title: A perinatal care quality and safety initiative: are there financial rewards for improved quality?
abstract: BACKGROUND
  Although costs of providing care may decrease with hospital initiatives to improve obstetric and neonatal outcomes, the accompanying reduced adverse outcomes may negatively affect hospital revenues.
  
  
  METHODS
  In 2008 a Minnesota-based hospital system (Fairview Health Services) launched the Zero Birth Injury (ZBI) initiative, which used evidence-based care bundles to guide management of obstetric services. A pre-post analysis of financial impacts of ZBI was conducted by using hospital administrative records to measure costs and revenues associated with changes in maternal and neonatal birth injuries before (2008) and after (2009-2011) the initiative.
  
  
  RESULTS
  For the Fairview Health Services hospitals, after adjusting for relevant covariates, implementation of ZBI was associated with a mean 11% decrease in the rate of maternal and neonatal adverse outcomes between 2008 and 2011 (adjusted odds ratio [AOR] = 0.89, p = .076). As a result of the adverse events avoided, the hospital system saved $284,985 in costs but earned $324,333 less revenue, which produced a net financial decrease of $39,348 (or a $305 net financial loss per adverse event avoided) in 2011, compared with 2008.
  
  
  CONCLUSIONS
  Adoption of a perinatal quality and safety initiative that reduced birth injuries had little net financial impact on the hospital. ZBI produced better clinical results at a lower cost, which represents potential savings for payers, but the hospital system offering improved quality reaped no clear financial rewards. These results highlight the important role for shared-savings collaborations (among patients, providers, government and third-party payers, and employers) to incentivize QI. Widespread adoption of perinatal safety initiatives combined with innovative payment models may contribute to better health at reduced cost.
authors.affiliation: Divisionof Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, USA. kbk@umn.edu
authors.forename: Katy B
authors.initials: KB
authors.lastname: Kozhimannil
authors.forename: Samantha A
authors.initials: SA
authors.lastname: Sommerness
authors.forename: Phillip
authors.initials: P
authors.lastname: Rauk
authors.forename: Rebecca
authors.initials: R
authors.lastname: Gams
authors.forename: Charles
authors.initials: C
authors.lastname: Hirt
authors.forename: Stanley
authors.initials: S
authors.lastname: Davis
authors.forename: Kristi K
authors.initials: KK
authors.lastname: Miller
authors.forename: Daniel V
authors.initials: DV
authors.lastname: Landers
mesh_terms: D001720:Birth Injuries / Q000191:economics* / Q000517:prevention & control*; D003299:Cooperative Behavior; D017046:Cost Savings / Q000191:economics*; D005260:Female; D006284:Health Plan Implementation / Q000191:economics / Q000458:organization & administration; D017721:Hospital Costs / Q000706:statistics & numerical data*; D006801:Humans; D007231:Infant, Newborn; D033183:Interdisciplinary Communication; D008910:Minnesota; D061214:Patient Safety / Q000191:economics*; D018743:Perinatal Care / Q000191:economics* / Q000592:standards*; D011247:Pregnancy; D058996:Quality Improvement / Q000191:economics* / Q000592:standards*; D012201:Reward; D016896:Treatment Outcome