Guide lists C-section rates of state’s doctors

Docs have input into risk-adjustment, accuracy

A new consumer guide in Virginia provides the risk-adjusted cesarean rates of 622 physicians in the state, making it one of the most comprehensive physician "report cards" yet issued.

Virginia Health Information (VHI), a non- profit health care information organization in Richmond, used hospital discharge data to obtain raw cesarean rates. A panel of physicians, nurses, and researchers then identified 46 factors that affect the rates, including hypertension, pre-eclampsia, and fetal distress.

"The model allowed us to compare a physician’s actual rate of cesarean delivery with what you would have expected given the conditions reported by the provider," says Michael Lundberg, VHI’s executive director. "They can have a 35% rate and be within the expected range if they have patients with these conditions."

VHI sent the data to the physicians and hospitals and gave them an opportunity to make corrections — for example, if a cesarean actually was performed by someone else or if a patient had a condition that hadn’t been noted. Physicians also could provide their office address, medical school information, and board certification for a listing.

Few physicians voiced concerns about the guide or argued with its results. That was because of the open process that involved physicians at every step, says Lundberg.

The guide, released in December, shows whether physicians’ rates were above, below, or at the expected rate of cesareans. It also lists the average charges for vaginal and cesarean deliveries, and the average length of stay for vaginal deliveries for each physician.

The guide provides detailed information on care, cost, service, and staffing in Virginia hospitals, such as whether they have a neonatalogist on staff and how many birthing rooms they have.

"The guide was designed as an important reference for anyone considering having a child," says Lundberg.

[Editor’s note: For a free copy of Obstetrical Services: A Consumer’s Guide, contact Virginia Health Information, 1108 E. Main St., Suite 1201, Richmond, VA 23219. Telephone: (877) 844-4636. Fax: (804) 643-5375. World Wide Web:]