Early Elective Deliveries: Bad for Babies, Good for Hospitals?
It seems that a new, alarming healthcare statistic appears every time I open my e-mail. Oftentimes they go unnoticed by the general public.
The Leapfrog Hospital Survey came out in January, providing data on how well hospitals abide by national performance standards in a range of categories. The measurement that caused a stir in the 2012 report related to the rates at which hospitals are providing what the organization terms “early elective deliveries.”
Early elective deliveries occur when a doctor delivers a child before the 39thweek of gestation when there is no medical reason to do so. This is not a new phenomenon –doctors do it to avoid labor-related lawsuits or for efficiency and scheduling.
According to the report, the number of early elective deliveries decreased overall between 2010 and 2011, with 65 percent improving their performance. But some hospitals are still scheduling them more often than not and a handful even admitted to performing the procedures more than 70 percent of the time.
So why do we care if a baby is born a couple of weeks early? Because of the well-documented risks of even slightly premature birth.
Babies born prematurely are more likely to have underdeveloped lungs, temperature control problems, infections, and blood conditions like anemia and jaundice. And though the rate of really serious problems may be low, research by the March of Dimes has found the risk of death more than doubles for babies born before 37 weeks of pregnancy in comparison to those born full term (3.9 for every 1,000 live births compared to 1.9 per 1,000 respectively).
In spite of warnings against early elective deliveries by groups like the March of Dimes and the American College of Obstetrics and Gynecology, it has continued to occur. That's because of what Michael Leonardi, head of maternal fetal diagnostic center at OSF Saint Francis Medical Center in Peoria, Ill., calls the “normalization of deviance.”
“It is a little easier to do it when it is more convenient for the patient or the doctor,” he said. “And most physicians don’t do enough deliveries to see the harm that they cause.”
Hospitals may not track the number of early elective deliveries and not realize how many are being performed. Patients likely don’t know that a couple of weeks can make a big difference to their baby. And a physician may genuinely want to deliver the baby of their patient, so they schedule ahead to make that happen.
More disturbing are the cost incentives for early elective delivery. Doctors are paid more for delivery than for prenatal care, so there is a financial gain in ensuring they perform the procedure. From a hospital standpoint, preterm babies are bigger money makers. They are more likely to end up in the neonatal intensive care unit, which costs about $3,000 per day. According to an article in Managed Care Magazine, the employer’s cost for a full-term baby is $2,830, while the average preterm baby costs $41,610.
With all of this knowledge at hand, some organizations are trying to change the system. Reducing the number of early elective deliveries was part of the Centers for Medicare & Medicaid Services’ Strong Start Initiative for the first time this year, said Erica Newman, Leapfrog program manager. She has seen preliminary numbers from a handful of hospitals that have reduced their rates. Some hospitals have been stopping the practice altogether if there is no medical necessity. And insurers have jumped on board as well. Aetna, United Healthcare, Wellpoint and Cigna worked together to craft a letter discouraging providers from the practice, Newman said.
When reporting this kind of story, check the numbers to see if your local hospital makes them public or not (in the Leapfrog report, many hospitals "declined to respond" – check out these state by state lists).
Hospitals have to report early elective deliveries to the Joint Commission, so they should be available. Are top officials people aware of the hospital’s numbers? Do they have procedures in place to prevent early elective deliveries for non-medical reasons? A good provider should answer yes to both of these questions.
Photo credit: Jon Ovington via Flickr