The Department of Justice had a busy week prosecuting Medicare fraud from coast to coast. Here's a rundown of some of the more notable, high-profile arrests and convictions.
LA Pastors Convicted in $14.2M Medicare DME Fraud
Two pastors of a now-defunct Los Angeles church and an accomplice have been convicted of conspiracy and fraud counts in connection with a $14.2 million Medicare fraud scheme involving durable medical equipment, the Departments of Justice and Health and Human Services said.
After a two-week trial in federal court in Los Angeles, a jury found Christopher Iruke, 60; his wife, Connie Ikpoh, 49; and Aura Marroquin, 30, guilty of multiple charges. Iruke, Ikpoh, and Marroquin billed Medicare for power wheelchairs, orthotics and other DME that were not medically necessary or never provided. The couple recruited parishioners from their now-defunct Arms of Grace Christian Center to help perpetrate the scheme, prosecutors said.
Philadelphia Physician, Pharmacist Indicted in Drug Fraud Case
A 498-count indictment was unsealed this week charging 53 defendants, including a Montgomery County physician and a Northeast Philadelphia pharmacist, in a multi-million dollar drug conspiracy involving phony prescriptions, phony patients, and an alleged drug trafficking organization, federal prosecutors said. The indictment was announced by United States Attorney Zane.
In addition to charges of drug possession and drug distribution, the indictment contains 240 counts of healthcare fraud.
Named in the indictment and arrested were Norman Werther, MD, of Horsham, pharmacist Ihsanullah "Sean" Maaf, of Northeast Pharmacy in Philadelphia, and alleged drug trafficker William Stukes, of Philadelphia. According to the indictment, Stukes and his alleged drug trafficking organization recruited large numbers of pseudo patients and took them to Werther's medical office for fake examinations.
These "patients" paid an office visit fee, usually $150, to the office staff and Werther would write prescriptions for oxycodone-based drugs without there being a medical need. The "patients" were driven to various pharmacies to have their prescriptions filled, including Northeast Pharmacy where Maaf would fill the prescription.
The drugs were then turned over to Stukes or his drivers. Stukes and his organization would allegedly sell the narcotics to numerous drug dealers, who are also named in the indictment, who would also then resell the drugs on the street.
CA Clinic, MD, to Pay $7.5M To Settle Fraud Case
An Orange County, CA physician and the clinic he operated will pay the federal government $7.5 million to settle whistleblower Medicare fraud civil claims related to billings for cancer treatments, the Department of Justice has announced.
Glen Justice, MD, an oncologist from Corona del Mar, CA, and the CEO of Pacific Coast Hematology, was sentenced last month to 18 months in prison after he pleaded guilty to submitting bills to Medicare for injectable cancer medications that were never administered to patients, DOJ said.
Federal prosecutors announced a settlement last week in the civil case against Justice, 66, which arose from a whistleblower lawsuit brought forward by former employees at the medical group.
The civil lawsuit essentially reiterates the allegations brought forward in the criminal trial.
The fraud, which prosecutors say began in 2003 and continued until late 2009, was brought by whistleblowers Dora Figueroa and Francisca Pages, who both worked for Justice at Pacific Coast Hematology, The women could receive up to 25% of the settlement, as part of the whistleblower statute.
MD Oncologist Pleads Guilty to Purchasing Misbranded Drugs
Isabella Martire, MD, age 52, of Laurel, MD, an oncologist in solo practice, has pleaded guilty to introducing a misbranded drug into interstate commerce.
According to Martire's plea agreement, in 2010, federal law enforcement investigators began investigating a pharmaceutical wholesaler based in England concerning allegations that the company was importing into the United States prescription drugs approved and labeled for use only outside the United States. Further investigation revealed that Martire purchased nearly $200,000 of misbranded prescription drugs from the company in 2010.
Martire used the misbranded drugs to treat her cancer patients. She sought reimbursement from Medicare, Medicaid, TRICARE, federal employee health benefit plans and private health insurers for reimbursement of the cost of those drugs. The cost savings Martire realized by purchasing the misbranded drugs was at least $790,600 in 2010.
