Abstract
BackgroundTraditional prenatal care includes up to 13 in person office visits, and the cost of this care is not well-described. Alternative models are being explored to better meet the needs of patients and providers. OB Nest is a telemedicine-enhanced program with a reduced frequency of in-person prenatal visits. The cost implications of connected care services added to prenatal care packages are unclear.MethodsUsing data from the OB Nest randomized, controlled trial we analyzed the provider and staff time associated with prenatal care in the traditional and OB Nest models. Fewer visits were required for OB Nest, but given the compensatory increase in connected care activity and supplies, the actual cost difference is not known. Nursing and provider staff time was prospectively recorded for all patients enrolled in the OB Nest clinical trial. Published 2015 national wages for healthcare workers were used to calculate the actual labor cost of providing either traditional or OB Nest prenatal care in 2015 US dollars. Overhead expenses and opportunity costs were not considered.ResultsTotal provider cost was decreased caring for the OB Nest participants, but nursing cost was increased. OB Nest care required an average of 160.8 (+/− 45.0) minutes provider time and 237 (+/− 25.1) minutes nursing time, compared to 215.0 (+/− 71.6) and 99.6 (+/− 29.7) minutes for traditional prenatal care (P < 0.01). This translated into decreased provider cost and increased nursing cost (P < 0.01). Supply costs increased, travel costs declined, and overhead costs declined in the OB Nest model.ConclusionsIn this trial, labor cost for OB Nest prenatal care was 34% higher than for traditional prenatal care. The increased cost is largely attributable to additional nursing connected care time, and in some practice settings may be offset by decreased overhead costs and increased provider billing opportunities. Future efforts will be focused on development of digital solutions for some routine nursing tasks to decrease the overall cost of the model.Trial registrationsClinicalTrials.gov Identifier: NCT02082275.
Highlights
The COVID-19 pandemic has caused a rapid reassessment of prenatal care models, with adoption of remote visits and decreased visit models expanding rapidly over the past year [1]
In March 2014, we developed and studied an alternative bundle of prenatal care – Mayo Clinic OB Nest - which included fewer on-site clinic appointments supplemented with virtual visits with an assigned nurse, home monitoring devices and access to an online prenatal community of expectant mothers [4,5,6]
OB Nest saved an average of 2.8 obstetric provider appointments per patient while significantly improving the patient experience [6]
Summary
The COVID-19 pandemic has caused a rapid reassessment of prenatal care models, with adoption of remote visits and decreased visit models expanding rapidly over the past year [1]. The largely traditional model of prenatal care in the United States is expensive, resourceintensive, and fraught with nationwide variation. If uniformly applied to the approximately 4 million pregnancies in the United States each year, the clinic personnel, administrative infrastructure, office space, and miscellaneous cost of providing care is clearly substantial [2]. In 2008, the national hospital bill was approximately 1.2 trillion dollars, with pregnancy and delivery accounting for the most expensive condition treated in the United States [3]. Quality studies investigating the costs of supplemental remote care in the setting of reduced prenatal care models remain limited. Traditional prenatal care includes up to 13 in person office visits, and the cost of this care is not welldescribed. OB Nest is a telemedicine-enhanced program with a reduced frequency of in-person prenatal visits. The cost implications of connected care services added to prenatal care packages are unclear
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