mem

 

 

horizons

Maryland Regional Medical Program # March, 4974 » volume 8 number 1 © promoting cooperation to
of health care services ® health manpower development © encouraging the regionalization of health facilities manpo

 

7
improve the quality and distribution
wer and other resources

Maryland Regional Organ Procurement and

 

G. Melville Williams, M.D., Co-Program Director, Professor of
Surgery, Chief, Division of Transplantation, The Johns Hopkins
University School of Medicine

MRMP originally submitted this project
proposal on October 31, 1972 to begin
“May 1, 1973. However, it was delayed
by the “phase-out” telegram from
RMPS on February 1, 1973. After re-
ceipt of the letter and memorandum
of September 7, 1973 from Dr. Herbert
J. Pahl, Acting Director of RMPS, it
was resubmitted with the full endorse-
ment of the Regional Advisory Group,
the Maryland Comprehensive Health
Planning Agency, the Maryland Com-
mission on Renal Disease and the
Chronic l!Iness and Aging Administra-
tion of the Maryland State Department
of Health and Mental Hygiene. The
grant became effective October 1,
1973 for $35,960 and was extended
January 1, 1974 through June 30,
1974 for an additional $29,038. It is ex-
pected that the program will be self-
supporting following July 1, 1974 from
third party payments from Medicare
(Section 2291, Title {l of the Social
Security Amendments of 1972). John

ham been aL aha KiAKwheAl

ca eo 4

Transplantation Program Receives Approv

    

al

eS

    

Left, Ron E. Purser, Physician Assistant, Coordinator of Technical
Programs of Division of Nephrology, University of Maryland. Right,
John H. Sadler, M.D., Project Director for MRMP Organ Procure-

ment and preservation Program, Associate Professor of Medicine,
Head Division of Nephrology, University of Maryland, School of

Medicine.

ogy Division at the University of Mary-
land School of Medicine, is the pro-
gram director. G. Melville Williams,
M.D., Professor of Surgery and Head
of Transplantation Surgery at Johns
Hopkins University is co-director.

The program represents an out-
standing example of full partnership
between the Region's two university
medical centers and other cooperating
institutions in furtherance of the goal
of a comprehensive regional program
of care for all chronic renal disease
patients. It supplies the major missing
link in the Maryland renal program in
making transplantation the top priority
in management of chronic renal dis-
ease whenever possible. MRMP is
proud of the way in which the several
key health institutions involved have
worked out really effective cooperative
arrangements to make the most effec-
tive use of the resources available.

For most patients with chronic renal

failure, kidney transplant offers. the
hact traatmant Far enmea nf them a

family member is able to give a kidney.
If this kidney is well matched, the like-
lihood of success is better than 80
percent. Most people are not so for-
tunate. Their kidney must come from
someone dying without renal disease.
This source of kidneys provides over
half the kidneys transplanted in Amer-
ica each year, but this is only a small
fraction of the need for transplants. It
is an even smaller fraction of the kid-
neys which might potentially be made
available for transplant, some estimate
{00,000 potential donors per year.
Half of these would be enough. Last
year, there were less than 2,000
donors.

A major public and professional edu-
cational program is carried on by many
agencies to stimulate a broader will-
ingness to donate organs. Progress is
slow. A major problem was obtaining
kidneys at a time when the transplant
could be done, maintaining them in a
viable state until the recipient, the kid-

nantiniian an nane 7
horizons

 

New Projects Approved for Fiscal Year 1974

The Regional Advisory Group, acting
on instructions from RMPS dated Sep-
tember 7, 1973, approved a first re-
quest application for $160,740 for the
months of October, November and
December, 1973. A second request for
$226,878 for the new budget period
January 1, 1974 through June 30, 1974
was also approved.

In addition to maintaining the re-
duced program staff and providing a
modest fund for “mini-contracts,” the
first request initiated the Maryland Re-
gional Organ Procurement and Preser-
vation Program and the contract with
the Greater Ocean City Health Care
Corporation to start implementing rec-
ommendations of the CHP Ocean City
Health Care Study for solving problems
of accessibility to health services. Both
of these projects, which are briefly
described below, had been included
previously in MRMP’s Anniversary Re-
view and Application submitted on
November 1, 1972, but were stalled by
the RMPS "phase out” telegram of
February 1, 1973.

The second request continued these
two programs and added five addi-
tional projects. MRMP has also been
assigned $178,620 (from FY 1973
fund), but ‘expenditure of these funds
cannot be made until instructed by
RMPS.” in the most recent award
notice dated December 27, 1973,
which approved the application for
January 1, 1974 through June 30, 1974,
this instruction was continued.

