Rural Missouri health center that delivers more than 525 babies a year with two OB/GYNs lands $540,000 for obstetric staffing

Two full-time obstetrician-gynecologists (OB/GYNs) at a federally qualified health center in Kirksville, Missouri, deliver more than 525 babies a year for patients from 22 northeast Missouri counties.

UnitedHealthcare announced Oct. 22 that it will give the center $540,000 to keep that staff in place, recruit more maternal health clinicians, help develop an OB/GYN residency pathway and lay the groundwork for a rural family medicine with obstetrics fellowship.

The announcement does not say how the money will be divided among those uses, over what period it will be paid or when the Northeast Missouri Health Council (NMHC) expects a residency pathway or fellowship to take its first trainees.

NMHC CEO Andy Grimm said in the announcement that the support comes “at a moment when many communities are losing the service.”

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

Where Missouri families deliver

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.

Nearly 140,000 Missouri women ages 15 to 44 live in those counties, and more than 120,000 live more than 30 minutes from a hospital with labor and delivery services. Nationally, 35% of counties are maternity care deserts.

Nine Missouri counties lost hospital-based obstetric services from 2010 to 2024, University of Minnesota researchers found. In a 2022 survey by the same group, rural hospital administrators said they generally needed at least 200 births a year for obstetric services to be financially viable.

Medicaid paid for 40% of Missouri births in 2023, according to KFF. UnitedHealthcare runs one of the managed care plans that administer MO HealthNet, the state’s Medicaid program.

What changes Jan. 1

Under the American Medical Association’s (AMA) 2027 maternity code set, the global obstetric package that has paid for prenatal care, delivery and postpartum care as one bundle goes away.

Each prenatal and postpartum visit will be billed as its own evaluation and management visit, and labor management and delivery get separate codes. The change deletes 17 codes, adds 12 and revises six.

The Centers for Medicare & Medicaid Services (CMS) proposed adopting the new codes in its 2027 Medicare Physician Fee Schedule but also asked for comment on 15 G-codes that would keep a bundled structure for Medicare.

CMS also proposed taking four prenatal visits out of its payment math and shifting that value to labor management and delivery, raising those codes about 15% while prenatal and postpartum visit values fall, according to an Oct. 20 analysis by the International Foundation of Employee Benefit Plans.

The AMA expects CMS to release the final rule in early November.

“Budget neutral doesn’t mean it’ll be budget neutral for each individual provider,” Carol Carden, CPA, ABV, ASA, CFE, managing principal of compensation valuation, planning and design at PYA, said in an interview with Medical Economics.

PYA’s modeling of an uncomplicated vaginal delivery came out to about four fewer work relative value units (RVUs) than the 37 credited under the current global code, Carden said.

Who feels it first

Hospitals that employ OB/GYNs have been contacting PYA ahead of January, Carden said.

Private practices “tend to compensate themselves on more of a collections or revenue attribution model, not a work RVU model,” she said, while employed OB/GYNs tend to have at least some of their pay tied to work RVUs.

Under the global package, prenatal and postpartum visits handled by an advanced practice provider or midwife counted toward the physician’s work RVUs, Carden said.

“Those visits will now be billed by that mid-level provider, not by the physician,” she said.

Carden also described a scenario in which commercial payers adopt the new codes while a state Medicaid program stays on the global package. In Missouri, Healthy Blue, another MO HealthNet managed care plan, has published a maternity reimbursement policy that replaces the global package with service-level billing as of Jan. 1, 2027.

UnitedHealthcare did not say in its announcement whether its Missouri Medicaid plan will make the same change.

What employed OB/GYNs can ask for

Some employers plan to freeze OB/GYN pay at 2026 levels while 2027 data comes in, and others expect the effect to be small enough to let it flow through, Carden said.

For an employed physician worried about a pay cut, she suggested asking for the freeze first.

“If that’s not an option or they’re not willing to do that, then I would probably ask for some interim reconciliation language,” she said, describing a 2027 contract amendment that checks productivity against pay at set intervals.

Compensation survey benchmarks will be distorted for several years, Carden said, because surveys published in 2027 will reflect 2026 billing under the old structure.

What’s next

The CMS final rule will settle whether Medicare pays on the new codes or the G-codes.

“Assume it’s going to go through now,” Carden said. She expects certainty by the end of November or early December.