Thursday, November 5, 2009

Same Set of Facts,... Totally Opposite Conclusion

About 15 years ago, the cesarean-section rate was climbing to alarming levels. At that time, insurers and Medicaid paid substantially more for cesarean sections, then for vaginal birth. The payers decreed that henceforth: vaginal birth and cesarean section will pay the same.

The obstetricians said: "Do you expect us to perform surgery for the same amount of money as a vaginal birth?" Thus, for the same amount of money, the obstetricians started doing more vaginal birth and cesarean rates declined.

A generation of obstetricians later, the cesarean section rate is at an all time high and climbs with no end in sight. When asked, “Why the change?”, the response that can be read between the lines is: "For the same amount of money, do you really expect us to go into the hospital at all hours of the night and wait hours to deliver a baby, when we can do a cesarean during normal business hours in 15 minutes?”

The same set of circumstances: “paying equal for cesarean as for vaginal delivery,” yielded totally opposite results. The reason depends on where you started. If you were being paid more for cesareans and the change came paying the same, then you felt that you feel your work is being devalued and you would lean toward non-surgery. However, if you were ALREADY being paid the same, then the amount of extra and unpredictable time that it takes to do a vaginal delivery would be hard to justify.

That is why it is important to understand someone's current mindset and to propose changes based on how things are operating today, and not how they operated years ago. You cannot understand a person, unless you've walked a mile in their shoes (or moccasins, or sneakers, or Birkenstocks).


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