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Reducing Early Elective Births Could Save $1B Annually

Cheryl Clark, for HealthLeaders Media, January 26, 2012

Binder said it's been tough to get hospitals and obstetrical practices to understand the urgency and voluntarily report, although Leapfrog and collaborative organizations like Childbirth Connection and Catalyst for Payment Reform are making progress. The groups are also trying to reach pregnant women, explaining that estimates of their conception dates may be off by as much as two weeks.

The groups are also emphasizing the burden of a C-section, which includes four to six weeks of home recuperation after a two to four day stay in the hospital, and the potential for infections and bleeding.

"The unfortunate fact is that the cost savings and the financial advantage do not accrue necessarily to the hospital, quite frankly," Binder said. "The hospital could probably earn more revenue by doing more invasive procedures and having babies in NICUs, which tend to be high revenue areas.

"To the credit of the hospital community, I've never met a hospital leader who says they want to see that happen...Nonetheless, it's worth mentioning that it is a revenue loss for hospitals when they do the right thing for these babies and their mothers."

Binder was asked how hospitals and doctors justify their push to get women to undergo early elective delivery when they don't have to. She replied that in talking with hospitals and doctors, it appears "Obstetricians would like to have more control over when the deliveries are scheduled for a variety of reasons, whether it's their own scheduling issues—they're going to be in the office one week rather than the next—and by waiting after 40 weeks, there's more chance the woman will go into labor at any time.

She added that there's "a perception that's not a problem. But as we're pointing out...it is not safe and that is something they need to be much more aware of."

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