Hospital maternity stays are expanded Md. legislators close loophole to guarantee 48 hours after births

March 19, 1996|By Peter Jensen | Peter Jensen,SUN STAFF

The House of Delegates yesterday approved legislation to guarantee new mothers and their babies a minimum two-night stay in the hospital.

The Senate passed a similar bill earlier this month, so yesterday's action makes it virtually certain that the General Assembly will give final approval before it adjourns April 8.

Support for the legislation has been overwhelming. The House voted 139-0 for the measure yesterday and afterward members applauded. The Senate action also was unanimous, and Gov. Parris N. Glendening is expected to sign the bill.

"He absolutely supports the concept," said Judi Scioli, a spokeswoman for the governor.

One year ago, the same General Assembly made Maryland the && first state in the nation to mandate a minimum 48-hour stay, but that bill had what critics later termed a loophole. If mother and baby were judged healthy by their doctors, insurers could offer only a 24-hour stay, followed by a home health care visit by a nurse.

Since the home visit is much less expensive than a hospital stay costing $1,000 to $1,500 a night, insurance companies generally opted for the visit.

"We have a situation where hospitals are pushing women out," said Del. John P. Donoghue, a Washington County Democrat who sponsored the House bill. "We didn't realize the insurance companies would jump through that loophole and make it the standard practice."

Representatives of the insurance industry insist that the measure isn't necessary and that consumers will see their health insurance premiums rise as a result.

Both versions of the bill assign the mother the choice of whether to stay a second night. Women who have undergone a Caesarean section are guaranteed the option of at least a four-night stay.

Giving a patient the ability to decide how long to remain in the hospital instead of a doctor may be unprecedented, opponents say. They worry it could open the door for mandated longer hospital stays for other types of problems.

"For the first time that I know of, the legislature has dictated a specific procedure be dictated by a patient and not the physician," said J. William Pitcher, a lobbyist for the Maryland Association of Health Maintenance Organizations.

"I'm sure there are a lot of people who have to go to hospitals for procedures who would like to call their own shots."

Insurers also question whether a 24-hour stay has caused any medical problems for new mothers or their babies. Even the legislation's proponents admit that they can't prove their case with statistics.

Devin J. Doolan, a lobbyist for Blue Cross and Blue Shield in the Washington area, said he fears that many mothers will elect the second night simply because they are fatigued and not because is medically necessary.

"Her decision to stay when she's tired may be a $1,100 choice," Mr. Doolan said. "Somewhere, there has to be accountability."

About 74,000 women give birth each year in Maryland. If just half elect to spend one more night in the hospital, the additional cost could be in the tens of millions of dollars. The proposal is expected to eventually cost the state about $1 million annually to cover its own employees.

There are some differences between the House and Senate versions of the bill. Under the Senate plan, new mothers who decide to stay one day after delivery would be eligible for two home health care visits instead of just one.

Postpartum care has been a sensitive issue for legislators. The ,, two committees that approved the legislation are both chaired by men whose wives have given birth in the last three months. Some legislators, like Delegate Donoghue, were lobbied by their own family doctors.

"There's a very emotional reaction to this issue," Mr. Pitcher said. lot of male legislators don't want to step in its way and ask the tough questions."

Del. Michael E. Busch, an Anne Arundel Democrat who chairs the House Economic Matters Committee, said the issue became one of common sense, however.

"A one-day stay doesn't pass the 'guy in the street' test," Delegate Busch said. "The average guy in the street doesn't think one night in the hospital after a major medical procedure made a lot of sense."

The effort is a bit of a turnaround for legislators, who just a few years ago were getting deluged by complaints about high health care premiums. Insurers fear that it may be the start of a broader backlash against managed care.

"The problem today is that memory is sadly somewhat brief," Mr. Doolan said. "We are passing mandates that will ratchet up the cost for many people."

Pub Date: 3/19/96

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