Amy VanBlaricom, an OB-GYN who delivers about 25 to 30 babies a month, said she wasn’t opposed to sharing the data. But she said doctors were worried that the rates would be used to penalize them rather than to drive improvement.
“It’s very heated,” she said. “We should use this data as an opportunity rather than a polarizing topic.”
VanBlaricom already tracked her own rate, which she said fell in the middle of the pack, and she has only seen a small drop since Hoag released the numbers. But she said being aware that Hoag is monitoring the C-sections has changed how she thinks about her practice and has encouraged her to let women remain in labor as long as it is safe for the mother and baby, rather than turning to C-section when a labor is taking too long.
That’s what Hoag administrators were aiming for—a realization among doctors that C-sections should not be undertaken lightly. They carry surgical risks, including serious infection and blood clots, and require longer hospital stays.
“Doctors and patients look at Cesareans as an easy way to time the birth,” said Dr. Marlin Mills, chief of perinatology at the hospital. “But a C-section is not benign. It’s a big surgery.”
The costs are also well-documented. Surgical births cost nearly $19,000, compared to about $11,500 for vaginal births, according to the Pacific Business Group on Health, an organization of employers that is also working to bring down C-section rates around the state.
The business group worked with the hospital on the financial side. It enlisted the help of some of the biggest local employers, including Disney, and another insurer, Blue Shield, to adjust payments so the hospital didn’t earn more from elective C-sections than vaginal births.
“The data helped people achieve the culture change,” said Brynn Rubinstein, a senior manager for the business organization. “Hopefully payment reform will help us sustain it.”
In addition, the hospital set new scheduling rules. In the past, doctors could simply call in with the woman’s due date and schedule the birth. Now, they would have to fill out a detailed form, with some requests, like those for deliveries earlier than 39 weeks, requiring special approval from a hospital administrator.
The hospital also stepped up its patient education, encouraging women to wait for labor to come naturally. If patients did want an elective C-section, they would have to sign an easy-to-understand consent form in the doctor’s office that detailed the risks.
Nurses were asked to help, by using techniques to avoid C-sections for women already in labor. They got women walking around the unit to speed up labor and reduce their chances of needing the surgery. The nurses each received an end-of-year bonus if they helped the hospital reach certain goals on reducing surgical births.