ROANOKE TIMES
Copyright (c) 1997, Roanoke Times
DATE: Friday, March 7, 1997 TAG: 9703070066
SECTION: NATIONAL/INTERNATIONAL PAGE: C13 EDITION: METRO
DATELINE: WASHINGTON
SOURCE: LOS ANGELES TIMES
Insurers won't be allowed to limit women's hospital stays or to treat them only as outpatients.
The Medicare program has ordered doctors, hospitals and insurers not to limit the number of days women may remain hospitalized after mastectomies, or to require that the surgery be performed on an outpatient basis.
Because Medicare pays for one-third of all mastectomies, the order by the Health Care Financing Administration is likely to have a major impact on the way insurers and health maintenance organizations handle the issue.
Controversy has arisen over cases where mastectomies and other surgeries for breast cancer were performed on an outpatient basis, with women being sent home within a few hours. There is growing support in Congress for legislation to guarantee women a choice of staying 48 hours in the hospital after the surgery.
Notification of the mastectomy policy has just been mailed to health providers, HCFA official Bruce Merlin Fried told a congressional hearing Thursday. The far-reaching policy affects most Medicare beneficiaries, the 87 percent who are in the traditional fee-for-service system, under which patients can choose virtually any doctor or hospital.
Fried's disclosure means Medicare has gone beyond its action last month, when it notified HMOs, which cover 13 percent of Medicare beneficiaries, that they could not impose arbitrary limits on the length of hospital stays for mastectomy patients.
The policy forbidding restrictions on length of stay provides added protections to all 21.6 million women in Medicare, which covers people over 65 and the disabled of all ages.
``The decisions about what is medically necessary should be made by a woman and her doctor,'' Fried told the Senate Labor Committee.
Medicare patients ``who receive mastectomies are entitled to coverage for all medically necessary care,'' he said.
Fried told the hearing, ``The national attention given to coverage of mastectomies indicates there is a need for greater oversight.
``Patients should be given the right to choose the kind of care they want,'' said Dr. Ronald E. Iverson, president of the Society of Plastic and Reconstructive Surgeons, who believes legislation ensuring patients the choice of staying up to 48 hours after surgery would be ``reasonable.''
LENGTH: Medium: 52 linesby CNB