- After being told by a major insurer that it might be cut from their network due to higher-than-average cesarean sections rates which were driving up maternity costs, Hoag Memorial Hospital Presbyterian made a significant push to lower their rates, Kaiser Health News reports.
- At the time, the CA hospital's c-section rate was around 5% higher than the state average of 33%.
- Within three years, the hospital was able to lower its c-section rates to around 25% for low-risk births and around 33% overall.
What's notable about this story is not just the pressure that the insurer leveraged against the hospital, but the pressure that data transparency put on it. In theory, this is how quality improvement data is supposed to be used—to identify shortcomings and drive change.
"In quality improvement, we call it 'the burning bridge,'" said Dr. Elliott Main, medical director of the California Maternal Quality Care Collaborative. "You can't just stay still. You've got to move."
Some of the nuts and bolts of Hoag's improvement plan: sharing each physician's c-section data with the entire department so that everyone would know who had the highest rates; implementing new scheduling rules; requiring approval in order to schedule a c-section in some cases. This created some cultural challenges within the organization—one physician called the new level of data-sharing "heated," expressing concerns that the data would be used to penalize, not improve
"There was a lot of upheaval," Dr. Jeffrey Illeck, the hospital's obstetrics department chair, told Kaiser Health News. "None of us want to look bad in front of our peers. …And some looked horrible."
Other strategies included increasing patient education about the benefits of a natural delivery and c-section risks, giving nurses end-of-year bonuses for helping the hospital to reduce c-section rates and opening an obstetrics emergency department that is staffed 24/7 with "laborists" to deliver babies.