Maryland Regional Medical Program * March, 1974 so volume 8 number I o promoting cooperation to improve the quality and distribution of health care services 0 health manpower development 0 encouraging the regionalization of health facilities manpower and other resource. Maryland Regional Organ Procurement and Transplantation Program Receives Approval G. Melville Williams, M.D., Co-Program Director, Professor of Left, Ron E. Purser, Physician Assistant, Coordinator of Technical Surgery, Chief, Division of Transplantation, The Johns Hopkins Programs of Division of Nephrology, University of Maryland. Right, University School of Medicine 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. MRMP originally submitted this project ogy Division at the University of Mary- family member is able to give a kidney. proposal on October 31, 1972 to begin land School of Medicine, is the pro- If this kidney is well matched, the like- May 1, 1973. However, it was delayed gram director. G. Melville Williams, lihood of success is better than 80 by the "phase-out" telegram from M.D., Professor of Surgery and Head percent. Most people are not so for- RMPS on February 1, 1973. After re- of. Transplantation Surgery at Johns tunate. Their kidney must come from ceipt of the letter and memorandum Hopkins University is co-director. someone dying without renal disease. of September 7, 1973 from Dr. Herbert The program represents an out- This source of kidneys provides over J. 'Pahl, Acting Director of RMPS, it standing example of full partnership half the kidneys transplanted in Amer- was resubmitted with the full endorse- between the Region's two university ica each year, but this is only a small ment of the Regional Advisory Group, medical centers and other cooperating fraction of the need for transplants. It the Maryland Comprehensive Health institutions in furtherance of the goal is an even smaller fraction of the kid- Planning Agency, the Maryland Com- of a comprehensive regional program neys which might potentially be made mission on Renal Disease and the of care for all chronic renal disease available for transplant, some estimate Chronic Illness and Aging Administra- patients. It supplies the major missing 100,000 potential donors per year. tion of the Maryland State Department link in the Maryland renal program in Half of these would be enough. Last of Health and Mental Hygiene. The making transplantation the top priority year, there were less than 2,000 grant became effective October 1, in management of chronic renal dis- donors. 1973 for $35,960 and was extended ease whenever possible. MRMP is A major public and professional edu- January 1, 1974 through June 30, proud of the way in which the several cational program is carried on by many 1974 for an additional $29,038. It is ex- key health institutions involved have agencies to stimulate a broader will- pected that the program will be self- worked out really effective cooperative ingness to donate organs. Progress is supporting following July 1, 1974 from arrangements to make the most effec- slow. A major problem was obtaining third party payments from Medicare tive use of the resources available. kidneys at a time when the transplant (Section 2291, Title 11 of the Social For'most patients with chronic renal could be done, maintaining them in a Security Amendments of 1972), John failure, kidney transplant offers the viable state until the recipient, the kid- , .- . I - -I -@ @ - k I k,@+ fr@@f-.nt ;:nr Qr)mp r)f thpm n @, nnno 7 I- norizonf 2 New Projects Approved for Fiscal Year 1974 The Regional Advisory Group, acting decrease in available physicians serv- on instructions from RMPS dated Sep- ices. tember 7, 1973, approved a first re- Several years ago the State and quest application for $160,740 for the Areawide CHP agencies anticipated months of October, November and the problem and the former commis- December, 1973. A second request for sioned a "Study and Plan to Meet $226,878 for the new budget period Health Needs in Ocean City" by con- January 1, 1974 through June 30, 1974 sultants from the Operations Research was also approved, Division of the Johns Hopkins Univer- In addition to maintaining the re- sity School of Hygiene and Public duced program staff and providing a Health. modest fund for "mini-contracts," the One of the recommendations was to first request initiated the Maryland Re- form a Greater Ocean City Health Care gional Organ Procurement and Preser- Corporation which was accomplished vation Program and the contract with in part by previous MRMP support. The Pediatric nurse practitioner, Mrs. Marcia the Greater Ocean City Health Care objective of the Corporation is to bring Katz, demonstrates her skills in gaining Corporation to start implementing rec- together all those elements in the com- confidence of the child and his mother. ommendations of the CHP Ocean City munity responsible for the health of the, of nurse clinical practitioners, pediatric Health Care Study for solving problems area and to serve as the focal point nurse practitioners, nurse-midwives of accessibility to health services. Both