Skip to main content
Subscribe
  • Sign Up Free
  • Login
  • Subscribe
  • News
    • Current News
    • Providers
    • Insurance
    • Government
    • Finance
    • Technology
    • Safety & Quality
    • Digital Health
    • Transformation
    • ESG
    • People
    • Regional News
    • Digital Edition (Web Version)
    • Patients
    • Operations
    • Care Delivery
    • Payment
    • Midwest
    • Northeast
    • South
    • West
  • Blogs
    • AI
    • Deals
    • Layoff Tracker
    • HIMSS 2023
  • Opinion
    • Breaking Bias
    • Commentaries
    • Letters
    • From the Editor
  • Events & Awards
    • Awards
    • Conferences
    • Galas
    • Virtual Briefings
    • Webinars
    • Nominate/Eligibility
    • 100 Most Influential People
    • 50 Most Influential Clinical Executives
    • Best Places to Work in Healthcare
    • Excellence in Governance
    • Health Care Hall of Fame
    • Healthcare Marketing Impact Awards
    • Top 25 Emerging Leaders
    • Top Innovators
    • Diversity in Healthcare
      • - Luminaries
      • - Top 25 Diversity Leaders
      • - Leaders to Watch
    • Women in Healthcare
      • - Luminaries
      • - Top 25 Women Leaders
      • - Women to Watch
    • Digital Health Transformation Summit
    • ESG: The Implementation Imperative Summit
    • Leadership Symposium
    • Social Determinants of Health Symposium
    • Women Leaders in Healthcare Conference
    • Best Places to Work Awards Gala
    • Health Care Hall of Fame Gala
    • Top 25 Diversity Leaders Gala
    • Top 25 Women Leaders Gala
    • - Hospital of the Future
    • - Value Based Care
    • - Hospital at Home
    • - Workplace of the Future
    • - AI and Digital Health
    • - Future of Staffing
    • - Hospital of the Future (Fall)
  • Multimedia
    • Podcast - Beyond the Byline
    • Sponsored Podcast - Healthcare Insider
    • Sponsored Video Series - One on One
    • Sponsored Video Series - Checking In with Dan Peres
  • Data & Insights
    • Data & Insights Home
    • Hospital Financials
    • Staffing & Compensation
    • Quality & Safety
    • Mergers & Acquisitions
    • Data Archive
    • Resource Guide: By the Numbers
    • Surveys
    • Data Points
  • Newsletters
  • MORE+
    • Contact Us
    • Advertise
    • Media Kit
    • Jobs
    • People on the Move
    • Reprints & Licensing
MENU
Breadcrumb
  1. Home
  2. Safety & Quality
March 08, 2017 11:00 PM

Why wildly varying C-section rates persist

Elizabeth Whitman
  • Tweet
  • Share
  • Share
  • Email
  • More
    Reprints Print
    maternal health

    More than 4.2 million babies are born annually, making mothers and their infants the largest group of hospital patients.

    For a baby born in the U.S., the likelihood of entering the world through the birth canal or by cesarean section is not based strictly on clinical factors. Insurance coverage and the hospital where that baby is delivered also play a role.

    Last year, about a fifth of all babies born at DMC Harper-Hutzel hospitals in Detroit were delivered by C-section. At two nearby hospitals, Henry Ford West Bloomfield Hospital and McLaren Macomb in Mount Clemens, Mich., a quarter and well over one-third of the babies were, respectively.

    The rate of babies born by C-section varied by 15.3 percentage points across the three hospitals, according to data they submitted to the Leapfrog Group, an employer-backed quality and patient-safety group in Washington, D.C

    But the numbers don't explain why a higher proportion of babies were born by C-section at McLaren Macomb than at Harper-Hutzel.

    Figuring out those drivers can lower the nation's high C-section rate and related healthcare spending. But there's a dearth of information about how delivery decisions are made at each hospital.

    “One of the things we don't know a lot about in maternity care is hospital management practices,” said Katy Kozhimannil, an associate professor at the University of Minnesota School of Public Health. “Obstetrics is not the most lucrative service line for healthcare delivery systems, so it's not the place where most attention goes.”

    High and wildly varying rates of C-sections across the U.S.—and the reasons for both—are well-established. Insurers pay more for C-sections than vaginal births, which take more time in hospitals that are often pressed for space. Doctors also fear malpractice suits stemming from natural births, even though C-sections are considered riskier than vaginal births unless medically necessary.

    Accounting for nearly one third of births in 2014, C-sections in the U.S. are performed at double the rate the World Health Organization considers medically necessary.

    The average rate of C-sections among women considered less likely to need the procedure—first-time mothers with a single baby at term and positioned head-down—was 25.8% among hospitals that reported to Leapfrog in 2016. That C-section rate fell less than 1 percentage point from the year before, when the average rate was 26.4%. Meanwhile, rates varied wildly by state, from 17.1% in New Mexico to 32.1%, in Louisiana.

    Kozhimannil, who reviewed the report, said the variability was striking. Her own research corroborates Leapfrog's findings. C-section rates varied at least tenfold across 593 U.S. hospitals, from 7.1% to 69.9%, according to a Health Affairs study she co-authored in 2013.

    The state of California, which has been working on lowering its C-section rate, has what experts call unusually good data on C-sections thanks to an online database that gathers hospital discharge records with birth certificate data. The data shed light on individual doctors and tracks procedures and flags problems that lead to more C-sections.

