Countering Early Elective Deliveries that Drive Up Health Costs

'Call for action' reduced unnecessary C-sections at Illinois hospitals; national initiatives launched

By Stephen Miller, CEBS Feb 27, 2012

Following progress in a regional effort to eliminate unnecessary, early elective newborn deliveries in Illinois, a national effort is being launched to reduce nonmedically indicated deliveries, according to The Leapfrog Group, an employer-driven hospital quality watchdog, and its Illinois regional leader, the Midwest Business Group on Health (MBGH).

In the wake of coordinated efforts involving employers, consumers, insurers and medical providers, over 71 percent of Illinois hospitals reduced their rates of early elective deliveries over 12 months, with 40 percent of reporting hospitals bringing their early elective delivery rate to 5 percent or less, according to 2011 results from the annual Leapfrog Hospital Patient Safety Survey.

"Elective C-sections and inductions are performed on women of all backgrounds and incomes," according to an analysis by MBGH. "They are often conducted to address the needs of physicians, who want to avoid weekends or other inconvenient times, as well as to accommodate the requests of patients, who may want to deliver on certain days or holidays or just to end the pregnancy due to discomfort. These elective procedures are distinct from early deliveries performed due to clinically appropriate reasons that necessitate early birth to avoid clinical and health problems facing the mother or the infant," MBGH found.

Maternity care is the number one reason for hospitalization among most employee populations, and the highest cost for maternity care is when a pre-term infant (those born at less than 39 completed weeks of gestation) is treated in the neonatal intensive care unit of a hospital, according to MBGH, citing research by the March of Dimes.

Coordinating Efforts

When early elective delivery rates in Illinois were first published in 2011 by the Leapfrog Group, MBGH issued a “call for action” for hospitals and physicians to reduce nonmedically related elective deliveries in the state. MBGH joined Quality Quest for Health of Illinois, the Illinois Chapter of the March of Dimes and the Perinatal Quality Collaborative of Illinois to convene a series of summits for employers, government agencies, health plans, hospitals, physicians, consumer groups and others to discuss how to build on and coordinate efforts to achieve better outcomes in maternity care. These summits were funded under a grant program to promote community improvements sponsored by the National Business Coalition on Health and United Health Foundation.

The summits identified the following issues that need to be addressed to reduce early elective deliveries:

Development of a standard and statewide performance clinical data definitions and collection efforts leading to provider and public reporting of performance.

Adoption by every maternity hospital of elective delivery clinical policies aligned with best practices.

Designing and implementing payment reform to align financial incentives with best practices and full-term births.

Promoting malpractice relief for providers following best practices.

Conducting consumer education and outreach, including worksite programs, to increase knowledge of the importance of full-term births and best practices for maternity care.

“There is wide variation among reporting hospitals throughout Illinois,” said Larry Boress, president and CEO of MBGH. “While we’re pleased to see improvement, there is much more work to do, since over 60 percent of our maternity centers did not reach the targeted 5 percent rate and many hospitals do not even disclose their patient safety performance to the public. By shining a light on this problem, we encourage physicians to advise patients desiring early deliveries for convenience reasons of the serious lifelong health and cost ramifications to their infants of such actions.”

Ken Nunes, M.D., executive medical director of The Women’s Care Center, University of Chicago Medical Center, which reduced its early elective delivery rate from 33 percent to 2 percent, added that “It’s hard to ignore the growing body of evidence over the past five years that there are risks to newborn babies when electively delivered between 37 and 39 weeks gestational age. In an effort to improve outcomes among newborns at the University of Chicago, we implemented a written protocol to deter this practice. With education and departmental support, we have seen a dramatic reduction, with a rate below the national target of 5 percent.”

National Initiatives Underway

MBGH announced that it will participate with the Leapfrog Group and other organizations in a series of national initiatives to eliminate early elective deliveries and to make available tools that encourage health care consumers, employers, health plans, hospitals and policy-makers to take action.

As part of this effort, the Leapfrog Group's website now allows consumers, providers and employers to compare hospital rates of elective deliveries. This data on early elective deliveries come from Leapfrog’s 2011 annual hospital survey, where hospitals are asked to report the percentage of nonmedically indicated births between 37 and 39 completed weeks gestation delivered electively by induction or by cesarean section before the mother had gone into active labor.

Stephen Miller, CEBS, is an online editor/manager for SHRM.

Related Resource—External:

Prematurity Prevention Resource Center, March of Dimes

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