Health Officials Trying to Lower C-Section Rates

by Mark Friedman  on Monday, Dec. 24, 2012 12:00 am  

Arkansas health officials and hospitals are trying to lower the state’s percentage of cesarean section births, which are nearly double the cost of a vaginal birth.

C-section births in Arkansas had increased from 27.8 percent of births in 1990 to 35.62 percent in 2010, according to records at the Arkansas Department of Health. The percentage slipped, though, to 34.7 in 2011. That year, the national average of cesarean section births was 32.8 percent, said Maureen Corry, executive director of Childbirth Connection of New York, a nonprofit whose mission is to improve the quality of maternity care. She would like to see the rate under 15 percent, which is what the World Health Organization recommends.

The average hospital charge in Arkansas was about $6,200 for a vaginal delivery, while a C-section ran up a bill of about $10,800. The amounts include prenatal, delivery and postpartum care.

Some Arkansas hospitals are making a push to lower the C-section rate, and they’ll have a financial incentive to do it under the Arkansas Health Care Payment Improvement Initiative.

The initiative is the new Medicaid reimbursement policy that will financially reward health care providers who control costs while penalizing those who don’t. Medicaid will set a target price for procedures, such as those for pregnancy and deliveries. Doctors and hospitals that keep actual costs below that target price will then share in the savings, but those who go over the target price might have to pay. The state Department of Human Services began collecting data for pregnancies and deliveries Oct. 1, said Amy Webb, a DHS spokeswoman. Information tied to pregnancies and deliveries will be collected for a year, and then providers will be measured against an average price.

The move away from C-sections to vaginal births could save money for payers, Webb said.

“Vaginal deliveries have a lower length of stay, possibly lower maternal complications,” Webb said in an email to Arkansas Business. “Fewer C-sections is one element of several approaches Arkansas providers could use to reduce average cost of care per pregnancy.”

In the last six months, the University of Arkansas for Medical Sciences introduced a checklist that doctors must follow before a woman is induced for labor before the first day of the 39th week of her pregnancy, said Dr. Curtis Lowery Jr., chairman of the obstetrics and gynecology department at UAMS.

“And the nurse has the authority to stop the process” if the criteria aren’t met, Lowery said. “The nurses in the hospital don’t work for the doctor. They work for the hospital.”

Of course, if there is a medical issue, then it’s OK to induce labor early, he said.

“But if you don’t have a reason, then the idea of inducing people before 39 weeks is a bad idea,” Lowery said.

The medical staff of Baptist Health Medical Center-Little Rock keeps “a close eye” on its C-section rate, which stands at about 35 percent, said Doug Weeks, senior vice president of hospital operations. He said the medical staff will review a doctor who performs more C-sections than the norm at Baptist Health.

He said Baptist Health doctors also don’t induce labor before the 39th week of pregnancy unless there is a medical reason to do so. Women who are induced face a higher rate of having a C-section, said Corry, of Childbirth Connection.

Having to induce labor could mean that the baby isn’t “ready to be born yet,” she said.

“That’s why we recommend going into spontaneous labor.”



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