PEDIATRICS: Study Criticizes Cost-Cutting Measures
A study released this month in the medical journal Pediatrics backs some of the claims in a Houston lawsuit that cost-cutting guidelines used by HMOs and insurance companies may put children at grave risk, the Houston Chronicle reports. According to the report, the guidelines published by Seattle-based consulting and actuarial firm Milliman & Robertson often recommended shorter hospital stays for pediatric conditions than the average stay of patients in New York hospitals in 1995, which raises concern about the safety of the rules. Dr. Thomas Cleary, head of pediatric infectious diseases at the University of Texas-Houston Medical School, recently sued M&R over the guidelines, arguing that "kids might die" because of them. He said he supported the Pediatrics article, adding "There's likely going to be more studies pointing out how unreasonable and dangerous the guidelines are if insurance companies follow them." M&R spokesperson Jim Loughman declined to comment on the study, but said in a previous interview the company "has full confidence in the integrity of its guidelines and stands behind them 100%."
Guidelines Have Little Scientific Merit
The Pediatrics study, which compared the lengths of hospital visits in New York in 1995 for 16 childhood ailments with the stays recommended by M&R, found that the guidelines tended to deviate from standard practices, especially for the more dangerous diseases. This is primarily because M&R guidelines recommend in-home care and monitoring for illnesses involving prolonged antibiotics treatment, a suggestion that the study said "may not be realistic." Jill Joseph, a study co-author and pediatrician at the Children's National Medical Center in Washington, D.C., said, "That means basically assessing whether or not a child is critically ill," adding, "What are we doing assessing that at home?" Joseph explained that she and her colleagues performed the M&R study because "our practice is strongly impacted by these guidelines," which the study showed had little, if any, scientific validity (Nissimov, 4/29).