Guest post by Jill’s Friend, MD
I was asked my cesarean rate recently and gave my stock answer of “I do not know. I have never calculated the percentage because it is as low as possible, so why bother with the number?”
I then took the time to calculate my section rate [Editor’s note: Rates were calculated under extreme duress]. I picked 2010 because it was handy. The 2011 calendar year would have been harder as all the data might not be in. Easy pickings right? Punch up the server, put in the section and vag codes and voila. WRONG! I noted that there were weird spikes in the cut-to-cure rates in certain months. Breaking it down further, I noted that the rate more than doubled for my patients on the weekends when I was not on call. OK, I needed to look at just the deliveries I did so I went through the call schedule and excluded all deliveries done on these weekends. This took over an hour.
Next, I needed to exclude deliveries by my non-VBACing partner. There is no way to separate these out except to look at every delivery she did, which was easier than going through all of mine. These deliveries excluded, and another hour lost, I now had the total deliveries I had performed myself on my patients. As deliveries performed for other docs were billed by them they did not show up in my server. Unreferred would have been trickier, but since they are my billing, I left them in despite a near 50% section rate for these patients. I covered multiple weekends for a small hospital and rural health care clinic. I called and got all of my deliveries from them even though I did not bill for them. Trying to break out primary from repeat cesareans was difficult until I found the code for scar revision. I clean up the old scar nearly 100% of the time so it made the repeats stand out. The results are a 22% section rate with with a 10.2% primary rate. FYI, I had 36 successful VBACs.
Now enlightened, I can see the problem with providers trying to be accurate about their rates. It is hard to pin down the exact number because the perfect criteria to determine if it was “yours” is elusive. My rate is probably higher because some of the sections on weekends were scheduled sections that presented in labor. Others were complications notorious for occurring after 5 p.m. In a larger group the rates would be even harder to individualize but most members of a clan will follow the same hunter/gatherer patterns; therefore, the group percentage as a whole should be easy to render. Hospital rates likewise should not be too misleading as they tend to have like practitioners even amongst different groups. One group among four or five usually will not produce too much of an anomaly.
So how do you select the person or group that will give you the best-standard-of-care shot at a normal delivery? Beats the hell out out me. There is no place to adequately look up self-reported rates. There is no way to verify these rates. There is no policing of these rates. Jesus, I cannot even confirm my own!
I do not personally know of any practitioner or group that posts their numbers and the hospitals have no clue who does what for whom. They rarely seem to even get the numbers close. All I can say is good luck in your search and let me know when the veil on true section rates by provider is lifted. It will either make me laugh my arse off or throw up.
Jill’s Friend, MD, has a cesarean rate that is half of the local and state rate and works way too much (which is why Dr. Jill’s Friend has a high VBAC rate and low primary cesarean rate). Jill’s Friend, MD, is going to kill her for defiling a perfectly good post with the Philosoraptor meme.