Starting Oct. 1, 2014, the Centers for Medicare & Medicaid Services wants hospitals to start reporting these measures and other maternal care processes as part of the Hospital Inpatient Quality Reporting Program—or suffer financial penalties.
For some hospitals, failure to change could be an embarrassing mark of poor quality for the nation's most common hospital discharge. And that could result in employers and insurance companies dropping contracts or negotiating lower rates.
Last year, three federal agencies, including CMS, together launched the Strong Start for Mothers and Newborns Initiative to raise hospital and patient awareness and allocate funding to reduce elective premature births.
The Leapfrog Group, a Washington, D.C.–based organization that focuses on healthcare safety and quality, now publishes online rates of early elective inductions and C-sections at each of 773 hospitals that report to the organization, with press conferences each year to announce results of which hospitals provide the best motherhood services.
Melissa Danforth, senior director for hospital ratings for The Leapfrog Group, says that while more hospitals are reaching a target rate of 5%, "still more than half of the hospitals reporting to Leapfrog do not meet our target of 5%," and 138 had rates of at least 20% in 2012. "As more and more people look at these rates, question their doctor, and put pressure on hospitals to improve, we are confident that deliveries will be safer and fewer newborns will be harmed," Danforth says.
At Valley Hospital, executives first had to lay down the law with their physicians, many of whom were not aware of the latest evidence that allowing these early deliveries was potentially harming newborns, Grande says.
"A lot of the problem was the fear among our physicians that if they didn't do what the patient asked, they'd go find another doctor," Grande says. "It was a financial issue." Valley's 52 obstetrician-gynecologists of course wanted to provide safe care, she says, but they "didn't have up-to-date evidence that shows 39 weeks really does make a difference" in the well-being of the newborn.
"We used the March of Dimes toolkit, which has tremendous graphics, and a picture of the size of a baby's brain at 35 weeks versus the size of the brain at full term. That definitely got their attention."
At Valley Hospital, Grande says, the campaign first targeted just hospital policies and physician practices, which led to physician leadership agreeing to a strict "hard stop," a refusal to schedule any woman's delivery prior to 39 weeks without documented medical necessity. That meant everyone had to agree "that 38 weeks and six days did not equal 39 weeks."