Martire faces a maximum penalty of one year in prison followed by a year of supervised release when she is sentenced on Oct. 17, prosecutors said.
Miami Home Health RN Gets 10 Years for Fraud
Armando Santos, RN, of Miami, was sentenced last week to a statutory minimum of 10 years in prison following his conviction by a federal jury in May on several counts related to healthcare fraud, federal prosecutors said.
Santos, 46, was employed by a Miami-Dade based home healthcare agency called Ideal Home Health, and was paid to provide care for Medicare beneficiaries that were homebound, diabetic, insulin dependent, and so ill that they were unable to inject themselves with insulin.
Evidence at trial showed that at least two of the Medicare beneficiaries that the defendant claimed to be injecting with insulin twice daily, seven days per week, were neither in need of insulin nor homebound.
The owners of Ideal Home Health, Elizabeth Acosta Sanz and Luis Alejandro Sanz, both of Miami, were recently arrested and face related healthcare fraud and conspiracy charges.
Miami Woman Is 10th Person Arrested in $27M Healthcare Fraud Conspiracy
Elizabet Lombera, 39, of Miami Lakes, FL was indicted August 10 by a federal grand jury in Miami of conspiracy and fraud charges for her alleged role in a scheme to scam more than $27 million from Medicare. The indictment Lombera and her co-conspirators installed nominee presidents to hide her control of five durable medical equipment companies in Miami that submitted fraudulent claims to Medicare.
Collectively, the five companies submitted approximately $27,383,328 in fraudulent claims to Medicare and received $12,438,952 in reimbursements. The indictment alleges that Lombera used the money for personal gain, including paying for a trip to Japan. Six of Lombera's co-conspirators have already been sentenced for their roles in this conspiracy.
A lawsuit filed this week by six Georgia physicians illustrates the growing resentment and anger that primary care providers have with what they say is a secretive Medicare reimbursement process that is skewed towards specialists, says Roland Goertz, MD, president of the American Academy of Family Physicians.
"For a group of physicians to resort to legal action should give you an indication of how frustrated primary care physicians are," Goertz told HealthLeaders Media. "Their feeling is that the system over the last 20 years has not appropriately rewarded them for the care they provide. Nor has it appropriately positioned them for their importance in this system."
In a lawsuit filed this week in U.S. District Court in Maryland, the Georgia physicians, all from the Center for Primary Care in Evans, GA, complain that for nearly 20 years the Department of Health and Human Services and the Centers for Medicare and Medicaid Services have relied on the "specialist-dominated" Relative Value Scale Update Committee (RUC) for reimbursement advice.
The 74-page suit, filed this week in U.S. District Court in Maryland, claims that the RUC violates the Federal Advisory Committee Act's requirements for representation, transparency, and methodological rigor. As a result, the Center for Primary Care physicians claim, the RUC "has systematically overvalued many specialty procedures while undervaluing primary care." The plaintiffs want a federal judge to suspend the RUC process until HHS and CMS comply with FACA rules.
AAFP declined to join the suit, Goertz says, because the physician organization wants to change the way RUC does business without going to court. "We are taking a different tack at this point, sending a very direct letter to RUC itself and meetings with CMS to see if there is an alternative. One of the problems with shutting things down is what alternative would be used for payment?" he says.
The RUC now has 29 total members, 23 of whom come from medical specialty societies. Of the 23 physician-members, three are rotating seats and two of the three rotating seats are reserved for internal medicine sub-specialties The remaining six seats include the chair of the RUC, a representative of the AMA, a representative of the CPT-editorial panel, a rep of the AOA, a rep from the healthcare professionals advisory (non-physician provider), and a rep from the practice expense review committee.
Goertz says, the AAFP has asked RUC to:
? Create more seats for general internal medicine, general pediatric medicine, and general family medicine;
? Add three new seats for external representatives, such as employers, health plans, and consumers ("We believe the presence of three external seats on the board would provide a more transparent process with good input from those that the decisions impact");
? Create a permanent seat for geriatric medicine, which is now one of the rotating seats;
? Eliminate the existing rotating specialty seats as the current representatives on the board term out;
? Improve transparency on all votes.