for planning, development, implemen- and physician assistants. The RAG as- of these projects, which are briefly tation and evaluation of present and signed a no. 1 priority to this project. desc ribed below, had been included future health care services within its The program located at the School previously in MRMP's Anniversary Re- area of responsibility. At present a of Nursing, University of Maryland, has view and Application submitted on principal activity is the creation of a already prepared 1 6 registered nurses November 1, 1972, but were stalled by new Medical and Diagnostic Center, from rural and urban areas of Mary- the RMPS "phase out" telegram of w IC wou e related in t e uture February 1, 1973. to an existing community hospital for land to practice in this expanded role. secondary care and specialized diag- All 16 graduates are employed in com- The second request continued these nosis and to a university center for munity based programs or private two programs and added five addi- tertiary care and continuing profes- physicians' offices and have assumed tional projects. MRMP has also been sional education programs, full responsibility for a case load to assigned $1 78,620 (from FY 1973 provide primary care for infants and fund), but "expenditure of these funds Maryland Regional children in their respective agencies. cannot be made until instructed by Procurement and Preservation Activities include initial new born as- RMPS." In the most recent award sessments at local hospitals (in two of notice dated December 27, 1973, Program-$29,038 the rural counties); routine well baby which approved the application for (January 1, 1974-June 30, 1 974) health supervision; diagnosis and treat- January 1, 1974 through June 30, 1974, This program, which is a key compo- this instruction was continued. .nent of Maryland's comprehensive pro- ment of minor childhood illnesses; col- gram for the care of chronic renal dis- laboration with pediatricians; providing Since the extended budget year ease, is sponsored jointly by the Uni- continuity of care between the Health ended on December 31, 1973, carry- Department and the private sector; and over of $52,61 7 in estimated unex- varsity of Maryland and Johns Hopkins providing health guidance and coun- pended funds has also been approved. Medical Schools. This is described on seling to parents. page one. The objective of the present exten- Greater Ocean City Health Pediatric Nurse sion' is to prepare another group of 8 Care Corporation-$17,742 Practitioner Program- registered nurses to function in a pri- (January 1, 1974-June 30, 1974) $9,075 mary capacity in ambulatory health This is an example of health planning care for children through collaboration (January 1, 1974-June 30, 1974) to promote geographic equity of ac- This project is the only one which rep- with physicians and other health pro- cess to health services in a rural (but resents an extension of an existing fessionals. Some aspects of the curric- changing) area of Maryland's Eastern MRMP program. It deals effectively ulum will be revised as a result of the Shore where the summer (four-month) with the maidistribution-access prob- evaluation of the performance of the population soars from approximately lem which the Administration has re- 16 graduates now practicing, i.e. in- 3,500 in non-vacation months to nearly peatedly emphasized in recent policy creased emphasis upon defining, in- 200,000 at peak periods. This phe- statements, namely the high priority terpreting and implementing role nomenon has been accompanied by a which will be placed on increased use change for the nurse practitioner. After horizor)f 3 termination of MRMP support in July ment to provide reports to serve the Of course, the "end result" will need to it is expected that the program will con- following purposes: be adjusted for age and type and tinue from other sources of support 9 report patient care outcome as com- severity of the disease, available to the School of Nursing and pared to pre-established norms and In conjunction with the Medical Staff the activity will be coordinated with a standards of care for use in a medical of the participating community health similar program at the Johns Hopkins staff's medical audit function. centers, the Management Advisory School of Health Services to achieve * management and evaluation of the Services, Inc. will develop the key maximum benefit from teaching re- utilization/claims review, preadmission parameters for which norms and cri- sources and to avoid duplication of certification, and discharge planning teria will need to be established in the effort. functions. future for ambulatory services in com- * report all hospital data for service munity health centers, health main- Demonstration of a Model area analysis; utilization analysis; pa- tenance organizations and other or- Hospital Quality Assurance tient profile analysis. ganized health care delivery models Information System-$31,280 which are evolving. (January 1, 1974-June 30, 1974) Development of Quality Comparative evaluation of the pa- Assurance Norms, Criteria tient's health