LAW ALLOWS MOMS, BABIES LONGER STAYS IN HOSPITAL

Mothers and newborns can stay in the hospital longer at insurers' expense under a new state law.

The law, which allows mothers to stay in the hospital for up to 48 hours, or 96 hours after a Caesarean delivery, reverses a continuing trend toward shorter hospital stays.

The law takes effect Aug. 28.

Supporters of the law say some insurance companies were forcing women and babies to leave the hospital too soon -- sometimes less than 24 hours after birth.

Women and their babies have the option to go home early under the new law, but they will have to have at least two checkups, including at least one at their home.

Southeast Missouri Hospital's Mother-Baby Home Visit program grew out of the shortened hospital stay allowed by insurance companies, said LaDonna Wills, who coordinates the program.

In some cases, she said, health problems in both mothers and babies may not be apparent within the first 24 hours after birth.

"Babies can develop serious illnesses like infections. There can be heart problems that develop. They may have a major heart problem and signs and symptoms that don't show up until several days down the road," Wills said. "Jaundice usually won't show up for three days after birth. That's very common."

Problems with breast feeding and adjusting to the new baby are issues with which mothers may need professional guidance, she said.

The new law "levels the playing field" for the insurance industry, said Dr. Joseph Huguenard, corporate medical director for Blue Cross and Blue Shield of Missouri. At the same time it provides additional support for new mothers and babies, he said.

While the additional time will be helpful for some women, Wills said: "I don't know how much of an impact it will have. Some women are ready to leave early." She said she expects many women to opt to go home within 24 hours.

Missouri's new law targets "drive-through" births, but experts don't foresee legislative mandates covering other medical treatments.

"Having a baby's kind of unique among the things that put you in the hospital," Huguenard said. "It's about the only thing that takes basically healthy people and puts them in the hospital. Everything else, either you're very sick or you're having an unnatural event, like having surgery. With childbirth, you're not basically sick. With natural childbirth, when there's not a C-section, there's nothing happening to the body that's pathological or invasive."

Hospital stays have shortened significantly in the last 10 to 15 years. Experts say a number of factors from controlling costs to improved medical techniques and technology are behind that trend.

"We used to keep cardiac patients almost a month if they'd had a serious heart attack," said Dan Berry, director of special projects at Southeast Missouri Hospital. "In the last 10 years, since the advent of managed care, that's been ratcheted down."

The trend started when Medicare revised the limits on how much coverage it would provide for inpatient care and procedures in 1983, said Cheryl Mothes, center leader at St. Francis. "We really started looking at what we were doing. We were ordering every test for every patient and leaving them here in the hospital for days and weeks."

When Medicare tightened its requirements and private insurers filed suit, medical care got leaner and meaner.

In 1983, the average length of stay in Missouri's hospitals was 7.8 days, said Barbara Long of the Missouri Hospital Association. By 1988, the average stay had dropped to 7.5 days, and by 1994, to 6.7 days.

Nationally, the average length of stay has dropped from 7.3 days in 1984 to 6.7 days in 1994, according the American Hospital Association.

Not all of that is because of insurance companies cutting costs and forcing patients to go home early, Long said. In that same time period, many procedures that used to require lengthy hospital stays became same-day procedures.

Among those are arthroscopic knee surgery, laparoscopic gall bladder removal and cataract surgery, all of which may require only a few hours in the doctor's office.

In 1983, Missouri hospitals reported 357,950 inpatient surgeries, versus 100,141 outpatient surgeries.

By 1994, inpatient surgeries had dropped to 216,596, and outpatient surgeries had jumped to 345,343.

By the same token, 3.5 million outpatient visits were reported in 1983, while by 1994, that figure more than doubled to 9.4 million.

New technology and techniques, better drugs and improvements in physical therapy, home health care and other developments mean hospitals are being utilized "in a whole new way," Huguenard said, as outpatient care becomes more and more prevalent.

Huguenard doesn't expect to see the length of stay decrease by much more. "I think we've gotten all the efficiency out of it we can," he said.

Jeff Andersen, the associate executive director of Humana HealthCare in Cape Girardeau, said mandates like Missouri's increased stay for new mothers will ultimately mean higher costs for consumers as insurance companies pass their increased costs along.

"There's certainly a cost ramification, but it doesn't affect Humana," he said. "Organizations like Humana have to account for that."

Insurance companies are already required to provide minimum types of basic health-care coverage, Andersen said, and those requirements vary from state to state.

"When you present a health-care program to an employer it has to consist of certain things," he said, such as coverage for childbirth or catastrophic accidents.