Under the existing structure, Goertz says, primary care physicians are underrepresented and have little power. "There are a total of 29 votes at any given time and only three that you can identify as primary care representatives. One of the reasons for our request for the four new seats is that to pass anything at RUC requires a two-thirds vote. There is no ability to challenge a two-thirds vote when you only have three primary care votes."
The lack of transparency with the RUC process is particularly troubling, he says. "That is one of our requests for them -- that they make the process more transparent to the public because the public -- particularly the Medicare recipient -- is impacted significantly by the decisions that are made," he says.
Goertz says AAFP wants a decision on its demands by next March, "which would give the RUC group two meetings to consider our requests. In the interim we have created a task force made of the best minds we could put together from the physician payment world to develop a more-appropriate payment methodology for paying particularly primary care physicians."
Even though AAFP is not joining the Georgia physicians' suit Goertz says many of their complaints are legitimate. "Regardless of who you are, when you sit on a committee you represent your own interests no matter how the process may be set up to not reflect that," he says. "The proof is in how the payment process has separated primary care physicians from non-primary care physicians, particularly over the last 20 years since RUC has been in place."
Peninsula Regional Medical Center will pay the federal government $1.8 million to settle claims that officials at the Salisbury, MD hospital knew about, but failed to act on, unnecessary cardiac stent procedures performed by a cardiologist, the Department of Justice has announced.
The cardiologist, John R. McLean, MD, was convicted of fraud last month after federal prosecutors showed that he inserted unnecessary cardiac stents into more than 100 patients as part of a scheme to defraud government and private insurers of more than $700,000.
The settlement this week with PRMC resolves allegations that senior medical staff at PRMC failed to act on complaints of staff in the cardiac catheterization laboratory about the medically unnecessary procedures that McLean was performing, DOJ said in a media release.
PRMC also agreed to repay money it received from federal health benefit programs between April 24, 2003 and Dec. 4, 2006 for medically unnecessary stents performed by McLean.
The hospital entered into a Corporate Integrity Agreement with the Department of Health and Human Services, Office of Inspector General, which requires PRMC to ensure accurate billing. The CIA also requires the hospital to appoint physician executives to oversee medical staff quality-of-care matters, DOJ said.
McLean, 59, could receive up to 35 years in prison when he is sentenced on November 10. Prosecutors want to recover $711,583 that they believe McLean garnered in the scheme, but U.S. District Judge William D. Quarles, Jr. will determine the exact amount of forfeiture at the sentencing.
Evidence presented at the two-week trial showed that from at least 2003 to May 2007 McLean performed cardiac catheterizations and implanted unnecessary cardiac stents in more than 100 patients at the hospital, prosecutors said.
McLean, federal prosecutors added, falsely recorded in the patients' medical records the existence or extent of coronary artery blockage to justify the stents and the claims to health insurers, including Medicare and Medicaid.
In a statement released Wednesday, PRMC said: "Although Dr. McLean was convicted in federal court in July of criminal charges, Peninsula Regional Medical Center has never been the focus of any criminal investigation or faced any criminal action related to his stenting practices."
PRMC referred to McLean as an "independent medical practitioner who "resigned his medical privileges in March 2007, shortly after questions arose about his stenting practices."
Six primary care physicians from Georgia have filed a lawsuit against the federal government, claiming that a committee of volunteer physician-advisors that recommends reimbursement rates for Medicare procedures and services is secretive and skewed toward medical specialists.
The physicians, all from the Center for Primary Care in Evans, GA complain that for nearly 20 years the Department of Health and Human Services and the Centers for Medicare and Medicaid Services have relied on the "specialist-dominated" Relative Value Scale Update Committee (RUC) for reimbursement advice.