Since the extended budget year
ended on December 31, 1973, carry-
over of $52,617 in estimated unex-
pended funds has also been approved,

Greater Ocean City Health
Care Corporation—$17,742

(January 1, 1974—June 30, 1974)

This is an example of health planning
to promote geographic equity of ac-
cess to health services in a rural (but
changing) area of Maryland's Eastern
Shore where the summer (four-month)
population soars from approximately
3,500 in non-vacation months to nearly
200,000 at peak periods. This phe-
nomenon has been accompanied by a

decrease in available physicians serv-
ices.

Several years ago the State and
Areawide CHP agencies anticipated
the problem and the former commis-
sioned a “Study and Plan to Meet
Health Needs in Ocean City” by con-
sultants from the Operations Research
Division of the Johns Hopkins Univer-
sity School of Hygiene and Public
Health.

One of the recommendations was to
form a Greater Ocean City Health Care
Corporation which was accomplished
in part by previous MRMP support. The
objective of the Corporation is to bring
together all those elements in the com-

munity responsible for the health of the |

area and to serve as the focal point
for planning, development, implemen-
tation and evaluation of present and
future health care services within its
area of responsibility. At present a
principal activity is the creation of a
new Medical and Diagnostic Center,
which wouid be related in the future
to an existing community hospital for
secondary care and specialized diag-
nosis and to a university center for
tertiary care and continuing profes-
sional education programs.

Maryland Regional
Procurement and Preservatio
Program—$29,038

(January 1, 1974—June 30, 1974)

This program, which is a key compo-
nent of Maryland's comprehensive pro-
gram for the care of chronic renal dis-
ease, is sponsored jointly by the Uni-
versity of Maryland and Johns Hopkins
Medical Schools. This is described on
page one.

Pediatric Nurse

Practitioner Program—
$9,075

(January 1, 1974—June 30, 1974)

This project is the only one which rep-
resents an extension of an existing

.MRMP program. It deals effectively

with the maldistribution-access prob-
lem which the Administration has re-
peatedly emphasized in recent policy
statements, namely the high priority
which will be placed on increased use

 

gh A

Pediatric nurse practitioner, Mrs. Marcia
Katz, demonstrates her skills in gaining
confidence of the child and his mother.

of nurse clinical practitioners, pediatric
nurse practitioners, nurse-midwives
and physician assistants. The RAG as-
signed a no. 1 priority to this project.

The program located at the School
of Nursing, University of Maryland, has
already prepared 16 registered nurses
from rural and urban areas of Mary-
land to practice in this expanded role.
All 16 graduates are employed in com-
munity based programs or private
physicians’ offices and have assumed
full responsibility for a case load to
provide primary care for infants and
children in their respective agencies.
Activities include initial new born as-
sessments at local hospitals (in two of
the rural counties); routine well baby
health supervision; diagnosis and treat-
ment of minor childhood illnesses; col-
laboration with pediatricians; providing
continuity of care between the Health
Department and the private sector; and
providing health guidance and coun-
seling to parents.

The objective of the present exten-
sion is to prepare another group of 8
registered nurses to function in a pri-
mary capacity in ambulatory health
care for children through collaboration
with physicians and other health pro-
fessionals. Some aspects of the curric-
ulum will be revised as a result of the
evaluation of the performance of the
16 graduates now practicing, i.e. in-
creased emphasis upon defining, in-
terpreting and implementing- role
change for the nurse practitioner. After

 
horizons

termination of MRMP support in July
it is expected that the program will con-
tinue from other sources of support
available to the School of Nursing and
the activity will be coordinated with a
similar program at the Johns Hopkins
School of Health Services to achieve
maximum benefit from teaching re-
sources and to avoid duplication of
effort.

Demonstration of a Model
Hospital Quality Assurance
Information System—$31,280
(January 1, 1974—June 30, 1974)

The primary leadership for this demon-
stration comes from the Maryland Hos-
pital Association in cooperation with
five hospitals —-3 urban and 2 rural.
The Maryland Foundation for Health
Care is also participating and discus-
sions are underway with other groups
with a view to ultimate development of
a commonly held corporation to man-
age a statewide health services infor-
mation service.

