Re­duc­ing li­a­bil­ity risks in OB

Hos­pi­tals, docs use pro­to­cols to cut costs from avoid­able OB/GYN in­juries

Modern Healthcare - - Front Page -

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.”

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