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Issue 6, May 29, 2015



The intersection of maternity care, data transparency, health care costs and patient safety in a weekly curated list of articles of interest.

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What to Elect When You’re Expecting

Group says employers should consider intervening before their pregnant employees elect to have riskier early deliveries.



In America, inequality begins in the womb

What better opportunity to start “doing better than that” and break the vicious cycle of poverty and inequality than during that miraculous nine months in the womb that separates conception from birth.




International Day of Action for Women’s Health: Obstetric Violence

Obstetric violence is a specific type of violation of women’s rights, including the rights to equality, freedom from discrimination, information, integrity, health, and reproductive autonomy. It occurs both in public and private medical practice during health care related to pregnancy, childbirth, and post-partum and is a multi-factorial context of institutional and gender violence.



Click to view full infographic



“Obstetric Violence” Introduced as a New Legal Term in Venezuela


We Need More Nurses




Doctoring, Without the Doctor        

Nurses say their aim is not to go it alone, which is rarely feasible in the modern age of complex medical care, but to have more freedom to perform the tasks that their licenses allow without getting a permission slip from a doctor — a rule that they argue is more about competition than safety. They say advanced-practice nurses deliver primary care that is as good as that of doctors, and cite research that they say proves it.




How One Supermarket Chain Is Tackling Health-Care Costs

Mike Dendy, chief executive of Advanced Medical Pricing Solutions, a Georgia-based company that helps Bashas’ recover any unwarranted charges on a contingency basis, argues that the relationship between hospitals and insurers is both too cozy and opaque. He alleges that toothbrushes can cost $1,000 or more and both insurers and hospitals are gaming the system




‘Less Is More’: The Next Big Thing for Medicine

If the doctor just says no, what does the patient hear?

When billionaire-entrepreneur-Dallas Mavericks owner Mark Cuban lobbed a Tweet in early April advising his followers to have their blood tested “for everything available” every 3 months, he probably didn’t expect to unleash a Twitterspheric debate on medical overuse.




An American Self-Made Woman: Mary West And Her Quest To Lower Healthcare Costs

The Wests also set up a $100 million fund (entirely their money) to invest in digital health start-ups that deploy technology to potentially make health care more efficient and save money.



Cesarean rates of hospitals  |   Where can I VBAC?  |  Maternity Data Reports



Issue 5, May 22, 2015



The intersection of maternity care, data transparency, health care costs and patient safety in a weekly curated list of articles of interest.

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Vaginal Delivery After C-Section Often Safe

Most women who had a previous C-section scheduled another C-section for their subsequent birth, but about 20 percent attempted to give birth vaginally, which researchers call a VBAC (vaginal birth after cesarean). Of these, about 70 percent had a successful vaginal delivery, whereas the other 30 percent wound up needing a C-section anyway, according to the report, from the Centers for Disease Control and Prevention.




Maternal Morbidity for Vaginal and Cesarean Deliveries, According to Previous Cesarean History: New Data From the Birth Certificate, 2013 (CDC)




New Blueprint Seeks to Improve Patient Safety During Childbirth

As part of an unprecedented cooperative effort between several such organizations – including the American College of Nurse Midwives, the American Congress of Obstetricians and Gynecologists, the Association of Women’s Health, Obstetric and Neonatal Nurses and the Society for Maternal-Fetal Medicine – Lyndon and colleagues from these groups did two initial studies to identify the patient safety issues confronting nurses, midwives, physicians and others involved in maternity care. These studies uncovered communication problems and disconnects between clinicians and administrators as key threats to patient safety.



From the archives: Is Home Birth Safer than Hospital Birth? What Does New Research Show? (2014)


The Smoking Gun: How U.S. Health Care Came to Cost Insanely More

That first big leap is between 1982 and 1983. What was different in 1983 that was not there in 1982? DRGs, diagnosis-related groups — the first attempt by the government to control health care costs by attaching a code to each item, each type of case, each test or procedure, and assigning a price it would pay in each of the hundreds of markets across the country. The rises continue across subsequent years as versions of this code-based reimbursement system expand it from Medicare and Medicaid to private payers, from inpatient to ambulatory care, from hospitals to physician groups and clinics, to devices and supplies, eventually becoming the default system for paying for nearly all of U.S. health care: code-driven fee-for-service reimbursements.




Interview: Washington HCA policy change on early elective inductions

The Washington Health Care Authority (HCA) has announced that Washington Apple Health will no longer reimburse physicians and hospitals for elective birth inductions before 39 weeks without documented medical necessity. The policy, effective Oct. 1, seeks to promote the health of mothers and children in Washington by decreasing the number of non-medically necessary c-sections.





