered by Illinois Medicaid has risen to 54% as the options for cost-efficient child birth services have dwindled. Illinois’ history includes a
rich tradition of providing home birth services to low income families. For over 75 years, between 1895 and the 1970s, Chicago Maternity Center served hundreds, sometimes thousands of families at home every year. Despite the general poor health and poor living conditions of these families, the adjusted maternal mortality rate for these women giving birth at home was one-sixth of the adjusted national rate (.09% versus .59%). At the time of its closing in 1974, the Maternity Center’s clientele was 50% black, 35% Latina and 15% non-Hispanic white.

###

Childbirth Freedom Would Save Illinois Medicaid $5 Million Annually

How much money could Illinois Medicaid save by integrating Certified Professional Midwives into the system? While a scientific answer is not available, there is plenty of evidence suggesting the answer is in the ball park of five million dollars a year.

It's no secret that Certified Professional Midwives offer cost-effective care. No one knows this better than Jeffery Thomspon MD MPH, Chief Medical Officer for Medicaid, Washington state. Recognizing the important role Certified Professional Midwives play in reducing Medicaid costs in Washington state, Dr. Thompson is encouraging the US Congress to pass federal legislation to ensure Medicaid coverage for Certified Professional Midwives nationally.

Years ago Washington state commissioned a health management firm
to study this issue. The report documents cost savings of $473,000 per biennium
as well as quality improvements (better birth outcomes). The study, published in 2007, included
births from 2001-2004. In 2009 however, the Health and Recovery
Services Administration in Washington revised the total savings to $3.1
million per biennium.

How does this relate to birth in Illinois today? Illinois is about twice as big as Washington in terms of the numbers of babies born each year as well as in terms of each state's Medicaid budget. Also the two states have similar rates of Medicaid-paid births (2008: 47.5% of IL births were paid by Medicaid and 47.8% of WA births were financed by Medicaid. See National Vital Statistics Reports and Kaiser Family State Health Facts.)

If Illinois embraced midwifery care as much as Washington does, Illinois would experience about twice as many births attended by Certified Professional Midwives as Washington does; and likewise, Illinois' potential reductions in Medicaid expenditures would be about twice as those experienced in Washington. Thus I am using an estimate of $3.1 million per year in 2004 dollars as Illinois' lost Medicaid savings. In other words, if Illinois followed Washington's home birth example back in 2004, Illinois Medicaid would have spent $3.1 million less.

According to Milliman statistics, health care costs have increased 73% since 2004. A seventy-three percent increase on $3.1 million is $5.4 million. The Illinois Policy Institute reports Illinois' Medicaid liabilities increase at a rate of 6.9% per year. A 6.9% compounded rate of increase on $3.1 million from 2004 to 2012 is $5.3 million.

Surprisingly, the "Home Birth Medicaid Bonus" results from just 2%. It only takes 2% of births to be delivered at home instead of the hospital to realize these huge cost savings. The 2% represent Birth Freedom. When given the freedom, about 2% of US moms choose home birth. The Home Birth Medicaid Bonus is achieved by granting mothers freedom -- freedom to deliver with state licensed, nationally-certified, maternity care professionals. Currently Illinois mothers are denied this freedom, and Illinois tax payers are paying for it at the cost of about $5 million per year.

It's time for the Illinois General Assembly to pass the Home Birth Safety Act (HB5370). The Home Birth Safety Act calls for licensure of Certified Professional Midwives based on national midwifery standards. It also will recognize Certified Professional Midwifes as Medicaid providers.