Commentary: In the last 40 years, the number of women in the workforce has skyrocketed. In 1975, only 47% of women with children under 18 were employed. Now, that number is 70%. Unlike many other medical conditions for which employees will require care, maternity care offers a unique opportunity for employees to plan ahead for a hospital stay so employers are wise to help employees and their families select the best hospital. This will help new mothers receive good care during pregnancy and delivery, and it makes good business sense, as well: Employers collectively pay for more than one-third of all deliveries in the U.S., through employer-sponsored health insurance plans. According to new data, there are many opportunities for improvements that would save lives and money.
The Leapfrog Group, a national purchaser-driven nonprofit watchdog organization, surveys hospitals on their progress in meeting maternity care standards. More than 1,500 hospitals publicly report data that is otherwise unavailable, in part because purchasers apply market leverage to encourage reporting. This week, Leapfrog released its Maternity Care Report, based on data analysis performed by Castlight Health. The report, available at www.LeapfrogGroup.org/HospitalSurveyReport, is the first in a series of reports on the most pressing areas of hospital quality and safety from the annual Leapfrog Hospital Survey, with data analysis performed by Castlight Health. The Maternity Care Report focuses on three areas of care: early elective deliveries, episiotomy and high risk deliveries.
Early elective deliveries: Since 2010, Leapfrog has reported on rates of early elective deliveries inductions or caesarean sections performed before 39 completed weeks without a medical necessity. These deliveries can be dangerous to both the mother and infant, and have been discouraged by the American College of Obstetricians and Gynecologists for more than 30 years. Yet when Leapfrog began publicly reporting rates by hospital, it found that the national average of early elective deliveries across more than 750 hospitals nationwide was 17%. Nearly one in five infants was potentially experiencing a compromised start to life.
Fortunately, over the past five years, there has been tremendous improvement, thanks to the efforts of organizations like Childbirth Connection, the March of Dimes, the Department of Health and Human Services, business coalitions, and hospitals themselves. In 2014, Leapfrog saw the national average of early elective deliveries decline to its lowest rate yet: 3.4%. This is good news for women and infants, as well as the employers that provide their health care coverage. With fewer early elective deliveries, employers see a reduced cost of delivery expenses and better outcomes for moms and babies.
Despite this progress, more than 200 hospitals still report a rate higher than Leapfrogs target of 5%, and many hospitals perform early elective deliveries at an alarming rate of more than 20%. Employees who deliver at one of these facilities may not be properly counseled against early elective deliveries and may not be educated about the real risks posed to them and their newborn. Armed with Leapfrog data, employers have the responsibility and opportunity to steer their employees away from those hospitals, and into those that adhere to firmly established guidelines about safe care.
Episiotomy: The Maternity Care Report also examines the rate of episiotomy, which has dropped to just below 12% nationally. Once a standard practice in childbirth, episiotomies are now recommended in only a narrow set of cases, according to ACOG guidelines. Mothers who have an episiotomy during childbirth experience a longer recovery time, are at higher risk of complications, and report less satisfaction with the birthing process overall. Yet, despite clear evidence against the practice, 35% of birthing hospitals still perform episiotomies at a rate greater than Leapfrogs target of 12%. For the sake of their employees post-partum well-being, employers would be well-served to ensure that their employees are delivering babies at hospitals with a low rate of episiotomy.
High-risk deliveries: The final area examined in the Maternity Care Report is hospital performance on the delivery of high-risk, very low birth weight babies. For women with a high-risk pregnancy who may be delivering their baby between 24 to 32 weeks gestation, it is absolutely critical that their babies be born in a hospital with a neonatal intensive care unit adequately equipped to care for their highly specialized needs. The 2014 Leapfrog Hospital Survey showed that only a quarter of hospitals fully met Leapfrogs standard for high-risk deliveries. Far too many high-risk infants are being born at hospitals that may not be prepared to care for them.
Leapfrog is the only source of public data on a hospitals capability to care for a very low birth weight baby, so women who may be at risk can benefit greatly from consulting Leapfrogs public ratings to choose a hospital. For employers, the cost implications of a high-risk pregnancy and delivery are dramatic. Enabling employees to choose a hospital that fully meets Leapfrogs standard for high risk deliveries will help secure a better chance at a positive outcome as well as decreased costs.
Employers and employees stand to benefit greatly from using the results of Leapfrogs Maternity Care Report as well as publicly reported Leapfrog Hospital Survey results to select the best hospital for an infants start to life. By guiding employees to these resources and ratings, employers can not only ensure that their costs are kept low, but more importantly, will help ensure the health and well-being of working moms.
Leah Binder is president and CEO of The Leapfrog Group , a national nonprofit watchdog based in Washington, D.C., representing employer purchasers of health care and calling for improvements in the safety and quality of the nations hospitals. Her organization operates the annual Leapfrog Hospital Survey, which collects and publicly reports information on hospital quality and safety, as well as the Hospital Safety Score, which assigns letter grades assessing the safety of general hospitals across the country.
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