C-Section Payment as a Priority: Overview of Value-based ... · PDF fileof Value-based Payment...
Transcript of C-Section Payment as a Priority: Overview of Value-based ... · PDF fileof Value-based Payment...
C-Section Payment as a Priority: Overview of Value-based Payment for Birth in
California and Nationally
Elliott K. Main, MDMedical Director,
CMQCC
Stanford University
Cathie Markow, MBAAdministrative Director, CMQCC
Stanford University
https://www.cdc.gov/nchs/data/nvsr/nvsr63/nvsr63_06.pdf
The Problem: Rising Rate of Cesareans
California rates are the same as national
averages, but did not show any decline
between 2010-2013
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Large Variation of Total Cesarean Rate Among 251 California Hospitals: 2013
Range: 15.071.4%Median: 32.5%Mean: 32.8%
Hospitals4
Why should we care about CS rates? Relentless Rise without Baby or Mother benefit
6% in early 70s, 20% in mid 80s, 33% in 2010 CP rates, neonatal seizures unchanged since 1980 Overall, no benefit for long-term urinary continence
Increased maternal and neonatal morbidity Impaired neonatal respiratory function, NICU admits Affects maternal-infant interaction/Breast Feeding Increased maternal PP infections, VTE, transfusions Longer recovery, 2X PP re-admissions
Prior CS can have major complications Placenta previa and accreta (invasion deep into or
thru the uterine wall) hysterectomy or worse Uterine rupture; abdominal adhesions
Nulliparous, Term, Singleton, Vertex (NTSV) Cesarean Section Rate
Risk Stratified (standard population) No further risk-adjustment needed (more discussion later)
Widely adopted nationallyACOG: Task Force on Cesarean Section rates (2000)DHHS: Healthy Person 2010 and 2020NQF endorsed, Joint Commission Perinatal Core Measure
(PC-02), LeapFrog, CMS e-measure
>15 years experience National data and trends available
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NTSV CS Rate Among CA Hospitals: 2014 (Nulliparous Term Singleton Vertex)
(Source: Linked OSHPD-Birth Certificate Data)
Range: 12%70%Median: 25.3%Mean: 26.2%
40% of CA hospitals meet national target
Large Variation = Improvement Opportunity
National Target =23.9%
Hospitals
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Rate
ntsvcesareansectioncmqcc_2015-0
HospitalRateNumeratorDenominatorPopulation
Sutter Davis Hospital112.00%725981,503
Emanuel Hospital213.00%513911,318
Mammoth Hospital314.00%64396
Sonoma Valley Hospital414.30%749162
Bakersfield Memorial Hospital515.00%1751,1703,137
Kaiser-Redwood City616.00%1157181,539
Sutter Maternity & Surgery Center716.20%744571,029
El Camino Hospital-Los Gatos816.30%59362782
Sierra Nevada Memorial Hospital916.40%25152437
Kaiser-Roseville1016.90%3041,7945,319
San Joaquin Community Hospital1116.90%1771,0453,468
Mad River Community Hospital1217.00%39230589
Santa Paula Hospital1317.10%19111374
San Francisco General Hospital1417.30%673871,176
John Muir Medical Center1517.40%1699712,791
La Palma Intercommunity Hospita1617.50%24137454
Woodland Memorial Hospital1717.70%36203687
Loma Linda University Medical Center - Murrieta1818.10%764211,168
Plumas District Hospital1918.50%52765
UC San Francisco Medical Center2018.50%1981,0692,213
Corona Regional Medical Center2118.70%613261,046
Sutter Solano Medical Center2218.90%38201592
Lompoc Valley Medical Center2319.10%22115432
St. Helena Hospital - Napa Valley2419.20%20104254
Kaiser-Woodland Hills2519.30%1226331,571
Redwood Memorial Hospital2619.30%1788351
Marin General Hospital2719.50%1015181,408
Ukiah Valley Medical Center2819.60%49250815
Rancho Springs Medical Center2919.70%2011,0183,216
St. Helena Hospital - Clear Lake3019.70%1366177
Tahoe Forest Hospital3119.90%32161362
Barstow Community Hospital3220.00%20100371
Kaiser-San Jose3320.20%1577762,168
St. Rose Hospital3420.20%52257788
Redlands Community Hospital3520.30%1708382,615
Alameda County Medical Center - Highland3620.40%693381,121
Pomona Valley Hospital Medical Center3720.40%4472,1957,032
Twin Cities Community Hospital3820.40%45221666
Henry Mayo Newhall3920.50%944591,280
Kaiser-Modesto4020.50%1808782,615
Simi Valley Hospital4120.50%53259687
Ventura County Medical Center4220.50%864201,477
Kaiser-Panorama City4320.60%1597722,156
Arrowhead Regional Medical Center4420.70%1527342,656
Fairchild Medical Center4520.80%1153184
Kaiser-South Sacramento4620.90%1808612,469
San Joaquin General Hospital4721.00%864091,799
Dominican Santa Cruz Hospital4821.10%62294876
Kaiser-Fresno4921.20%994681,193
St. Jude Medical Center5021.20%1738162,242
George L. Mee Memorial Hospital5121.40%2198447
Sutter Santa Rosa5221.50%1225681,658
Lodi Memorial Hospital5321.60%632911,045
Petaluma Valley Hospital5421.60%33153450
Riverside County Regional MC5521.60%914221,751
CPMC-California5621.70%4682,1534,905
CPMC-Saint Luke's5721.70%97448941
Mercy Medical Center Mt. Shasta5821.70%1046133
Santa Clara Valley Medical Center5921.70%2089593,352
Sutter Delta Medical Center6021.70%70322988
Kaiser-Vallejo6121.80%1105041,538
Kaiser-Oakland6221.90%2089492,329
Sutter Roseville Medical Center6322.10%2129612,931
Anaheim Regional6422.30%1205371,707
Kaiser-San Francisco6522.30%2761,2352,841
Desert Valley Hospital6622.40%69308923
Kaiser-Riverside6722.40%2371,0562,959
Kaiser-Santa Rosa6822.40%1777891,985
Kaiser-Hayward6922.50%843741,068
Downey Community Hospital7022.60%743281,097
Kaiser-Antioch7122.70%1265561,563
Kaiser-Walnut Creek7222.70%2891,2753,435
Los Alamitos Medical Center7322.70%1054631,364
Mendocino Coast Hospital7422.70%1044132
Methodist Hospital of Southern Californi7522.70%1948562,001
Feather River Hospital7622.90%72314901
Providence Holy Cross7722.90%2571,1233,282
Providence Little Co Mary-San Pedro7822.90%44192602
UC Irvine Medical Center7922.90%1024461,531
Salinas Valley Memorial Healthcare Syste8023.00%1155011,794
St. Louise Regional Hospital8123.00%38165560
Mercy Hospital of Folsom8223.10%81350932
UC San Diego Medical Center8323.20%2018682,426
Citrus Valley Medical Center8423.30%2901,2424,068
Kaiser-Baldwin Park8523.30%2431,0432,791
Santa Rosa Memorial Hospital8623.40%56239739
Alta Bates Hospital8723.50%5472,3306,426