The Leapfrog Group to Publish Low-Risk Cesarean Rates in 2015

By Jill Arnold

The Leapfrog Group, a nonprofit advocate for purchasers of health care, has jumped into the hospital cesarean rate reporting scene. With the Joint Commission’s upcoming public reporting of NTSV cesarean rates only including Joint Commission accredited general medical/surgical hospitals with 1,100 births per year starting with January 1, 2014 discharges, Leapfrog will collect data for its purchaser members on hospitals with 50 or more births reported per year and publicize each hospital’s NTSV cesarean rate in 2015.


According to their Frequently Asked Questions, Leapfrog’s audience for these data are its “purchaser members [who] want these data for all hospitals with which they are doing business.”

The NTSV (Nulliparous, Term, Singleton, Vertex) cesarean rate is the rate of births to first-time mothers of a single baby at term in the head-down position.


The Leapfrog Group's Frequently Asked Questions about NTSV cesarean rate reporting: 


1. Why is The Leapfrog Group adding this measure to the 2014 Leapfrog Hospital Survey when the Joint Commission is not requiring collection until January 2014?

The Joint Commission will only require hospitals that report at least 1,100 births annually to report on the measure. Leapfrog’s purchaser members want these data for all hospitals with which they are doing business. In addition, Leapfrog would like to give hospitals a year to collect, report, and receive feedback on their responses to these new questions before Leapfrog begins to publicly report the results in 2015.


2. What will be The Leapfrog Group’s target NTSV cesarean section delivery rate for all hospitals?

Leapfrog’s proposed target is 15%. This target aligns with the National Priorities Partnership (NPP) goal of reducing rates of cesarean delivery among low-risk women to 15 percent or less. The NPP is a partnership of 52 major national organizations, including The Leapfrog Group, with a shared vision to achieve better health, and a safe, equitable, and value-driven healthcare system. (Find more on the National Priorities Partnership at


3. Since The Leapfrog Group is not publicly reporting the results from this NTSV cesarean section delivery measure in 2014, is it optional to report on this measure in 2014?

It is not mandatory for hospitals to report on the NTSV cesarean measure on the 2014 Leapfrog Hospital Survey. However, Leapfrog strongly urges hospitals to report on 2014 so that they may gain experience with the data collection for this measure and receive feedback from Leapfrog on their responses.


4. Is this NTSV cesarean section delivery rate risk-adjusted? If so, how is it adjusted?

 The NTSV cesarean section delivery rate will be adjusted based on the mother’s age. Leapfrog will utilize the method of direct standardization. The direct standardization methodology uses the mother’s age to adjust for risk and adjusts the measure rate based on the age stratification profile of the hospital compared to that of the United States national maternal population. Leapfrog will align with the Joint Commission and use the 2010 data from the U.S. Center for Health Statistics to determine the percent of mothers in each age stratification for the standard population. 


Additional Reading:

Understanding the Obstetric Data Reporting Landscape

HHS Inpatient Quality Indicators for Childbirth

Video Blog: How Cesarean Rates Are Reported

What is practice variation in obstetrics and why should I care?

World Health Organization's 15 Percent Cesarean Rate Recommendation