I recently learned there is a new policy in place regarding hospital stays post mastectomy. It is not an insurance mandate. It's hospital policy at one hospital (that I know of at the moment) and, it appears it's being driven by fiscal concerns. Can't stress this enough: I don't know how many hospitals are doing this, I'm just discussing what I learned about ONE hospital.
Breast cancer surgical patients will be discharged from the hospital 24 hours post surgery. This includes bilateral mastectomy with placement of tissue expanders. I had that surgery and I can assure you, there is NO WAY I was equipped either physically or mentally to be released from the hospital in 24 hours.
This is a No Exception Rule. You are not permitted to cry to your doctor that you need just 12 more hours. Unless there are obvious signs of infection, fever or uncontrolled vomiting, don't even bother trying. No amount of pain, lightheadedness, nausea or anything else for that matter, is reason enough to forgo hospital policy. No Exceptions. That was made indisputably clear when the information was shared with me.
I am saddened by this and I am on many levels, outraged. This is a major cancer center. This is an institution whose fellows must participate in "talk training" before completing their fellowship. Doctor patient communication is high on their list of priorities. It is one of only a few formal training programs to teach new doctors what we lay folk call "bedside manner." This is a hospital that has more programs available for current patients, former patients, caregivers of patients and the quality of those programs is like nothing I have seen or heard about, in any other hospital, from any of the other advocates with whom I speak.
This is a place where a holistic approach to care is not only embraced, it is encouraged. Chairside acupuncture or reflexology during chemotherapy. Appointments can be made with Reiki masters and massage therapists during a hospital stay. And this care will be provided in your hospital bed. Integrative medicine is so important, it is housed in its own building. Patients who are post treatment can utilize the services (there is a fee for outpatient care) for as long as they like. Guided meditation, yoga..... you get the picture.
I am involved in many different volunteer activities with several organizations. I have met and collaborated with advocates from all over the world. No, I'm not "all that" but in a world where social media affords us this opportunity, it's easy to connect with like-minded people and join forces for the greater good.
A few years ago, there was tremendous hype and equally vocal pushback to stop "drive through mastectomies." Laws were passed in several states to compel insurance companies to step aside and allow doctors to do what was best for their patients. Within those laws, the patient has an equal voice. Some states mandate 48 hours. New York is not one of those states.
The NYS law reads as follows:
"HMO's and insurers that provide coverage for inpatient hospital care must provide inpatient hospital coverage for a mastectomy. After a mastectomy, a woman has the right to stay in the hospital until she and her doctor decide she is ready to go home."
And there's the catch. In the world of empowered patients, self advocacy, patient centered care, personalized medicine and patients as partners, the decision making process regarding what constitutes "ready to go home" involves only one person. And, it's not even a person. It's a policy. A decision between a woman and her doctor which was previously dictated by insurance companies is now being dictated by hospital policy.
This is a gigantic backward step and it is a step being taken by one of the finest institutions in the world. I am bitterly disappointed. I learned of this policy a couple of weeks ago even though it was put into place two months prior. I waited to get definitive information before sharing my disappointment. Faced with a surgery that leaves us scarred physically and emotionally, likely still crippled with fear over a cancer diagnosis, staring at drains hanging from their bodies, women will now be told they don't get a voice in their own care which is their right under the laws of the state of NY.
If the woman says yes and the doctor says no in accordance with "hospital policy," I'm guessing the insurance company will have enough medical information to deny to cover the additional time. In other words, leave quietly OR pay the bill OR spend the next several months fighting for coverage through the NYS appeal process. That's just the thing to throw at someone who is physically compromised, emotionally drained and quite possibly facing chemotherapy.
I did not have to go far to read the writing on the wall and it is crystal clear. Some policy decisions may be driven by cost and that most certainly appears to be the case with this policy. We have once again, ceased being women with diseases that require what most of us see as radical treatment. Instead, we are ONCE AGAIN, tied to that financial bottom line.
As my heart sank for those whose care, in my opinion, is being compromised by "policy" THIS hit my medical feed:
From Medical News Today, the title of the article?
