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Frequently Asked Questions

What is the Maternal Morbidity Structural Measure?

The new Maternal Morbidity Structural Measure has been finalized in the Centers for Medicare and Medicaid Services (CMS) 2022 Inpatient Prospective Payment System (IPPS) Final Rule. The measure is intended to determine the number of hospitals currently participating in a state or national perinatal quality collaboratives (PQCs) and whether hospitals are implementing the safety practices or bundles included as part of these initiatives. Such programs have shown to be effective in decreasing maternal morbidity and the quality of obstetric care delivery.1, 2

Access the detailed measure specifications, and read the measure description is provided here:

Does your hospital or health system participate in a Statewide and/or National Perinatal Quality Improvement Collaborative Program aimed at improving maternal outcomes during inpatient labor, delivery and post-partum care, and has implemented patient safety practices or bundles related to maternal morbidity to address complications, including, but not limited to, hemorrhage, severe hypertension/preeclampsia or sepsis?

  • Yes
  • No
  • N/A (our hospital does not provide inpatient labor/delivery care)

Where did this measure come from? Did ACOG develop it?

ACOG did not develop the specifications of this measure; however, prior to the COVID pandemic, we were meeting with the inpatient quality team at CMS to brainstorm ways to capture quality maternity care in hospitals. As a first step, ACOG recommended that CMS capture who is participating in the Perinatal Quality Collaboratives (PQCs).

What are Perinatal Quality Collaboratives (PQCs)?

Perinatal Quality Collaboratives (PQCs) are state or multi-state networks of multidisciplinary teams of perinatal health care providers and public health professionals working together to improve outcomes in maternal and infant health. This work is conducted through the implementation of quality improvement (QI) initiatives designed to continually monitor, analyze, and improve the quality of care provided.

For example, the Alliance for Innovation on Maternal Health (AIM) is a national, data-driven maternal safety and QI initiative coordinated by PQCs in many states. They include bundles, which are evidence-based standardizations for delivering care for leading known causes of preventable severe maternal morbidity and mortality. These bundles include:

  • Obstetric Hemorrhage
  • Severe Hypertension in Pregnancy
  • Safe Reduction of Primary Cesarean Birth
  • Obstetric Care for Women with Opioid Use Disorder
  • Cardiac Conditions in Obstetrical Care
  • Postpartum Discharge Transition (in development)

Why is this measure important?

Maternal morbidity and mortality are long-standing issues that continue to impact pregnant women and individuals across the country. This even further exposes health inequities faced by women of color, as Black women are three times more likely to die from pregnancy-related complications than non-Hispanic White women. Finding ways to tackle this issue is a prime focus of ACOG advocacy and policy initiatives, and a priority of the Department of Health & Human Services. ACOG believes PQCs are an important tool in the arsenal in fighting maternal morbidity and mortality.

Who does this measure apply to?

This measure applies to all hospitals and providers participating in the Hospital Inpatient Quality Reporting (IQR) Program.

Does this only apply to Medicare patients?

No. However, this measure applies to hospitals that accept Medicare patients and are listed on the Medicare.gov Hospital Compare site. Eventually, patients will be able to look at Hospital Compare and determine if their hospital participates in a PQC. The American Hospital Association 2021 report indicates of the over 6,000 hospitals in the US, Hospital Compare reports over 4,000 in their lookup tool.

How can my hospital report this measure?

This new measure will be reported through the CMS-approved web-based data collection tool available on the QualityNet website, similar to other measure reporting methods. Given the structure of the measure, answers will vary from yes, no, or N/A on whether a hospital is participating in a PQC and have implemented patient safety practices or bundles.

When will reporting for this measure begin?

The initial reporting period for the measure will begin on October 1, 2021 and end on December 31, 2021. In subsequent years, data will be reported between January 1 through December 31.

How can my hospital get involved in statewide or national PQCs or AIM?

Many states have active collaboratives and others are currently in development. The Centers for Disease Control and Prevention (CDC) maintains an interactive list of PQCs in the United States. Hospitals interested in engaging with their state PQC should contact the coordinating entity directly.

PQCs are the coordinating the efforts of the Alliance for Innovation on Maternal Health (AIM) program in many states. Access an interactive list of states currently enrolled in the AIM program. Hospitals interested in participating in the AIM program should contact aim@acog.org to be connected with their state contact. State contacts exist for all states, regardless of AIM enrollment status.

Will this affect my reimbursement?

Reporting of this new measure could have an impact on payment determinations beginning in FY 2023, based on the initial reporting period of October 1, 2021 to December 31, 2021. Subsequent payment determinations will be based on a full year’s worth of data. Impact on individual provider reimbursement will be dependent on the provider’s contract negotiated with their hospital or facility.

References

  1. Main, E.K., Cape, V., Abreo, A., Vasher, J., Woods, A., Carpenter, A., Gould, J.B. (2017). Reduction of Severe Maternal Morbidity from Hemorrhage Using a State Perinatal Quality Collaborative. American Journal of Obstetrics and Gynecology, 216(3): 298.e1. Available at: https://www.ncbi.nlm.nih.gov/pubmed/28153661
  2. Arora, K.S., Shields, L.E., Grobman, W.A., D’Alton, M.E. (2016). Triggers, Bundles, Protocols, and Checklists What Every Maternal Care Provider Needs to Know. American Journal of Obstetrics and Gynecology, 214(4): 449- 450