MRT Initiative # 103

Reduce the Use of Certain Services

The initial methodology developed by the Department of Health to implement MRT Proposal #103, Reduce the Use of Certain Services - specifically to reduce the number of unnecessary cesarean sections performed by NYS hospitals - is being revised.

• Due to general concerns raised by clinicians and providers regarding possible unintended consequences to patients, unfairly cutting payments to providers which have a very low incidence of medically unnecessary c-sections, and the administrative concern over the large volume of appeals that would be generated has led to consideration of other options for implementing this proposal.

The Department will continue to work with various stakeholders on different options to develop a plan that will be clinically viable and risk adjusted for providers with appropriate cesarean section rates while maintaining the targeted $24.2 million savings in SFY 2011-12 and annually thereafter. The first step of this process will be to charge the recently authorized Quality Institute task force and medical malpractice technical committee to develop clinical standards and guidelines that can be used in determining medical necessity for cesarean deliveries.

In the interim, an adjustment to the hospital inpatient DRG statewide base price to achieve the $24.2 million targeted savings will be implemented for the period July 1, 2011 – March 31, 2012. This will allow time for feedback from the clinical committees to develop a clinically sound, risk adjusted payment option that will address medical necessity for this procedure.