I cut and pasted the article exactly as it appeared on my screen. In other words, where there is bold type or any other emphasis, that is not MY emphasis. It is the opinion of the writer. The part that is most upsetting? When they examined the TYPES of procedures where complications occurred, 78.7% of breast procedures had post discharge complications. I get it. They are playing the numbers. I'm sure they examined their own incidences of post-op complications before boldly (and quietly) instituting a policy that I find rather distasteful. I am not raging against the machine because I'm secretly hoping that sticking to the point without going over the top might open a dialogue. And I'm secretly hoping this new policy will be revisited and revised so that breast cancer patients can continue to receive the type of care that is consistent with one of the finest cancer hospitals in the world.
And now, the article which I hope will bolster the case to rethink what I believe is an AWFUL decision, in its entirety:
A new US study finds that over 40% of complications after general surgery procedures arise after patients have been discharged, with three quarters occurring within the first two weeks of leaving hospital. At least one expert suggests the study highlights the importance of focusing on patient needs and calls for insurers to invest the proposed savings they would make into research for safer surgery.
Lead author Hadiza S. Kazaure, of Stanford University at Palo Alto in California, and colleagues, analyzed 2005 to 2012 data from the American College of Surgeons National Surgical Quality Improvement Program, and found, overall, 16.7% of general surgery patients experienced a postdischarge (PD) complication, and 41.5% of complications occurred postdischarge.
They write about their retrospective study online in the November issue of Archives of Surgery, a JAMA Network publication.
Postdischarge Period is Vulnerable Time
The period following discharge from hospital is a vulnerable time for surgery patients, and it can also be an expensive one for the healthcare system when patients have to go back into hospital because of a complication related to the procedure.
In their background information the researchers refer to the Patient Protection and Affordable Care Act, which says one of the targets to save costs is to reduce avoidable postdischarge hospitalization.
For their study, Kazaure and colleagues examined postdischarge (PD) complications that occurred within 30 days of leaving hospital in 21 groups of inpatient general hospital procedures. They were particularly interested in the types of procedure, the rates and the risk factors for PD complications.
The data they used covered 551,510 patients whose average age was nearly 55 years.
They found 75% of PD complications occurred within 14 days of leaving hospital.
They also note:
"We found that more than 40 percent of all post-operative complications occurred PD; approximately 1 in 14 general surgery patients who underwent an inpatient procedure experienced a PD complication."
Varied By Type of Procedure
When they ranked PD complications by type of procedure, at the highest end they found 14.5% were for proctectomy (surgery involving the rectum), 12.6% were for enteric fistula repair (abnormal passageway repair) and 11.4% were for pancreatic procedures.
When they looked within each type of procedure, they found 78.7% of breast procedures had PD complications, followed by 69.4% of bariatric, and 62% of hernia repair procedures.
For all procedures, they found surgical site complications, infections and blood clots (thromboembolisms) were the most common complications, while a complication while still in hospital increased the chances of having one after discharge (12.5% compared with 6.2% without an inpatient complication).
Re-operation Rates Higher
The researchers also note that patients with a PD complication had higher rates of re-operation (17.9% compared with 4.6% without a PD complication).
Death was also more likely within 30 days after surgery in patients with a PD complication (6.9% versus 2% without a PD complication).
And the highest rates of re-operation and death were among patients whose PD complication was preceded by an inpatient complication.
Need to Improve Quality in Inpatient General Surgery
The researchers conclude their study shows "PD complications account for a significant burden of postoperative complications and are an important avenue for quality improvement in inpatient general surgery".
They call for more research to develop and explore the usefulness of a cost-effective and "fastidious" postdischarge follow-up system for surgical patients.
Desmond C. Winter of St. Vincent's University Hospital, Dublin, Ireland, notes in an invited critique of the study published in the same issue of the journal, that every surgeon will read the paper from Kazaure and colleagues with interest, because "complications are the statistics that define us all".
He says the need to reduce disease is what drives the scientific evolution of surgery.
"Patient needs, not financial penalties, should be everyone's primary focus. Let us see further advancements in surgical care through research funded by the proposed insurer savings and together strive for safer surgery," urges Winter.
Written by Catharine Paddock PhD
Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today