Kaine talks with docs ‘in the trenches’ on black maternal health

Looking for solutions and strategies, Sen. Tim Kaine went to health care professionals “in the trenches,” and chatted with them Friday during a roundtable about racial disparities in maternal mortality.

About two dozen professionals exchanged solutions during the roughly 90-minute session at the Hampton-Newport News Community Service Board offices in Hampton.

The ideas ranged from extending Medicaid coverage, to reimbursement programs for midwives, to looking at educating doctors about implicit racial bias.

The Virginia democrat was joined by Del Marcia “Cia” Price, D-Newport News, who has called for greater accountability with physicians who are treating patients. Price said the racial disparity is an issue that affects both the wealthy and the poor.

“If people have the coverage and are seeking the treatment, what is the disconnect?” Price said.

Kaine wanted feedback from the local health care community, to hear their biggest concerns and what they are doing in their organizations.

One observation with African American maternal health issues came from Dr. Holly Puritz, with the American College of Obstetricians and Gynecologists. She suggested that Medicaid be expanded to help pregnancy patients who end up in emergency rooms seeking routine care.

What happens with many patients is that they lose the continuity of care, and the lack of care contributes to other chronic conditions.

“Half of all deliveries are Medicaid paid for and Medicaid stops the coverage at two months,” Puritz said. “If you expand Medicaid for that first year, they don’t have to go to the emergency room.”

Other ideas called for looking at the racial bias some doctors may have, with some saying their organization is already providing training for incoming residents.

“I think we need to tackle it from the system level … and then on the practice level,” said Dr. Naved Jafri, with Sentara HealthCare. “If we just focus on the on the bias part, we miss out on the preventative care.”

Another doctor said looking at reimbursing for care that uses midwives or more centering, which is group care, can also help with costs for patients.

Other physicians agreed that recruiting more African American physicians is also something to stem implicit racial bias toward patients.

The biggest problem for many physicians is that too many patients are in dire need of basic medical care long before they are pregnant.

“I am getting someone who is pregnant and their blood pressure is high,”said Dr. Lea Porsche, with Eastern Virginia Medical School maternal and fetal medicine. “We need to start normalizing prenatal care and normalizing health care.”

Hearing a few ideas he can take with him back to Washington, Kaine said expanding Medicaid was one he wasn’t expecting.

Looking at Medicaid benefits in connection with delivery and extending it from 60 days to a full year, to help a mother dealing with chronic conditions, is worth considering, he said.

“The idea that you could take it from 60 days to a year — yes we can, but it will have a cost,” Kaine said.

From 2004 to 2013, the pregnancy-associated death rate for African American women more than doubled that of white women, according to data from the Virginia Department of Health.

Black women die in or near childbirth more than three times as often as those from any other race, according to the Centers for Disease Control and Prevention.

“The U.S. is an outlier on maternal mortality issues,” Kaine said. “When I look at the other industrialized nations … we are doing something wrong.”

Kaine also has co-sponsored the Maternal Care Access and Reducing Emergencies (CARE) Act. It is legislation to create two new grant programs focused on reducing racial disparities in maternal health.