Phoenix-area obstetrician-gynecologists are delivering more babies and getting less reimbursement, which could result in a maternity care shortage.
"Fewer clinicians for more people," explained MomDoc CEO Nick Goodman. He said the Valley's population is growing, but there are 12 percent fewer OB-GYNs than a decade ago.
"We are willing and able to hire 30 doctors tomorrow," Goodman said. "We don't have that many candidates, much less that many qualified candidates."
At Baby Bloomers, a Phoenix maternity consignment store, moms say they'd been disappointed by their options for maternity care providers.
Sky Boucher, a mom of twin boys, said, "It was a very long process to find out who is going to be delivering them."
"I didn't know that I had any choice," said Annie Goodfellow, a mom of three. "I was told that this was the expert that I needed to go to."
Arizona is at high risk for an OB-GYN shortage, according to a 2018 study by medical network Doximity.
The study found OB-GYNs in the Phoenix area have the fourth highest workload, compared to other major metropolitan areas. On average, the Valley doctors delivered 136 babies a year.
Goodman said he faces another obstacle to hiring doctors. "Reimbursement rates to physicians are too low," he said.
Our analysis found Arizona's Medicaid system, AHCCCS, pays doctors less for maternity care than Medicaid in most western states. We looked at Medicaid fee-for-service rates in 11 states for two global obstetrics billing codes. Global obstetrics billing includes a physician's lump-sum payment for routine prenatal appointments, delivery, and a postpartum visit.
For global obstetrics care, including a vaginal delivery, the AHCCCS fee-for-service rate was about $1750. That's roughly $217 less than the 11-state average of $1967. Montana had the highest obstetrics rates, and Colorado had the lowest in June 2019. However, Colorado is set to increase its obstetrics reimbursement rates in July.
INTERACTIVE MAP: Medicaid physician fee-for-service rates for global obstetrics (vaginal delivery) June 2019
According to AHCCCS, the majority of its patients are covered by managed care organizations, which do not use the fee-for-service schedules. Agency officials also said they do not regularly check their payment rates against neighboring states.
"FFS [Fee-for-service] rates may be lower than those of neighboring states for a variety of reasons, including state-specific policies that may define different sets of covered services that are reimbursed under the global OB package," AHCCCS spokeswoman Heidi Capriotti said.
In addition, Capriotti said AHCCCS has not received complaints about obstetrics fee-for-service rates or seen access-to-care issues.
Other health insurance providers indicate Arizona moms are having problems getting to see their doctors.
"They're struggling to get appointment times because the number of available OB-GYNs in the market, which therefore means they're not getting the level of prenatal care they should be getting," said Kim Shepard, CEO of Cigna Arizona.
Concerns about a looming OB-GYN shortage come as Arizona public health officials express concern about maternal mortality and morbidity rates. Obstetrics providers say more needs to be done to improve outcomes for both moms and babies.
"Arizona's having more babies that have low birthweight," Goodman said. "More low birthweight babies mean more days in the neonatal ICU."