Effect of 48-hour rule assessed Maternity costs rose 10% in Md. with longer stays, study finds

Hospital care

October 19, 1998|By M. William Salganik | M. William Salganik,SUN STAFF

Maryland's law ordering insurers to pay for a 48-hour hospital stay for births increased the cost of an uncomplicated delivery by $245, or 10 percent, according to a study by two researchers at the state's Health Services Cost Review Commission.

Together with an increase of more than 6 percent in the cost of an average uncomplicated Caesarean delivery -- the law also required coverage of a 96-hour stay for Caesarean births -- the total cost of the extended stay to insurers and patients is about $11 million a year, the study concluded.

Written by Nduka U. Udom, a research statistician, and Charles L. Betley, chief of special projects for the commission, the study, "Effects of Maternity-Stay Legislation on 'Drive-Through Deliveries,' " appears in the current issue of Health Affairs, a journal of health services and policy.

Maryland was among the first states to adopt a 48-hour rule for births; it became part of federal law this year. With some HMOs limiting hospital stays for normal births to 24 hours, advocates of legislation decried "drive-through deliveries" and argued that care would be better with longer hospitalizations.

Opponents, chiefly the HMO industry, said the shorter stays had no impact on health and the new requirement would add to costs paid by patients and employers. Legislators were unimpressed: They approved the 48-hour law unanimously in March 1996.

The study draws no conclusions about whether the cost was higher or lower than it should be. And it doesn't look at whether the longer stays produced any health benefits.

Udom and Betley said they would like to do another study that looks at outcomes. Given the data they use -- the commission collects data on every hospital admission as part of its rate-setting duties -- they said they can probably tell whether mothers or babies were readmitted to the hospital because of complications that developed.

However, they said, since their records only cover inpatient hospital care, they would not be able to see if mothers or babies received additional treatment that did not result in a hospital admission.

Even if Udom and Betley could collect good data on re-admissions, "you can't measure whether the mother is bonding with the baby or whether the mother is successful at beginning breast feeding," said Bobbi Seabolt, executive director of the Maryland chapter of the American Academy of Pediatrics.

Without outcomes measures, "it's only half a study," said state Sen. Paula C. Hollinger, a Baltimore County Democrat and strong supporter of the legislation.

She said she believed the mandate generated savings to cover some of the additional cost by preventing re-admissions.

And like others who supported the 48-hour mandate, Seabolt said the issue is not extra cost.

"Sometimes," she said, "somebody has to put their foot down and say, 'This is the standard of care.' "

Del. Michael E. Busch, an Anne Arundel Democrat who chairs the House Economic Matters Committee, concurred.

"Sooner or later, there's got to be a balance between the quality and the cost. I don't have any regrets," he said.

Busch's committee, and the legislature as a whole, have since resisted several calls for length-of-stay legislation covering other procedures, such as mastectomies.

The state's HMO trade group opposes coverage mandates because "they can increase the cost of health care by tens of millions of dollars," said D. Robert Enten, lobbyist for the Maryland Association of Health Maintenance Organizations.

Enten said the maternity legislation passed despite the fact that "no study was presented to the legislature which showed the health of mothers and infants was being negatively impacted" by shorter stays.

The national HMO trade association, the American Association of Health Plans, argued against federal 48-hour legislation by citing a study by HCIA, the Baltimore health data company, showing no correlation between length of stay and hospital readmissions for newborns.

While the Maryland trade group still opposes maternity-stay laws, Enten said, "It would be very, very difficult to repeal this legislation. It's kind of like apple pie and the flag."

The Udom-Betley study reviewed records of more than 45,000 births by vaginal delivery and routine Caesareans in the six months after the law took effect and the same period a year earlier. Hospital stays increased about half a day, on average, after the law.

Costs increased by a smallerpercentage than length-of-stay, the researchers wrote, "because the resources used in additional inpatient days decline precipitously after the first day."

They found stays increased the most for white mothers aged 19 to 35 with private health insurance who delivered babies in suburban and rural hospitals.

However, Betley said, the differences were not large, and appeared to be because other groups, such as teen-age mothers, had more health problems, and thus had longer hospital stays even before the legislation.

Betley said the commission's research staff has done studies of the impacts of mandates in the past at the request of the legislature. For example, a 1997 study ordered by lawmakers found little change in emergency room billings after coverage of ER visits was broadened.

In the future, he said, the commission staff is also looking to generate other studies on its own.

Pub Date: 10/19/98

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