'It's time that it stopped'

Sunday, March 31, 2002

Petit responds to negative home obstetrics study
Editors note: Although regular readers of HME News don't typically provide home obstetrical care, providers of home respiratory care, particularly home sleep therapy, have felt a similar bias toward in-home technology clinical physicians. Pete Petit was chairman of Healthdyne Technologies before Respironics acquired the manufacturer of home respiratory products in 1997.

MARIETTA, Ga. - For Pete Petit, president, CEO and chairman of Matria Healthcare, a recent study in the New England Journal of Medicine on home uterine activity monitoring was the last straw. Year after year, he's read studies in the publication portraying home obstetrical care negatively. "It's time that it stopped," he said. So, he fired off a press release blasting the results of the study, which looked at 306 women who used a home contraction monitor from 22 to 24 weeks of gestation until delivery and found that no threshold frequency of contractions effectively identified women who delivered before 35 weeks. Some of Petit's gripes: The contraction data collected in the study was not reviewed daily by a physician or an obstetrical nurse; and the study evaluated effectiveness only in terms of preventing or predicting "pre-term delivery" not extending the gestational period, which can save money and improve health. Here's what Petit had to say after the dust settled.

HME NEWS: Why do you believe this publication continuously discredits home obstetrical care?

PETE PETIT: When you see a small group of academically based obstetrical specialists continue to write scientific papers discouraging this kind of care, you start to wonder if they have an agenda outside of research. As I see it, their motives are two-fold. First, if a patient isn't in a hospital, they can't practice. Second, if they continuously put out negative studies, they'll get more money for further studies. It's economically motivated.

HME: Is this the case with other HME or just home obstetrical care?

PETIT: I've been in the homecare industry for 25 years, and I've seen all kinds of high-tech home care, including home apnea monitoring and ventilator support. Home obstetrics has been singled out.

HME: What about home monitoring and telemedicine, in general?

PETIT: Home monitoring and telemedicine are entering an age where they're appreciated more. They've matured, and the clinical evidence is accepted. The healthcare industry is moving more toward disease management (DSM), and they're a critical part of that.

HME: Are there publications supporting home obstetrical care?

PETIT: Yes, plenty have found that home obstetrics is both clinically effective and cost effective. An article in the November 2001 issue of Managed Care said just that. It's an effective way to treat high-risk pregnancies where appropriate. Some 10,000 physicians believe that.

HME: Don't healthcare plans encourage home care to save costs?

PETIT: Again, home obstetrical care is an exception. Most healthcare plans whose medical directors are well informed are certainly interested in clinically effective and cost-effective home care. It happens routinely in every other area. The majority of the payer community sees the value of home obstetrical care and reimburses for it, but others have gotten caught up in these scientific papers and have started denying it, even though hospital care costs them 10 times as much.

HME: How much is home obstetrics used?

PETIT: Not anywhere as much as it should be. There are probably 250,000 births a year that are classified as high risk, and we see less than 10% of those. The rest are hospitalized, or go without care and see catastrophic results in terms of bad pregnancy outcomes.

HME: Have you had any feedback from your press release?

PETIT: No, not really. The study speaks for itself, and its design is totally irrelevant to the way medicine is practiced today.