A Five-Point Plan to Recruit and Retain Ob/Gyns in Iowa
Point 1: Increase Medicaid reimbursement to physicians who deliver babies.
Currently, Iowa is almost dead last when it comes to how much Medicaid pays Ob/Gyns to deliver babies. The vaginal delivery global fee covers all prenatal office visits, management of labor, delivery of the baby, postpartum care in the hospital, and postpartum care in the office. We are asking for a 25% increase in Iowa Medicaid payments to doctors for OB care, which will help our Iowa Ob/Gyns maintain their practices and recruit other Ob/Gyns to join them. We estimate this would cost the State of Iowa $2.5 million per year, providing a solid return on investment to keep our birthing hospitals open.
Please contact your state legislators. Tell them you want Ob/Gyns to stay in Iowa, and ask them to support a bump in Medicaid rates for OB care: you can find them here.
Current payment for CPT Code 59400 (vaginal delivery global fee):
South Dakota Medicaid: $2,220.16
Nebraska Medicaid: $1,853.20
Illinois Medicaid: $1,840.25
Missouri Medicaid: $1,802.10
Kansas Medicaid: $1,532.15
Minnesota Medicaid: $1,387.89
Iowa Medicaid: $1,364.46
Wisconsin Medicaid: $1,149.32
Point 2: Build a Community Ob/Gyn Residency in Des Moines.
Iowa has just one Ob/Gyn residency, graduating just 6 newly-minted Ob/Gyns per year, and because of its outstanding academic nature, many of these will not become the community Ob/Gyns that Iowa needs so badly. By contrast, Minnesota has 2 Ob/Gyn residencies (14 total slots); Wisconsin has 3 (15 total slots); Illinois has a whopping 12 residencies; and even Nebraska has 2 (9 total slots). Iowa is a little odd among the Midwestern public medical schools, because its teaching hospital is not in its major population center, but instead in Iowa City. Therefore, Des Moines is the perfect place to start a community Ob/Gyn residency to make more Ob/Gyns for Iowa. While this residency will eventually be financially self-sustaining, it will require startup costs of $1-2 million, which may have to be funded by the State of Iowa.
Point 3: Clarify Medical Abortion Exceptions
The fact is, it’s difficult to practice as an Ob/Gyn in a state with an abortion ban, even one with a medical exception for the life of the mother, because when a woman with a life-threatening medical condition arrives on the Ob/Gyns’s doorstep, the chorus of second-guessing and back-seat driving commences: “Are you sure she’s sick enough to need an abortion? Has she decompensated enough?” The pushback comes from nurses, anesthesia staff, and hospital administrators. When Ob/Gyns are not supported in their medical expertise to perform abortions for patients with life-threatening pregnancy complications, tragedies ensue like the the death of Texas’s Josseli Barnica. There have already been reports in Iowa of women with clearly life-threatening medical complications of pregnancy, such as ectopics, being forced to cross state lines due to nervousness and confusion about the law, not on the part of Ob/Gyns, but on the part of other hospital staff. The State of Iowa could step in to endorse ACOG’s document on Understanding and Navigating Medical Emergency Exceptions in Abortion Bans and Restrictions to ensure that Iowa women get the life-saving care they need in a timely fashion, and Ob/Gyns are not harassed and retaliated against for providing this care by the hospitals they work in or the Board of Medicine.
Point 4: Intervene in Catholic Hospitals that Forbid Tubal Ligations
Several communities in Iowa lost a tremendous number of Ob/Gyns when their practices were taken over by Catholic systems which then forbid birth control, including tubal ligations. As Ob/Gyns we care for our patients very much, and so it is degrading and depressing to be forced to provide second-class, even dangerous, medicine to them. For example, the sad story of Mason City losing nearly all its Ob/Gyns is told in this article. It is puzzling that this situation has gone on for so long, since it is so destructive and serves absolutely no one. The State of Iowa should intervene by requiring these health systems to allow their physicians to prescribe the full range of birth control, including tubal ligations, or if they cannot do this due to their personal beliefs, to transfer the administration of their hospitals to someone who can.
Point 5: Consider further malpractice reform
Ob/Gyns in Iowa are grateful for the 2023 legislation that capped non-economic damages in malpractice suits at $2 million. However, this is still a higher cap than in many surrounding states, and the State of Iowa should implement medical injury legislation with Wisconsin or Kansas as a model, to decrease frivolous lawsuits against Ob/Gyns. As an Ob/Gyn friend in Wisconsin told me once, “In Wisconsin, we only get sued if we actually do something wrong.”