Hospitals Stingy with C-section Data

Nearly half of the hospitals queried about caesarean section rates by researchers from the Leapfrog Group declined to provide the information.

Why can't we get cesarean sections right? We've had the feminist women's health movement followed by evidence-based medicine and now the push for patient engagement. Still, more than half of all hospitals are doing too many C-sections, according to this week's report from the Leapfrog Group, a national advocate for patient safety.

Known for its consumer-friendly "Hospital Safety Scores," Leapfrog has taken on cesarean sections. "Never before have purchasers or patients had a single, standardized C-section rate to compare by hospital at the national level," the group notes.

It's technically true, but Consumer Reports also scores hospitals on C-section rates. CR's findings only include hospitals in the 22 state where public data is available, however.

The Leapfrog Group tried to take if further by adding a C-section query to its annual survey of 2,500 hospitals. But, click on the "Find your Hospital's Rate" link and you get a long list of institutions that "declined to respond."

Granted, the list is alphabetical and Alabama hospitals seem especially reluctant to report. Only six of roughly 90 hospitals in the state voluntarily shared their C-section data with Leapfrog. And while some of the 2,500 hospitals surveyed don't offer obstetrics, the net result is that only 1,122 hospitals disclosed their rates.

Consumer Reports offers more information on questionable pregnancy and birth procedures, with this document: The Risks of C-sections: What Hospitals Don't Want You to Know.

Is there also something about the C-section rates that they don't want us to know? Let's not assume any variation of this scenario, such as that hospitals are looking the other way because doctors make these choices. And those doctors must know what they are doing and, by the way, they are keeping beds filled and revenue up. Also, Medicare isn't watching because not many women over 65 are having babies. (With assisted reproductive technology, that's not unheard of.)

Let's speculate that some hospitals are watching their numbers internally and acting on them, even if they don't want to share them. Or that they might not be tracking C-section data at all.

Still, in talking to a reporter from New Jersey, Leapfrog CEO Leah Binder said she was concerned about the ten Garden State hospitals that declined to respond to the Leapfrog survey. "You do have to worry as to why they're not reporting," she said in the article.

This data, incomplete as it is, comes at a time when the national C-section rates are dropping after more than a decade of increases. The Centers for Disease Control and Prevention reports that the low-risk cesarean delivery rates peaked at 28.1% in 2009. The rate decreased from 2009 through 2013, reaching 26.9%. "Declines were widespread during this time. Low-risk cesarean delivery rates were down for more than one-half of states."

Hospitals are dealing with a lot of demands, right now, including meeting health information technology standards, ICD-10 implementation, Medicare performance measures, and other patient safety initiatives. And on top of the hospital ranking efforts of Leapfrog, Consumer reports, and U.S. News & World Report, hospitals now have to cope with the sometimes snarky rankings from patients/consumers on Yelp and Facebook.

C-section Reporting Guidelines Issued
Leapfrog set its target rate at 23.9%, not a huge difference from the actual national rate. Still, that the rates vary so much suggests that there's a problem.

For example, a pregnant woman in Colorado has a 22% chance of getting a C-section; in Florida, the rate is 33%. With no Medicare stick out there, we'll have to count on hospitals and the doctors who work in them—or increasingly for them—to assess and address their rates, and by doing so, improve outcomes.

Last year, the American College of Obstetrics and Gynecology offered some help by issuing new guidelines that call on doctors to allow women to spend more time in labor before considering a C-section.

"Although cesarean birth can be life-saving for the baby and/or the mother, the rapid increase in cesarean birth rates raises significant concern that cesarean delivery is overused without clear evidence of improved maternal or newborn outcomes," the ACOG statement read.

Better Discharge Planning May Cut Postpartum Risks

A recent review published in the British Medical Journal offered another reason to avoid the operation if possible—higher rates of asthma, diabetes, and obesity in those delivered via C-section.

The hundreds of hospitals that didn't report their rates to the Leapfrog Group should be aware that they may not be able to keep them private for long. Consumer Reports notes that fewer than half the states currently collect C-section numbers. With the push for transparency in health quality and health pricing, that number is likely to grow.