By Clive Riddle, March 2, 2012
Last week, Larry S. Boress, President & CEO of the Midwest Business Group on Health was one of three featured speakers in the HealthcareWebSummit event: Managing an Increasing Trend of Elective Preterm Deliveries.
MBGH has taken a keen interest in facilitating a reduction in elective preterm deliveries, and Larry shared why purchasers have gotten involved, and what they are doing about it.
Larry’s opening arguments were:
- Maternity care is the number one reason for hospitalization among employee populations
- The highest cost for maternity care is when underdeveloped infants are treated in the neonatal intensive care units of hospitals
- Preterm infants are less likely to survive to their first birthday than infants delivered at full term
- Those preterm babies who do survive are more likely to suffer long-term costly disabilities than infants born at term
He shared 2009 Data compiled by Thomson Reuters for the March of Dimes, which compared average expenditures for newborn care yielding $4,551 for uncomplicated cases vs. $49,033 for premature/ low birth weight cases.
So what exactly is an early elective delivery. Larry offered these characteristics:
- The newborns delivered with a gestational age between the 37th and 39thcompleted week, that were delivered electively
- Early elective deliveries are performed on women of all backgrounds and incomes.
- These are distinct from early deliveries performed due to clinically-appropriate reasons to avoid health problems facing the mother or the infant
And what is the scope of early elective deliveries? We learned that the national average is up to a rate of 17% of deliveries, while the Leapfrog group has set a current target at 12%. Minnesota, South Carolina, Indiana and Arizona all have rates above 25%. Virginia, Florida, and New York exceed 20%. While 53% of hospitals are at or below the Leapfrog target of 12%, 33% of hospitals have rates of 20% or higher (6% of hospitals have rates of 45% or higher.)
What are the motivations to have an elective preterm delivery, despite the dangers and costs? Larry cites these delivering physician convenience factors: (A) Guarantee attendance at birth; (B) Avoid potential scheduling conflicts; (C) Reduce being woken at night; and (D) the NICU can handle it. Furthermore, Larry offered these motivations for the mothers:
- Prior bad pregnancy
- Desire to deliver on special date or holiday
- Special circumstances
- Cultural factors
- Ability to plan in advance for birth
- Ability to be delivered by her doctor
- Maternal intolerance to late pregnancy
- Excess edema, backache, indigestion, insomnia
But there are serious quality implications of non-medically indicated early deliveries beyond cost that Larry cited:
- Increased NICU admissions (and separation from mother)
- Increased respiratory illness
- Increased jaundice and readmissions
- Increased suspected or proven sepsis
- Increased newborn feeding problems and other transition issues
- Under developed brain and lungs
- Potential development of cerebral palsy
The good news is this is now a national quality measure for the National Quality Forum (NQF); Leapfrog Group; The Joint Commission; and AMA Physician Performance Consortium Measure.
Larry closed by noting that in the twelve months since MBGH made its initial Call to Action to reduce elective preterm deliveries, over 70% of hospitals reduced their early elective delivery rates below previous levels, and many have set 5% as their goal.