American Morning

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March 3rd, 2010
10:00 AM ET

Prescription for waste: Pricey & unnecessary procedures

Editor's Note: All this week, in the American Morning original series "Health care – Prescription for waste," we're examining more waste in the health care system – and this time it could involve your money. Today, our Elizabeth Cohen looks at one hospital's war on unnecessary and outrageously expensive procedures.

(CNN) – The number of women giving birth by cesarean is on the rise. It's estimated that one in three moms have a c-section, but often the pricey procedure is done out of convenience rather than to avoid complications. As our senior medical correspondent Elizabeth Cohen tells us, it's putting a strain on our health care system.

soundoff (22 Responses)
  1. OBDOC

    If TORT reform could happen for all doctors in all states, perhaps we would see a decline in the number of cesarean sections. We are forced into practicing defensive medicine – thereby performing more sections- out of fear of being sued. Blame the legal community for the health care disasters. It is absolutely outrages.

    March 5, 2010 at 4:00 pm |
  2. mat

    I have enjoyed reading comments left by many intellegent people and been amused by others written by people who assume they know more about good OB/Gyn care than their doctor.

    My husband is 50 years old & has been in practice for 15 years. During these years: 1) reimbursement income from insurance, medicaid, & medicare have decreased by more than 50% although the number of patients have continued to increase; 2) cost of malpractice insurance continues to rise; 3) cost of health insurance for his employees continues to rise but offers less coverage; 4) overrhead costs of running his practice has increased because of the malpractice & health insurance increases AND because of all the documentation, etc. required by government; 5) he is working much longer hours and seeing many more patients yet his income has decreased by more than 60%; 6) medicare & medicaid reimbursements in most cases are not enough to cover the actual cost incurred.

    Sadly, I am so glad that our children chose NOT to become doctors. I have seen so much frustration, high blood pressure, loss of sleep, disrespect, fear,etc. that it is hard to recognize the profession as what it should be allowed to be.

    My husband loves his patients and what he does for them, but it's getting more and more difficult to see the good at the end of the day. He can't run a practice worring if he can make payroll. Congress needs to think hard about this...they are about to close down a lot of good doctors.

    Concerning the $121 Pacifier – President Obama wants "Income Redistribution"...well when you are charged $121 for a 'binky', you are experiencing "cost redistribution". You pay a couple of dollars for yours and the rest is for all the ones that were not paid for b/c insurance refused to pay or medicaid did not reimburse enough. It stinks, doesn't it? Sort of like paying higher taxes to support handouts for people who pay no taxes.

    And to Dan – you might want to reserve your 'easily done' comments regarding having babies at home until you actually know from personal expericence. I feel sorry for your wife.(And don't be too excited about the cost of having those last babies. I'm thinking you got a little ripped off.)


    March 5, 2010 at 12:23 pm |
  3. SP

    "if obama's health care passes we can stop alot of unneccessary medical procedures such as heart surgery when your over 65, or dialysis or unneccessary treatment of terminal breast cancer patients." Unneccessary for who? Your not the person that is sick, so you have no say in the matter.

    March 5, 2010 at 10:29 am |
  4. Milan Popovic (Conan the Barbarian)

    American brothers and you had the opportunity to be convinced in my purity and sincerity. I hope that when I come to your country that you welcomed me with the most beautiful women of all races.
    Forward this to the American people and regards them as a Johnny Deep I hope to have the opportunity to meet him.
    Milan Popovic (07.03.1980) Peter Pecije 19, Banja Luka, Republika Srpska, Bosnia and Herzegovina.
    Remember the name.
    Hello America

    March 5, 2010 at 9:48 am |
  5. tina

    What you do not realize or think about is the "binky" does not cost 121 dollars. IT is the STUPID legal and medical and nursing and other costs that make the hospitals charge that much. And, irresponsibly, Dr. Gupta said that the medical field does not pay out much in large legal cases. It is actually a lot of money on silly settlements that cost the average citizen $121 on the baby's binky!! get the facts straight!

    March 5, 2010 at 8:02 am |
  6. Robert

    Individuals that have simple answers to healthcare issues usually have very little understanding of health care. Personal experience does not equate to good medical practice. In a perfect world, where child birth is 100% successful and without complication, everyone would have their baby at home with a mid wife. It would be the best experience and cheap. Unfortunately the real world doesn't work that way. The unexpected happens all the time and as a society we do not accept the death of a mother and/or baby very well. The complications that occur are real but fortunately because of a good medical system that promotes prenatal care, research, testing and the development of advanced medical procedures most people do not have unexpected complications. Only a small percentage of women, usually healthy with normal pregnancies, deliver at home. If the number were to rise, more bad outcomes would occur and we would be having a different discussion. Cut down on c-sections and promote healthy pregnancies should be our goals. Real health care reform will occur when as a society we stop blaming everyone else for our health issues and take responsibility for our unhealthy lifestyles.

