I promised some thoughts on my blog post with the medical group rates last week. I was really interested in how many people actually clicked through to read the long as heck report! That’s awesome! But in some discussions online, a few things came up that need clarification.
First of all, this report is put out by Minnesota Community Measurement, an non-profit. I just find it and try to boil down the information in a way that’s more manageable. A lot of people were also wondering why some groups, namely midwife groups and family med groups, weren’t on the list. Here’s the exact methodology, as found on page 175:
This measure assesses the percentage of nulliparous women with a term, singleton baby in a vertex position delivered by cesarean section between July 1, 2014 and June 30, 2015 patients who had a C-section delivery. Any clinic that is part of a medical group in which the medical group has providers who perform cesarean deliveries were eligible to report data for this measure.
The statewide rate for Maternity Care: Primary C-Section Rate was 22 percent (a lower rate is better for this measure). Table 26 displays the details of this statewide rate. Figure 12 shows the average rate for this measure over time.
In maternity care, patients often seek care from multiple providers across locations within a medical group. Additionally, there are some providers who provide maternity care but may not perform c-sections, and patients who require a c-section are referred to a physician who does. Previous clinic level reporting of the maternity care measure did not include the deliveries performed by providers at a site without providers who performed c-sections, and as a result, rates for the state and at the medical group level had the potential to be artificially elevated. The maternity care measure is most appropriately calculated and reported at the medical group level in order to account for these considerations.
A few other people bemoaned the fact that we don’t have info on VBAC rates versus repeat cesareans. I agree. Given that, out of their whole existence, this is only the third report that MN Community Measurement has put out that has any Cesarean information, we’re really lucky to have the info we have. And really, maternity care transparency is just a problem in Minnesota– we don’t really have any. We have a teeny bit, and I share as much as I can find.
OK, but my thoughts on the numbers:
For their volume, Park Nicollet had a really impressive primary rate of 20.1%, though it was up slightly from last year’s 19.2%. Since being bought by HealthPartners, which had a rate of 21.7% in this report, I do worry about the Park Nicollet number creeping up. Oh, and if you remember back to the post on costs of birth, there’s a major difference in price between Methodist and Regions.
In groups that had drops, I’m really impressed by John A Haugen Associates at 16.2% ( down from 21.2%), Multicare Associates at 19.3% (previously at 29.5%!), Adefris and Toppin Women’s Specialists down to 21.9% ( from 27%), and the biggest group on the list was Allina Health Clinics who was at 21.6%, down from last year’s 25.8%.
Hennepin County Medical Center, which had high marks in the 2012 report from MNCM, had an even worse showing than last year, going from 24.7% in the 2015 report after having a primary cesarean rate of 19.1% in 2014’s report. I’m curious to see how this will be reflected in the 2015 cesarean rates.
Speaking of 2015 Cesarean rates, that info isn’t available, but I’m going to throw caution to the wind and make a few guesses. I think we’ll see an increase in rates at Woodwinds, a slight increase at Methodist and a larger increase at Maple Grove (largely as a result of the high primary rates from OBGYN West and Western OBGYN), increases at Ridges, Southdale, and Regions. I’m going to predict a drop in the overall censarean rate at Abbot Northwestern, St. Joe’s, and North Memorial. I don’t think there will be many changes at St. Francis, St. John’s, or United. As far as the Unity and Mercy…who knows. Now, we’ll have to see if I’m right.
What do you find interesting about all of this? I’d love to know your thoughts!