profile will be performed The primary leadership for this demon- and Standards for Community on the basis of disease category, as stration comes from the Maryland Hos- Health Care-$30,000 well as use rate of health care by dis- pital Association in cooperation with (January 1, 1974-June 30, 1 974) ease type. five hospitals-3 urban and 2 rural. In brief, the expected results are the The Maryland Foundation for Health The principal sponsor of this project is development of methods and proce- Care is also participating and discus- the West Baltimore Health Care Cor- dures for establishment of norms and sions are underway with other groups poration located in an urban setting in criteria for quality assurance of ambu- with a view to ultimate development of close collaboration with the South latory care on the basis of "outcome" a commonly held corporation to man- County (Anne Arundel) Health Care and "end results" as indicated by: age a statewide health services infor- Center which is located in a rural area. o The frequency and use pattern of mation service. Technical consultation and direction is the patient's ambulatory care, adjusted cry The project will demonstrate the provided by Management Advis for age, type and degree of disease. feasibility and effectiveness of per- Services, Inc., of Columbia, Maryland. For selected diseases this will result forming the following quality assess- The activity is directed towards de- in the establishment of numerical per- ment/claims review activities, consis- velopment of methods and procedures centile tables. tent with Joint Commission on Accred- to assess the quality of personal health . itation of Hospitals (JCAH) and Pro- care delivered in two ambulatory set- 9 An analysis of potential differences between urban and rural patient popu- fessional Services Review Organiza- tings, both administered by consumer lations pertaining to their use fre- tion (PSRO) requirements, through the citizen groups. quency and pattern of ambulatory care. use of a centrally managed, single, uni- . The program will utilize the data form, reporting and review process for: base of a currently operating computer 0 utilization review and certification of based encounter system to derive Supplementary Studies to medical necessity acceptable by third norms, - criteria, standards and tech- Augment State Comprehensive niques associated with current en- Health Plan-$7,299 party purchasers deavors to assure quality of care in (January 1, 1974-June 30, 1974) o the collection of uniform discharge various Federally funded medical care data abstract information programs. The encounter system has This is a supplementary grant adding o interfacing with medical audit func- a data base which includes disease to the State Health Plan Study currently tions diagnosis, medical procedures and being undertaken by the Johns Hop- Related objectives will be to demon- medication for every patient treated kins University Multidisciplinary Health strate the value and feasibility of de- for each encounter. Subsequently, dis- Planning Group. The source of funding veloping a single, uniform method of ease profiles and associated usage for the Maryland Health Plan Study is external third party claims surveillance rates of health care services can be the Maryland Comprehensive Health and utilization review which could be determined as a function of demo- Planning Agency. applied to all hospitals in the State graphic and socioeconomic charac- The supplementary activity has two and to all patients regardless of source teristics. main objectives of great interest to of payment, utilizing a process similar For example, the information con- MRMP: to that of the Maryland Admission Re- tent of the encounter form allows for o To describe and determine the vari- view Program (MARP) of the Maryland the comparative evaluation of different ous health services in 72 Maryland Fouri-dation for Health Care. medical procedures and medication hospitals and surrounding hospitals in Also the program will endeavor to and the outcome as indicated by the West Virginia, Virginia, District of Co- establish a health services information frequency and duration of acute and lumbia, Pennsylvania and Delaware. system utilizing a single source docu- intensive care required by the patient. Through the use of questionnaires horizonf 4 and personal interviews, these specific services and procedures available in Development of an H MO each hospital will be determined using levels of care methodology approach. Information System 9 To attempt to determine patient flow for Maryland to West Virginia, Virginia: Background - By December 31, Institutions, with grant support from the District of Columbia, Pennsylvania an@ 1973, the terminal date of the grant to Bureau of Health Services Research Delaware in order to determine overait the Office of Health Care Programs and and Evaluation (DHEW) and Founda- regional patient-flow patterns and the the Health Services Research and tions, is being directed at the issue. effects of hospitals located in the fiv Development Center of the Johns Hop- The groundwork laid