Prompted by legislative initiatives in Maryland and elsewhere to deal with "drive-through" deliveries and outpatient mastectomies, a high-ranking Maryland senator is introducing a bill requiring regulatory approval for any major reduction in hospitalization standards. Maryland Senate Finance Committee Chairman Thomas L. Bromwell (D-Baltimore) plans to introduce the bill by late January in an attempt to avoid a piecemeal approach to insurers' reductions of hospital stays in a managed care environment, says Vikram Khanna, president of the consulting company State Health Policy Solutions, who helped draft the legislation. "Legislators should not be forced to micromanage HMOs every time they create guidelines, such as outpatient mastectomies, which are not based on clinical studies," Sen. Bromwell said in a letter to the Baltimore Sun. "A comprehensive approach to addressing this situation is necessary." In this session, the Maryland legislature also will consider legislation requiring insurance plans to allow patients to opt for a minimum 48-hour hospital stay following a mastectomy, says Ilene Heaney, aide to Sen. Bromwell. "The alternative to this bill is to legislate by ICD-9 (insurance classification) code," Mr. Khanna says, adding that he knows of no other states that have regulated length-of-stay guidelines. "The bill also addresses the industry criticism that we're substituting the judgment of legislators for that of physicians and insurers." Under the proposed legislation, any practice parameter or guidelines established by an HMO or health insurance carrier that shortens by 50% or more, or eliminates, an inpatient hospital stay would require approval by the state's Advisory Committee on Practice Parameters. The ACPP is an independent 15-member panel appointed by the governor and made up of physicians, plaintiff and defense lawyers, deans of the state's two medical schools, and representatives of insurers, hospitals, government agencies and the public. The panel's current role is to define appropriate clinical indications and methods of treatment for diseases that are subject to a significant amount of malpractice litigation. But Mr. Khanna says panel members have indicated they're comfortable with expanding their role to insurance practice protocols. Part of the panel's process includes surveying specialists in the state who treat the condition in question and ascertaining that at least 60% concur with the standards developed. Under the bill, Maryland insurers also would have to develop home-care alternatives for patients subject to reduced length-of-stay or newly required outpatient treatment. The Maryland Association of HMOs hasn't had a chance to review the legislation and won't comment until it does, says Deron Johnson, director of legislative and regulatory affairs. —Jack Neff Contact Sen. Bromwell’s office at 410-841-3190.