The project will demonstrate the
feasibility and effectiveness of per-
forming the following quality assess-
ment/claims review activities, consis-
tent with Joint Commission on Accred-
itation of Hospitals (JCAH) and Pro-
fessional Services Review Organiza-
tion (PSRO) requirements, through the
use of a centrally managed, single, uni-
form, reporting and review process for:
e utilization review and certification of
medical necessity acceptable by third
party purchasers
e the collection of uniform discharge
data abstract information

® interfacing with medical audit func-
tions

Related objectives wiil be to demon-
strate the value and feasibility of de-
veloping a single, uniform method of
external third party claims surveillance
and utilization review which could be
applied to all hospitals in the State
and to all patients regardless of source
of payment, utilizing a process similar
to that of the Maryland Admission Re-
view Program (MARP) of the Maryland
Foundation for Health Care.

Also the program will endeavor to
establish a health services information
system utilizing a single source docu-

ment to provide reports to serve the
following purposes:

e report patient care outcome as com-
pared to pre-established norms and
standards of care for use in a medical
staff's medical audit function.

® management and evaluation of the
utilization/claims review, preadmission
certification, and discharge planning
functions.

e report all hospital data for service
area analysis; utilization analysis; pa-
tient profile analysis.

Development of Quality
Assurance Norms, Criteria -
and Standards for Community
Health Care—$30,000
(January 1, 1974—June 30, 1974)

The principal sponsor of this project is
the West Baltimore Health Care Cor-
poration located in an urban setting in
close collaboration with the South
County (Anne Arundel) Health Care
Center which is located in a rural area.
Technical consultation and direction is
provided by Management Advisory
Services, Inc., of Columbia, Maryland.

The activity is directed towards de-
velopment of methods and procedures
to assess the quality of personal health
care delivered in two ambulatory set-
tings, both administered by consumer
citizen groups.

The program will utilize the data

base of a currently operating computer *

based encounter system to derive
norms, : criteria, standards and tech-
niques associated with current en-
deavors to assure quality of care in

' various Federally funded medical care

programs. The encounter system has
a data base which includes disease
diagnosis, medical procedures and
medication for every patient treated
for each encounter. Subsequently, dis-
ease profiles and associated usage
rates of health care services can be
determined as a function of demo-
graphic and socioeconomic charac-
teristics.

For example, the information con-
tent of the encounter form allows for
the comparative evaluation of different
medical procedures and medication
and the outcome as indicated by the
frequency and duration of acute and
intensive care required by the patient.

Of course, the ‘‘end resuit’” will need to
be adjusted for age and type and
severity of the disease.

In conjunction with the Medical Staff
of the participating community health
centers, the Management Advisory
Services, Inc. will develop the key
parameters for which norms and cri-
teria will need to be established in the
future for ambulatory services in com-
munity health centers, health main-
tenance organizations and other or-
ganized health care delivery models
which are evolving.

Comparative evaluation of the pa-
tient’s health profile will be performed
on the basis of disease category, as
well as use rate of health care by dis-
ease type.

In brief, the expected results are the
development of methods and proce-
dures for establishment of norms and
criteria for quality assurance of ambu-
latory care on the basis of “outcome”
and ‘end results” as indicated by:

« The frequency and use pattern of
the patient's ambulatory care, adjusted
for age, type and degree of disease.
For selected diseases this will result
in the establishment of numerical per-

_centile tables.

« An analysis of potential differences
between urban and rural patient popu-
lations pertaining to their use fre-
quency and pattern of ambulatory care.

Supplementary Studies to
Augment State Comprehensive
Health Plan—$7,299

(January 1, 1974—June 30, 1974)

This is a supplementary grant adding
to the State Health Pian Study currently
being undertaken by the Johns Hop-
kins University Multidisciplinary Health
Planning Group. The source of funding
for the Maryland Health Plan Study is
the Maryland Comprehensive Health
Planning Agency.

The supplementary activity has two
main objectives of great interest to
MRMP:
© To describe and determine the vari-
ous health services in 72 Maryland
hospitals and surrounding hospitals in
West Virginia, Virginia, District of Co-
lumbia, Pennsylvania and Delaware.
Through the use of questionnaires
horizons

 

and personal interviews, these specific
services and procedures available in
each hospital will be determined using
levels of care methodology approach.
e To attempt to determine patient flow
for Maryland to West Virginia, Virginia,
District of Columbia, Pennsylvania and
Delaware in order to determine overall
regional patient-flow patterns and the
effects of hospitals located in the five
surrounding areas on the Maryland
health care delivery system.