by the MRMP surrounding areas on the Marylano kins Medical Institutions, the major grant is making possible this study of health care delivery system. objectives of MRMP Project #36, "De- the strengths and constraints of infor- velopment of an HMO Information Sys- mation systems in addressing specific Hypertension Materials tem," had been met, Briefly, these planning and evaluation questions. Development Project for objectives were directed at the devel- The Information System - Major Lower Socio-Economic opment of a data collection and infor- components of the information system mation system which would serve man- operating in the Columbia Medical Levels-$10,000 agement, clinical, and evaluation func- Plan and the East Baltimore Medical (January 1, 1974-June 30, 1974) tions that are particularly useful to Plan follow (the system has also been This is a modest cooperative project HMOs in their quality assurance and introduced in the Broadway-Orleans between the Central Maryland Heart related utilization review programs. Housing Project clinic, a non-HMO Association, the Educational Films Before considering the details of facility): Foundation (a non-profit organization) progress made, it is worth noting that o Routine reports of face-to-face en- and the MRMP, Financing is coopera- national events since the start of the counters between enrollees and pro- tive as well, e.g. total budget $25,400, project have increased the significance viders (physicians, nurse practitioners, plus one-half time of staff coordinator: of the program. The Health Mainte- health associates, and other mid-level Educational Films Foundation $15,400, nance Organization Act of 1973 (S.14) health personnel). MRMP $10,000 and Central Maryland emphasizes evaluation and there is lit- o Computer stored information about Heart Association one-half time staff tle question but that the development the encounter including identification salary. of data information systems in HMOs of patient and provider seen, diagnosis Objective is the production of audio will accelerate as a result. Contributing (or problem), procedures performed, visual materials suitable for use in ed- to this movement is the recent ap- disposition, referrals, laboratory tests, ucating and motivating known hyper- pearance of recommendations that de- and X-ray procedures ordered, pre- tension patients in the lower soci'o- fine the structure and content of such scriptions filled, unit cost assigned to economic level, with the object of systems and provide a minimum set of each service, and other descriptive making the patient a member of the items and tabulations for adoption by data about the visit. therapeutic team, HMOs.* The basic elements of the in- 9 Reports of hospitalizations and com- formation system developed under the puter storage of data on where pa- MRMP grant and implemented at the tient was admitted, dates of admission Columbia Medical Plan and the East and discharge, discharge diagnosis, NARMP WINS Baltimore Medical Plan are consistent surgical procedures performed, admit- with these recommendations and, in ting physician; computer files on am- SUIT fact, the experience with this system bulatory and in-patient care are being contributed to the formulation of the merged. A U.S@ District Court in Washington, recommendations, 0 Computer based enrollment file that D.C. on February 7, 1.974 has ruled in Accompanying the interest in infor- identifies families and each member of favor of the National Association of mation systems is the recognition that the family enrolled in the HMO; the RMPs in a suit calling for release of realization of their full potential for ad- file also contains information on per- impounded 1973 and 1974 funds. dressing management and clinical is- sonal characteristics (data of birth, sex, Judge Flannery enjoined any inter- sues related to economics and quality marital status, relationship of individ- ference with the actual spending of the of care in HMOs requires new reseach ual to primary subscriber, contractor money, denied a stay'pending appeal, efforts. A major activity of the Health group through which family enrolled). and ordered the government to pay Services Research and Development o Computer programs to retrieve in- costs of the plaintiff, The National Center, The Johns Hopkins Medical formation for currently defined man- Association of RMPS, Inc. A non-profit agement, clinical, and evaluative pur- corporation, NARMP -receives no pro- *Murnaghan, J. H. (Editor): Ambulatory poses (with aid of other grants these gram funds, but is supported entirely Care Data, Report of the Conference on programs are to be expanded during Ambulatory Care Records, Philadelphia, I D I rn 107@q 1974 and 1975). horizonf 5 Costs for operating the above sys- availability of comparative data in tem. Of interest here is how often a tem is being met by the HMOs where other prepayment medical plans. This more definitive diagnosis is made, they were developed under the MRMP has become apparent from the com- whether these patients are especially grant. Manuals and programs are avail- parisons made