U.S. Reps. Ted Strickland, D-Lucasville, and Tom Coburn, R-Okla., last week introduced the Hospital Length of Stay Act, which would require health plans to cover hospital stays deemed medically appropriate by doctors and patients.

If patients' stays are extended past the health-care providers' guidelines, these providers might raise rates to cover extra lengths, said Carol Steele, Strickland's press secretary.

The bill could decrease individual stay costs because patients would receive adequate care during their first visits and would not have to return, she said.

But one patient concern is whether the bill will raise the premiums of the insured to cover the lengthened stays of the uninsured.

Ben Zelman, vice president of care management for Medical Mutual of Ohio, which provides health care and insurance, said the bill is likely to cause an increase in health-care premiums. He said Medical Mutual of Ohio already has a system that lets patients stay in hospitals longer if necessary. Also, if patients' stays are longer than what the guidelines outline, patients are not liable for the extra costs, he said.

Zelman said some other health-care providers do not cover hospital stays that extend past the companies' guidelines. As a result, he said, the bill will increase the number of people who stay in hospitals longer than medically necessary.

Lynn Patton, vice president of community relations at O'Bleness Memorial Hospital, said when hospitals provide care to uninsured people, they usually aren't paid. This raises costs for those who are insured because they will pick up the extra costs.

Steele said that because uninsured people are not limited to certain hospital stays by health-care providers, the treatment they receive should not change. She said these people already should be treated in medically appropriate ways, so their costs to hospitals will not increase.

Steele said this bill was introduced because insurance companies and health maintenance organizations are limiting their coverage.

When patients need to stay longer than a guideline allows, health-care providers can refuse to cover their extra stays. In many cases, patients leave hospitals before they are healed because they do not have money to pay for the extra care.

"It is simply unconscionable for insurance companies and HMOs to arbitrarily decide when it is time for you to leave the hospital after a medical procedure," Strickland said.

Steele said doctors and patients still will have the option of releasing patients early if they are recovered.

Some doctors, including Coburn, support the bill because it promotes better medical care.

"As a practicing physician, I don't need a non-medical professional telling me when my patients are ready to go home. Sending patients home before they are well places a terrible burden on families and often creates medical emergencies that cost the system far more than simply giving doctors the freedom to practice sound medicine," he said.

Steve Albrecht, assistant director of the center for health policy for the American Academy of Neurology, said the AAN supports the proposal because neurologists in some cases have had to release patients early because managed-care groups said the allotted time was up.

Cindy Brown, manager of the Washington, D.C., office of the American College of Surgeons, said the ACS endorsed the legislation because health plans are imposing arbitrary time limits.

She said these guidelines are goals for patients under optimal conditions but don't necessarily work for average people or a majority of people.

The American Medical Association and American Psychological Association also have endorsed the bill.

The bill, which was introduced last year and died in committee, addresses only one aspect of the health-care system that Congress is trying to reform, and if this bill passes, it will be one more step in reforming the whole system, Steele said.