Fix Disparities, Payment to Improve Maternal Health, AAFP Advises

It's striking counsel for a sweeping issue: Some 700 U.S. women a year die from pregnancy-related complications. Many of those deaths are traceable to preventable health disparities -- inequities that widen for women with low incomes and those who live in rural areas, and yawn still further for racial minorities.

The Academy's May 31 letter called for a "comprehensive critical examination of policies and procedures, empowering the development of diverse formal and informal leadership and developing a plan that increases accountability, demonstrates transparency and reorganizes power."

"The AAFP recognizes that these unequal outcomes are the consequence of decades of structural and systemwide inequities designed to deliver unequal and disparate care for women of color based on institutionalized racism and the unconscious biases of health care providers toward women of color," the letter said.

The Academy urged policies that would

• educate physicians about implicit bias and build strategies to address it by supporting culturally appropriate, patient-centered care and reduce health disparities; and
  
• educate physicians about inequities in maternal morbidity and mortality, and support strategies to integrate birth equity into the delivery of family-centered maternity care.

The letter was sent to CMS Administrator Seema Verma, M.P.H., in response to a request for information. It was signed by Board Chair John Cullen, M.D., of Valdez, Alaska.

"Specifically, the CMS Office of Minority Health is seeking information related to opportunities to improve health care access, quality and outcomes for women and infants in rural communities before, during and after pregnancy," the agency wrote in February.

The AAFP's reply detailed numerous such opportunities at the regulatory and legislative levels, repeating and sometimes expounding on urgent recommendations that the Academy sent to the Senate Finance Committee in April.  

In both cases, the AAFP advanced positions staked out by its maternal health task force, which first convened last year. The task force's priorities include retaining obstetric care professionals, supporting maternity care education, reducing health care disparities, improving access to care, and addressing social determinants of health.  

The task force -- and the Academy as a whole -- also continue to advocate for increasing the supply of family physicians

"More than one-half of rural hospitals with obstetrics units depend on family physicians to attend births, and family physicians continue to attend the majority of births in small hospitals," the May 31 letter said. It also pointed out that 28% of rural family physicians -- whose practices are now under severe threat from effects of the COVID-19 pandemic -- continue to provide obstetrical services, helping to backstop the public health costs of 5 million U.S. women who live in obstetric deserts. 

"Therefore, CMS should invest in primary care workforce strategies, along with policies that would improve health access and financial viability of providing maternity care for both family physicians and hospitals," the AAFP wrote.

Among its recommendations, the letter urged CMS to

• increase Medicaid primary care reimbursements to at least the Medicare rate;
  
• back the Helping Medicaid Offer Maternity Services Act (H.R. 4996), which would allow state Medicaid coverage for mothers up to one year after delivery and include an enhanced 5% federal medical assistance percentage to encourage state support; and
  
• fund home visiting, which more than 30 states cover through Medicaid and which addresses social determinants of health.