(Also, I know this is veering off topic, so I'm happy to take it to private emails if desired)

Interestingly, Pat, I can't really speak to why we do early elective deliveries, because here, we don't. I trained in SC and I practice here. Although we are usually at the bottom of the lists of "good" things, we are actually in a great place with regard to early elective deliveries. 

In 2011, a vision team for the "Birth Outcomes Initiative" began to meet. The BOI was a joint effort of the Department of Health and Human Services, the March of Dimes, BCBS, and the SC hospital association. Other groups (like the SC association of obstetricians and gynecologists) were also invited to participate. 

Essentially, SC is the first state to have both Medicaid and private payers (BCBS) disallow payment for non-indicated deliveries before 39 weeks. Every pre-39 week delivery (vaginally or via cesarean) must contain a modifier that explains its medical necessity. The list of medically necessary conditions is compiled from ACOG guidelines (e.g. PPROM, severe preeclampsia, active labor, ...). Additionally, a physician can seek permission from an MFM for an early term delivery if she feels there is a criterion not included on the list (e.g., my practice recently sought approval to post a fifth repeat section at 38 weeks). 

Data are collected from all the hospitals about early elective deliveries. In my hospital, we review them quarterly to see who posted the case and why it was done. I'm not sure if they are still doing it, but initially non-compliant obgyns received a letter explaining the goals of the BOI (reduce nicu admits, length of stay, and racial disparities). 

So far BOI has saved about 6 million in healthcare costs here. 

http://www.catalyzepaymentreform.org/images/documents/birthoutcomes.pdf has a case study on the BOI. If you're a little nerdy like me you might find it to be interesting reading. I should note that obgyns in SC, particularly at our academic centers, were very much on board with these goals. 

(One of the other joint goals is to get all the hospitals to be baby friendly!)

Thanks for the question!

Elizabeth


Elizabeth Boggs
Women Physician Associates
Columbia SC 29203
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