LARC’s in Oklahoma

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49% of pregnancies in the United States are unintended. Adolescents are at higher risk for unintended pregnancies with rates approaching 98%. In the State of Oklahoma, unintended pregnancies cost taxpayers an estimated $214 million dollars a year. Long-acting reversible contraception (LARC’s) have been shown to have higher continuation rates than short-term contraception. ACOG endorses LARC’s as a first line contraception for adolescents.

 

iud

Immediate postpartum LARC placement is insertion of an IUD (see image, courtesy of Wikmedia Commons) or implantable device prior to discharge after delivery. This practice is endorsed by ACOG as safe and effective. It results in increased compliance with contraception especially in at-risk populations such as adolescents. The largest barrier to this type of LARC placement is billing and reimbursement. The State of Oklahoma Medicaid program uses a single DRG (diagnosis related group) code for billing and has previously not allowed reimbursement for a separate procedure such as in-hospital LARC placement. Recent advocacy efforts by providers and patients in Oklahoma have compelled a change in Medicaid policy that allows for separate reimbursement for immediate postpartum LARC placement. Challenges still remain to encourage hospitals to stock LARC’s and incorporate the new practice into their billing. Few providers place LARC’s immediately postpartum and efforts will need to be made to educate them on the policy change and create a shift in practice habits to support this practice. With implementation of this practice, there will be an opportunity to decrease the unintended pregnancy rate in at-risk women in Oklahoma.

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7 Responses to “LARC’s in Oklahoma”

  1. dscordi1 Says:

    This is a very serious issue and I am very glad to you brought this to the attention of the forum. In Maryland (at least at my tertiary care facility), postpartum woman are almost always counseled on birth control methods and offered an IUD, implantable device or pills. This is an important first step.

    However, this is postpartum and the stigma of birth control needs to be addressed and IUD or implantable devices should be offered to sexually active youths. Oral contraceptive is less effective and is often taken incorrectly. Young woman are a significant risk of health effects from pregnancy, the child is at risk and socially/economically they are both at risk as well. A very important topic that should be addressed.

  2. marettelee Says:

    Young women are certainly at greater risk of non-compliance with contraceptive methods, that is if they are using contraception at all! LARC is a great option, especially for this group, which may also not show up for postpartum visits, which would be the usual next opportunity to offer contraception. The idea of having another appointment and another “procedure” to have an IUD inserted later on may dissuade some young women who might otherwise be willing to have it at the time of delivery. It is exciting that this policy change will facilitate further change in this area.

    I do agree however, that there is a lot of education that needs to be done, both in terms of physicians and other healthcare providers and in terms of patients. There are many misconceptions out there about IUDs and how they work and what complications may be associated with them. They have a tainted history (Dalcon shield), of which thankfully many young women will be unaware, but this is part of the reason many people shy away from them, including physicians. Many doctors have also been reluctant to provide IUDs to nulliparous or adolescent women, and these arguments, at best, are thin and do not apply to most people. Professional societies, such as ACOG, should use conferences and CME events to promote this valuable method of birth control in the interest of patients and public health.

  3. tfreder6 Says:

    This is an excellent discussion. I am an OB/GYN in Kentucky and we are having similar issues in our hospital. We are even to the point that we are willing to waive the placement fee but the hospital is having problems getting the LARCs in the hospital since they are an expensive medicine or device. Many times we lose our patients to follow-up for their postpartum care. If they do show up, their insurance may have lapsed and they are no longer affordable for the patient. If you miss the window of opportunity, your patient may also show up to her 6 week postpartum visit pregnant!

    I also agree with the comment above that physicians need to be educated (or re-educated) about LARCs. Unfortunately, some physicians are hesitant to place LARCs when they are a very appropriate (and ACOG recommended first line treatment). For nulliparous women, the Skyla is now available which is a smaller IUD to accommodate a smaller uterus. Even if physicians are proponents of LARCs sometimes, they will be hesitant to place them postpartum. According to the CDC contraception guidelines, they benefits outweigh the risks immediately postpartum. ACOG also supports immediate placement. This has been something I recently investigated for my own practice habits but not discussed frequently, even in a large university hospital.

  4. Judy Yeh Says:

    This is a very interesting topic. LARC is undoubtedly a great option to mitigate unintended pregnancies from technology point of view. Having said that, the target recipient of LARC in this blog is adolescent females. Receiving LARC as a way of contraception is very different than handing out condoms to promote safe sex. So even if covered through medical insurance, remember that sexually active teenage girls will have to obtain their guardians’ consent to have the procedure performed on them. Similar to some of the case studies we discussed in this course, the topic of sex is just as difficult to discuss with parents in the United States as in other parts of the world. The thought of a teenage girl informing her parents that she is sexually active and would like to get contraceptives can be very daunting for both her and her parents. The rate of adoption cannot be expected to increase just with the reform of getting medical insurance coverage for LARC. Stages of change should be considered as to where Oklahoma is at and take appropriate actions (I assume many families could be in the pre-contemplation stage either not recognizing they have sexually active teenagers or the teenage girls themselves think that pregnancies would not as so unlucky to happen to them).

  5. mollykern2 Says:

    I totally agree with your argument. As an OB/GYN, I fully support and recommend LARC as often as possible. A recent article noted the significant benefits of free coverage of LARC use in Colorado with decreasing their teen pregnancy rate by 40%.
    http://www.bbc.com/news/magazine-28693239

    With the new IUD by Bayer, Skyla, I am hoping to use this IUD more frequently on teenage nulliparous women. The diameter is smaller than the Mirena making it easier to insert. These methods typically require a 30 minute visit for placement and rarely require follow up after placement. In the military, we have easy access to health care and cost is not an issue for these methods, so I have not placed an IUD immediately postpartum. I see a huge benefit to immediately placing IUDs postpartum and would not hesitant to provide this service. Thank you for bringing up such an important issue as unplanned teen pregnancy.

  6. Karl Jobst Says:

    Karl Jobst

    LARC’s in Oklahoma | SBFPHC Policy Advocacy

  7. Freddom Mentor reviews Says:

    Freddom Mentor reviews

    LARC’s in Oklahoma | SBFPHC Policy Advocacy

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