    March 5, 2010 at 5:23 am |
  7. sheebytg

    I tell you what... you can blame some of the rise in malpractice increases on none other than John Edwards. His effective litigation strategy of parading CP children in front of jurors to maximize awards to parents led in a direct increase in c-section rates. Want to limit defensive medicine? Stop suing OB/Gyn docs for things completely out of their control.

    March 4, 2010 at 4:46 pm |
  8. aldafan

    I'm 55 and on dialysis (have been for over 12 years). Nice to know I have ten years left. THat's why we have living wills. If I cannot make my own decisions, there will be no more dialysis. But that's MY decision. I live alone, drive and take care of my own needs. I suspect you are believing everything the media prints about dialysis.

    March 4, 2010 at 2:48 pm |
  9. Christina

    After 15 hrs of normal labor following a fairly normal pregnancy my baby's heart rate dropped very low and my doctor ordered an emergancy c-section. Good thing too because even though his heart rate went back up, my son wasn't recieving any oxygen.
    At the second recovery appointment I asked about the possibility of VBAC for my second. My doctor recommended against it since the reason for my first was that my placenta failed (aka died) right before we had to do the c-section. I'm disappointed that I won't ever have a natural child birth but I'd rather have a healthy baby.
    If my son had been born at home like we had originally considered, he would have likely died.

    March 4, 2010 at 12:00 pm |
  10. Bob

    This info is from the World Health Organization:
    Maternal death rate in the early 1900's = 1%
    Maternal death rate in 2005 = 0.011%

    Dan, your implication that birth is a "natural action, just like eating" and we should therefore ignore medical progress is flawed. Perhaps we should also eat rotting carcasses that we scavenge and ignore the benefits of cooking to kill parasites and bacteria.

    Most women will survive childbirth, and many without complication. In those cases, a physician's presence doesn't make much difference. However, when things don't go smoothly, a seasoned obstetrician can make the difference between life and death, for both the mother and the child. Clearly, you agree with this on some level, and that is why you chose to have a doctor take over on your first child rather than let your wife and firstborn die in the hands of a midwife.

    The only way that midwives and family practioners can deliver babies is that they have an obstetrician to call for back up when things go wrong.

    Caesarean is more controlled and is safer than vaginal birth, if the goal is infant and maternal survival. Clearly, there are complications that can occur with either. The ACOG (American College of Obstetrics and Gynecology) used to advocate VBAC (vaginal birth after caesarean). They have since revised this position for one reason only: Women who were counseled about the risks of VBAC causing uterine rupture still sued their doctors. A quick search online reveals several law firms targeting VBACs as an easy way to make money in the malpractice game. OB's have been increasing the number of caesareans for two reasons: Increased litigation, and the fact that things are less likely to go wrong in a c-section than a vaginal birth.

    Regarding other practices that occur in birthing centers, such as water birth, google Harry Eccles, an Irish infant who aspirated and died in a water birth. Most midwives who use the diving reflex as an explanation to ensure the safety of the child don't understand that the diving reflex only applies to cold water. I've never seen a woman give birth in ice-water before.

    Obstetricians should be lauded as one of the most successful medical practices in the field. What other type of doctor can say that they have reduced mortality by 99% in the past 100 years?

    I live in Murray, UT, and am very familiar with Intermountain Health Care. Their care model is something to be emulated. This is truly one of the best hospitals in the country, and they do it relatively cheaply.

    March 4, 2010 at 11:51 am |
  11. Billy Offs

    The most unnecessary medical procedure in American hospitals is circumcision. Most of the world does not routinely steal an important protective organ from a defensive child"s body without considering the child's right to intact genitals. I equate the preventive logic offered as ridiculous and careless. Why not remove an appendix from all infants at birth, adults sometimes need this surgery later in life and it would save us the need to worry about it even thought the odds are slim. If you are planning on having children please stop and consider your child's body as something that belongs to him and do not mutilate his genitals regardless of what you are told by your physician. A very small percentage of men in the world develop problems with their foreskins later in life, do not rob you child of a functioning part of his body that nature in all its wisdom has given him.

    March 4, 2010 at 10:43 am |
  12. rkk11

    Interesting piece. As a physician/health economist, this video is a bit simplistic. It would be excellent to reduce your c-section rate from 30% to 20%, reducing imaging, etc., but it's difficult to do. First off, OBs need to do what they have been trained to do. When our OB told my wife she needed a c-section, he explained why, and we did it. It MINIMIZED risk to our baby, but obviously probably could have been done vaginally with increased risk. So our choice was easy. If you add a CEO or administrator to the formula, what would have happened? I'm not sure I like them involved in my care. Finances and health care are significantly tied together, but when you're making individualized medical decisions, I think we'd all like for them to be independent from each other, giving the best care, at the best time, and the best quality for the patient.

