Approximately 10% to 15% of all births in the United States are performed early without a medical reason. Government health plans and private insurers think that number is far too high and are taking steps to discourage OB/GYNs and mothers from scheduling early deliveries. 
According to the American College of Obstetricians and Gynecologists (ACOG), infants born between 36 and 38 weeks may weigh and appear to be the same as those born later, but they are more likely to have serious lung problems and other medical conditions resulting in admissions to the neonatal intensive care unit (NICU). That’s why the ACOG discourages OB/GYN physicians and pregnant mothers from scheduling deliveries before 39 weeks unless there is a medical reason. Despite the risks, thousands of mothers request early deliveries each year citing discomfort or inconvenience. “After 37 weeks, patients really push for it because they are miserable and don’t want to be pregnant anymore,” said Alfred Khoury, director of maternal-fetal medicine at Inova Fairfax Hospital, in an interview with Kaiser Health News. “Or they say, ‘My mother is here’ or ‘I have to be in a wedding.’ ” OB/GYN doctors may also prefer scheduling deliveries early in order to manage their own schedules. However, government health plans and private insurers are working to make early deliveries less attractive. NICU stays are expensive, averaging $76,000 per stay, as are costs to care for long-term conditions due to early deliveries. Limiting elective early deliveries could save millions in healthcare costs. As of January 1, the South Carolina Medicaid program and BlueCross BlueShield of South Carolina denied payments for early deliveries performed without medical cause. The Texas Medicaid program implemented a similar policy in 2011. Starting this year, UnitedHealthcare makes incentive payments to hospitals that take steps to limit early deliveries without medical cause and can demonstrate a drop in their rates. Finally, Medicare will begin to collect data from hospitals on rates of elective deliveries before 39 weeks this summer. Starting in 2015, Medicare will penalize hospitals whose rates remain high.
According to the American College of Obstetricians and Gynecologists (ACOG), infants born between 36 and 38 weeks may weigh and appear to be the same as those born later, but they are more likely to have serious lung problems and other medical conditions resulting in admissions to the neonatal intensive care unit (NICU). That’s why the ACOG discourages OB/GYN physicians and pregnant mothers from scheduling deliveries before 39 weeks unless there is a medical reason. Despite the risks, thousands of mothers request early deliveries each year citing discomfort or inconvenience. “After 37 weeks, patients really push for it because they are miserable and don’t want to be pregnant anymore,” said Alfred Khoury, director of maternal-fetal medicine at Inova Fairfax Hospital, in an interview with Kaiser Health News. “Or they say, ‘My mother is here’ or ‘I have to be in a wedding.’ ” OB/GYN doctors may also prefer scheduling deliveries early in order to manage their own schedules. However, government health plans and private insurers are working to make early deliveries less attractive. NICU stays are expensive, averaging $76,000 per stay, as are costs to care for long-term conditions due to early deliveries. Limiting elective early deliveries could save millions in healthcare costs. As of January 1, the South Carolina Medicaid program and BlueCross BlueShield of South Carolina denied payments for early deliveries performed without medical cause. The Texas Medicaid program implemented a similar policy in 2011. Starting this year, UnitedHealthcare makes incentive payments to hospitals that take steps to limit early deliveries without medical cause and can demonstrate a drop in their rates. Finally, Medicare will begin to collect data from hospitals on rates of elective deliveries before 39 weeks this summer. Starting in 2015, Medicare will penalize hospitals whose rates remain high.
