South Carolina's Medicaid agency to stop covering elective early deliveries



COLUMBIA — South Carolina’s Medicaid agency and its largest health insurance company will no longer pay for women to give birth early for reasons of convenience, in an effort to improve babies’ health while cutting costs, Gov. Nikki Haley announced Monday.

Starting Jan. 1, the Department of Health and Human Services and BlueCross BlueShield of South Carolina – which together cover 85 percent of births in the state – won’t cover elective deliveries prior to 39 weeks, Haley said.

“We’re not paying anymore,” she said. “It’s not healthy. It’s not right. We’re not going to do it.”

The agreement is part of a larger effort, called Birth Outcomes Initiative, to improve newborns’ health.

Officials decided to start with elective early deliveries, partly because there’s no medical reason for them, said HHS Director Tony Keck. Last fall, his Medicaid agency partnered with the state Hospital Association and other medical groups to eliminate those early cesarean sections. Many hospitals and doctors voluntarily agreed to stop the practice, and the number of unnecessary early inductions has since dropped by half, Keck said.

“This is the next step that takes us the rest of the way,” he said. “Even half a day early makes a big difference in a baby’s development.”

Last week, the March of Dimes again gave South Carolina a D for its premature birth rate. The March of Dimes considers births before 37 weeks of pregnancy to be premature. That described more than 14 percent of births in South Carolina in 2011, accounting for one in every seven babies born. Only three states – Alabama, Louisiana and Mississippi – posted worse rates. Officials hope to lower South Carolina’s to 13.5 percent by 2014, preventing 700 preterm births.

Those rates don’t include births in the 38- to 39-week window. And health officials say too many women are scheduling unnecessary C-sections in those final weeks of gestation, unknowingly jeopardizing their babies’ health.

“Just because we can doesn’t mean we should,” Keck said.

Those last weeks provide, for example, a “tremendous amount of brain development,” said Dr. Amy Picklesimer, an obstetrician and March of Dimes volunteer.

C-sections generally cost more than a natural delivery, but the savings extend far beyond the operation. Additional costs range from a couple of days in the neonatal intensive care unit to a lifetime of care for developmental issues.

The median hospital bill for newborns rushed to intensive care is $22,000, compared to $1,200 for a full-term delivery, Picklesimer said.

A BlueCross BlueShield spokeswoman said it’s well-established that babies do best with at least 39 weeks’ gestation.

“We believe we have an important role to play in this effort and are pleased to be part of a statewide initiative that is dedicated to ensuring children get the healthiest possible start in life,” said Patti Embry-Tautenhan.



Wed, 01/17/2018 - 23:14

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