By Susan Levine
Washington Post Staff Writer
Thursday, December 21, 2006
Six years after opening its doors in a lower-income neighborhood with many health challenges, the District's only independent birthing center is saving the health-care system more than $800,000 a year thanks to substantially reduced rates of Caesarean sections and preterm deliveries, the center's founder says.
Ruth Watson Lubic, founder and chairman of the Family Health and Birth Center, said the total would be even greater if she had a way to figure the cost implications of the percentage of babies with low birth weights, which from 2003 to 2005 fell to less than half of a citywide rate.
The nurse-midwife has theories on why the program is achieving these results, and she cares most about the import for healthier babies and mothers. But as the center continues to struggle because of skyrocketing malpractice premiums and mainly stagnant insurance reimbursements, she wonders why it shouldn't be rewarded for its success with a cut of the savings.
"Why can't we get something out of this?" she said in a recent interview.
Lubic, who has been honored nationally for her work in maternal health, presented the financial projections this fall to the D.C. Council health committee. It was her second appearance in 2006 before the committee and Chairman David A. Catania (I-At large); she had testified in March about the data indicating the center is narrowing key health disparities with its predominantly African American patients.
"Across the board, from the perspective of the mother and the perspective of the treasury, the birth center is an amazing asset for the District of Columbia," Catania said this week. If hospitals replicated its numbers -- or, he suggested, if the center itself were replicated in other neighborhoods -- "we would just multiply the savings and multiply the quality of life for these mothers and their babies."
The nonprofit center is housed in a former supermarket, completely transformed in atmosphere and appearance, on 17th Street NE in Ward 5. There, it offers gynecological and obstetrical services, parenting guidance to women and general care to children. Every year, an increasing number of prenatal patients choose to deliver in its homey birthing rooms. The rest, accompanied by one of the center's seven midwives, give birth at Washington Hospital Center.
According to preliminary 2006 numbers, the staff seems likely to celebrate a record number of newborns -- exceeding the 153 births last year, as well as the greatest percentage ever delivered away from the hospital. Through mid-October, less than 5 percent of those infants had arrived before 37 weeks and only 2 percent were considered low birth weight. Just 7 percent of their mothers had Cesarean sections.
Citywide rates for those measures remain in double digits. For Ward 5 alone, the percentage of babies with low birth weights was 13.2 percent in 2004, the latest year for which a statistic is available.
As Lubic told the health committee, there is "value added" in these numbers. Using an estimate in a recent Institute of Medicine report -- which pegged "the annual societal economic burden" of preterm births at $51,600 per child -- she calculated how much the center's 2005 preterm-birth rate meant in health-care savings. Its lower rate, compared to the city's, represented a difference of 11 newborns. Multiply 11 by $51,600 and the total exceeds $567,000 a year.
She did the same kind of math with the Caesarean-section rate and estimated that 24 fewer center patients had C-section deliveries because of its lower rate in 2005. Using a national cost number for the procedure, her multiplication worked out to nearly $285,000 more in savings.
"There's a lot of talk about performance measures," Lubic said, "and if you perform well you should get more money for what you do."
That money certainly would help the center cope with malpractice premiums that keep rising by tens of thousands of dollars annually -- another $75,000 next year alone. In 2005, the center nearly shut its doors because of the financial shock. The D.C. Council has since provided $450,000 in grants.
On the eve of her 80th birthday, Lubic has an idea about the center's success that traces to her lifelong training. The trust and communication that develop between patients and midwives during prenatal appointments often lasting up to an hour translates into better health outcomes for babies, she believes. Plus, something more:
"If we don't help women feel good about their ability to give birth, then they're not going to feel so good about their ability to mother," she said. Conversely, "there's nothing better than a birth well done to raise self esteem."