Hypertension Materials
Development Project for
Lower Socio-Economic
Levels—$10,000 —

(January 1, 1974—June 30, 1974)

This is a modest cooperative project
between: the Central Maryland Heart
Association, the Educational Films
Foundation (a non-profit organization)
and the MRMP. Financing is coopera-
tive as well, e.g. total. budget $25,400,
plus one-half time of staff coordinator:
Educational Films Foundation $15,400,
MRMP $10,000 and Central Maryland
Heart Association one-half time staff
salary.

Objective is the production of audio
visual materials suitable for use in ed-
ucating and motivating known hyper-
tension patients in the lower socio-
economic fevel, with the object of
making the patient a member of the
therapeutic team. -

NARMP WINS
SUIT

A U.S. District Court in Washington,
D.C. on February 7, 1974 has ruled in
favor of the National Association of
RMPs in a suit calling for release of
impounded 1973 and 1974 funds.

Judge Flannery enjoined any inter-
ference with the actual spending of the
money, denied a stay pending appeal,
and ordered the government to pay
costs of the plaintiff, The National
Association of RMPs, Inc. A non-profit
corporation, NARMP ‘receives no pro-
gram funds, but is supported entirely

hue nehonta individual anantrihiitinne

Development of an HMO
Information System

Background — By December 31,
4973, the terminal date of the grant to
the Oftice of Health Care Programs and
the Health Services Research and
Development Center of the Johns Hop-
kins Medical Institutions, the major
objectives of MRMP Project #36, “De-
velopment of an HMO Information Sys-
tem,” had been met. Briefly, these
objectives were directed at the devel-
opment of a data collection and infor-
mation system which would serve man-
agement, clinical, and evaluation func-
tions that are particularly useful to
HMOs in their quality assurance and
related utilization review programs.

Before considering the details of
progress made, it is worth noting that
national events since the start of the
project have increased the significance
of the program. The Health Mainte-
nance Organization Act of 1973 (5.14)
emphasizes evaluation and there is lit-
tle question but that the development
of data information systems in HMOs
will accelerate as a result. Contributing
to this movement is the recent ap-
pearance of recommendations that de-
fine the structure and content of such
systems and provide a minimum set of
items and tabulations for adoption by
HMOs.* The basic elements of the in-
formation system developed under the
MRMP grant and implemented at the
Columbia Medical Plan and the East
Baltimore Medical Plan are consistent
with these recommendations and, in
fact, the experience with this system
contributed to the formulation of the
recommendations.

Accompanying the interest in infor-
mation systems is the recognition that
realization of their full potential for ad-
dressing management and clinical is-
sues related to economics and quality
of care in HMOs requires new reseach
efforts. A major activity of the Health
Services Research and Development
Center, The Johns Hopkins Medical

*Murnaghan, J. H. (Editor): Ambulatory
Care Data, Report of the Conference on

- Ambulatory Care Records, Philadelphia,

An ft B Finninratt Cn 1973

institutions, with grant support from the |
Bureau of Health Services Research
and Evaluation (DHEW) and Founda-
tions, is being directed at the issue.
The groundwork laid by the MRMP
grant is making possible this study of
the strengths and constraints of infor-
mation systems in addressing specific
planning and evaluation questions.
The Information System — Major
components of the information system
operating in the Columbia Medical
Plan and the East Baltimore Medical
Plan follow (the system has also been
introduced in the Broadway-Orleans
Housing Project clinic, a non-HMO
facility):

® Routine reports of face-to-face en-
counters between enrollees and pro-
viders (physicians, nurse practitioners,
health associates, and other mid-level
health personnel).

e Computer stored information about
the encounter including identification
of patient and provider seen, diagnosis
(or problem), procedures performed,
disposition, referrals, laboratory tests,
and X-ray procedures ordered, pre-
scriptions filled, unit cost assigned to
each service, and other descriptive
data about the visit.

e Reports of hospitalizations and com-
puter storage of data on where pa-
tient was admitted, dates of admission
and discharge, discharge diagnosis,
surgical procedures performed, admit-
ting physician; computer files on am-
bulatory and in-patient care are being
merged.

e Computer based enrollment file that
identifies families and each member of
the family enrolled in the HMO; the
file also contains information on per-
sonal characteristics (data of birth, sex,
marital status, relationship of individ-
ual to primary subscriber, contractor
group through which family enrolled).
¢ Computer programs to retrieve in-
formation for currently defined man-
agement, clinical, and evaluative pur-
poses (with aid of other grants these
programs are to be expanded during
1974 and 1975).
horizons

 

Costs for operating the above sys-
tem is being met by the HMOs where
they were developed under the MRMP
grant. Manuals and programs are avail-
able to facilitate the introduction of the
information system by other HMOs in
the region, in consultation with the de-
velopmental staff.

