California’s ACA exchange will punish hospitals ordering unnecessary procedures

Covered California, the state’s Affordable Care Act marketplace, has announced a new initiative aimed at cracking down on common problem areas for hospitals by staking their in-network status on meeting safety and quality goals.

As California Healthline reports, hospitals will be expected to perform fewer unnecessary C-sections, cut down on imaging procedures for lower back pain and prescribe fewer opioids. If they don’t do so by the end of 2019, Covered California will try to get participating health insurers to exclude those hospitals from their networks.

C-sections in particular have been a major source of unnecessary care ordered by hospitals based on costs rather than patients’ needs. California Healthline said the C-sections take less time (40 minutes for a scheduled procedure versus 24-hour on-call staffing for vaginal deliveries) while allowing the hospital to charge more. Even for low-risk deliveries, several California hospitals are delivering 40 percent of babies by C-section, according to Covered California’s chief medical officer Lance Lang, MD.

“That means that when a woman goes to a hospital, it’s the culture of the hospital that really determines whether or not she gets a cesarean section, not so much her own health,” Lang said.

Covered California is setting a much lower C-section rate of 23.9 percent for hospitals to keep their in-network status.

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