The 74-page suit, filed this week in U.S. District Court in Maryland, claims that the RUC violates the Federal Advisory Committee Act's requirements for representation, transparency, and methodological rigor. As a result, the Center for Primary Care physicians claim, the RUC "has systematically overvalued many specialty procedures while undervaluing primary care." The plaintiffs want a federal judge to suspend the RUC process until HHS and CMS comply with FACA rules.
One of the plaintiffs, Paul Fischer, MD, told HealthLeaders Media that the timing of the suit is "very fortuitous," as Congress grapples for ways to contain Medicare costs.
"We are going to win this. The law is pretty clear and the facts are pretty clear. We will win on a legal basis," Fischer says. "But the second thing is Medicare is too expensive and so broken and the government doesn't have too many things it can do. This gives the government a tool."
Fischer says the existing payment structure that RUC has dominated is a huge driver of healthcare costs. "We have too many specialists doing too many unnecessary procedures and the price that we pay doctors has been fixed by this secret little committee of the AMA. That is illegal," he says. "Let's come up with a better way of pricing physician services more in line with the value they provide to the society."
The suit notes that CMS has historically accepted more than 90% of RUC recommendations. The resulting higher income for specialists has discouraged medical students from primary care and exacerbated the nation's shortage of generalist physicians, the plaintiffs contend.
Barbara Levy, MD, chair of the RUC, issued a statement that acknowledged the lawsuit but did not talk about the specific allegations. "The RUC is an independent panel of physicians from all medical specialties, including primary care, who make recommendations to CMS as all citizens have a right to do. These volunteers provide physicians' voice and expertise to Medicare decision-makers through their recommendations," Levy said.
Fischer says his group tried to go through traditional channels to have their grievances heard but that they were ignored by the AMA and the American Academy of Family Physicians. "The first thing we did was go to them almost a year ago to support this effort. But AAFP sits on the RUC. They are part of the problem. When they were unwilling to do anything I decided to go it alone," Fischer says.
Attempts to speak with AAFP leaders on Wednesday afternoon were not successful, but the AAFP has created a task force to increase efforts to add cognitive value to the relative value unit physician fee formula. And the group is calling for the RVU formula to be revised.
Fischer says he and his colleagues are forced to address the issue in a lawsuit because nobody else has taken it up. "Family medicine and primary care are in a crisis in this country and nobody's been willing to fix it. The government hasn't tried to fix it. The medical schools haven't tried to fix it. The specialists are off doing procedures and making a lot of money," he says.
"My daughter is a resident in family medicine and I am doing this at the end of my career to make things better for her as she becomes a family doctor." Fischer says the practice has spent about $100,000 in legal fees. "It's money coming from seeing patients one at a time in the office," he says.
The plaintiffs have set up a Web site to solicit donations from primary care physicians, patients and other sympathizers. "Some people call it David and Goliath. One guy in the office called it Don Quixote," Fischer says. "Pick your metaphor."
Chronic understaffing at Carlisle (PA) Regional Medical Center may have played a role in the deaths of at least two emergency department patients in June, a report from the Pennsylvania Department of Health says.
Executives at Naples, FL-based Health Management Associates Inc., which owns Carlisle Regional, dispute the state's findings.
On June 5, a critical care patient at Carlisle Regional died while undergoing a CT scan. An employee told state investigators that the patient was sent for imaging without a nurse because only four nurses were on duty to service the overflowing emergency department.
The employee, identified as EMP4, told state investigators the "that management was aware of the staffing situation throughout the hospital and ED nurses were told that they must be more creative in their care."
On June 11, a patient in the emergency department complained of chest pains, and light-headedness died at the hospital more than seven hours after a cardiologist recommended that the patient be transferred to Harrisburg Hospital for an aortic valve replacement.
The state report reviewed documents from the hospital and includes interviews with at least 18 unnamed employees who complained about poor and unresponsive management and retaliation against "troublemakers."
Several employees told state investigators that an emergency department supervisor who had repeatedly complained to management about the chronic understaffing was fired. "We all fear for our jobs because corporate will fire at will with no reason," a hospital worker identified as EMP9 told state investigators. Another unnamed worker said nurses were afraid. "This is an unsafe place to work and management is aware," EMP18 said.
