Accessing the Spectrum of Quality Care

Lisa M. Hollier, MD, MPH, FACOG

Reflections on Women's Health as ACOG Wraps its Annual Meeting

The American College of Obstetricians and Gynecologists (ACOG) has just wrapped the 2019 Annual Clinical and Scientific Meeting. Held in Nashville from May 3-6, the theme for this year's national gathering was "Accessing the Spectrum of Quality Care."

The conference also sets the stage for leadership transition. ACOG President Lisa M. Hollier, MD, MPH, FACOG, welcomed colleagues to the 67th annual meeting before passing the gavel to 2019-20 President Ted L. Anderson, MD, PhD, during the annual business meeting.

Now Immediate Past President, Hollier shared thoughts on the past year as she led the organization of more than 58,000 members.

Medical News:
What were some of the key issues addressed during the meeting and over the past year?

Dr. Hollier: This year's meeting's theme - Accessing the Spectrum of Quality Health Care - included an information-packed program that addressed the most timely and challenging topics our members face as ob-gyns. Healthcare access has been a key component of everything we've been working on during my year as president, so having access as a focus of the meeting was vitally important.

Access to quality healthcare is a key to ensuring the health of women. ACOG is pursuing policy and legislative solutions to address the rising rate of maternal mortality and severe maternal morbidity in the United States. This includes advocacy for Medicaid coverage for women up to a year postpartum, support for state perinatal quality care collaboratives, support for efforts to reduce racial and ethnic disparities in maternal health outcomes, and support for the Alliance for Innovation on Maternal Health (AIM), a national data-driven maternal safety and quality improvement initiative to improve maternal outcomes in the U.S.

ACOG has always supported access to affordable healthcare, and we will continue to oppose every attempt to roll back critical women's health gains in the Affordable Care Act, particularly for women with preexisting conditions. We also continue to oppose efforts to deny access to reproductive healthcare and access to qualified providers through the Title X Family Planning Program. Title X is the only federal program exclusively dedicated to providing low-income patients with access to family planning and preventive health services and information.

Recent actions by the Administration to change Title X will limit access to vital healthcare services to low-income women, men, and adolescents. These actions restrict information that physicians can provide to their patients, weaken safeguards that ensure that Title X-funded programs offer evidence-based contraception, and impose medically unnecessary requirements on healthcare facilities that will exclude qualified providers from offering care to low-income women.

Last year, ACOG and other leading medical groups actively opposed these proposed changes and submitted public comments to the U.S. Department of Health and Human Services. On April 9, 2019, ACOG and leading medical groups filed amicus briefs in several cases across the country in support of states' and organizations' motions for preliminary injunction to stop the recently issued changes to Title X from going into effect.

Medical News:
What key clinical areas were explored during the recent meeting?

Dr. Hollier: The trifecta clinical seminars covered topics that are most important to ACOG members, including endometriosis, genetics, substance use disorder and trauma-informed care, and DVT prophylaxis. This year we had a new session, EdTalks, which were three powerful, 10-minute presentations followed by a Q&A panel with the speakers. The EdTalks topics covered financial models, reproductive endocrinology and infertility, menopause, microbiomes, polycystic ovary syndrome, the annual well-woman visit, sterilization, and the environment. This was all in addition to more than 700 scientific ePosters with cutting-edge research in women's health.

Medical News:
Maternal mortality rates have been a big part of your efforts as ACOG president, what are your thoughts on improving care?

Dr. Hollier: The United States is the only developed country with a rising maternal mortality rate. This has been a tremendous impetus for change. My Presidential Program at the meeting and all of my presidential initiatives focused on implementable solutions to eliminate preventable maternal mortality. We are seeing changes in the leading causes of maternal mortality. With reductions in pregnancy-related deaths due to hemorrhage and hypertension, we are seeing that cardiovascular disease and cardiomyopathy are the leading causes.

Fortunately, we know from maternal mortality review committees in states across the country that as many as 60 percent of maternal deaths are preventable. Because of the important role of cardiovascular disease in maternal mortality, a large part of my presidency was dedicated to updating ACOG's clinical guidance on pregnancy and heart disease. Cardiovascular disease and cardiomyopathy account for about 1 in 4 maternal deaths and disproportionately affect black women. I am proud to say that the dedicated, multidisciplinary members of my presidential task force completed comprehensive guidance on this topic that covers screening, diagnosis and management of cardiovascular disease in pregnancy and the new Practice Bulletin was released during the annual meeting.

ACOG members have also been working hard across the country to promote a culture of safety in hospitals, particularly in labor and delivery units. With the infrastructure and support provided by AIM, hospitals are implementing standardized, evidence-based practices that reduce complications and improve women's outcomes. AIM is a national data-driven maternal safety and quality improvement initiative to reduce maternal mortality and severe morbidity. Over the last several years, and with an additional $10 million grant from the Health Resources and Services Administration, the AIM program has grown and now enrolled 26 states ... and counting. Our goal is to have participation from all 50 states, and I am confident that we will do it.

Medical News:
During the national meeting, you passed the gavel to Dr. Anderson. Could you share some reflections on your time leading this organization over the past year?

Dr. Hollier: ACOG has made incredible progress on behalf of patients and our members in just one short year. Our committees have created and updated our clinical guidance. We've developed and created programs and education that help our members implement our Practice Bulletins and Committee Opinions in their clinics and in hospitals. ACOG members have taken to the Hill and gone to their state legislatures to ensure the leading voices of women's healthcare are heard and influence legislative and regulatory policies. It's been a year of accomplishment, and I am so proud to have handed the gavel to Dr. Ted Anderson as our 70th president of ACOG.

I'm really proud of the advocacy work we've done with our partners to get better data on the causes and contributing factors to maternal mortality. We recently celebrated the passage of the Preventing Maternal Deaths Act, which was subsequently signed into law in December. ACOG staff, along with our dedicated members, spent nearly 10 years advocating for this important legislation that will now ensure funding and infrastructure for state-based maternal mortality committees. I'm thrilled that I could help usher this bill across the finish line and that it became law during my tenure.

To help ensure that advocacy holds a central role in our organization and our specialty, I created the ACOG Annual Junior Fellow College Advisory Council Advocacy Leadership Training program. This innovative and immersive program offers exclusive opportunities and experiences to our next generation of ob-gyn leaders, our JF chairs.

We've also invested in our Levels of Maternal Care program this year. The initial guidelines were developed and published in 2015 and were designed to promote collaboration among maternal facilities and healthcare providers with the goal that pregnant women receive care at a facility appropriate for their risk. ACOG and the Society for Maternal Fetal Medicine (SMFM) have worked together to develop and pilot the levels of maternal care verification program. The lessons learned from the pilot were published this year.

Medical News:
Any other thoughts on the state of healthcare for women?

Dr. Hollier: Healthcare providers and facility leaders can all make a difference -- can all do more to improve the health of women. There are so many opportunities to implement policies, procedures, and guidelines that are effective in promoting better outcomes.

We know that women's lives are worth saving, and we need to focus on our common goals. Together, we must make women's healthcare a national priority and ensure that women have access to the spectrum of high-quality healthcare.


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ACOG, American College of Obstetricians and Gynecologists, Lisa Hollier, Maternal Care, Maternal Mortality Rates, Title X, Women's Health
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