Shining a Light on a Bad Practice

Submitted by hci3-usr on Friday, July 8, 2016 - 11:30

Newtown, CT – July 8, 2016

It has often been said that it can take two decades or more for innovation to spread in health care, but sometimes the wrong innovation spreads very fast, and people get hurt. Amid the general and appropriate outcry over the steady and significant increase in the number of C-sections, policy makers, private and public sector payers, as well as industry leaders and not-for-profit organizations have all stepped up to try and reverse the trend. And contrarily to the efforts of more than a decade ago which saw behaviors lapse back to prior form, this time payment is being used to more permanently affect change. The Learning and Action Network’s Clinical Episode Payment workgroup recently came out with a draft white paper on a maternity episode of care that can form the basis for a comprehensive bundled payment. The concept here is to pull together three sub-events that, to-date, have mostly been treated distinctly by payment – pregnancy, delivery, newborn – into a single payment that links it all together. Practical implementations of this model are already underway in Texas and New York, and early results are coming in. The upshot is that by creating a blended rate for vaginal deliveries and C-sections, the frequency of the latter are decreasing, and by linking baby outcomes to the delivery, the right decision is made for both mom and baby. That’s good for everyone. Unfortunately, the same cannot be said when it comes to another important procedure for women, hysterectomies. In fact, quite the opposite.

What this means to you – For several years now the preferred mode of surgery for hysterectomies has increasingly been laparoscopic, and the growth in that mode has been so significant that about 60% of commercially-insured women having a hysterectomy get it done laparoscopically. And this, despite the fact that the still current and official recommendation of the American College of Obstetrics and Gynecology is to perform routine vaginal hysterectomies as the core protocol. One conclusion is that innovation has spread rapidly. However, it has come at a cost, both physical and financial because our research suggests that laparoscopic hysterectomies are costlier and have more complications than traditional hysterectomies. But wait, it actually gets worse. ACOG’s recommendation clearly states that the preferred route is vaginal, and yet a full 60% of hysterectomies are abdominal, which leads to higher complications and longer recovery time for women. Our research shows that less than 10% of hysterectomies conform to ACOG recommendations, and even for those of us who have grown to expect anything and everything from this industry, it’s pretty shocking. There is, however, a lot that can be done to reverse this unfortunate trend, and it starts with shining a bright light on these findings, and engaging advocacy groups to pay attention. But it also now falls on employers, public and private payers, to enact new payment policies to curb the perverse incentives that drive the newer, fancier, less affordable and poorer quality procedure to flourish. The maternity bundle shows us the path and we should take a similar approach with this procedure to make sure that the “innovation” in hysterectomy surgery is rapidly reversed. Women’s health and wealth depend on it.


Francois Sig


Francois de Brantes
Executive Director