Unnecessary C-Sections Targeted By Covered California : Shots - Health News Covered California, the state's health insurance exchange, will exclude hospitals from insurance networks if they don't reduce their numbers of C-sections, back scans and opioid prescriptions.
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California's Message To Hospitals: Shape Up Or Lose 'In-Network' Status

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California's Message To Hospitals: Shape Up Or Lose 'In-Network' Status

California's Message To Hospitals: Shape Up Or Lose 'In-Network' Status

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MARY LOUISE KELLY, HOST:

California is making a big move to get people more value for their money when they receive health care in hospitals. Among the measures to make sure the quality of care is improving will be how many C-sections are performed. From member station KQED in San Francisco, April Dembosky explains.

APRIL DEMBOSKY, BYLINE: We're all used to pharmaceutical commercials that end like this.

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UNIDENTIFIED VOICE ACTOR #1: Call your doctor if you have fever, stiff muscles and confusion, as these may be signs of a life-threatening...

DEMBOSKY: But you would never hear a chipper hospital ad that ends like this.

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UNIDENTIFIED VOICE ACTOR #2: People who get care here may die from medical mistakes, get a hospital-acquired infection or have an unnecessary C-section.

DEMBOSKY: Well, Covered California, the state's insurance marketplace, has devised a new way to hold hospitals accountable, not in its advertisements but in its contracts. If hospitals don't meet certain targets on safety and quality, they could be excluded from the marketplace.

LANCE LANG: Basically, we're saying time's up.

DEMBOSKY: Lance Lang is the chief medical officer for Covered California.

LANG: We've told health plans that by the end of 2019, we want networks to only include hospitals that have achieved that target.

DEMBOSKY: One target is C-sections. Hospitals get paid more to do them, and they usually take less time. So women who don't need a C-section often get one. Even in low-risk cases, several California hospitals are delivering more than 40 percent of babies by C-section. At one hospital, it's 78 percent.

LANG: So that means that when a woman goes to a hospital, it's the culture of the hospital that really determines whether or not she gets a cesarean section, not so much her own health.

DEMBOSKY: C-sections are major surgery. Doing them when they're not needed exposes women to unnecessary risks.

LANG: Bleeding, hemorrhage, even death.

DEMBOSKY: That's why Covered California, state health programs and big companies want hospitals to keep C-section rates below 24 percent for low-risk births. But only Covered California is telling hospitals that if they don't play by the rules, they'll be benched.

LANG: It's basically a quality improvement project but with a deadline.

LEAH BINDER: It's probably the boldest move we've seen in maternity care ever.

DEMBOSKY: Leah Binder is CEO of the Leapfrog Group, a nonprofit that rates hospitals on quality. She says quality control of any kind has been recent and mostly voluntary.

BINDER: Back in the '80s, '90s, nobody ever thought that hospitals should ever have to report to anyone on how they were doing.

DEMBOSKY: California has more than 240 hospitals. And most are now working actively to improve their C-section rates. But state data show that there are about 40 hospitals that are still far off, including a cluster in East Los Angeles that treats low-income patients. OB-GYN Malini Nijagal says the target rate is harder for them to reach.

MALINI NIJAGAL: So if you have somebody who is on methamphetamines and is homeless and has not gotten any prenatal care, her chance as a C-section is way higher than someone who is not all of those things. And so the problem is, how do you adjust for the patient population of a hospital?

DEMBOSKY: Covered California's Dr. Lang says it may take some awkward conversations. But he believes all hospitals will be on board by the 2020 deadline, either meeting the target or on their way.

For NPR News, I'm April Dembosky in San Francisco.

KELLY: And that story is part of a reporting partnership with NPR, KQED and Kaiser Health News.

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