Midwifery care at a freestanding birth center: a safe and effective alternative to conventional maternity care.

Objective: To estimate the effect of a midwifery model of care delivered in a freestanding birth center on maternal and infant outcomes when compared with conventional care.

Data Sources/study Setting: Birth certificate data for women who gave birth in Washington D.C.

Reforming Medicare payments to skilled nursing facilities to cut incentives for unneeded care and avoiding high-cost patients.

Despite many changes made in 2010 and 2011 to Medicare's payment system for short-term stays in skilled nursing facilities, a flawed payment structure continues to underpay facilities for certain types of patients and overpay for others. The flaws in the payment structure create incentives to selectively admit or refuse patients based on the type and complexity of their conditions, while payments that vary with level of use encourage providers to furnish therapy services, such as rehabilitation care, that some patients might not need. We propose an alternative payment design and demonstrate that it would dampen such incentives by making payments that are more closely matched to costs and based on characteristics of the patients treated.