Editorial| Volume 90, ISSUE 5, P466-467, November 2014

Global fee prohibits postpartum provision of the most effective reversible contraceptives

      Early postpartum access to highly effective reversible contraceptives [intrauterine contraceptives (IUCs) and the implant] and sterilization is key to helping women prevent unintended pregnancy [
      • Teal S.B.
      Postpartum contraception: optimizing interpregnancy intervals.
      ]. However, most current hospital reimbursement policies deny postpartum women access to IUCs and implants prior to hospital discharge. For women whose deliveries are covered by private insurance or Medicaid, hospitals receive a global fee based on the diagnosis-related group (DRG) for all delivery-related care. Postpartum sterilization is carved out by insurance companies and Medicaid as a procedure that may be billed separately from the global fee, which in turn means that hospitals are not financially driven to deny such procedures. In contrast, in most states, postpartum IUCs and implants are not carved out for separate reimbursement and the costs of the devices must be deducted from the DRG payment. Since the wholesale acquisition costs for IUCs and implants range from US$600 to US$775, covering those costs would be fiscally rash. Consequently, most hospitals do not permit postpartum placement of the most effective reversible methods, a policy that not only hinders women's ability to space their pregnancies but also prohibits an important option for those who have completed childbearing but do not wish to be sterilized. Equally, for women who are covered by Medicaid and desire postpartum sterilization, the twin requirements of a minimum 30-day waiting period after signing the consent form and having that form present in the delivery room still inhibit access [
      • Borrero S.
      • Zite N.
      • Potter J.E.
      • Trussell J.
      Medicaid policy on sterilization — anachronistic or still relevant?.
      ]. For these women, postpartum placement of IUCs and implants would be a valuable alternative. Although the Affordable Care Act may go a long way toward expanding outpatient access to the most effective methods of contraception, it does not specifically facilitate inpatient access to IUC or the implant for new mothers prior to hospital discharge.
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