Court case shows how health insurers rip off you and your employer

Commentary: Blue Cross Blue Shield of Michigan added hidden fees to hospital claims

The fees came to light when Hi-Lex Controls, an automotive technology company, took Blue Cross Blue Shield of Michigan (BCBSM) to court in 2013 after becoming suspicious that the company had been systematically cheating it over 19 years. After reviewing evidence in the case, a judge ordered that BCBSM stop charging the hidden fees and pay Hi-Lex $6.1 million.


After suing and getting documentation from BCBSM, attorneys for Hi-Lex were able to show the court that BCBSM marked up hospital claims by as much as 22 percent. BCBSM didn’t disclose the markups, however. As part of the scheme, regardless of the amount BCBSM was required to pay a hospital for a given service, it reported a higher amount to Hi-Lex and pocketed the difference.



Annual Healthcare Cost For Family Of Four Now At $24,671



Cesarean rates of hospitals  |   Where can I VBAC?  |  Maternity Data Reports



ANFSCD: Checking in on #BirthCenterNWA

And Now For Something Completely Different…


As a lot of original blog readers know, I am a huge fan of birth centers and midwifery care. The difference in quality of care between the hospital where I gave birth the first time and the birth center I used for my second birth was striking enough to, you know, propel me to start this blog.

When I moved to Arkansas two years ago, the state’s first freestanding birth center, Birth Center of Northwest Arkansas or BCNWA, was just opening. I had the chance to help them on various projects and I don’t think I fully realized until later on what an enormous undertaking opening a birth center, let alone a birth center in Arkansas, was. If I can say that I personally know all of the Certified Nurse-Midwives catching babies in Arkansas (not because I’m popular but because I can count them all on one hand), that gives you a good idea of the founders’ starting point while trying to work with the state and various payers on licensing and reimbursement.

I visited BCNWA recently and it was great to see that not only is the Rogers, Arkansas, location going strong but another site is open in Cary, North Carolina, under the umbrella of the same parent company, Baby+Co. Three more birth centers are opening soon in Denver, Nashville and Charlotte.

My visit to the birth center was aptly timed, and not just because it reminded me that I need to schedule my overdue well-woman visit with the midwives there. In researching cost and pricing transparency along with rates of procedure utilization and quality metrics in maternity care, I keep happening upon mentions in articles of birth centers as potentially high-quality, low-cost alternatives to hospital care. The gist of a lot of it is global billing for the perinatal episode, like a prix fixe for patients whose birth occurs at the birth center (as opposed to those who risk-out or must transfer to a hospital for care), which keeps costs down and encourages coordination of care.

Check out this excerpt from a 2013 Integrated Healthcare Association policy brief:

There is a compelling need to improve how we pay for and deliver maternity care in the United States. Evidence indicates that reducing the number of medically unnecessary obstetric interventions, currently rewarded by the fee-for-service payment system, would reduce maternity care costs while improving care and outcomes for mothers and babies.

Bundled payment has the potential to realign incentives in maternity care. Combining all costs into a single, episode-based payment creates financial incentives for providers to enhance care coordination and increase efficiency, which in turn should lead to lower costs and improved health outcomes.

Beyond the obvious benefits and perks of high-quality health care in absolutely gorgeous settings, the care model that Baby+Co is implementing across the country— a scalable, turnkey model of a freestanding birth center with a close relationship to a local hospital— is worth watching as a maternity care reform innovator.

While Baby+Co is off changing the landscape of maternity care in the U.S., their midwives are available for a free consultation for people considering giving birth at the birth center and will take care of your well-woman visits, too!


Still curious about the Birth Center of Northwest Arkansas? This video gives a great overview:



Issue 4, May 15, 2015



The intersection of maternity care, data transparency, health care costs and patient safety in a weekly curated list of articles of interest.

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In terms of Internet virality, this was by far the article of the week:

How One Hospital Brought Its C-Section Rate Down Fast

Faced with the possible loss of an important insurer, one California hospital rapidly reduced excessive cesarean section rates in part by sharing each physician’s rate with everyone in the obstetrics department.




Study: CA hospitals waste money by ignoring ‘big data’

The idea floated by advocates of the Affordable Care Act — that the U.S. government could change the “cost curve” of medicine to achieve major savings — wasn’t well-explained by many Washington reporters. Encouraged by official reports, they often focused on the idea that preventive care would be the change agent.

But as the C-section research shows, the change agent could be the “big data” approach. It may have the potential to bring U.S. health care costs more in line with those seen in other advanced countries — so long as there are incentives to encourage physicians and hospital administrators to try to do what’s most sensible, not what’s easiest.




