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Your Pregnancy Matters

Texas hospitals must prove pregnancy care expertise or lose Medicaid dollars

Mom and baby in the hospital

For years, Texas has ranked among the lowest states in the U.S. for maternal morbidity and death. In 2017, Texas was the worst, citing heart issues, hemorrhages, and infections – conditions that often should be preventable.

But the Texas State Legislature has given patients and providers hope that positive change is coming. A law passed in March 2018 mandates that any hospital providing maternity care must go through a formal designation process to certify themselves as a Level 1 through Level 4 maternal health center – or lose Medicaid reimbursement eligibility, which accounts for 50 to 60 percent of all obstetric care in the state. 

The law stemmed from a 2015 consensus paper co-authored by the American Congress of Obstetricians and Gynecologists (ACOG) and the Society for Maternal-Fetal Medicine (SMFM). Their paper suggested that a designation process could help reduce maternal morbidity.

Texas hospitals have until Sept. 1, 2020, to complete the designation process, which evaluates patient-centric criteria including the expertise of staff and the resources available to care for certain populations of patients. This law is an important step forward in addressing the maternal health crisis in our state. 

How do levels of maternal care benefit patients?

A uniform designation process can lead to clear, recognizable information for patients and referring doctors. 

Mothers-to-be should expect better, more thoughtful care plans. The law requires hospitals to examine their high-risk maternity care processes and strengthen deficiencies, which is a clear patient benefit. 

Women should anticipate a team approach to pregnancy care. High-level centers are being asked to actively develop relationships with community doctors to ensure referred patients go the center that is best suited to care for their complex conditions. 

Patients should expect transparency. Women have the right to information about the care capabilities of a hospital. This is particularly important for women with chronic or complex health conditions. We recommend that these patients ask their potential hospital, regardless of the level designation, the following questions before choosing to deliver there:

  • Does the hospital have an intensive care unit and blood bank if labor/delivery complications arise? 
  • Are anesthesiologists and Ob/Gyn providers available 24/7, or just on call?
  • Just in case, does the care team include a critical care doctor, cardiologist, and/or pulmonologist?
  • Is a doctor for my chronic condition (such as an existing heart issue) available?

Finally, patients should also expect more answers to their questions. The law calls on high-level centers to serve as community education leaders, providing patients and referring doctors from lower-level centers with easy access to health care information. For example, we provide the Your Pregnancy Matters blog as a community outreach tool for patients, and even referring doctors. It’s also available free to the public as a community service. 

Patients should expect transparency. Women have the right to information about the care capabilities of a hospital. This is particularly important for women with chronic or complex health conditions.

Robyn Horsager-Boehrer, M.D.

Patient care, not a marketing tactic

My concern with levels of care, however, is that there’s a fine line between patient education and marketing. I worry that some hospitals will use their designations as a gimmick instead of a communication tool. 

For example, a Level 1 hospital that is close by might be a perfectly fine place for a woman with a low-risk pregnancy to deliver. But if she sees advertisements that suggest she travel a few hours away to “the best hospital to give birth in North Texas,” she might be tempted to make an unnecessary and potentially expensive trip. 

Level of maternal care designations are meant to guide women with high-risk pregnancies to specialized care, not increase hospital patient volume or revenue. 

Finally prioritizing maternal health

Under the new law, centers applying for Levels 2 through 4 must go through an application process to prove they have the resources they claim. The State of Texas will perform its due diligence, from conducting site inspections to requiring comprehensive care plans. 

UT Southwestern is applying to be a Level 4 center, and our site survey will be in November 2019. We are eager for the new designations to take effect. For years, the medical community and patients themselves have focused “pregnancy care” more on fetal health than maternal health. And we hope the new law is the first step in recognizing and improving the gaps in women’s health care in Texas.

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