Management Applications — A
monthly series of reports to monitor
the volume and types of medical serv-
ices rendered by the physician and
non-physician practitioners in the HMO
is in effect. This series routinely covers
many of the items of information on
the encounter form and reports of hos-
pital stays and is designed to provide
management with a means for deter-
mining (1) trends in utilization of dif-
ferent specialties and non-physician
manpower, laboratory tests, X-ray pro-
cedures, drugs prescribed and hospi-
tal care; (2) the influence of changes
in subscriber composition on these
trends; and (3) the need to consider
modifications in manpower allocations.
Utilization data are in the form of
numbers and rates per person per
year and are aggregated on a “year to
date’ basis to supplement the sum-
mary of monthly experience. Two addi-
tional sets of data that give insight to
the functioning of the HMO are the
distributions of patients by number of
encounters during specified periods
of time and the relationship between
duration of enrollment and utilization.
The above data are related to co-
payment revenues and capitation costs
to provide a basis for judging the
effect of demand for services on the
current economics of the HMO and to
estimate future utilization and revenue
in the program. Information on utiliza-
tion and enrollment that is computer
stored includes the identity of the
membership group which makes it
possible to generate utilization, reve-
nue, and cost data for different groups.
In addition, the data will provide a
starting point in determining whether
some groups require educational
efforts to improve utilization practices
(under or over utilization) with impli-
cations for both the economics of the
plan and quality of care.
The ability to assess utilization levels
and costs would be enhanced by the

availability of comparative data in
other prepayment medical plans. This
has become apparent from the com-
parisons made between the experience
in the East Baltimore Medical Plan and
the Columbia Medical Plan and be-
tween the experiences of these two
HMOs with those of other HMOs which
are producing similar types of data.
Although this is still highly limited, it is
expecied that as a result of the HMO
legislation and the recommendations
for establishing information systems
in organized health delivery programs,
many additional sets of utilization data
will become available. The information
system implemented through the
MRMP grant can be used to parallel
almost all types of data that might
conceivably be produced by both well
established and newly emerging HMOs.

Clinical Applications —- A relatively
costly but essential item of informa-
tion for clinical application in quality
assurance programs is the statement
of diagnosis (or medical problem). The
HMO Information System has routinely
included this item in the computer
data bank and significant steps were
taken during 1973 to develop profiles
of medical care received by patients
with specified diagnoses. With the par-
ticipation of clinicians, several condi-
tions have been selected to test the
capability of the systern to provide in-
formation that would be useful in un-
derstanding the patterns of care re-
ceived and variability in these patterns
associated with patient and provider
characteristics.

Conditions that are being examined
from this standpoint include hyperten-
sion, bronchial asthma, urinary tract
infection and headache. In the care of
hypertension, profiles of care have
been generated for patients who had
this diagnosis during
September-December, 1972. Intervals
between initial diagnosis and _ first
follow-up visit, between first and sec-
ond follow-up visit, etc. have been
determined, medications prescribed
are being determined, and cases that
require further studying to assess qual-
ity of care are being identified. in the
case of headache, a sample of patients
presenting this problem has been
identified through the information sys-

the period.

tem. Of interest here is how often a
more definitive diagnosis is made,
whether these patients are especially
high utilizers, and in what situations
referrals are made for psychiatric con-
sultation. '

To extend these applications to a
wider range of conditions, a major in-
vestment has been made to develop
an automated procedure for coding the
diagnostic information being stored in
text format. By February 1974, a dic-
tionary of terms and corresponding
codes that are consistent with the
ICDA (and a compatible symptom list)
will be programmed for this purpose.
All but a small proportion of the terms
that appear on the encounter form
will be codable. This will facilitate the
conduct of many clinical and epidemi-
ologic studies.

Evaluation Applications — The im-
plementation of the HMO Information
System has opened the door to com-
plex evaluation studies of approaches
to increase the efficiency and quality of
care in HMOs. Examples of the types
of studies planned or underway that
are dependent on the information sys-
tem follow (all of the projects are sup-
ported by other grants):

® Utility of the information system for
quality of care assessment. Central to
the review of outcome of care under
the Experimental Medical Cara Review
program (EMCRO) in the Columbia
Medical Plan is the derivation of a
problem status index during each of a
repetitive series of inquires, followed
by evaluation and modification of the
questionnaires. An objective of the
EMCRO study is to measure change
in problem status over time and its re-
jationship to accessibility and the ex-
penditure of health care resources. In
coordination with the EMCRO study,
the relationship between process of
care determinable from data stored in
the information system and changes in
problem status will be examined.

