Budget cuts to NICU admissions will have a ripple effect

What is wrong with the state of Texas? Have they no heart? Why is it that at the time of fiscal crisis, it’s always the “little” people whose services are eliminated first?

The “little” people in this case would be babies who are either born sick or premature. The New York Times article, In Search of Cuts, Health Officials Question NICU Overuse, was shocking. The Texas state officials have set their sights on looking at “inappropriate admissions” to the neonatal intensive care units as a way of cutting costs.

Allegedly, they have “data” that demonstrates that $36 million dollars could be saved every two years if they curtail “over-utilization” of NICU admissions. Admittedly, some of my OB-GYN colleagues brought this level of scrutiny upon themselves when they performed “elective” inductions and cesarean sections based on “maternal requests.” That was clearly a faux pas.  Any medical school and residency training program worth their salt instilled in their students the necessity to have a clinical reason as justification before performing a medical or surgical procedure.

However, these elective procedures only represent a small percentage of NICU admissions. The main reason for NICU admissions are based upon premature births that represent 12 percent of the annual 4 million U.S. births.  The Texas Commissioner of Health and Human Services thinks the Texas NICUs are “over-utilized.”It’s a pity he didn’t provide any examples. The NICU typically takes care of babies with very specific high risk conditions such as hyperbilirubinemia that causes jaundice and potential death, hemolytic disease of the newborn that, if untreated in an emergent manner could lead to death from the baby hemorrhaging, very low birth weight babies, respiratory distress syndrome, congenital heart disease and a myriad of other life-threatening problems. Without having medical training, it is mind-boggling how the Texas commissioner or anyone else can determine if a NICU admission is appropriate or not.

In today’s litigious climate of medical malpractice and lawsuits abound, it is not unreasonable for a baby to be admitted to the NICU for observation if its APGAR scores are low. Better safe than sorry. Does the state of Texas propose to ration healthcare to newborns in the same manner that insurance companies ration healthcare to adults? Will you now become gatekeepers regarding life and death decisions?

I strongly urge the Commissioner to rethink this issue. Budget cuts to NICU admissions will have a ripple effect. Not paying for life-saving NICU admissions will lead to an increase in the cost of paying for chronic debilitating illnesses that could have been avoid. Every baby that’s born deserves to live. Please don’t set the stage for them to die.

Linda Burke-Galloway is an obstetrician-gynecologist and author of The Smart Mother’s Guide to a Better Pregnancy. She blogs at her self-titled site, Dr. Linda Burke-Galloway.

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  • paul

    not paying for nicu admissions will not reduce nicu admissions. it will lead to the prices of everything else to go up to make up the difference. that or the hospital can go out of business.

    • http://www.smartmothersguide.com Dr. L. Burke-Galloway

      Totally agree, Paul. This is what happens when people have decision making power but no fundamental knowledge of the issues.

  • sch

    Welcome to the future where hard decisions will become
    increasingly common. A Texas $31B budget deficit won’t be
    fixed by reducing NICU beds or availability but you have
    to start somewhere and healthcare is not going to be exempt.
    Obamacare proposes $50B/yr cut in the medicare budget
    starting in 3 yrs while the # of beneficiaries on medicare
    is expected to increase by upwards of 2M/ year every year
    while this cut is accomplished. Better hope you don’t need a pharmaceutical ending in -ab in 10-20yrs, they won’t be
    there unless you are a congress person or G15 or so.

  • DrB

    This kind of argument and using alarmist language is not very helpful.

    It is more helpful to begin the discussion by asking neonatologists and NICU nurses and other experienced workers where they feel like some resources are wasted and where such waste can be avoided.

    I think we can all agree that not EVERY baby born should go to NICU straight from the delivery room, correct? (Term, great apgars, healthy mom, etc.) And we can all agree that some babies are born and need NICU immediately, no questions asked, correct? (preemies, respiratory support, etc.)
    So the debate is really about where to draw the line, because, logically, there IS a line drawn somewhere, right? (If there weren’t a line, it takes us to either all or none, which we established is not the case…)

    So it follows that if we draw the line too low, so to speak, we will send a large number of babies to NICU who actually don’t *need* NICU…and conversely, if we set the bar too high for admission, then we risk some babies not getting the immediate care they might need.

    So instead of scare-mongering essays like the one above, this issues calls for healthy debate — a bar needs to be set, so us medical types should be instrumental in deciding where to set it.

  • Dave

    Here is the easiest way to tell if a section of medicine is overcomponsated: Are the hospitals remodelling/expanding that section and/or advertise their facilities? There is a reason NICU’s, cardiology, etc have spanking new facilities and it’s not because flat screens and new carpeting improve outcomes. It’s because these patients actually make a hospital money and thus they are competing with each other with marketing and cosmetic upgrades. The opposite is also true. There is a reason why mental health and AAD facilities are often pretty shabby. I don’t think we should outright bar nicu admissions but payments do need to be changed and levels of care adjusted.