Cesareans following shift toward patient-centered care




Various Reasons for High Maternal Mortality in US

According to Dr. Anita Kuriya from McGill University Health Centre “The increase in caesarean rate has lead to deaths due to haemorrhage”.





White House Moves to Fix 2 Key Consumer Complaints About Health Care Law

The White House is moving to address two of the most common consumer complaints about the sale of health insurance under the Affordable Care Act: that doctor directories are inaccurate, and that patients are hit with unexpected bills for costs not covered by insurance.




Crowd-Sourcing Healthcare Costs

Clearhealthcosts.com is an experiment in crowd-sourcing with the goal of bringing transparency to healthcare costs by sharing real costs with real people: patients and clinicians.




What do high deductible health plans really mean for hospitals?

As consumers become responsible for a greater portion of their healthcare costs, hospitals will see their role as collection agent grow.




Watchdog: HHS program lacks transparency

The Department of Health and Human Services lacks transparency in how it makes approval decisions about billions of dollars in experimental projects in the Medicaid program, the nonpartisan Government Accountability Office said Wednesday.




Surprise medical bills are costing consumers

Nearly one third of privately insured Americans have dealt with medical bill shock in the past two years




U.S. News Health Care Index Shows Massive Increase in Consumer Costs

But deductibles – the out-of-pocket costs consumers must pay before their health insurance benefits kick in – are the components that have seen the most growth from 2002 to 2013. In 2002 – the earliest year for which data about deductibles were available – less than half of private-sector health insurance plans had a deductible. By 2013, more than 80 percent had a deductible, and the amount paid by consumers was skyrocketing.

“Premiums were steadily rising,” says Douglas Holtz-Eakin, president of the American Action Forum and former director of the Congressional Budget Office. “Employers tried to manage this expanding price tag by shifting costs to their employees in the form of higher deductibles and increased co-pays. This is one of the factors – in addition to the Great Recession – that contributes to the slowing of health care spending growth in the latter part of the period.”




Healthcare providers and consumers both stung by rising costs, report shows

As providers face declines in reimbursement from commercial plans, they are seeing more patients covered under Medicaid and Medicare.




Should Malpractice Settlements Be Secret?




Centers for Disease Control and Prevention (CDC)’s New FAQ’s on Birth Control Coverage




I’m still amazed that someone at The Onion satirized hospital cost reporting!

Report: U.S. Hospitals Spend $2 Billion Each Year Replacing Gowns Taken By Escaped Patients




Anatomy of Error

Marsh isn’t interested in the usefulness of error… he writes about his errors because he wants to confess them, and because he’s interested in his inner life and how it’s been changed, over time, by the making of mistakes.




Cesarean rates of hospitals  |   Where can I VBAC?  |  Maternity Data Reports



Issue 3, May 8, 2015



The intersection of maternity care, data transparency, health care costs and patient safety in a weekly curated list of articles of interest.

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This week’s collection of articles is brought to you by BabyLove. Are you in Minnesota near the Mall of America? Veronica Jacobsen and the whole team at BabyLove, an independent childbirth education center, have a lot to offer! Check out the class schedule and pass on the good word about BabyLove to pregnant friends in or around Eagan, MN.



An avalanche of unnecessary medical care is harming patients physically and financially. What can we do about it?




In case the above article in the New Yorker was on your TL;DR list, Vox.com summarizes it…

McAllen, Texas, used to be everything wrong with American health care. Not anymore.



Here is the poster that Neel Shah and the team at Ariadne Labs presented at the 2015 ACOG Annual Meeting this week. Click on the image to open a PDF.

RESULTS: Processes that take place on the labor floor are highly resource-intensive as a result of the level and number of personnel required, whereas postpartum processes are less resource-intensive. On average, vaginal deliveries require more than 700% more labor floor time compared with cesarean deliveries. Within the bounds of our sensitivity analyses, we found that vaginal deliveries are approximately 200% more expensive than cesarean deliveries until the birth takes place and cost equivalent to cesarean deliveries when summed over the entire length of stay. (Read the abstract in the Green Journal)



The U.S. Is Still a Terrible Place for Maternal Health




Paying People To Use Lower Cost Health Care Providers Saves Money




For Breech Births, C-Sections May Be the Safest Choice




New Evidence Updates C-Section Techniques




The Mom’s Beat: Care, not childbirth, is the measure of a mom




Celebrate International Day of the Midwife




From the archives:

Did Tort Reform in Texas Lower the State’s Total Cesarean Rate? (2012)



Cesarean rates of hospitals  |   Where can I VBAC?  |  Maternity Data Reports