Number of 'Patient Choice' C-Sections Rises by 25 Percent, HealthGrades Study Finds.

LAKEWOOD, Colo. -- New York, New Jersey and Florida Have Highest Rates; Rates 50 Percent Higher in Mothers 35 Years and Older

Also Found: Vaginal Deliveries Have Higher Overall In-hospital Complication Rates Than "Patient Choice" C-Sections

Women are increasingly choosing to give birth by Cesarean section when there is no medical necessity to do so, according to a new study released today by HealthGrades, the healthcare quality company. The report was released in conjunction with HealthGrades' annual update of its consumer quality ratings for obstetric and other women's procedures for nearly 2,000 hospitals at http://www.healthgrades.com.

The study found that "patient choice" C-section deliveries rose 25 percent in the U.S. from 2000 through 2002, representing 2.21 percent of all deliveries in the U.S. in 2002. HealthGrades released a similar study in 2003, examining data from 1999 through 2001, and found that the percent of "patient choice" C-sections, grew from 1.56 percent to 1.88 percent -- a 20 percent rise for those three years.

For the 2004 study, HealthGrades analyzed 1,684 hospitals in 16 states. These states represented approximately 50% of all U.S. deliveries. In absolute terms, 108,435 women elected to have a "patient choice" C-section from 2000 to 2002 in these 16 states. Extrapolating this rate to the entire U.S., 235,322 women delivered their babies by "patient choice" C-section from 2000 to 2002. The full report, with state-by-state rates and overall associated complication rates, can be found at http://www.healthgrades.com.

"When we conducted this study last year, we were able to show a clear trend toward an increasing number of women choosing C-sections over vaginal births," said Dr. Samantha Collier, HealthGrades' vice president of medical affairs. "Now we see that this increase is continuing, and that the overall in-hospital complication rates for 'patient choice' C-sections may be lower than that of vaginal deliveries."

HealthGrades' study revealed that women who choose a C-section over vaginal delivery have reduced overall in-hospital complications. This is the first time that this has been found. Dr. Collier pointed out that comparing vaginal and C-section complications cannot be done in a statistically significant way, as the complications are different. "But this observational finding, in conjunction with the increased demand for this procedure, underscore the need for more research comparing the overall immediate and long-term benefits and risks of both delivery methods. Only then can we truly provide the necessary and meaningful comparative information to women contemplating this choice."

A recent study published in OB/GYN News found that, in the long-term, "patient choice" C-sections might be more cost-effective than vaginal deliveries as a result of fewer long-term complications. Nora M. Doyle, M.D. of the University of Texas found that a "patient choice" C-section initially costs $920 compared to $780 for a vaginal delivery. However, Dr. Doyle found that due to the costs associated with long-term treatment for complications resulting from vaginal delivery -- including urinary and fecal incontinence -- "patient choice" C-sections were more cost-effective over time.

The HealthGrades study also found that older women -- ages 35 and older -- had a 50 percent higher rate of "patient-choice" C-sections than women 30 years old and under.

Of the 16 states studied by HealthGrades, New York, Florida and New Jersey had the highest "patient choice" C-section rates in 2002. The states with the highest rate of increase between 2000 and 2002 were Utah, Virginia and Florida. The absolute number of "patient choice" C-sections has increased year over year.

"Patient Choice"              Percent of all
    Year        C-sections in 16 states     deliveries(a) in 16 states
======================================================================
   1999                 29,257                        1.56%
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   2000                 32,950                        1.77%
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   2001                 34,792                        1.88%
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   2002                 40,693                        2.21%
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(a) Does not include women with a previous C-section or any of the 12
    medical indications described by Gregory and Korst in Health
    Services Research, October 2002.

Since HealthGrades' 2003 study was released, the American College of Obstetricians and Gynecologists (ACOG) released an updated opinion on the ethics of "patient choice" C-sections (www.acog.org; ACOG News Releases, October 2003). The statement supported C-section by "patient choice" so long as the patient is fully informed of the risks and benefits of this procedure over vaginal delivery. ACOG also stated that if the physician believes that performing a Cesarean section would be detrimental to the overall health and welfare of the woman and her fetus, he or she is ethically obliged to refrain from performing the surgery.

"The obstetric community is split by this issue, with some believing that women who understand the risks should be able to choose," said Collier. "Others believe that it is malpractice to allow someone to choose major surgery when it is not necessary. So far, insurers and providers have stayed out of the debate. But with C-sections costing more than vaginal deliveries, we can expect them to weigh in on this growing trend."

2004 Hospital Quality for Obstetric and Women's Health Services

To help women choose a high-quality hospital in their area, HealthGrades publishes new ratings of hospital care quality in the categories of Women's Health and Obstetric Care annually on its public Web site and makes them available to the employees of 125 companies, including more than 50 Fortune 500 companies, via their corporate intranets. The 2004 ratings, announced today in conjunction with the study on "patient choice" C-sections, covers hospitals in 16 states and awards a star rating for each hospital: one for poor, three for average and five for excellent.

The Obstetric star ratings are based upon an analysis of five factors: obstetric volume, overall complication rates, "patient choice" C-section complication rates, presence of a newborn intensive care unit, and newborn mortality rates. The Women's Health ratings include the performance in Obstetrics plus female cardiac and stroke mortality in the following diagnoses and procedures: coronary bypass surgery, valve replacement surgery, interventional procedures such as angioplasty, heart attack, heart failure and stroke.

The states that gather hospital data and made it available for this research were: California, Florida, Iowa, Maine, Maryland, Massachusetts, Nevada, New Jersey, New York, North Carolina, Pennsylvania, Texas, Utah, Virginia, Washington and Wisconsin.

About HealthGrades

Health Grades, Inc. (OTCBB: HGRD) is the leading independent healthcare quality company, providing ratings, information and advisory services to healthcare providers, employers, health plans and insurance companies. HealthGrades works with healthcare providers to help assess, improve and promote their quality. HealthGrades provides consumers access to information about healthcare providers and practitioners through its Web site and provides liability insurers, employers and payers with critical information about healthcare quality.