Category
3MT - Three Minute Thesis
Description
After more than a decade of declining, c-section delivery rates in the United States are once again rising. In 2021, there were 1,174,545 c-sections, accounting for 32.1% of all U.S. live births. Remarkably, c-sections are even increasing in young, low-risk, first-time deliveries. Csections can save lives; however, when elected for non-medical reasons, they pose unnecessary short and long-term risks for both mother and child and cost Medicaid about 50% more than natural deliveries. To quantify unnecessary c-sections in low-risk deliveries, we measured variation in clinician practice, identified excessively high rates, and estimated the national and state fiscal impact of the outliers. Medicaid funded 41% of all U.S. births in 2021. For this reason, we used the 2021 Medicaid fee-for-service data to evaluate clinician c-section rates in all low-risk Medicaid beneficiary deliveries and found that c-section rates by clinicians (N=12,811) vary (mean[SD]0.25[0.15]) (median[IQR] 0.23[0.15-0.31]). Identifying c-section rates over 35% found 2,370 physicians (18.5%) were outliers, and 21 physicians performed c-sections on 100% of their low-risk patients. The estimated excess Medicaid cost of these 41,907 excess surgeries was $186,865,319.55. Geographically, the highest c-section rates in low-risk deliveries were in the U.S. Virgin Islands (60.6%), Puerto Rico (40.9%), Alaska (33.5%), Rhode Island (31.1%), and New Hampshire (29.2%). States with the lowest c-section rates were North Dakota (15.6%), Delaware (17.1%), Colorado (18.5%), and Wyoming (19.4%) and Arkansa/Michigan (tied 19.8%). These results highlighting practitioner, state, and national level details align with the Healthy People 2030 objective of “reducing cesarean births among low-risk women with no prior births.” Quantifying these trends and contextualizing their impact, can help efforts to improve future practices standards, accountability, and stewardship of common resources.
Counting the Cost of Too Many C-sections in Low-Risk Deliveries
3MT - Three Minute Thesis
After more than a decade of declining, c-section delivery rates in the United States are once again rising. In 2021, there were 1,174,545 c-sections, accounting for 32.1% of all U.S. live births. Remarkably, c-sections are even increasing in young, low-risk, first-time deliveries. Csections can save lives; however, when elected for non-medical reasons, they pose unnecessary short and long-term risks for both mother and child and cost Medicaid about 50% more than natural deliveries. To quantify unnecessary c-sections in low-risk deliveries, we measured variation in clinician practice, identified excessively high rates, and estimated the national and state fiscal impact of the outliers. Medicaid funded 41% of all U.S. births in 2021. For this reason, we used the 2021 Medicaid fee-for-service data to evaluate clinician c-section rates in all low-risk Medicaid beneficiary deliveries and found that c-section rates by clinicians (N=12,811) vary (mean[SD]0.25[0.15]) (median[IQR] 0.23[0.15-0.31]). Identifying c-section rates over 35% found 2,370 physicians (18.5%) were outliers, and 21 physicians performed c-sections on 100% of their low-risk patients. The estimated excess Medicaid cost of these 41,907 excess surgeries was $186,865,319.55. Geographically, the highest c-section rates in low-risk deliveries were in the U.S. Virgin Islands (60.6%), Puerto Rico (40.9%), Alaska (33.5%), Rhode Island (31.1%), and New Hampshire (29.2%). States with the lowest c-section rates were North Dakota (15.6%), Delaware (17.1%), Colorado (18.5%), and Wyoming (19.4%) and Arkansa/Michigan (tied 19.8%). These results highlighting practitioner, state, and national level details align with the Healthy People 2030 objective of “reducing cesarean births among low-risk women with no prior births.” Quantifying these trends and contextualizing their impact, can help efforts to improve future practices standards, accountability, and stewardship of common resources.
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Doctorate