John Kristel, CEO at Carlisle Regional Medical Center, said in a media statement that the hospital "takes the findings of a recent state Health Department report very seriously."
"However, we take great exception to the notion that the regrettable deaths of two patients may have been related to staffing issues at the hospital," Kristel said in a prepared statement. "We look at our staffing levels on a continuous basis and at this juncture we have no reason to believe that these deaths were in any way connected to staffing levels. Our deepest sympathies go out to the two families involved."
Kristel conceded that "like most other Pennsylvania hospitals, we face challenges with our staffing levels for nurses from time to time." He said the hospital recently hired more nurses, and "will continue to take steps to insure appropriate staffing."
The Health Department requires Carlisle Regional to file a response this week outlining the steps it will take to address concerns raised in the report and correcting any inaccuracies.
"The hospital will meet that deadline," Kristel said. "We will be providing the state a concrete plan of action -- part of which we have already begun to implement -- that we are confident will address the issues that have been raised."
In recent weeks there have been dizzying developments that will have an impact on job growth in the healthcare sector. The problem is, nobody really knows what that impact will be.
Let’s start with some favorable trends.
Healthcare job growth continues to be steady and strong, and one of the few bright spots in an increasingly grim economy. The Bureau of Labor Statistics monthly jobs report for July showed that the healthcare sector created 31,300 new jobs for the month, and 170,900 new jobs so far this year. Healthcare, everything from hospitals to ambulatory services centers to podiatrists’ offices, is responsible for 18.4% of the 930,000 non-farm payroll additions in the overall economy in 2011.
Why is this happening?
The easiest answer is simple demographics. We Americans are getting older, fatter, and sicker, all of which require more care. And there are more of us. The population was about 281 million in 2000, 311 million in 2010, and is projected to reach 392 million by midcentury.
The healthcare reform law is also a factor in job growth. Hospitals, physicians’ offices, and other providers across the nation are hiring for the expected ramp up of healthcare services created by the new law, which will add about 30 million Americans to the ranks of the insured in 2014.
Unfortunately, there are several issues out there that are creating uncertainty in the healthcare sector.
The most immediate concerns are the Medicaid cuts that almost every state government has imposed on their providers. In the past few months, media outlets have been full of stories about hospital layoffs—some of them involving hundreds of employees—acquisitions, mergers, or outright closures that were prompted by financial distress that hospital leaders often directly attribute to Medicaid cuts.
Even more ominous is this new 12-member, bipartisan Congressional “super committee” that will meet later this year to whack $1.5 trillion from the budget. Lawmakers insist that “everything” will be on the table and considered, and that includes Medicare, Medicaid, and other safety-net programs.
If this were all a one-shot deal, perhaps hospitals and other providers could be expected to take the hit and move on. However, it is becoming painfully obvious that the first recourse of many elected officials at the state and federal level is to cut safety-net programs like Medicare and Medicaid.
Causing more uncertainty is the speculation that we are on the cusp of—if not already in—a double-dip recession. The recent stock market dive has evaporated considerable wealth for a lot of folks, including healthcare providers. The last time the market crashed in 2008, it prompted a lot of workers to delay retirement because they couldn’t afford it. Will that happen again?
At some point, regardless of what the stock market does, these folks will have to retire. They may have to adjust to a lower standard of living, but they aren’t getting younger.
In the past few months I’d been hearing from HR professionals across the country who said they believed that many of their staff were feeling confident enough to consider to retiring. After the stock market blood-letting of late last week, is that is still the case?
And finally, how will the prospect of a double-dip recession impact provider operations. In the most-recent recession, providers complained they were being required to make huge increases in the amount of charity care they provided, as the newly unemployed sought essential healthcare services. Will that happen again?
And, given this uncertainty about the economy, will that dampen any enthusiasm for capital improvement projects like new hospitals, or expansions, or delay employment of new staff?
