Medicaid program helps moms, babies, and staff
Medicaid program helps moms, babies, and staff
Sometimes, care delivery is about need, not money
It doesn’t make St. Mary’s Hospital Home Health Care money. In fact, in today’s strict bottom-line world of health care, it may not even make a lot of sense. But then, you can’t always put a price tag on value.
At least that’s how administrators and staff of the Athens, GA-based hospital-affiliated agency feel about participating in a state Medicaid program to combat teen pregnancy and the high rate of infant mortality in Georgia. Medicaid reimburses St. Mary’s, but it isn’t enough to cover the cost of the visits. So the home care provider absorbs the rest.
St. Mary’s doesn’t even consider its New Mom/ Baby Program, as it is called, a "public relations" tactic. The rewards are more personal than that.
"We have strong values," says Marilyn Hill, RN, MS, vice president of St. Mary’s Hospital and director of the home health agency. "The margin is not always our mission, although we are aware that without the margin, you have no mission."
St. Mary’s Home Health Care/Hospice Service and St. Mary’s Hospital in Athens, known collectively as St. Mary’s Health Care System, started its service about five years ago. The Medicaid program, also available through the Clarke County public health department, was of particular interest to St. Mary’s, not only because of its mission as a Catholic health care system, but also because Clarke County has a higher infant mortality rate than the state has overall.
Statistics paint a picture
The county, which is home to the agency and the University of Georgia, recorded 11.5 infant deaths per 1,000 live births, according to the 1994 vital statistics furnished by the university. The state’s infant mortality rate in 1994 was 10.1. Those same statistics show births to unwed mothers at 16.1 per 1,000 females age 15-44. The state of Georgia’s 1994 rate was 23.5.
Considered in conjunction with other statistics on education and poverty, a pattern begins to emerge. In 1993, 20.5% of Clarke County’s population lived below the poverty level, and 28.1% of those were children ages 5-17. In 1995-96, Clarke County’s high school dropout rate was 15.3 students per 100 enrolled. The state dropout rate was 8.6 in the same period.
"Looking at the statistics on economics, dropout rate, and unwed mothers, you can see how it all sort of dovetails," says Hill. She says there is a need for a women’s community health program that would provide health education and care beginning in childhood and continuing through old age.
But for now, she and St. Mary’s will concentrate on infant mortality and helping unwed teenage mothers raise healthy babies.
"Medicaid designed this program to educate especially the young mothers, so that they would know how to care for their children and themselves," says Jeannine Richardson, RN, St. Mary’s special services manager, who oversees her agency’s program. She adds that the state’s effort is also aimed at cutting dependence on other social programs like welfare.
St. Mary’s New Mom/Baby Program provides the following:
• a physical examination of mother and baby by a registered nurse during the first few weeks after delivery;
• teaching mothers about normal physical changes after delivery and how to care for themselves;
• teaching all aspects of new baby care, including breast feeding, formula feeding, care of umbilical cord, circumcision, bathing, and signs and symptoms of illness.
"We get reimbursed very little," Richardson acknowledges, "about $60 each for the first two initial visits, and about $35 for the follow-up health checks."
Some moms don’t want to be found
It’s all about monitoring and early detection, Richardson notes, but it’s not a service the clients always eagerly seek. These mothers often are hard to find, she says. "They feel threatened by the system. They’ll give us the wrong information after the baby is born about where they live. Sometimes we never find them. They don’t want to be found."
To get the word out, St. Mary’s staff tack flyers up in local laundromats that encourage mothers to call the program. Even though the program is offered by the county, Richardson says, "it’s better to have it in the home because you get a true assessment of how they are living."
The first visit is scheduled no sooner than the third day after birth, and the second comes within two weeks. Both the mother and baby are checked, Richardson says, and the mother is given instructions on which situations would require calling the doctor. "We make sure the mom knows how to mix formula or breast feed, how to take the baby’s temperature, get into the county food stamp program if necessary, what to do if the baby has diarrhea."
Nurses check the mother for postpartum depression during the visit, which can last up to two hours. "We assess the home situation, baby supplies, and her support system."
Nurses make follow-up visits when the baby is 6 months old and again at 12 months for a "healthy baby check," Richardson says. "Then we talk about safety issues like poisons, immunizations, developmental issues. If the nurse notices a problem, like infections or jaundice, or if the baby needs more care, they can be switched to a Medicare program and monitored."
Although patients are not required to obtain a physical to participate in the program, the state Department of Medical Assistance, which administers it, requires all nurses to have a provider number. "You have to demonstrate that you have OB postpartum experience to meet their qualifications."
The information required of nurses is highly detailed, Richardson says. "They want to know where you have worked, what you did. They want to know about all your experience. It’s like giving a detailed resume."
Because nurses are required to have so much specialized experience, only three who work for St. Mary’s perinatal program have received provider numbers, Richardson says.
"They don’t want just any home health nurse going out to do it," she explains.
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