Group prenatal care: an analysis of cost.

INTRODUCTION: Group prenatal care may have benefits over traditional care; however, the economic performance of this model is largely unexplored. We sought to understand the finances of group prenatal care at a small, rural, critical access hospital.
METHODS: Volume, cost, and revenue estimates were obtained and an economic model was created. Determination was made of total time spent providing prenatal care, financial breakeven point and number of hours of prenatal care per patient.
RESULTS: Group size required to equal or exceed the time efficiency of traditional prenatal care varied based on the structure of the prenatal care models. Small group sizes decrease efficiency and increase costs. The baseline financial breakeven point of 305 deliveries per year decreases to 302 deliveries if all women receive group care. Shifting prenatal care from higher to lower cost providers decreases the breakeven point to 218 deliveries per year, if the acquired time is used to provide gynecologic services. With group sizes between eight and 12, the time efficiency of lower cost providers improves from an average of seven to four hours of prenatal care per patient.
CONCLUSION: In organizations with low volume obstetrics, group prenatal care can lead to decreased efficiency and greater cost. In settings with sufficient volume, financial benefit is realized if prenatal care is shifted from higher to lower cost providers. Using a group model of prenatal care allows lower cost providers to see additional patients efficiently. Although group prenatal care may offer some benefits, cost analysis should be considered before initiation.