Throughout the last recession, the healthcare sector showed that while it wasn’t recession proof, it was recession resistant. People need healthcare in good economic times, and bad. If we are double-dipping into another recession, we may soon find out how much that resistance was been worn down.
Sanford Health has made public the construction plans for its new $60 million Sanford Thief River Falls (MN) Medical Center and Clinic.
Ground breaking will be next spring, and construction should be completed by late 2014. The new hospital will centralize care, with clinic and hospital services on one campus, Sanford Health said in a media release.
Sanford has had a presence in Thief River Falls since 2007, operating the existing 25-bed, critical access Medical Center that was built in 1932. More than 540 Sanford Health employees work in the town, located in northwestern Minnesota, about 80 miles northeast of Fargo, ND.
The project will also include remodeling of an existing clinic that will house and expand behavioral health inpatient and outpatient services, dialysis services, and a wellness center.
If the existing hospital building in downtown Thief River Falls isn’t sold, it will be torn down and converted into a green space.
Sanford Health is headquartered in Fargo, ND and Sioux Falls, SD and is the largest, rural, not-for-profit healthcare system in the nation. The integrated system has a presence in 111 communities in eight states, including 32 hospitals, 111 clinics and more than 900 physicians in 70 specialty areas of medicine.
More than one in four of the 117,000 new jobs created in the U.S. economy in July were in healthcare, according to preliminary figures from the Bureau of Labor Statics
Healthcare created 31,300 new jobs for the month and 170,900 new jobs in the first seven months of 2011. The healthcare sector has accounted for 18.4% of the 930,000 non-farm payroll additions in the overall economy so far this year, BLS preliminary data show.
A further breakdown of BLS preliminary data shows that within the healthcare sector, hospitals gained 14,000 new jobs for July, despite widespread reports of layoffs due primarily to state Medicaid cuts. Hospitals lost 2,000 jobs in June, but have created 47,800 new jobs for the first seven months of 2011. By comparison, in the first seven months of 2010, hospitals created 10,300 new jobs, BLS data and preliminary data show.
Ambulatory services created 14,100 new jobs in July, after posting 13,700 new jobs in June, and has been responsible for 55% (94,000) of new jobs in healthcare in the first seven months of 2011,. Ambulatory services created 95,000 new jobs in the first six months of 2010, BLS data and preliminary data show.
Physicians' offices reported 6,300 payroll additions in July and 30,600 new jobs so far in 2011. Physicians' offices created 9,400 new jobs in the first seven months of 2010, BLS data and preliminary data show.
Some smaller subsectors in the healthcare industry saw job losses in July. For example, outpatient care centers and nursing care facilities each reported 500 payroll reductions, BLS preliminary data show.
BLS data from June and July are preliminary and may be considerably revised in the coming months.
The healthcare sector accounted for nearly 14.1 million of the nation’s jobs in July, with more than 4.7 million jobs at hospitals, more than 6.1 million jobs in ambulatory services, and more than 2.3 million jobs in physicians' offices, BLS preliminary data show.
Nonfarm job growth in the larger U.S. economy gained slightly in July, with 117,000 payroll additions reported. The nation's unemployment rate remained essentially unchanged at 9.1%, with 13.9 million people unemployed.
The number of people unemployed for less than five weeks fell by 387,000 in July. The number of long-term unemployed—people jobless for 27 weeks or longer—was 6.2 million in June, and represented 44.4% of the unemployed, BLS preliminary data show.
A Michigan physician faces 20 years in prison after pleading guilty to four felony counts involving drug trafficking, taking kickbacks, and healthcare fraud, federal prosecutors said.
Gwendolyn Washington, MD, admitted to running a lucrative and diversified criminal enterprise from her Southfield, MI, offices.
The U.S. Attorney’s Office in Detroit offered a long summation of the conviction plea accepted by Washington, 67, who will be sentenced on Oct. 5 in U.S. District Court.
