New County Network to Boost Prenatal Care for the Low-Income

Acountywide plan to vastly improve prenatal care for low-income women was approved Tuesday by the San Diego County Board of Supervisors.

With local hospital emergency rooms handling an increasing number of cases in which women have had no prenatal care, the new Perinatal Provider Network was adopted to reduce infant mortality and the number of babies born prematurely, according to supervisors and health and social service workers.

The existing public and private health care system is fragmented and inefficient, the new network will coordinate services and improve access for pregnant women who cannot afford prenatal care, said Paul Simms, deputy director of physical health services for the county health department.

Also, Medi-Cal reimbursements will be increased for obstetricians, Simms said.

The network will require no county money; state funds and billing fees to participating doctors will cover expenses.

“You cannot measure the human suffering (of premature babies), and the financial impact is tremendous,” Board of Supervisors chairman Leon Williams said. “This project will prevent many of these problems. . . . It will be humanitarian and cost-effective.”

The average cost for prenatal care for a healthy woman is $600, while costs for a premature baby needing intensive medical care are $2,500 a day. Last year, there were 3,889 births to women who had had no prenatal care.

Children with low birth weights often have developmental disabilities and require years of expensive care in the public health, social service and education systems, and are at increased risk for being abused and neglected, health experts say.

Although an estimated 72% of San Diego obstetricians refuse to treat Medi-Cal patients because of billing problems and low reimbursement, county officials hope to change that by increasing physician fees from $650 a patient to $1,000 and using electronic billing. Doctors will be eligible to participate in the new network, which will guarantee reimbursement within 30 days, if they accept one new Medi-Cal patient a month.

At first, 12 to 15 workers will be hired to recruit doctors to join the program. The network’s first-year costs will be paid for with $835,000 in state funds. Future expenses will be covered by a 7% billing fee charged to doctors for Medi-Cal payments. The time needed to complete Medi-Cal paper work will be reduced from five to seven weeks to up to three weeks.

The network, which is expected to be running within 45 days, is the product of five years of review and several months of study, Simms said.

Under the network, a variety of private physicians and community programs will provide patients with medical care and support services from the time of pregnancy to 60 days after the birth.

The network will also include an outreach program to educate women about the dangers of tobacco, drugs, alcohol and ignoring prenatal care; case management to better handle each patient’s needs, and follow-up services to detect any post-birth problems.