The hospital that delivers the largest number of babies in the Baltimore area says insurance companies that force new mothers to go home within 24 hours of giving birth should pay for a follow-up visit from a nurse.
If they refuse, the hospital is prepared to put its money where its mouth is and pick up the $100 cost for the visit.
Officials at the Greater Baltimore Medical Center, which delivers 4,500 babies a year -- second in the state only to Silver Spring's Holy Cross Hospital -- were to announce a plan today to send nurses home the day after a birth to check on mother and child. The service is intended to help new parents through the critical early stages of identifying health problems in their infants and to help new mothers with bonding and breastfeeding techniques.
GBMC is believed to be the first hospital in the state to institute such a program in the face of cutbacks by insurers, said Deedee Frank, a nursing specialist in home postpartum services.
"It means, among other things, every mother delivering at the hospital will have a home nurse visit on the day following discharge," said hospital President Robert P. Kowal. "Given the concern of so many mothers, we felt we had a responsibility to take a leadership role in doing something about it."
Mr. Kowal said the hospital is trying to convince insurers to pay for the extra service by arguing that it is medically necessary. The service is also far less costly than the $500-$600 a day insurers save by not allowing new mothers to stay a second day.
Mr. Kowal estimated that the hospital would have to pick up the cost of 20 percent of the home visits. Three insurers already are paying for home nurses, he said, but "bigger companies such as Blue Cross, we're working with them," he said.
Blue Cross and other hospital officials said yesterday, however, that only the managed care or health maintenance organizations were considering the new plan. For the most part, Blue Cross will continue its policy of covering a home visit only if ordered to do so by a physician in a case involving acute medical needs.
Hospitals across the state went into a tailspin this spring and summer after the state's largest insurer, Blue Cross and Blue Shield, announced it would refuse to pay for mothers or babies to stay more than 24 hours in normal vaginal births. A number of insurers had similar policies but they included a mandatory home visit from a nurse.
Early discharge is not recommended by the American Academic of Pediatrics except where the mother and child are visited by a doctor immediately after birth. But few mothers felt like putting their child into a car and taking it to the doctor's office the day after a delivery, doctors said.
The policy led to massive complaints from new mothers and fathers, as well as from doctors and nurses concerned about the health of new infants. It also forced hospitals to think up new ways to educate new parents to care for their babies. Since the 24-hour rule went into effect, GBMC has seen a definite increase in the number of readmitted babies for neonatal jaundice, according to Dr. Victor Khouzami, chair of obstetrics.
"With the shortened length of stay there was a concern mothers were really not given adequate time to recover and be physically fit and bond and especially breast feed," Dr. Khouzami said. He said new mothers were going home unprepared for their own care or that of their child. Many pediatricians worried that early signs of jaundice, for instance, would not be apparent, he said.
Under the GBMC program, education for child care will begin in pre-birth sessions, he said. Once at the hospital, nurses will identify mothers whose insurance covers only 24-hour stays and will arrange for the follow-up visit.
The 1 1/2 -hour visit will allow the nurse to go over one-on-one feeding and other care techniques and answer any questions mothers may have, Dr. Khouzami said.
Doctors would be alerted to any potential problems by the nurses.
In addition, the hospital will have a closed-circuit television instruction program available at any time during the parents' stay and an instructional video, "Baby Talk," for new parents to take home.
The program starts Nov. 2, the day the hospital opens a new $70 million obstetrics and acute-care facility that will allow it to deliver up to 6,000 babies a year.
Dr. Khouzami said a trial run of the program had been well-received by new parents.