Midwives, Patient Centered Care and Health Reform: An Analysis of Private Payer Claims Data

As health reform proceeds, provider payment structures will undergo potentially significant changes. One area particularly ripe for investigation is maternity care and the role Certified Nurse-Midwives (CNMs) may play in improving outcomes and reducing costs. The current effort examines a national collection of private payer claims data for differences in reimbursement rates between certified nurse-midwives and obstetricians. Through the use of two different dependent variables and quartile regressions I find unexpected results for payments between CNMs and obstetricians. When estimating the reimbursement amount for a single billing code (the "global" code that covers prenatal, delivery and postpartum care for uncomplicated vaginal births) midwives are predicted to collect more than their physician counterparts across all quartiles. These findings are statistically significant at the .01 level. However, in the second model that measures all claims submitted for a particular delivery obstetricians are predicted to collect more than midwives in the sample. Future research may require investigating potential self-selection biases inherent in the provider choice and what policy tools may be available to encourage patients to select lower-cost providers that achieve similar or better outcomes.