ACOG Battles Maternal Mortality in Texas Through Maternal Site Surveys

Eugene Toy, MD

Eugene Toy, MD, is the medical director of ACOG’s Texas Levels of Maternal Care (LoMC) Verification Program, vice chair of District XI, and an ob-gyn at the University of Texas Medical School at Houston.

Levels of maternal care play an important role in supporting Dr. Hollier’s signature initiative to reduce preventable maternal mortality. The ACOG/Society for Maternal-Fetal Medicine Levels of Maternal Care (LoMC) Obstetric Care Consensus supports this initiative by proposing uniform designations for levels of maternal care related to hospital capabilities and resources. Through the LoMC Verification Program, ACOG aims to foster collaboration among facilities at varying levels of care so that pregnant women receive care at a facility appropriate for their risk.

ACOG launched the LoMC program in Texas, where Level II, III, and IV facilities that provide maternal care must undergo site surveys to receive the level of care designations that will allow them to receive Medicaid reimbursement. I had the privilege of attending the site visits for each of the 11 surveys the LoMC program completed in 2018. Here are some observations:

  • Build purposeful partnerships. By using a collaborative and transparent approach, ACOG serves as a resource and mentor as well as a survey organization. This partnership builds trust with hospital leadership.
  • Quality is key. Maternal quality programs are the key to reducing severe morbidity and mortality. Each hospital has its strengths and excellent initiatives, but can also make improvements, including implementation of consistent triggers for quality reviews, monitoring outcomes or closing the loop, and providing education to staff.
  • It’s about the team. In many settings, the obstetrical unit is fairly isolated and lacks communication, shared processes and guidelines, joint team training, and joint quality reviews. In our surveys, we bring all key hospital services and leadership to the table over dinner to discuss how each area interfaces to work together for the maternal patient.
  • Trust but verify. Our approach is to verify that the processes put in place by the maternal leadership are utilized consistently and documented. We do this with chart reviews, hospital tours, and interviews of bedside staff.
  • Show flexibility. ACOG’s approach has been to be open-minded to how medicine is practiced in different settings, since Texas is so geographically diverse. Ultimately, our top priority is patient care.

I’m happy to report that after six months, our Texas LoMC Verification Program has already made a substantial impact in equipping hospitals, doctors, and nurses to improve care for Texas mothers. If you know someone working in a hospital in Texas, tell them to schedule their survey with ACOG and join our efforts in reducing maternal mortality.