Reducing liability risks in OB
Hospitals, docs use protocols to cut costs from avoidable OB/GYN injuries
At HCA, the number of malpractice claims in obstetrics plummeted in the past decade. Specifically, it dropped from 12 per 10,000 births in 2000 to four per 10,000 births in 2009. How did HCA do it? “Our approach to reducing malpractice has been to reduce bad outcomes. If we have healthy mothers taking home healthy babies, we won’t have litigation. And that has been the key to our success,” says Steven Clark, medical director of women’s and children’s services at HCA. The Nashville-based, 159-hospital chain, which began adoption of standardized, evidence-based protocols in 2000, delivers about 220,000 babies annually, or about 5% of all U.S. births.
Even a small drop in the number of claims in obstetrics can equal big dollars. In the healthcare reinsurance industry, for example, “about 50% of the losses we see and pay are birth injuries. Those are the most expensive ones,” says Nat Cross, team leader for the healthcare underwriting practice at Londonbased Beazley Group. “If you injure a baby at birth and there is profound brain damage, and they have a life expectancy of 30 or 40 years but they are on 24-by-7 nursinghome care, that is going to cost a lot of money,” Cross says.
HCA isn’t the only healthcare organization applying the tenets of evidence-based medicine and quality improvement to deliver safer care and lower malpractice risk. Other efforts include a statewide collaboration in Michigan, a city-based solution in Des Moines, Iowa, and a system-centric initiative at 32-hospital Catholic Healthcare Partners, Cincinnati.
The impact of improved quality in obstet- rics could be huge. More than 4.2 million babies are born in the U.S. each year, making mothers and newborns the largest group of hospital patients, accounting for 25% of hospital discharges, according to the Childbirth Connection, a New York-based research and advocacy organization.
In 2007, hospital costs associated with pregnancy, childbirth and newborn care totaled $34.2 billion, according to the Healthcare Cost and Utilization Project of the Agency for Healthcare Research and Quality.
And although the rate of avoidable injury during childbirth declined 20% from 2000 to 2006, there still were 157,700 preventable injuries to mothers and newborns in 2006, according to the AHRQ’s cost project.
Mortality rates for mothers and babies are high in the U.S. as compared with other developed countries. The maternal mortality rate per 100,000 live births in 2008 was 24 in the U.S., compared with 12 in Canada, six in Japan and 12 in the U.K., according to a 2010
Hospital costs associated with pregnancy, childbirth and newborn care totaled an estimated $34.2 billion in 2007, federal data show.
Keller: Most people want elective birthing procedures “for convenience.”