Biden plan requires hospitals to improve maternal care

Driving the news: The Centers for Medicare and Medicaid Services on Wednesday proposed the first-ever federal maternal health and safety requirements for hospitals.

• Hospitals would have to keep basic resuscitation equipment available in labor and delivery rooms, document maternal health training for staff and have written policies for transferring patients to other hospitals.
• All hospitals offering emergency services — even if they lack an obstetrics unit — would be required to have proper protocols and supplies for emergency deliveries and other needs.

Hospitals not following these standards could eventually be booted from the Medicare and Medicaid programs.

• The two programs cover almost 40% of U.S. patients.

Follow the money: The industry will pay about $4.46 billion over 10 years to implement the policy — or an average of $70,671 per year for each hospital, CMS estimated.

• The policy is part of a swath of changes proposed for hospital outpatient services on Wednesday, including a 2.6% ($5.2 billion) increase in Medicare payments for 2025.

Zoom out: The United States is in the throes of a maternal mortality crisis, with a death rate more than double that of most other high-income countries. Hospitals across the country are closing or reducing unprofitable obstetrics wards.

• But hospitals haven't universally adopted best practices in maternal care, CMS wrote in the regulation. After a literature review, listening sessions and requests for information from the public, CMS decided hospitals needed new Medicare participation mandates.

What they're saying: "President Biden and I are fully committed to addressing a maternal health crisis" that disproportionately affects Black women, Native women and women in rural communities, said Vice President Kamala Harris.

The other side: Hospitals and their advocacy groups say the new conditions are an unnecessary and onerous policy that could scare more hospitals from providing obstetric services.

• "This was a step too far, too soon," said Soumi Saha, senior vice president of government affairs at Premier Inc. CMS should focus on incremental policies, including data standardization, that benefit maternal care for the meantime, she said.
• The American Hospital Association also shot down the policy last month in a response to a request for comments on the idea. Conditions of participation are "ill-suited to address the complex factors contributing to poor maternal outcomes, most of which occur outside of hospital walls," the trade group wrote.

• AHA reiterated that position on Wednesday, calling instead for a "less punitive and more collaborative and flexible approach" to improving maternal health.

Between the lines: "The maternal health crisis in our country is dire," Saha told Axios. "It absolutely needs to be addressed and cannot afford to be political rhetoric going into the election."

OB-GYNs are concerned, too. While the American College of Obstetricians and Gynecologists is still reviewing the policy, the organization is worried adding new conditions of Medicare participation on maternal care could wind up reducing patient access to obstetric services.

• "[W]e need smart and innovative policy solutions that do not further stress an overstretched health care system," Lisa Satterfield, ACOG's senior director of health and payment policy, said in a statement to Axios.

Yes, but: Patient advocates think the proposed requirements are a step in the right direction, and see hospitals' fears as overblown.

• "There are other other requirements that are already in conditions of participation, and in large part, we don't see large numbers of hospitals being kicked out of the program," said Ben Anderson, deputy senior director of health policy at patient advocacy group Families USA.