Use of hospital intensive-care units for newborns appears to be dropping as a result of a federal push to reduce preterm births, according to early evidence cited by federal officials.
Dr. Richard Gilfillan, director of the Center for Medicare and Medicaid Innovation at CMS, attributed much of the improvement to the efforts of his office and other public and private entities.
The HHS-funded Partnership for Patients recently reported that the rate of early elective deliveries at some participating facilities plummeted from as high as 20% of births to as low as 2%. CMMI administers the partnership, which includes 26 hospital engagement networks working with 3,700 hospitals on patient-safety initiatives.
“We've been able to raise the consciousness, the awareness, of this problem nationally and we are seeing major changes across health systems, across state hospital associations, in hospitals putting that in place,” Gilfillan said during an appearance before the Senate Finance Committee. It was Gilfillan's first congressional testimony on the progress of the agency, established under the Patient Protection and Affordable Care Act as a laboratory for ways to improve healthcare delivery.
Early anecdotal evidence indicated that the effort has resulted in a decreased use of neonatal intensive care units, Gilfillan said, because 8% of pre-term children require such care. However, detailed national data was not available to show that.
Such effects have not yet appeared in an annual American Hospital Association facilities survey, the latest data from which reported that the number of NICUs hovered just short of 950 from 2007 to 2011. The percentage of hospitals with such facilities ranged from 22% to 23% in that timeframe.
Before the Partnership for Patients' initiative on early elective deliveries, “the vast majority” of hospitals lacked policies discouraging them, Gilfillan said. CMMI, meanwhile, launched its own preterm birth initiative last year, which is testing and evaluating “enhanced prenatal care interventions” for women in Medicaid at risk for a preterm birth, according to Gilfillan's written testimony.
Separately, the CMS has finished and CMMI has begun to use a centralized database to prevent duplicative payments to providers involved in incentive payment programs, Gilfillan said.
A November 2012 Government Accountability Office report noted that the database could allow improved coordination by CMMI, which is operating several incentive payment programs involving over 50,000 providers nationwide.
The hearing also featured complaints from Republican senators that Gilfillan's office has been slow or nonresponsive to requests for information. For instance, Sen. Orrin Hatch (R-Utah) said it took CMMI 6 months to respond to letter asking for information on its budget.
The lack of transparency “is too pervasive in this administration and we've got to stop that or there's going to be unholy war,” Hatch said.
Hatch also questioned whether the innovation center should reduce some of the 17 innovative care delivery and payment models it is testing to avoid “confusion and a lack of focus.”
Other Republicans echoed some rural providers' concerns that CMMI is testing relatively few of the models in rural settings, even though models deemed successful may be administratively expanded to all Medicare or Medicaid providers.
“There's a tremendous bias to have ACOs succeed in urban environments,” said Sen. Pat Roberts (R-Kan.).