48-hour hospital stay law isn't working Insurers still sending mothers home early, legislators are told

January 25, 1996|By Peter Jensen | Peter Jensen,SUN STAFF

One year after the General Assembly passed groundbreaking legislation that seemed to give new mothers and their babies a minimum 48-hour hospital stay, irate mothers are asking lawmakers to protect them from being sent home much earlier.

Instead of allowing them two days in the hospital, insurers are sending most women and babies home the next day. And women who deliver by Caesarean section are going home in just 48 hours, even though insurers routinely allowed three-day stays for C-section deliveries before the legislation was passed.

The issue has already begun to evoke strong sympathy from some lawmakers, who have been hearing complaints since the law became effective in October. Many had expected quite a different outcome when Maryland became the first state in the nation to adopt a 48-hour minimum last year.

"The way the insurance industry responded to me is inexcusable and irresponsible," said Sen. Thomas L. Bromwell, chairman of the Finance Committee, which oversees insurance law. "We did not make a mistake last year. The way insurance companies have responded was a mistake."

Under the law approved last year, insurance companies and Health Maintenance Organizations can refuse to pay for a second night's hospital stay if the mother and baby are healthy and an alternative is provided: a home health care visit by a nurse.

While physicians have the option of ruling that a longer stay is Medically necessary, health care providers say insurers have ways to discourage such decisions.

They may, for instance, make getting approval for a longer stay inconvenient for a doctor or they may threaten to drop physicians who permit longer stays from insurance plans, said Barbara E. Seabolt, a lobbyist for the Maryland chapter of the American Academy of Pediatrics.

Linda M. Kempske, a Perry Hall nurse and nursing instructor, told a House committee yesterday that she didn't need a home visit from a nurse after she endured a difficult, 25-hour labor. She asked for, and was denied, a second night in the hospital even though her child was jaundiced and required around-the-clock care.

"I needed someone to take care of me," Ms. Kempske, 38, a mother of two, told the Economic Matters Committee. "Instead, I went home exhausted with a 2-year-old and a sick baby."

Insurers disagree

Insurance industry officials testified they have followed the new law to the letter. The 24-hour discharges follow guidelines developed by doctors, they said, and they questioned whether the policy has harmed mothers or babies.

Since the 48-hour minimum was approved in Maryland last spring, a handful of states have taken similar action.

Senator Bromwell said he intends to introduce legislation modeled after a New Jersey law that would clearly mandate a 48-hour stay for vaginal birth and 96 hours for Caesarean delivery.

A bill introduced by Del. Donald B. Elliott, a Carroll County Republican, would create the same mandate and leave it up to the patient to decide whether she wants to go home any earlier than that.

"You just can't send a mom home when she's not ready to go home," said Sen. Paula C. Hollinger, a Baltimore County Democrat and a nurse. "We're seeing profit over pregnancy.

Common sense urged

`You have to have common sense in health care decisions, and no common sense has been used," she said.

But insurers have vowed to fight giving patients that authority, saying too many of the 74,000 women who give birth each year in Maryland might elect to stay since they have no incentive to save the $1,000 or more an extra night could cost.

The Medical and Chirurgical Faculty of Maryland, the state medical society, also opposes allowing patients to make that decision.

"The reality is that hospital stays are unbelievably expensive," said Devin J. Doolan, a lobbyist for Blue Cross and Blue Shield in the Washington area. "The decision will affect what all of us pay for health insurance."

Economic Matters Chairman Michael E. Busch, an Anne Arundel Democrat, said he is inclined to keep the decision in the hands of doctors.

"Last year, we followed the national pediatric guidelines," Mr. Busch said. "I want to make sure we continue to follow guidelines given us by health care providers."

Larger issue at stake

Legislators see post-partum care as emblematic of the larger debate over managed health care and the balance between cost and quality of care.

But the issue also seems to have gained resonance in Annapolis because of the number of lawmakers having babies, including Chairman Busch, whose wife delivered last month, and Chairman Bromwell, whose wife is nine months pregnant.

"An awful lot of people have had babies," said Ms. Seabolt. "This is something people can identify with."

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