SPEAK UP, MANAGED CARE

TIMING IS EVERYTHING.

That aphorism is clearly illustrated by the recent release of a study on whether the duration of maternity stays in the hospital after delivery affects the health of mothers and their babies.

The study by Milliman & Robertson Inc. attempts to shed light on the alleged problem of managed care plans imposing medically dangerous limits on the amount of time mothers and newborns can spend in the hospital after deliveries.

For the managed care industry and employers, though, the research comes about two years too late. Anecdotal evidence of "drive-through deliveries" sparked the imaginations and ire of politicians and led to a surge of state and later federal legislative proposals mandating health care plans to provide coverage for longer maternity stays. Indeed, next year federal legislation will go into effect requiring health care plans to offer 48 hours of inpatient coverage after vaginal deliveries and 96 hours of coverage after Caesarean sections.

However, the M&R study, released last month, found that one-day hospital stays after vaginal births and two-day hospital stays after Caesarean section births do not cause higher readmission rates for either mothers or babies than longer hospital stays. In fact, after studying roughly 2 million medical records, M&R found the readmission rate for those who spend only one day in the hospital after a normal vaginal delivery is marginally less for both mother and child than for those who stay longer.

As a result of its findings, M&R, which is a leading source of practice guidelines for health care companies, recommends a 24-hour post-delivery stay for mothers who have vaginal deliveries and 48 hours those who have Caesarean sections.

Despite those findings, the odds of either state or federal lawmakers revisiting this issue and scrapping or modifying their earlier approved mandates are remote.

The timing of the research demonstrates the failings of the managed care industry to effectively respond to anecdotal charges of poor practices that have besieged it in recent years.

As we have said of most anecdotes regarding alleged managed care abuses-from outrageously short stays for deliveries and mastectomy care to muzzles on doctors discussing uncovered treatment options-there are undoubtedly some cases of improper care, but to paint the entire managed care industry with such a broad brush is unfair.

The managed care industry needs more research like the M&R study to answer its critics and must deliver it before the lawmakers uncap their pens and pass more benefit mandates.

If managed care plans don't make a better case for their practices and demonstrate that cost-saving procedures don't compromise quality, then employers better take up the charge. For ultimately, it is the employers whose workers will grow increasingly leery of managed care options and employers whose premiums will grow as medical treatment is defined by legislators.

Before the next anecdotal assault is made, we hope the managed care industry learns that timing is everything.