Last spring, when a breast cancer diagnosis sent me to the hospital for a double mastectomy, my surgeon told me I'd need to stay the night. So when I saw the word outpatient on my plastic hospital ID bracelet, I was confused. "Oh, we have to do that for insurance purposes," said the woman at the check-in desk. "Your insurance company requires that we get you out in less than 24 hours." And get me out they did; 23 hours later, I was discharged. My stay was such a whirlwind that the sole bouquet of flowers sent to me at the hospital was delivered to my lap on my way out the door.
Within two weeks, I was checking back in for follow-up surgery (the surgeon had missed some of the tumor in my chest). And this time the stay was even shorter: A mere five hours after being wheeled into the operating room, I was out the door. That night the pain was excruciating—far worse than the first time around. How could this be? I wondered, and then it hit me: no professional nurses or morphine on tap.
I've since learned that healthcare advocates call these in-and-out hospital stays drive-through mastectomies. I've also learned—much to my relief—that their days may be numbered.
In March Connecticut congresswoman Rosa L. DeLauro introduced the Breast Cancer Patient Protection Act of 2009 (HR 1691) in the House of Representatives. The bill would guarantee, among other things, a minimum hospital stay of 48 hours for a woman having a mastectomy or lumpectomy. Those first two days are critical because that's when the risk of surgical complications is greatest, says Marisa Weiss, MD, a breast oncologist and founder of breast Cancer.org , a nonprofit resource. And complications (such as bleeding or infections) are worrisome for breast cancer patients because they can delay chemotherapy and radiation. As Weiss explains, "Any significant delay in treatment can increase the risk of the cancer growing and possibly spreading."
As it stands, 20 states have laws mandating minimum inpatient coverage, but the majority—including my state, Indiana—do not. (To find out if your state requires minimum coverage, go to StateHealthFacts.org and click on Women's Health and then Minimum IP Mastectomy Stay.) In states without such laws, insurance companies, not physicians, determine the length of a woman's hospital stay. And thousands of us are affected: This year alone, 125,000 women will undergo a mastectomy, and 65 percent will be discharged within 24 hours, according to a report presented to the American Society of Clinical Oncology last year.
Although DeLauro's bill has broad bipartisan support, its passage isn't guaranteed. In the fall of 2008, an earlier version of the bill passed in the House 421 to two, only to sputter and stall in the Senate under pressure from the health insurance lobby. But with healthcare reform on the horizon, DeLauro is optimistic. At press time, the bill was being reviewed by committees, and its sponsors were pressing for a vote by the end of the year.