Medicare ends outpatient mastectomy rules
A direct countermove to managed care providers’ pressure for same-day release of mastectomy patients came recently from the Department of Health and Human Services (HHS) in Washington, DC. Decisions about appropriate lengths of stay are not for insurers to make, said HHS Secretary Donna E. Shalala. And in his January State of the Union address, President Bill Clinton weighed in on the issue, calling outpatient mastectomies "dangerous and demeaning."
The Health Care Financing Administration (HCFA), the agency that administers Medicare, sent letters in February to 350 managed care plans that contract to provide services to elderly Americans. HCFA directed that plans may not require outpatient surgery or limitations on hospital stays for beneficiaries undergoing surgery for the treatment of breast cancer; it also reminded insurers that current law requires them to provide all medically necessary care relating to mastectomies and related surgical interventions. Since Medicare paid the bills for 84,000 mastectomies in 1996, about one-third of all those performed, HCFA’s voice is anything but weak.
"We are telling managed care plans that they may not impose sweeping, generalized policies that might endanger a woman’s health," Shalala said. The directive stated that 24-hour discharge guidelines "do not take into account individual patient circumstances." Medicare patients may lack the social support of a spouse or nearby relatives to care for them after such a short hospital stay, said HCFA administrator Bruce Vladeck. He warned that premature discharge from the hospital can set patients up for complications. (For more on outpatient mastectomies, see Women’s Health Center Management, February 1997, p. 17.)
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