ROANOKE TIMES
Copyright (c) 1996, Roanoke Times
DATE: Saturday, June 29, 1996 TAG: 9607010047
SECTION: VIRGINIA PAGE: C1 EDITION: METRO
SOURCE: SANDRA BROWN KELLY STAFF WRITER
THE MOST VISIBLE legislation likely will be one that allows a woman to see her gynecologist without first getting permission from a primary care physician.
Beginning Monday, health insurance companies no longer will be able to require a woman who has given birth to leave the hospital in less than 48 hours, unless her doctor agrees.
It is among a trio of laws that should guarantee many Virginia women better health care.
The new maternity stay regulation is a reaction to a national trend in which new mothers are being discharged from the hospital within 24 hours of childbirth. The practice, often referred to as "drive-through delivery," has prompted several states to pass laws like Virginia's.
The birth-stay law does not affect self-insured companies, which includes many major employers. And it will have minimal impact in the Roanoke area, where, officials say, women who give birth at hospitals generally stay longer than a day.
Probably 95 percent of the women who deliver at Lewis-Gale Medical Center in Salem stay two days, said spokeswoman Nancy May. The hospital had more than 1,000 deliveries last year.
The percentage of early releases is higher at Carilion Roanoke Community Hospital. About a third of the women involved in 200 deliveries at the downtown Roanoke hospital each month go home within 24 hours, but with a doctor's permission, said Melina Perdue.
Community has always required a doctor to approve the discharge time, said Perdue, vice president of women's and children's services for Carilion Health System of Roanoke.
A new law that requires insurance companies to provide mammograms and Pap smears as part of their coverage for women also isn't expected to create much change. Most companies already offer those services, insurers say. The law recommends that the companies follow American Cancer Society guidelines for the mammogram, which means a woman should have one before age 50.
The most visible new legislation likely will allow a woman to see her gynecologist without first getting permission from a primary care physician, said Cynthia Webb, practice manager at Physicians to Women in Roanoke.
The six-doctor group lobbied for the women's health laws by sending letters to patients asking them to support the issues with their legislators. Physicians to Women has more than 20,000 patients on its rolls and said it sees between 100 and 150 patients a day.
Webb said many women come in with a problem and are delayed from getting treatment while a primary care doctor is contacted and an insurance company grants its required referral.
How much that will change, however, is going to depend on how insurance carriers interpret the law, Webb said.
Only two of the insurance companies she deals with have called to say they will give their clients open access, she said.
The law includes a provision that allows managed care companies to ask OB-GYN doctors to report a woman's visit to her primary care doctor.
The Virginia Association of HMOs lobbied for that, said Tom Jones, a member of the association board and regional manager of John Deere Healthcare of Roanoke Valley. John Deere does allow its female clients open access to gynecologists and is one of the companies that already has contacted Webb at Physicians to Women.
Communication among doctors who see the same patient is important to quality care, Jones said.
"The thrust of managed care using a gatekeeper model is to have one doctor know what's going on with a patient so he or she can balance care or make certain there are not conflicting medicines being given," Jones said.
In any case, the health care providers and insurers say individuals should check with their companies about the changes rather than make assumptions about what is covered.
No health professionals were ready to discuss a bill that requires managed care companies to disclose when doctors have incentives not to refer patients to specialists.
That law is still being interpreted by company lawyers, one provider said.
Jones said he doesn't think providers are concerned about the disclosure law.
"I know of no HMO that had such a structure," he said. "I was mystified by the legislation."
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