Northeast Missouri health center gets $540,000 to keep its two-OB/GYN delivery service staffed

A Kirksville, Missouri, health center whose two full-time obstetrician-gynecologists (OB/GYNs) deliver more than 525 babies a year will use $540,000 from UnitedHealthcare to stabilize that staff and build a pipeline of new maternity clinicians, the insurer announced Oct. 22.

The Northeast Missouri Health Council (NMHC), a federally qualified health center, plans to recruit additional maternal health providers, support an OB/GYN residency pathway and lay groundwork for a rural family medicine with obstetrics fellowship.

NMHC serves more than 20,000 patients a year through 11 clinics and two mobile units, and patients from 22 northeast Missouri counties rely on its delivery care in Kirksville, according to the announcement.

The announcement does not say how the $540,000 will be split among those uses, over what period it will be paid or when the first trainees would start.

“This kind of collaboration is what makes it possible for a health center like ours to plan for the long term,” NMHC CEO Andy Grimm said in the announcement.

Missouri’s maternity staffing gap

More than half of Missouri’s counties have no labor and delivery unit and no obstetric physician, according to a March of Dimes report, The Beacon reported in September.

In a 2022 University of Minnesota survey cited in that reporting, rural hospital administrators said they generally needed at least 200 births a year for obstetric services to be financially viable.

Missouri has no certified nurse midwife training program. The state’s health and social services departments are working with the University of Missouri Sinclair School of Nursing to start one, with the school seeking accreditation to open in fall 2029 with support from the federal Rural Health Transformation Program, KCTV reported Oct. 14.

The billing change practices are staffing around

On Jan. 1, the American Medical Association’s (AMA) 2027 maternity code set replaces the global obstetric package with separate reporting for antepartum care, labor management, delivery and postpartum care.

Prenatal and postpartum visits will be billed one encounter at a time as evaluation and management (E/M) visits.

Under the global package, prenatal and postpartum visits handled by advanced practice providers (APPs) or midwives counted toward the delivering physician’s work relative value units (RVUs), said Carol Carden, CPA, ABV, ASA, CFE, managing principal of compensation valuation, planning and design at PYA.

“Those visits will now be billed by that mid-level provider, not by the physician,” Carden said in an interview with Medical Economics.

The new E/M visits also carry complexity levels the global package never had. Carden said practices need documentation that supports the level billed so they don’t “inadvertently code a level of complexity that the record doesn’t support” or “leave money on the table” by billing too low.

Visit limits in Missouri Medicaid

Healthy Blue, one of the managed care plans that administer MO HealthNet, Missouri’s Medicaid program, updated its maternity reimbursement policy in September to replace the global package with service-level billing as of Jan. 1, 2027.

The plan will pay for up to 13 routine prenatal E/M visits and three routine postpartum visits within 12 weeks of delivery, 16 combined, per pregnancy for services billed under the same tax identification number. Visits tied to a high-risk pregnancy or a pregnancy-related complication fall outside those limits.

The first prenatal visit and every professional delivery claim must carry an ICD-10-CM Z3A code for weeks of gestation as a condition of payment, and the plan limits labor management to one service per calendar date, per setting, at the highest applicable level, according to the policy.

UnitedHealthcare, which also runs a MO HealthNet managed care plan, did not say in its announcement whether that plan will move to service-level maternity billing Jan. 1.

If commercial payers adopt the new codes while a state Medicaid program stays on the global package, employers will probably track work RVUs by individual clinician for the payers that adopt and pool and allocate the rest, Carden said.

“It could get a little bit messy,” she said.

The Centers for Medicare & Medicaid Services (CMS) proposed adopting the new codes for Medicare but also asked for comment on 15 G-codes that would keep a bundled structure. The AMA expects the final rule in early November.

Pay plans for 2027

Among hospital employers of OB/GYNs, Carden said she is seeing “a little bit of all of that”: some freezing pay at 2026 levels until 2027 productivity data is in, some adjusting conversion rates now and some letting the change flow through.

For organizations that adjust conversion rates up front, PYA recommends reconciliation checkpoints during the year, “maybe at six months and nine months,” Carden said, to catch overpayment or underpayment before it becomes a retention problem.

Compensation surveys published in 2027 will reflect 2026 billing, and some employers’ freezes will carry the old structure further, Carden said.

“It’s going to take several years for that to flow through,” she said.

What’s next

The CMS final rule will decide whether Medicare pays on the new codes or the G-codes. Carden expects certainty by the end of November or early December and is telling clients not to wait.

“Assume it’s going to go through now,” she said.