between the experience high utilizers, and in what situations able to facilitate the introduction of the in the East Baltimore Medical Plan and referrals are made for psychiatric con- information system by other HMOs in the Columbia Medical Plan and be- sultation. i the region, in consultation with the de- tween the experiences of these two To extend these applications to a velopmental staff. HMOs with those of other HMOs which wider range of conditions, a major in- Management Applications - A are producing similar types of data. vestment has been made to develop monthly series of reports to monitor Although this is still highly limited, it is an automated procedure for coding the the volume and types of medical serv- expected that as a result of the HMO diagnostic information being stored in ices rendered by the physician anci legislation and the recommendations text format. By February 1974, a dic non-physician practitioners in the HMO for establishing information systems tionary of terms and corresponding is in effect. This series routinely covers in organized health delivery programs, codes that are consistent with the many of the items of information on many additional sets of utilization data ICDA (and a compatible symptom list) the encounter form and reports of hos- will become available. The information will be programmed for this purpose. pita@ stays and is designed to provide system implemented through the All but a small proportion of the terms management with a means for de MRMP grant can be used to parallel that appear on the encounter form t almost all types of data that might will be codable. This will facilitate the mining (1) trends in utilization of d@irf: ferent specialties and non-physician conceivably be produced by both well conduct of many clinical and epidemi- manpower, laboratory tests, X-ray pro- established and newly emerging HMOs. ologic studies. cedures, drugs prescribed and hospi- Clinical Applications - A relatively Evaluation Applications - The im- tal care; (2) the influence of changes costly but essential item of informa- plementation of the HMO Information in subscriber composition on these tion for clinical application in quality System has opened the door to com- trends; and (3) the need to consider assurance programs is the statement plex evaluation studies of approaches modifications in manpower allocations. of diagnosis (or medical problem). The to increase the efficiency and quality of Utilization data are in the form of HMO Information System has routinely care in HMOs. Examples of the types numbers and rates per person per included this item in the computer of studies planned or underway that year and are aggregated on a "year to data bank and significant steps were are dependent on the information sys- date" basis to supplement the sum- taken during 1973 to develop profiles tem follow (all of the projects are sup- mary of monthly experience. Two addi- of medical care received by patients ported by other grants): tional sets of data that give insight to with specified diagnoses. With the par- 9 Utility of the information system for the functioning of the HMO are the ticipation of clinicians, several condi- quality of care assessment. Central to distributions of patients by number of tions have been selected to test the the review of outcome of care under encounters during specified periods capability of'the system to provide in- the Experimental Medical Care Review of time and the relationship between formation that would be useful in un- program (EMCRO) in the Columbia duration of enrollment and utilization. derstanding the patterns of care re- Medical Plan is the derivation of a The above data are related to co- ceived and variability in these patterns problem status index during each of a payment revenues and capitation costs associated with patient and provider repetitive series of inquires, followed to provide a basis for judging the characteristics. by evaluation and modification of the effect of demand for services on the Conditions that are being examined questionnaires. An objective of the current economics of the HMO and to from this standpoint include hyperten- EMCRO study is to measure change estimate future utilization and revenue sion, bronchial asthma, urinary tract in problem status over time and its re- in the program. Information on utiliza- infection and headache. In the care of lationship to accessibility and the ex- tion and enrollment that is computer hypertension, profiles of care have penditure of health care resources. In stored includes the identity of the been generated for patients who had coordination with the EMCRO study, membership group which makes it this diagnosis during the period. the relationship between process of possible to generate utilization, reve- September-December, 1972. Intervals care determinable from data stored in nue, and cost data for different groups. between initial diagnosis and first the information system and changes in In addition, the data will provide a follow-up visit, between first and sec- problem status will be examined. starting point in determining