Guidance promotes evidence-based approaches to improve quality and reduce disparities in hospital maternity care  

The U.S. Department of Health and Human Services, through the Centers for Medicare & Medicaid Services (CMS) is taking critical steps to ensure pregnant and postpartum individuals have access to equitable, comprehensive maternity care. In support of Vice President Kamala Harris’ Call to Action to Reduce Maternal Mortality and Morbidity announced on December 7, 2021, CMS is encouraging hospitals to implement evidence-based patient safety practices for managing obstetric emergencies along with interventions to address other key contributors to maternal health disparities.

“Becoming a parent in America should not mean risking lives – especially among low-income women, especially in communities of color,” said Health and Human Services Secretary Xavier Becerra. “I am proud that the Biden-Harris Administration is committed to addressing the nation’s crisis in pregnancy-related deaths and health disparities. At HHS, we will continue to ensure safe pregnancies and improve maternal health outcomes for all new parents.”

“There is no greater priority than ensuring pregnant and postpartum individuals receive the best possible care, and the Biden-Harris Administration is committed to working with the provider community and beyond to make that happen,” said CMS Administrator Chiquita Brooks-LaSure. “Too many individuals  ̶  a disproportionate share of them people of color  ̶  experience unnecessary pregnancy-related complications and deaths. We must do everything we can to change that.”

In support of delivering equitable, high-quality maternity care, CMS encourages hospitals to review their policies and procedures for incorporation, where appropriate, of best practices.

One such evidence-based practice for improving patient safety and quality of care, referred to as “maternal safety bundles,” has been successful in driving improvements  ̶  particularly with obstetric hemorrhage, severe hypertension in pregnancy, and non-medically indicated Cesarean deliveries. These bundles have also been associated with narrowing the racial disparity gap in certain perinatal outcomes.

Today’s guidance is the latest in a series of actions CMS has pursued to further advance the safety and quality of maternal care. As part of Vice President Harris’ recent Call to Action, CMS announced the intent to propose a designation to further drive hospital improvements in perinatal health outcomes and maternal health equity. Beginning on October 1, 2021, CMS adopted a new quality measure for the Hospital Inpatient Quality Reporting Program that asks hospitals to attest to whether they participate in a statewide or national perinatal quality improvement collaborative, and whether they have implemented patient safety practices or bundles to improve maternal outcomes.

Initially based on data reported by hospitals on this measure, and in combination with data reported by hospitals on other measures in the future, a hospital could receive a “Birthing-Friendly” designation on the CMS Care Compare website. This could not only further advance maternity care safety and quality, but also provide information to consumers and their families in a user-friendly way as they consider options for where to seek care. 

In addition, CMS encourages states to take advantage of the American Rescue Plan’s (ARP’s) option to provide 12 months of postpartum coverage to pregnant individuals who are enrolled in Medicaid or the Children’s Health Insurance Program (CHIP) beginning April 2022. A recent report by HHS’ Office of the Assistant Secretary for Planning and Evaluation (ASPE) showed the dramatic impact if states extended Medicaid postpartum coverage to 12 months. If every state adopted an extension  ̶  as proposed in the Build Back Better Act  ̶  then the number of Americans getting coverage for a full year postpartum would roughly double, extending coverage for an estimated 720,000 in a given year. Over half of pregnancy-related deaths occur immediately after delivery and up to one year postpartum. The ARP’s option represents another tool in combatting disparities in maternal health driven by interruptions in postpartum care continuity and access. View a copy of the Medicaid State Health Official Letter on the postpartum extension option.

Each year in the U.S., approximately 700 women die from pregnancy-related complications, and over 25,000 experience severe complications of pregnancy. There are significant racial, ethnic, and geographic disparities in maternal morbidity and mortality as well: Black and American Indian/Alaska Native women die from pregnancy-related causes at a rate 2-3 times higher and experience severe complications at a rate nearly two times higher than their white, Asian Pacific Islander, and Hispanic counterparts. Pregnant people who live in rural communities are at higher risk for severe maternal morbidity and about 60% more likely to die from pregnancy-related causes than those living in urban settings. However, two out of three pregnancy-related deaths are considered preventable.

See the Quality, Safety, and Oversight memo.