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Managed-Care Group Recommends Hospital Stay for Mastectomies

November 15, 1996

WASHINGTON (AP) _ A thousand managed-care companies, seeking to defuse growing criticism, are pledging to allow an overnight hospital stay for women who have a breast removed for cancer.

However, a congresswoman hopes to put that protection into federal law so no woman is forced to undergo an outpatient mastectomy.

The American Association of Health Plans had hoped its announcement Thursday that its 1,000 members would not require mastectomies to be performed as outpatient surgery would head off growing calls for federal legislation.

The move comes as new Medicare data show more elderly women are having outpatient mastectomies, particularly in the South.

Rep. Rosa DeLauro, D-Conn., said the voluntary measures are encouraging, but not enough to assure ``that women will not find themselves in a situation where their health can be jeopardized.″

``Doctors are under pressure from insurance companies to release patients earlier than should be,″ added DeLauro. She plans to introduce legislation in January mandating a 48-hour hospital stay for mastectomy patients unless they wish to leave earlier.

Mastectomy is the removal of a breast, often with its surrounding lymph nodes. In addition to the psychological trauma, patients can suffer severe pain and must have the rubber tubes that drain blood from their wounds emptied and cleaned several times a day.

In contrast, lumpectomy is the removal of just the breast tumor and some surrounding tissue. It is usually performed on an outpatient basis.

Many hospitals still keep mastectomy patients for two or three days, although some women opt to go home as soon as their anesthesia wears off _ an option the American Cancer Society and women’s groups support.

But the controversy began in August, when some doctors in Connecticut complained of new guidelines adopted by two health maintenance organizations, Cigna Healthcare and ConnectiCare Inc., that emphasized outpatient mastectomies. Doctors told of spending days arguing with the insurers that their patients needed to be hospitalized.

The industry group AAHP said Thursday that those complaints were caused by confusion, that no woman was ever threatened with being kicked out of the hospital.

``This is not hearsay, this is real,″ disagreed DeLauro.

The share of mastectomies performed on an outpatient basis is growing.

About 7.6 percent of mastectomies performed on Medicare patients in 1995 were outpatient procedures, up from 1.6 percent in 1991, said David Foster of HCIA Inc., a Baltimore research firm. Medicare paid for more outpatient mastectomies in the South _ 11.2 percent of patients _ than in any other region, he said Thursday.

Foster could not say how many of those elderly women were treated by HMOs, an insurance option that Medicare, the federal health plan for the elderly, began using during that time. He still is gathering data on younger women with other health plans.

There’s no way to know if all those women opted for an outpatient procedure _ and the Y-Me breast cancer support group’s national hot line is not logging calls from women who felt they were forced out of a hospital.

But Fran Visco of the National Breast Cancer Coalition said women’s advocates are hearing more complaints from doctors who feel coerced to send women home earlier than they think is safe.

The bad publicity, coupled with the threat of DeLauro’s legislation, prompted the insurance group to issue what its president, Karen Ignagni, called a ``pre-emptive strike.″

ConnectiCare, which agreed to the AAHP’s hospital guideline, acknowledged some doctors were frustrated when the insurer questioned them about hospitalizing mastectomy patients, a practice it said Thursday had ended.

Cigna, which is not an AAHP member, said it had no fixed policy on hospital stays for mastectomies, but that doctors would decide that issue with each patient.

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