whether ond follow-up visit, etc. have been o Impact of drug utilization review on some groups require educational determined, medications prescribed prescribing practices. This project is efforts to improve utilization practices are being determined, and cases that designed to measure the change in (under or over utilization) with impli- require further studying to assess qual- prescribing patterns over time as ap- cations for both the economics of the ity of care are being identified. In the propriate criteria for drug use is im- plan and quality of care. case of headache, a sample of patients plemented in the clinic and to docu- The ability to assess utilization levels presenting this problem has been ment cost savings as non-essential or and costs would be enhanced by the identified through the information sys- continued on page 7 horizonf 6 HMO Legislation: Maryland Health Maintenance Plan Continues Local Involvement The long-awaited Health Maintenance operational corporation, the Maryland The Plan will serve as a unifying ele- Organization Act (of 1973) was signed Health Maintenance Plan (MHMP) ment as well as a development vehicle by President Nixon on December 30, which engaged in negotiations with to bring about the high quality health after some three years of legislative the Blue Cross of Maryland. After care delivery intended by the new leg- deliberation. According to the Amer- sixteen months of negotiations, the islation. The Plan is in a unique posi'- ican Medical Association News of Jan- two organizations signed an agreement tion to take what has already been uary 21, 1974, President Nixon is en- in December, 1973 to collaborate, of- done in operating centers and use it thusiastically endorsing the Health fering the Committee's network pro- to minimize development and operat- Maintenance Organization program ef- gram to Blue Cross group subscribers ing costs in new centers. fort. The government is "going all out" as an alternative choice to traditional The Maryland Regional Medical Pro- to implement the new law "as rapidly fee-for-service benefit programs. gram (MRMP) approved two com- as possible", according to Charles It is expected that the Plan's agree- panion programs in the Fall of 1971 Edwards, M.D., Assistant HEW Secre- ment with Blue Cross will permit offer- - one involving funding support tary for Health. Proposed regulations ing in the near future high quality care ($79,816) for the MHMC information to carry out the HMO program are ex- in conveniently located health centers system and evaluation effort, and the pected to be issued by the end of in increasing numbers to the people other involving funding support (ap- March. proximately $140,000) to the Office of of Maryland. It will encourage the pro- The $375 million bill provides for a gress of these centers to operational Health Care Programs of the Johns program of grants, loans and con- prepaid group practices through its Hopkins Medical Institutions in an ef- tracts to encourage the expansion and development effort. fort to develop an HMO information development of both non-profit and svstem that would have general appli- The Maryland Health Maintenance for-profit HMOs. In addition to defining Plan is now anticipating enrollment cat)iiity to HMOs of a variety of types HMOs and the fixed payment (capita- from the first subscriber group: The and in a variety of settings. The MHMC tion) method of financing, the Act re- and the Office of Health Care Pro- State of Maryland is offering a dual grams conducted these two programs quires all employers with twenty-five choice program for its 50,000 em- or more employees and covered by the ployees and retirees and their approxi- in concert. Fair Labor Standards Act to offer an mately 100,000 dependents. In the near future, the MHMC's activ- HMO option (dual choice) in its em- ities in management information sys- ployee benefit plan. To qualify as an Already in agreement to- deliver tems will be based on the actual re- HMO, the health- care organization services 'to State of Maryland em- quirements of the operational network must have consumers, i.e., subscrib- ployees are the Columbia Medical and its participating health centers. As ing members, comprising at least one- Plan in Howard County and the Group a vehicle for consumer participation as third of its policy-making body. Health Association of Washington, well as a coordinator of provider re- D.C., through its two Maryland centers, resources, the Plan will work to de- Over the last three years the Mary- one in Rockville opening February 7 velop standards for medical groups land Regional Medical Program has and one in Takoma Park, Montgomery practicing in the network program. A participated with other groups in the County. In addition, the Chesapeake Medical Standards Board will be con- development of such an organization Physicians Professional Association of vened to plan for establishing quality in Baltimore, The Maryland Health Baltimore City Hospitals has contracted assessment programs which satisfy the Maintenance Committee (MHMC). In- to deliver services in east Baltimore in medical community and contribute to corporated (non-profit) in February conjunction with the Eastpoint Health patient satisfaction. 