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Re: ?? C-Sections to 'Boost Hospital Profits'From: jafar6 (jafar6@optonline.net)Sat Apr 7 14:12:31 2001
on 4/7/01 2:10 PM, Braun, R. Daniel at rbraun@iupui.edu wrote:
> What a crock of ___________. Sure there are a few jerks out there who I have heard of administrators trying to decrease cesarean rates as part of a quality improvement plan. I have also heard (the same and other) administrators trying to make sure that cesareans are done in a timely manner and when necessary. The latter has come up after bad outcomes are presented at peer review. Some hospitals don't seem to address the issue of cesarean rates or seem like they don't even care. Ask me to elaborate if you wish. I have never seen a hospital adequately develop an effective protocol to optimize the rate and performance of cesarean sections. They try with physician profiling, peer review, encouraging VBAC's. Their efforts seem as well directed as they do successful (nada on both counts). I am curious if experts on this list in managed care or the insurance industry could comment on priorities for cesarean delivery rates. Cesareans are now acceptable in some circles for protection of pelvic floor (in the absence of any history) and even patient autonomy. Therefore, I wouldn't be surprised if somewhere out there someone in a blue suit (with authority to command others) decided that vaginal deliveries are not the way to go. I find that cesareans are more economical to most practitioners because of the time required to watch a patient in labor. Solo practitioners without extensive backup might find that particularly true. But to plan a method of delivery or an operation for financial reasons is as unethical as one can get. Meanwhile, the ethical and skilled practitioner prods along, successfully managing his or her cesarean rate one case at a time. Gary Kleinman Bridgeport Hospital
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