« Impact of drug utilization review on
prescribing practices. This project is
designed. to measure the change in
prescribing patterns over time as ap-
propriate criteria for drug use is im-
plemented in the clinic and to docu-
ment cost savings as non-essential or

continued on page 7
horizons

HMO Legislation: Maryland Health Maintenance
Plan Continues Local Involvement

The long-awaited Health Maintenance
Organization Act (of 1973) was signed
by President Nixon on December 30,
after some three years of legislative
deliberation. According to the Amer-
ican Medical Association News of Jan-
uary 21, 1974, President Nixon is en-
thusiastically endorsing the Health
Maintenance Organization program ef-
fort. The government is ‘‘going all out’’
to implement the new law “as rapidly
as possible”, according to Charles
Edwards, M.D., Assistant HEW Secre-
tary for Health. Proposed regulations
to carry out the HMO program are ex-
pected to be issued by the end of
March.

The $375 million bill provides for a
program of grants, loans and con-
tracts to encourage the expansion and
development of both non-profit and
for-profit HMOs. In addition to defining
HMOs and the fixed payment (capita-
tion) method of financing, the Act re-
quires all employers with twenty-five
or more employees and covered by the
Fair Labor Standards Act to offer an
HMO option (dual choice) in its em-
ployee benefit plan. To qualify as an
HMO, the health care organization
must have consumers, i.e., subscrib-
ing members, comprising at least one-
third of its policy-making body.

Over the last three years the Mary-
land Regional Medical Program has

participated with other groups in the -

development of such an organization
in Baltimore, The Maryland Health
Maintenance Committee (MHMC). In-
corporated (non-profit) in February
1971, the MHMC was funded by the
Health Services and Mental Health
Administration of the Department of
Health, Education, and Welfare during
Fiscal Years '72 and '73 to develop a
network of prepaid group practice
health centers in the State.

MRMP awarded some $80,000 in
Fiscal Years '72 and '73 for research
and development efforts in quality as-
surance and information systems for
HMOs and demographic and _ third
party enrollment analyses.

The Cammittee created a non-nrofit

operational corporation, the Maryland
Health Maintenance Plan (MHMP)
which engaged in negotiations with
the Blue Cross of Maryland. After
sixteen months of negotiations, the
two organizations signed an agreement
in December, 1973 to collaborate, of-
fering the Committee's network pro-
gram to Blue Cross group subscribers
as an alternative choice to traditional
fee-for-service benefit programs.

It is expected that the Plan’s agree-
ment with Blue Cross wil! permit offer-
ing in the near future high quality care
in conveniently located health centers
in increasing numbers to the people
of Maryland. It will encourage the pro-
gress of these centers to operational
prepaid group practices through its
development effort.

The Maryland Health Maintenance
Plan is now anticipating enrollment
from the first subscriber group: The
State of Maryland is offering a dual
choice program for its 50,000 em-
ployees and retirees and their approxi-
mately 100,000 dependents.

Already in agreement to deliver
services to State of Maryland em-
ployees are the Columbia Medical
Plan in Howard County and the Group
Health Association of Washington,
D.C., through its two Maryland centers,
one in Rockville opening February 7
and one in Takoma Park, Montgomery
County. In addition, the Chesapeake
Physicians Professional Association of
Baltimore City Hospitals has contracted
to deliver services in east Baltimore in
conjunction with the Eastpoint Health
Center, Inc., a labor community cor-
poration organized to establish a con-
sumer-oriented HMO.

Negotiations are underway with a
medical group at Mercy Hospital in
downtown Baltimore; and merger dis-
cussions are in progress between the
Plan and the First Maryland Health
Care Corporation, funded by OEO to
deliver services to “grey area” popu-
lation. The merger is directed toward
eliminating duplication and achieving
maximum utilization of available re-
sources and exnerience.

The Pian will serve as a unifying ele-
ment as well as a development vehicle
to bring about the high quality health
care delivery intended by the new leg-
islation. The Plan is in a unique posi-
tion to take what has already been
done in operating centers and use it
to minimize development and operat-
ing costs in new centers.