1971, the MHMC was funded by the Center, Inc., a labor community cor- One of the Plan's vital roles in infor- Health Services and Mental Health poration organized to establish a con- mation systems will be to use existing Administration of the Department of sumer-oriented HMO. forms and systems, modifying them Health, Education, and Welfare during -Fiscal Years '72 and '73 to develo Nenotiations are underway with a where necessary to satisfy the quality a medical group at Mercy Hospital in assurance and management data network of prepaid group practice downtown Baltimore; and merger dis- needs of emerging network health cen- health centers in the State. cussions are in progress between the ters. As in other areas, the Plan will MRMP awarded some $80,000 in Plan and the First Maryland Health draw from the experience, procedures Fiscal Years '72 and '73 for research Care Corporation, funded by OEO to and methods already developed in our and development efforts in quality as- deliver services to "grey area" popu- operating centers to assure the quality surance and information systems for lation. The merger is directed toward of care in new health facilities and HMOs and demographic and third eliminating duplication and achieving minimize development costs by elimi- party enrollment analyses, maximum utilization of available re- nating the necessity of doing what has Tho (nmmittoiz erpntprf n nnn-nrnfit qntirrpq And experience. already been done successfully. ho(izonf 7 When the Maryland Health Main- grant to the combined Johns Hopkins/ HMO Information tenance Plan begins its initial market- University of Maryland transplant pro- ing and enrollment effort this Spring, gram has made this available. Also System with from two to five autonomous pre- through help from MRMP a shared tis- continued from page 5 paid group practice centers linked sue typing exists. Now a cooperative organizationally, it will be the first time organ preservation lab in University of duplicative expensive drugs are d6- a prepaid group practice plan has Maryland Hospital maintains a group leted from the formulary or are limited initiated operations as a network. of organ preservation machines to be in their use. Single copies of Public Law 93-222 continuously ready when organs are 9 Effect of changes in manpower "Health Maintenance Organization Act procured. The equipment will be mixes on utilization. In both the Co- of 1973", which was signed by Presi- shared by all procurement teams in the lumbia Medical Plan and East Balti- dent Nixon on December 29, 1973, are region and portable units will be avail- more Medical Plan, the number and available on request ot Maryland RMP, able at Johns Hopkins Hospital and type of health care manpower has Suite 201, 550 North Broadway, Bal- Baltimore City Hospitals as well as changed with time. timore, Maryland 21205. University of Maryland Hospital. The 9 To assess the relationship of these console machine which is not portable, changes to services provided, a retro- but can carry out more extended pre- spective analysis of utilization data MRMP Regional servation will be maintained in the cen- stored from the encounter form is Organ Procurement tral laboratory. being carried out. continued from page 1 ney and the operating team could be Regional Medical Programs Are together and testing the viability of the kidneys. With the advent of machinery Back in Business for extended organ preservation, far better answers to this problem were The reappearance of HORIZONS, As a result of this, the Division of obtained. MRMP's publication, signals the end Regional Medical Program (DRMP), If the kidney procured can be main- of a long series of on-again off-again the new name for RMPS, is hosting a tained in a healthy state for 40 to 80 non-events and vicissitudes set in mo- National Conference of Regional Medi- hours on this machine, a patient from tion by the "phase-out" telegram of cal Programs on March 18-19, 1974 at even remote areas can be brought in February 1, 1973 from Dr. Harold Mar- Arlington, Virginia to discuss the and made ready for transplant. All the gulies, who was then director of Re- future course for 1975. The Chairman necessary tests to determine the match gional Medical Programs Service. De- of the Maryland Regional Advisory and the viability can be carried out. tailed chronological account of the Group, Mr. J. Cookman Boyd, Jr., and The characteristics of the kidney's per- zig-zag events since then may be left the MRMP Coordinator, Dr. Edward fusion on this machine is a major test to historians and to constitutional Davens, will attend'this meeting. of its viability. Small versions of this lawyers interested in the interaction According to present information, at equipment are portable so that the kid- between executive, legislative, and least $97 million in impounded RMP ney may be transported to the site of judicial branches of government dur- funds for FY 1973 and 1974 are to be best matched recipient. Since