    Sometimes, C-sections are medically necessary, depending on the mother's risk factors—obesity, drug addiction or lack of prenatal care, to name a few examples—and so the data need to go deeper, to allow for risk adjustment and to reveal the deciding factors that led to a C-section.

    “The system nudges hospitals and clinicians toward greater use of cesarean sections,” Kozhimannil said. A C-section can take 30 minutes, making them much more appealing to doctors, hospitals and patients. Plus, Medicaid and private insurers typically pay twice as much for a C-section. The Center for Healthcare Quality and Payment Reform estimates the average commercial payment for vaginal births was $5,809 compared with $11,193 for cesarean births.

    Some areas of maternity care are straightforward to improve. To stop early elective deliveries, for instance, hospitals or payers can put a hard stop to them.

    They can refuse to schedule C-sections or to pay for deliveries when labor is induced without medical necessity. Some states have done this with their Medicaid programs

    With C-sections, it's more challenging. Payment reform to reduce financial incentives for C-sections has been limited to a handful of pilot projects, including bundled payments that pay the same amount for a delivery, be it vaginal or cesarean section.

    Hospitals should recognize that patients and payers are paying attention to C-section rates and other maternity care metrics, Leapfrog spokeswoman Erica Mobley said. “Some hospitals are performing much better than others. There are lessons to be learned.”

    Letter
    to the
    Editor

    Send us a letter

    Have an opinion about this story? Click here to submit a Letter to the Editor, and we may publish it in print.

    Recommended for You
    QUALITY OFFICER
    NCQA health plan quality ratings include new equity measure
    Hospital with money
    More hospitals to be charged readmissions penalties: CMS
    Most Popular
    1
    CMS tries luring providers to revamped Medicare ACOs
    2
    Oregon joins other states in setting ratios for nurse staffing
    3
    Blue Shield CA taps Amazon, Mark Cuban, CVS for new PBM model
    4
    A health innovation hub grows in Lake Nona Medical City
    5
    Hospital-at-home providers push for Medicaid coverage
    Sponsored Content
    Get Newsletters

    Sign up for enewsletters and alerts to receive breaking news and in-depth coverage of healthcare events and trends, as they happen, right to your inbox.

    Subscribe Today
    MH Magazine Cover

    MH magazine offers content that sheds light on healthcare leaders’ complex choices and touch points—from strategy, governance, leadership development and finance to operations, clinical care, and marketing.

    Subscribe
    Connect with Us
    • LinkedIn
    • Twitter
    • Facebook
    • RSS

    Our Mission

    Modern Healthcare empowers industry leaders to succeed by providing unbiased reporting of the news, insights, analysis and data.

    Contact Us

    (877) 812-1581

    Email us

     

    Resources
    • Contact Us
    • Help Center
    • Advertise with Us
    • Ad Choices
    • Sitemap
    Editorial Dept
    • Submission Guidelines
    • Code of Ethics
    • Awards
    • About Us
    Legal
    • Terms and Conditions
    • Privacy Policy
    • Privacy Request
    Modern Healthcare
    Copyright © 1996-2023. Crain Communications, Inc. All Rights Reserved.
    • News
      • Current News
      • Providers
      • Insurance
      • Government
      • Finance
      • Technology
      • Safety & Quality
      • Digital Health
      • Transformation
        • Patients
        • Operations
        • Care Delivery
        • Payment
      • ESG
      • People
      • Regional News
        • Midwest
        • Northeast
        • South
        • West
      • Digital Edition (Web Version)
    • Blogs
      • AI
      • Deals
      • Layoff Tracker
      • HIMSS 2023
    • Opinion
      • Breaking Bias
      • Commentaries
      • Letters
      • From the Editor
    • Events & Awards
      • Awards
        • Nominate/Eligibility
        • 100 Most Influential People
        • 50 Most Influential Clinical Executives
        • Best Places to Work in Healthcare
        • Excellence in Governance
        • Health Care Hall of Fame
        • Healthcare Marketing Impact Awards
        • Top 25 Emerging Leaders
        • Top Innovators
        • Diversity in Healthcare
          • - Luminaries
          • - Top 25 Diversity Leaders
          • - Leaders to Watch
        • Women in Healthcare
          • - Luminaries
          • - Top 25 Women Leaders
          • - Women to Watch
      • Conferences
        • Digital Health Transformation Summit
        • ESG: The Implementation Imperative Summit
        • Leadership Symposium
        • Social Determinants of Health Symposium
        • Women Leaders in Healthcare Conference
      • Galas
        • Best Places to Work Awards Gala
        • Health Care Hall of Fame Gala
        • Top 25 Diversity Leaders Gala
        • Top 25 Women Leaders Gala
      • Virtual Briefings
        • - Hospital of the Future
        • - Value Based Care
        • - Hospital at Home
        • - Workplace of the Future
        • - AI and Digital Health
        • - Future of Staffing
        • - Hospital of the Future (Fall)
      • Webinars
    • Multimedia
      • Podcast - Beyond the Byline
      • Sponsored Podcast - Healthcare Insider
      • Sponsored Video Series - One on One
      • Sponsored Video Series - Checking In with Dan Peres
    • Data & Insights
      • Data & Insights Home
      • Hospital Financials
      • Staffing & Compensation
      • Quality & Safety
      • Mergers & Acquisitions
      • Data Archive
      • Resource Guide: By the Numbers
      • Surveys
      • Data Points
    • Newsletters
    • MORE+
      • Contact Us
      • Advertise
      • Media Kit
      • Jobs
      • People on the Move
      • Reprints & Licensing