Calif. Hospital Could Be a Model for Reducing C-Section Rates

Efforts that quickly and significantly reduced cesarean section rates at one California hospital could serve as a model for how other facilities could improve their performance, Kaiser Health News reports.

Background

C-sections require longer hospital stays and often are associated with risks, such as blood clots and infections.

In addition, the procedure typically costs about $19,000, compared with $11,500 for a vaginal birth.

States in recent years have been working to reduce C-section rates, according to KHN.

In California, groups have shared data with the public to highlight differences among hospitals in the way they handle maternity care. However, many hospitals do not actively work to reduce their C-section rates until money is at stake, according to KHN.

Stephanie Teleki, senior program officer at the California HealthCare Foundation, said that reducing C-section rates can result in "better health to mothers and better health to babies and lower costs." CHCF publishes California Healthline.

Details of Efforts at Calif. Hospital

Administrators at Hoag Memorial Hospital Presbyterian in Newport Beach sought to reduce its C-section rate after an insurer warned it might cut the hospital from its network because of high maternity care costs.

About 38% of all births at the hospital in 2012 were C-sections. In comparison, the state average at the time was about 33%, according to the California Maternal Quality Care Collaborative.

To reduce the rate, hospital officials released individual C-section rate data on all physicians. In addition, the hospital:

• Added new scheduling rules that required doctors to complete forms and in some cases seek special approval for C-sections;
• Adjusted payments, with the help of large employers and insurers, to ensure the hospital did not earn more for elective C-sections than vaginal births;
• Increased patient education, encouraged women to wait for labor to naturally start and required women who elected to have C-sections to sign a consent form detailing the procedure's risks;
• Opened an obstetrics emergency department and gave additional responsibility to "laborists," who tended to labor emergencies around-the-clock; and
• Paid end-of-year bonuses to nurses who helped the hospital attain benchmarks in reducing C-section rates.

In the three years after such changes were implemented, the hospital:

• Reduced its C-section rates to about 33% of all births;
• Lowered C-section rates to about 25% of low-risk births; and
• Increased the rate of women who had vaginal births for subsequent pregnancies after previously delivering children by surgical birth.

Elliott Main, medical director of the California Maternal Quality Care Collaborative, said Hoag's efforts now are becoming a model for other hospitals (Gorman, Kaiser Health News, 5/11).