the ing a period of national stress, released. MRMP will be expected to transplant programs of Maryland at Insofar as the Maryland Regional submit two applications: One on May University of Maryland Hospital and the Medical Program is concerned, the 1, 1974 and the second on July 1, Johns Hopkins Hospital participate in matter has now been resolved (tempo- 1974. These applications will include the Southeastern Regional Organ Pro- rarily at least) by recent actions. In funds for program staff expense curement sharing program, it is often October, 1973, the President signed from July 1, 1974 through June '30, necessary to transport kidneys from the HEW appropriation bill for fiscal 1975 and new projects as approved Maryland to other parts of the region year 1974 which contained $81,953,- and priority ranked by the Maryland and from other centers into Maryland. 000 for the Regional Medical Pro- Regi onal Advisory Group. The RAG With this machinery, there is no loss of grams. At the same time he announced will meet in mid-April to act on the transplantability of the transported release of $1.1 billion in impounded May I application and again in June organ. health and education funds, but with for the July I application. Although hemodialysis and trans- the stipulation that the funds are to be A variety of interesting project appli- plantation have been available in stretched over fiscal years 1974 and cations by various health groups and Maryland for the last six years and 1975 (and perhaps longer). However, agencies which deal with improve- more, the ability to effectively procure on February 7, 1974 Judge Flannery of ments in the delivery of health care organs has been limited by the ab- the,District Court of Washington ruled services are currently in preparation. sence of such equipment and staff, that RMP impounded funds for FY These pending applications are di- trained in' its operation. The Maryland 1973 and FY 1974 be released forth- rected to quality assurance of health Regional Medical Program through a with (see page 4). rnntinitpri nn npyt nan,- ho(izon/ 8 RMP Back in grams-RMP, CHP, and Hill-Burton Appropriate Motto Business -should be consolidated as an im- for MRMP? portant step in preparing for national "and it ought to be remem- continued from page 7 health insurance. bered that there is nothing more care, improving nursing care of the With t is in mind, P wi exe difficult to take in hand, more; aged and chronically ill, comprehen- special effort to ensure that all projects powerless to conduct, or more sive approach to hypertension control, or proposals brought before the Re- uncertain in its success, than to implementation of the recently issued gional Advisory Group for approval take the lead in the introduction Standards for Cardiopulmonary Re- and setting of priorities will receive of a new order of things. Be- suscitation (CPR) and Emergen'cy Car- careful review and comment either by cause the innovator has for diac Care (ECC), data systems for the Maryland Comprehensive Health enemies all those who have done manpower planning and criteria deter- Planning Agency (the "A" Agency) or we// under the old conditions, mination in large hospital out-patient by the Areawide Comprehensive and luke warm defenders in departments, and local planning by a Health Planning Agency (the "B" those who may do well under the health services/education consortium Agency) as appropriate. The objective new. This coolness arises partly to improve access to primary care, is to fund only projects that will fit from fear of the opponents, who continuity of care, and a health serv- comfortably and merit continuation in have the laws on their side, and ices regionalization model. the anticipated reorganization by Con- partly from the incredulity of One feature of the new turn of gress of the key functions of regula- men, who do not readily believe events is $4.275 million has been set tion, planning and implementation. in new things until they have had aside on request by the Congress for a long experience of them. Thus proposals on a national competitive it happens that whenever those basis to develop models for "Compre- who are hostile have the oppor- hensive Arthritis Care Programs." ho(izoni tunity to attack they do it like Such a proposal is being developed Vol. 8, No. 1 partisans, whist the others de- in Maryland for review by MRMP proc- tend luke warmly, in such wise Published bi-montl ess and then submitted to Washington. land Regional M, that the prince is endangered A high level health official in HEW with officei@in the along with them." has stated that a bipartisan concensus in , 550 '@North B 9 more, Maryland 21@ from the Prince: Nicolo Machiavelli, exists among both the Congress and published 1513 translated by the Administration that the three pro- 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. C'4 BULK RATE 4 C,4 0) fn -0 8 LO U. S. POSTAGE C:) to C,4 WLU- - P A I D 3: C> CC CJ - -C, BALTIMORE, MD. C) m 0 0 m PERMIT NO. 4496 t 00 E c6 C:) ncz) if Lo - 0 U- LO M N E 0 0 @cr -r- lzo- C]o co 0 tbr. #on 7 co -CZUI.2 0 OL Z9 co 0 < @o FL-0 oz 2