reducing c-sections and health care reform

[PiePie]

http://tpmcafe.talkingpointsmemo.com..._less_costly//

[gcgirl]

Well, some of the comments are disturbing, but I like the direction Washington is taking.

[fwlady]

That is very interesting article. I am glad they are going that way too. About time!! I think that if the drs got pay by the hour, then natural births would be the way they would go. And, the mothers and babies would fare better. That way, we would have less Csections, less inductions (well, if they actually speed up labor). OTOH, if they are paying the hosp the same for easy Csections as complicated vaginal births, then they may try to make them complicated to get better reimbursement. With all the VBACs, that shouldn't be a problem, as they are automatically "complicated" by their standards. First time births, probably considered "complicated", inductions are DEF "complicated". So instead of sectioning the women, they will push inductions, or maybe epidurals. That probably isn't good.

If they are expecting drs to let women labor and birth naturally, the hospital still won't get paid enough. They will have to make them "complicated" and lets face it, truly natural childbirth ISN'T complicated, even by OB standards, I don't think.

They need to give a bonus to any doctor who gets his patients to naturally birth or to VBAC. Elective csections take no time at all, and they push the mothers out in many hospitals anyway, so they should be the cheapest reimbursement. The highest pay should go with the TOLs for complications, and truly life saving csections. And, I think that perhaps they could pay the hosp the same for the all natural healthy births the same AS the highest pay. That way, they can keep the moms for 24 hrs or less and get paid the same as the ladies who actually have real complications. They are going to try to make that natural thing happen as to have a bed open for the next one.

Kymberli

[Beppie]

Wow, I think that article is very interesting. I agree that more needs to be done to bring down the c/s rate. In my community the rate is 50%+ (but also because they don't allow VBACs at the local hospital).

[Storm Bride]

I agree with a lot of what you say, but I disagree with this:

Originally Posted by fwlady

They need to give a bonus to any doctor who gets his patients to naturally birth or to VBAC.

I don't want my doctor getting a bonus, based on "getting" me to do anything. The decision to RCS or VBAC should be up to the woman, because she's the only one who can do the risk/benefit analysis for her own situation.

[majormajor]

this has bad idea written all over it, if you ask me. sure, at least 50% of c-sections are unnecessary. but to try to curtail them by making it so that hospitals have a financial incentive to do vaginal births... i can just see this leading to too few c/s, which is far worse a disaster than too many.

i think the first thing that should happen is that they should force hospitals to offer VBAC. because really, any hospital that can do a regular birth can do a VBAC. at the same time, drs and midwives can't be priced out of offering VBAC by their insurance companies. if VBAC were a real option nation-wide, and it was encouraged (not forced, storm bride is 100% right, the choice should be the mother's. and the choice to VBAmC should ALSO be the mother's, and hospitals should support it, while i'm going on about my wish list anyway!). same goes for vaginal breech--if a mother understands the risks, and a HCP feels confident doing the delivery, it should be allowed.

i think VBAC is really the way to go. i think ERCS the single biggest group of "unnecessary" c/s.

[fwlady]

Of course it is the mother's decision. I didn't mean to imply that the dr should MAKE a woman VBAC. But, there are many women who are uneducated, and the doctor should try to educate her on the safety and benefits to VBAC. That is what I meant.

After my Csection at 6 wks PP, I asked the doc, "well, I guess it is "once a cesarean, always a cesarean?" and he corrected me that there was such a thing as VBAC. Had I not been told, the next doc might have had an easy time with me by just saying, "so when do you want to schedule your birth?"

I do think that a nationwide push to the hospitals for VBAC is the best way to start, but the only way they will do that is for monetary reasons, not because they actually want what is best for mothers and babies.

Fortunately, the hospital that I am considering, IF I go the hosp route, does whatever the mother wants to do. If she wants a VBAC, then they uphold that, with back up care or not. If she wants a family centered RCS, they do that too. But, the nurses are very purebirth friendly, they much prefer it. So, I am very lucky that we found this hosp when I transferred with #6. I didn't think those kind existed anymore. Kymberli

[gcgirl]

Originally Posted by fwlady

I think that if the drs got pay by the hour, then natural births would be the way they would go. Kymberli

I sort of agree: I think the fastest way to trim healthcare costs is actually to pay docs on salary, not by procedure. I say let's subsidize their education (because we need them) to reduce their debt burden, then pay them salary.

[Storm Bride]

I also feel that VBAC bans should be completely illegal. It is not a medical procedure, and hospital authorities have no right to tell a woman she can't perform a physiological function in their facility. What next - "You've had a catheter, so you're not allowed to ever pee here again."???

[Ruthla]

How about paying the attendant (OB, Family Physician, or midwife) the same thing to attend a birth, no matter what the outcome? Then there's no incentive to make a natural birth "complicated" or to push a "complicated" labor into a c/s.

Of course, the "payee" (gov't or insurance company) still saves money when a woman opts for a homebirth and saves them hospital fees, or has a natural hospital birth and doesnt' need an anesthesiologist (who gets a separate fee from the birth attendant.)

I'm very glad that this is on the table and being seriously considered. It's long overdue.

[mija y mijo]

I think it's a good idea and hope that other states catch drift of this and start to follow suit.

[annekh23]

I notice it talks about paying hospitals the same, not doctors. I just had a c-section in Washington state and I really felt that my doctor actually got a really raw deal out of the whole thing, she was in network for my insurance, so they obviously have some contract negotiated, I don't remember how much she billed, but she was paid 1500. For comparison the doctor that did my amnio got 900, she was literally in the room for 5 minutes! The doctor that did my hip surgery, which I think probably was more complex than a c-section, but not orders of magnitude so, got 5000.

If I'm understanding this proposal, it wouldn't be the doctor or anaethesist that got the same amount, but the hospital - when the hospital has all the cost of theatre equipment and staff, then you taking up a room for significantly longer. The hospital employs the labour and delivery nurses, which will have some effect on c-section rate, as would whether the hospital has a ban on vbacs or not, but when it comes to the crunch it's the doctor not the hospital that makes the ultimate decision.

Maybe the article is a misrepresentation of the new rules, but it definitely says paying the hospital not the doctor, which seems to me like the hospitals stand to lose out badly over something which they have minimal control.