In a backlash against managed-care limits on hospital stays for new mothers and infants, advocates for women and children are turning to the states for legislative relief.
In at least two states, the relief would take the form of mandates on managed-care plans. The measures represent another example of state attempts to wrest control over the design and operation of managed-care plans.
Under pressure to contain costs, it's become common practice for HMOs and other managed-care plans to release mothers and babies from the hospital 24 hours after a normal delivery and 72 hours after a Caesarean section.
On May 25, Maryland Gov. Parris Glendening signed the Mothers' and Infants' Health Security Act. Effective Oct. 1, the law allows insurers and HMOs to release moms and babies after 24 hours if the newborn meets certain "medical stability" criteria and if the insurer provides a home visit.
Most of Maryland's 20 HMOs already provide a home visit, but some ask patients to come to the doctor's office for follow-up tests. The law is a "dangerous precedent" because, without scientific evidence, the General Assembly "decided what is a best practice in medicine," charged Geni J. Dunnais, executive director of the Maryland Association of HMOs.
An even more restrictive measure sailed through the New Jersey Assembly last month on a 79-0 vote. The bill says insurers must cover a 48-hour hospital stay for mothers who have normal deliveries unless they provide three home visits. The bill establishes guidelines for the care provided, the training of the registered nurses who visit the homes and the timing of the visits.
Stays for uncomplicated births exceeding 48 hours must be deemed "medically necessary." The definition of a medically necessary stay would be defined through New Jersey Department of Health regulations.
On June 1, New Jersey's Senate Health Committee debated a less stringent version of the legislation, which was unanimously sent to the full state Senate.
The New Jersey Hospital Association favors an extra day in the hospital for thorough testing to take place before newborns are sent home. Furthermore, NJHA members have "real concerns about length of stay and how insurance companies are driving shorter lengths-of-stay to the possible detriment of patients," said Ron Czajkowski, an association spokesman.
"It's drive-in deliveries," asserted Anthony P. Caggiano, M.D., president-elect of the Medical Society of New Jersey and president of the New Jersey Obstetrics and Gynecology Society.
Although it appears that few states have pursued the length-of-stay issue, "it's something that we are definitely monitoring," said Don White, a spokesman for the Group Health Association of America.
In a statement issued late last month, the American College of Obstetricians and Gynecologists said such early discharges may lead to problems in newborns, such as dehydration and undetected jaundice (May 29, p. 16). Recommending stays of 48 hours for normal deliveries and 96 hours for Caesarean sections, the ACOG called for a moratorium on early discharges.
Insurers say there isn't enough clinical data to support lengthier hospitalizations either.
"We would not support a 48-hour stay for everyone regardless of conditions," said Fran Tracy, vice president of government affairs for Blue Cross and Blue Shield of Maryland.
However, unlike many commercial insurers, Maryland Blues officials were pleased with the 24-hour discharge law because it echoes the plan's own practices. Earlier this year, the plan instituted its home visit policy for moms and newborns, a benefit that costs about $100 a day but saves $700 to $1,000 a day in additional hospitalization.
Without scientific evidence, the Maryland General Assembly `decided what is a best practice in medicine.'
Geni J. Dunnais