The effect of third party payers on provider practice in a hospital based maternity practice

Background. A factor believed to have a significant effect on the practice of health care providers is source of payment. There have not been studies looking at the effect of payer on other types of providers that control for patient demographics, risk status, and provider type.;Specific aims. The purpose of this paper is to examine the effect of payer source on the practice of maternity care provided by Certified Nurse-Midwives (CNMs) in a hospital-based maternity practice when patient demographics and risk status are accounted for.;Methods. The study was based in a university hospital, and the provider groups were staff CNMs and staff Obstetricians. Subjects were 633 low risk pregnant women in early pregnancy. Risk assessment was done prior to enrollment and at admission in labor. Payer data and use of services was collected postpartum to insure inclusion of services and any changes in billing status. Independent variables were provider and source of payment.;Findings. Generally, charges varied significantly by provider type, with CNMs having lower mean charges than physicians in the three major charge groups. There were weaker relationships between provider type and charges for specific services, but when there were differences, the CNM charges were lower. Unexpectedly, charges by payer source did not vary significantly. Mean outpatient charges were 38% lower for CNM clients, inpatient charges were 27% lower, and professional fees were 11% lower. Significant predictor variables were provider and risk status at admission into labor.;Significance. CNMs and physicians practicing in the same service seeing comparable groups of patients have equally good outcomes, but significantly different charges. The different styles of practice exhibited by the two groups may result from their differing philosophies and beliefs about the care that women receive. It is imperative that non-physician providers be included in discussions about health care reform, and in the subsequent regulatory language.