The Maryland Regional Medical Pro-
gram (MRMP) approved two com-
panion programs in the Fall of 1971
—one involving funding support
($79,816) for the MHMC information
system and evaluation effort, and the
other involving funding support (ap-
proximately $140,000) to the Office of
Health Care Programs of the Johns
Hopkins Medical Institutions in an ef-
fort to develop an HMO information
system that would have general appli-
cability to HMOs. of a variety of types
and in a variety of settings. The MHMC
and the Office of Health Care Pro-
grams conducted these two programs
in concert.

In the near future, the MHMC’s activ-
ities in management information sys-
tems will be based on the actual re-
quirements of the operational network
and its participating health centers. As
a vehicle for consumer participation as
well as a coordinator of provider re-
resources, the Plan will work to de-
velop standards for medical groups
practicing in the network program. A
Medical Standards Board will be con-
vened to plan for establishing quality
assessment programs which satisfy the
medical community and contribute to
patient satisfaction.

One of the Plan’s vital roles in infor-
mation systems will be to use existing
forms and. systems, modifying them
where necessary to satisfy the quality
assurance and management data
needs of emerging network health cen-
ters. As in other areas, the Plan will
draw from the experience, procedures
and methods already developed in our
operating centers to assure the quality
of care in new health facilities and
minimize development costs by elimi-
nating the necessity of doing what has
already been done successfully.
horizons

When the Maryland Health Main-
tenance Plan begins its initial market-
ing and enroliment effort this Spring,
with from two to five autonomous pre-
paid group practice centers linked
organizationally, it will be the first time
a prepaid group practice plan has
initiated operations as a network.

Single copies of Public Law 93-222
“Health Maintenance Organization Act
of 1973", which was signed by Presi-
dent Nixon on December 29, 1973, are
available on request ot Maryland RMP,
Suite 201, 550 North Broadway, Bal-
timore, Maryland 21205.

MRMP Regional
Organ Procurement

continued from page 1

ney and the operating team could be
together and testing the viability of the
kidneys. With the advent of machinery
for extended organ preservation, far
better answers to this problem were
obtained.

if the kidney procured can be main-
tained in a healthy state for 40 to 80
hours on this machine, a patient from
even remote areas can be brought in
and made ready for transplant. All the
necessary tests to determine the match
and the viability can be carried out.
The characteristics of the kidney's per-
fusion on this machine is a major test
of its viability. Small versions of this
equipment are portable so that the kid-
ney may be transported to the site of
best matched recipient. Since. the
transplant programs of Maryland at
University of Maryland Hospital and the
Johns Hopkins Hospital participate in
the Southeastern Regional Organ Pro-
curement sharing program, it is often
necessary to transport kidneys from
Maryland to other parts of the region
and from other centers into Maryland.
With this machinery, there is no loss of
transplantability of the transported
organ.

Although hemodialysis and trans-
plantation have been available in
Maryland for the last six years and
more, the ability to effectively procure
organs has been limited by the ab-

sence of such equipment and staff -

trained in its operation. The Maryland
Regional Medical Program through a

grant to the combined Johns Hopkins/
University of Maryland transplant pro-
gram has made this available. Also
through help from MRMP a shared tis-
sue typing exists. Now a cooperative
organ preservation lab in University of
Maryland Hospital maintains a group
of organ preservation machines to be
continuously ready when organs are
procured. The equipment will be
shared by all procurement teams in the
region and portable units will be avail-
able at Johns Hopkins Hospital and
Baltimore City Hospitals as well as
University of Maryland Hospital. The
console machine which is not portable,
but can carry out more extended pre-
servation will be maintained in the cen-
tral laboratory.

HMO Information
System

continued from page 5

duplicative expensive drugs are dé-
leted from the formulary or are limited
in their use.

e Effect of changes in manpower
mixes on utilization. In both the Co-
lumbia Medical Plan and East Balti-
more Medical Plan, the number and
type of health care manpower has
changed with time.

e To assess the relationship of these
changes to services provided, a retro-
spective analysis of utilization data
stored from the encounter form is
being carried out.

Regional Medical Programs Are
Back in Business

The reappearance of HORIZONS,
MRMP’s publication, signals the end
of a long series of on-again off-again
non-events and vicissitudes set in mo-
tion by the “phase-out” telegram of
February 1, 1973 from Dr. Harold Mar-
gulies, who was then director of Re-
gional Medical Programs Service. De-
tailed chronological account of the
zig-zag events since then may be left
to historians and to constitutional
lawyers interested in the interaction
between executive, legislative, and
judicial branches of government dur-
ing a period of national stress.