    March 4, 2010 at 10:14 am |
  13. Spencer

    Dan would have been the first to sue had his wife's uterus ruptured at VBAC 1, perhaps causing her to bleed out internally and killing both mom and child in the worst scenario. Also, I'm thinking Dan is getting screwed by that Birth center. My wife is an OB/GYN who does standard vaginal births, including all of the prenatal care during the nine months prior to the delivery, for a "universal" fee of just $3,000. Yet, she went to schools like Harvard and can cut to save lives, if necessary. Don't listen to Dan. His experience doesn't set the appropriate standard of care.

    March 4, 2010 at 3:04 am |
  14. leo

    No heart surgery after 65? No dialysis? that is heartless...lets see if you feel the same way when someone close to you needs dialysis when they're 66 years old...Many otherwise healthy people who do not smoke or drink develop coronary artery disease or renal failure in their 7th or 8th decades of life, just when they hit retirement and are enjoying their grand-kids...and you think they should just be allowed to die? You should probably move to the UK and for your own 67th b-day...

    March 4, 2010 at 12:35 am |
  15. Dude

    The child the woman was holding at the end of this report had to be fake. Look at it, it didn't move and looked like plastic. Didn't respond to stroking of cheek with normal suckling reflex. Hate to think they had to stage that.
    I agree with Lisa's comments.

    March 3, 2010 at 10:39 pm |
  16. Suzanne

    Had to have emergency C-section with first child (not disputing this), but had to seek out special doctors in order to attempt VBAC with second and third child. Am so thankful I did this.

    Only one doctor in city of 200K would allow me to do this! Was so much cheaper and recovery so much easier. I don't think they should automatically make you have a C-section for subsequent pregancies. Let people decide for themselves.

    March 3, 2010 at 8:56 pm |
  17. center

    if obama's health care passes we can stop alot of unneccessary medical procedures such as heart surgery when your over 65, or dialysis or unneccessary treatment of terminal breast cancer patients.

    March 3, 2010 at 7:07 pm |
  18. Dan

    My wife:

    First child (2003): expected to due natural childbirth in a hospital. Carried to term. After many mishaps and botched care, my wife "had to have a c-section" by direct advice from the Dr. Botched second epidural, general anesthesia given. Baby weight 7lbs. 11oz. Hospital bill to insurance company in excess of $16,000 with post care.

    Second child (2005): told by Dr. that c-section was required, as hospital rules dictate it. Warned of uterin rupture, as well as baby death and well as mother. Decided to go to birth center. Carried to term, natural delivery. Baby weight 9lb 2oz. Succsessful VBAC. Personal Bill with 50% covered by insurance $3500

    Third child (2007): Went to birth center. Natural delivery. Baby weight 8lb 0oz. Second succsessful VBAC. Personal Bill with 75% covered by insurance (changed jobs) $3500

    Fourth child (2009): Went to birth center. Natural delivery. Baby weight 9lb 2oz. Third succsessful VBAC. Personal Bill with coverage still pending determination by insurance $3800 (Birth center raised their rate).

    Where's the rupture, death, disfigurment?
    Liability is what the hospital worries about, as well as money. Issue is that birth is a natural action, just like eating (or vomiting for that matter). Hospitals take it that the woman is sick, and needs a Dr. – a surgeon for that matter.

    My advice is to have the baby at home. Easily done, just like they did for centuries.

    March 3, 2010 at 6:32 pm |
  19. Pam

    Cut the needless lawsuits and maybe doctors would work toward the normal childbirth with all it's dangers. But if a mother can sue just because she is not happy with her child after birth and blame it on the doctor,we will see doctors to take the less risky birthing methods. And as for all the texts, we are back to covering their ...... from lawsuits if something happens. Blame the legal profession not the medical field

    March 3, 2010 at 2:27 pm |
  20. ColoradoHRSM

    It would be helpful when reporting on the government COBRA assistance program that you mentioned that anyone who has Meicare is not elgible for the 65% assistance with the monthly bill from the insurance company.

    March 3, 2010 at 1:01 pm |
  21. Lisa

    I saw this story this morning on CNN and after it aired, I could not believe that the anchor mentioned that at her doctor's office they say that "technically" a c-section is safer. Although they may say that, it is certainly NOT true, and anyone can look up the stats if they care to be informed. A cesarean is major abdominal surgery! Of course there are times when it is necessary for the safety of the mother or baby, but looking at all births it is not safer. I understand that light banter after a story is customary, but the anchors should be more considerate about what they say, because they are seen as journalists and people trust what they say. Likewise, John's comments about doctors scheduling c-sections because they want to make a golf or tennis game seemed equally reckless, although he did apologize for it. It would be nice if the anchors could be a bit more professional about what they say regarding the news being reported. It is misinformation like that which is part of the reason we have such high c-section rates in this country. It is certainly not safer and definitely not cheaper.

    March 3, 2010 at 12:52 pm |