Overnight Stays Recommended For Mastectomy Patients Hmo Group Makes Suggestion In Face Of Criticism, Threat Of Federal Laws

A managed-care trade group tried to defuse growing criticism and the threat of federal legislation Thursday by recommending that health plans allow an overnight hospital stay for women who have a breast removed for cancer.

All 1,000 members of the American Association of Health Plans - which includes nearly all of the nation’s HMOs pledged to abide by the recommendation against requiring mastectomies to be performed as outpatient procedures, the organization announced.

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

A congresswoman said Thursday that she will introduce legislation in January to require a 48-hour hospital stay for any mastectomy patient who wants one.

Voluntary industry measures don’t assure “that women will not find themselves in a situation where their health can be jeopardized,” said Rep. Rosa DeLauro, D-Conn.

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, the removal of just the breast tumor, 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.

But the controversy began in August, when some doctors in Connecticut complained of new guidelines adopted by two HMOs 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 charged Thursday that those complaints were only confusion, that no woman was ever threatened with being kicked out of the hospital.

DeLauro says her constituents disagree. “This is not hearsay, this is real.”

Outpatient mastectomies are 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.