Insofar as the Maryland Regional
Medical Program is concerned, the
matter has now been resolved (tempo-
rarily at least) by recent actions. In
October, 1973, the President signed
the HEW appropriation bill for fiscal
year 1974 which contained $81,953,-
000 for the Regional Medical Pro-
grams. At the same time he announced
release of $1.1 billion in impounded
health and education funds, but with
the stipulation that the funds are to be
stretched over fiscal years 1974 and
1975 (and perhaps longer). However,
on February 7, 1974 Judge Flannery of
the District Court of Washington ruled
that RMP impounded funds for FY
1973 and FY 1974 be released forth-
with (see page 4).

As a result of this, the Division of
Regional Medical Program (DRMP),
the new name for RMPS, is hosting a
National Conference of Regional Medi-
cal Programs on March 18-19, 1974 at
Arlington, Virginia to discuss the
future course for 1975. The Chairman
of the Maryland Regional Advisory
Group, Mr. J. Cookman Boyd, dr., and
the MRMP Coordinator, Dr. Edward
Davens, will attend this meeting.

According to present information, at
least $97 million in impounded RMP
funds for FY 1973 and 1974 are to be
released. MRMP will be expected to
submit two applications: One on May
1, 1974 and the second on July 1,
1974. These applications will include
funds for program staff expense
from July 1, 1974 through June 30,
1975 and new projects as approved
and priority ranked by the Maryland
Regional Advisory Group. The RAG
will meet in mid-April to act on the
May 1 application and again in June
for the July 1 application.

A variety of interesting project appli-
cations by various health groups and
agencies which deal with improve-
ments in the delivery of health care

. services are currently in preparation.

These pending applications are di-
rected to quality assurance of health

continued an neyt nana
horizons

 

RMP Back in
Business

continued from page 7

care, improving nursing care of the
aged and chronically ill, comprehen-
sive approach to hypertension control,
implementation of the recently issued
Standards for Cardiopulmonary Re-
suscitation (CPR) and Emergency Car-
diac Care (ECC), data systems for
manpower planning and criteria deter-
mination in large hospital out-patient
departments, and local planning by a
health services/education consortium
to improve access to primary care,
continuity of care, and a health serv-
ices regionalization model. :
One feature of the new turn of
events is $4.275 million has been set
aside on request by the Congress for
proposals on a national competitive
basis to develop models for ‘‘Compre-
hensive Arthritis Care Programs.”
Such a proposal is being developed
in Maryland for review by MRMP proc-
ess and then submitted to Washington.
A high level health official in HEW
has stated that a bipartisan concensus
exists among both the Congress and
the Administration that the three pro-

grams — RMP, CHP, and Hill-Burton

—should be consolidated as an im-
portant step in preparing for national
health insurance.

With this in mind, MRMP will exert
special effort to ensure that all projects
or proposals brought before the Re-
gional Advisory Group for approval
and setting of priorities will receive
careful review and comment either by
the Maryland Comprehensive Health
Planning Agency (the “A’’ Agency) or
by the Areawide Comprehensive
Health Planning Agency (the ‘’B”’
Agency) as appropriate. The objective
is to fund only projects that will fit
comfortably and merit continuation in
the anticipated reorganization by Con-
gress of the key functions of regula-
tion, planning and implementation.

horizons “a
Vol. 8, No. 1 March 1974” !

Published bi-monthly by the Mary-.
land Regional Medical ‘Program:
with offices in the Five Fifty Build-°
-. ing, 550 :North Broadway,
-.' more, Maryland 21205

  
  
 
 
 
 

 

Appropriate Motto
for MRMP?

“and it ought to be remem-
bered that there is nothing more
difficult to take in hand, more:
powerless to conduct, or more
uncertain in its success, than to
take the lead in the introduction
of a new order of things. Be-
cause the innovator has for
enemies ail those who have done
well under the old conditions,
and luke warm defenders in
those who may do well under the
new. This coolness arises partly
from fear of the opponents, who
have the laws on their side, and
partly from the incredulity of
men, who do not readily believe
in new things until they have had
a long experience of them. Thus
it happens that whenever those
who are hostile have the oppor-
tunity to attack they do it like
partisans, whilst the others de-
tend luke warmly, in such wise
that the prince is endangered
along with them.”

from the Prince: Nicolo Machiavelli,

published 1513 translated by
W. K. Marriott

 

 

The programs, projects and activities of the Maryland Regional Medical Program are operated. on a non-discriminatory basis. This
regulation prohibits discrimination on the basis of race, color, sex or national origin and applies to the provision of services, use
of facilities, opportunity to participate, practice of employment and granting of advantages, privileges and accommodations.

 

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