First, Washington admitted that between 2004 and 2010, she performed unnecessary ultrasounds, nuclear cardiac stress tests, balance tests, sleep tests, and nerve conduction tests on patients, who were told to come back every few months for repeat tests, even though initial results were normal. Washington billed Medicare and Blue Cross and Blue Shield more than $5 million for these tests, some of which were potentially harmful to patients. Nuclear stress tests, for example, use intravenous injections of radionuclide, which emits radiation.
Second, Washington falsely certified patients as being homebound, in return for kickbacks from home healthcare agencies of $200 to $500 per patient. Washington got $350,000 in total kickbacks. Medicare paid $2.8 million to agencies receiving the bogus referrals. Washington got another $250,000 directly from Medicare for false certifications of patients for home health services.
Third, Washington admitted to two drug offenses. In February 2010, when Medicare stopped paying Washington—resulting in a drastic reduction in her income—she began writing prescriptions for tens of thousands of doses of OxyContin, Opana ER, and Roxicodone.
She sometimes wrote prescriptions for people who were not her patients, without an examination or determination of medical necessity, and without a diagnosis or entry in a patient chart. Washington gave the illegal prescriptions to Virginia Dillard, a co-defendant, who filled the prescriptions at area pharmacies and sold the drugs to dealers. The prescriptions sold for $1,000 to $2,200 apiece, and Washington and Dillard shared the money. Dillard pleaded guilty earlier this week.
In an unrelated charge, Washington recently pleaded guilty in a public corruption case involving Detroit Public Schools and she is awaiting sentencing on that charge, prosecutors said.
The nation’s hospitals are getting poor reviews for their efforts to encourage new mothers to breastfeed their infants, and that failure could worsen the childhood obesity problem in this country, according to a Hospital Support for Breastfeeding report from the Centers for Disease Control and Prevention.
“Most U.S. hospitals have policies and practices that do not conform to international recommendations for best practices in maternity care and interfere with mothers' abilities to breastfeed,” the CDC said, adding that “suboptimal breastfeeding in the United States annually results in an estimated $2.2 billion in additional direct medical costs.”
CDC conducted a national survey in 2007 and 2009 of more than 2,650 obstetric hospitals and a handful of birth centers to determine how many were providing maternity care practices that were consistent with the Ten Steps to Successful Breastfeeding guidelines. Those guidelines are part of the Baby-Friendly Hospital Initiative created by the World Health Organization and the United Nations Children’s Fund.
In 2009, the survey found that staff at 93% of hospitals provided prenatal breastfeeding education, 89% taught mothers breastfeeding techniques, and 82% taught feeding cues. However, only 14% of the hospitals had model breastfeeding policies, 22% limited breastfeeding supplement use, and 27% provided post-discharge support. From 2007 to 2009, the percentage of hospitals with recommended practices covering at least nine of 10 indicators increased only slightly, from 2.4% to 3.5%.
CDC recommended that hospitals providing maternity care adopt evidence-based practices to support breastfeeding. “Because nearly all births in the United States occur in hospitals, improvements in hospital policies and practices could increase rates of exclusive and continued breastfeeding nationwide, contributing to improved child health, including lower rates of obesity,” the CDC report said.
The Ten Steps to Successful Breastfeeding include:
Existence of a model breastfeeding policy;
Staff competency assessment;
Prenatal breastfeeding education;
Early initiation of breastfeeding;
Teaching breastfeeding techniques;
Limited supplementation of breastfeeding infants;
Rooming-in;
Teaching feeding cues;
Limited use of pacifiers;
Post-discharge support.
The majority of hospitals were implementing three to five recommended practices (60.5% in 2007 and 54.3% in 2009), with only 2.4% of hospitals implementing at least nine recommended practices in 2007, and 3.5% in 2009.
Less than 1% of hospitals implemented all 10 policies and practices either year.
“For women who intend to breastfeed, the hospital experience is critical. These data illustrate the persistent use of practices that are inconsistent with best-practice standards and do not support breastfeeding. To give infants the best start in achieving a healthy life, including reduced obesity, mothers must be supported immediately after birth to establish breastfeeding,” the report said.