MEDICAID AND NON-MEDICAID PRENATAL CARE BY NURSE-MIDWIVES: Comparison of Risk, Time, Care Coordination, and Reimbursement

Authors

  • Karin Hangsleben CNM, MS,

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    • Karin Hangsleben is a senior staff nurse-midwife at Fairview Riverside Obstetrics and Gynecology Associates, Minneapolis, Minnesota. She graduated from the University of Utah in 1975 with a master of science in nursing.

  • Martha Jones CNM, MS,

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    • Martha Jones, formerly at Fairview Riverside Obstetrics and Gynecology Associates, established a nurse-midwifery practice in 1994 at Blue Ridge Women's Health Center in Harrisonburg, Virginia. She graduated from the University of Minnesota in 1986 with a master of science in nursing.

  • Betty Lia-Hoagberg RN, PHD,

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    • Betty Lia-Hoagberg is an Associate Professor in the School of Nursing, University of Minnesota, and received her PhD from the same university. She has conducted a number of research studies on prenatal care use.

  • Catherine Skovholt MN, MSPH,

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    • Catherine Skovholt is a faculty member at the University of San Francisco and a doctoral candidate at the University of Minnesota. She has a master of nursing from the University of Florida and a master of science in public health from the University of Minnesota.

  • Ruth Wingeier CNM, MS

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    • Ruth Wingeier practices full-scope nurse-midwifery at Long Prairie Medical Center in Long Prairie, Minnesota. She is a former assistant editor for the Journal of Nurse-Midwifery, and is an adjunct faculty for the University of Minnesota Nurse-Midwifery Educational Program.


Address correspondence to Karin Hangsleben, cnm, ms, 701 25th Ave. S., Suite 302, Minneapolis, MN 55454.

ABSTRACT

The purpose of the study was to compare high-risk pregnant women with medical assistance payment (HRMA) and those with private insurance payment (HRPI) on use of provider time, care coordination activities, and financial reimbursement. Comparisons were also conducted for the same factors between the high-risk and low-risk women (LRMA) that received medical assistance payment for their care. Total time spent by care providers in giving antepartum, intrapartum, and postpartum care was highest for the HRPI women. However, the two medical assistance groups started prenatal care significantly later and had fewer visits, and one-third did not return for their 6-weeks postpartum visit. The HRPI group also had a higher cesarean birth rate. Rates of care coordination activities such as calls, referrals, and consultations were significantly higher for the HRPI and HRMA women compared with those for the LRMA women. However, the HRMA women have limited financial and psychosocial resources that require additional provider management and referrals. Reimbursement rate was highest for the HRPI group in which approximately 73% of the total amount billed was collected compared with approximately 56% among medical assistance women. Recommendations for policy, practice, and further research are offered.

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