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C-Section Payment as a Priority: Overview of Value-based Payment for Birth in California and Nationally Elliott K. Main, MD Medical Director, CMQCC Stanford University Cathie Markow, MBA Administrative Director, CMQCC Stanford University

C-Section Payment as a Priority: Overview of Value-based ... · PDF fileof Value-based Payment for Birth in California and Nationally ... Cesarean Section Rate ... Potential payment

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  • 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

    66

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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