Health Planning Agencies Research Articles

Two magnetic scanners approved

The Food and Drug Administration has approved two magnetic resonance scanners, simultaneously opening a new window for the clinician in the diagnosis and management of disease and dumping a problem in the laps of the national health planning agencies. These planning agencies, which include private third-party insurers such as Blue Cross as well as the Health Care Financing Administration, are only now grappling with the problem of whether and under what circumstances they will approve coverage of scans done with magnets instead of roentgenograms. The scanners approved by the FDA's Bureau of Medical Devices are manufactured by Diasonics of Malpitas, Calif, and Technicare of Cleveland. Magnetic scanners have been under study for their potential in clinical practice for the past several years and have evoked a great deal of interest (<i>JAMA</i>[MEDICAL NEWS] 1984;251:869-877, 1982;247:151-159,<i>JAMA</i>1982; 247:1331-1334). Besides these two companies, other companies that manufacture similar scanners and are

Changing physician-hospital relations. Life in the fast lane.

In preparation for this talk, I reviewed the addresses of some of our previous presidents. I was impressed with their concern with both the social and economic influences of American surgery. Their talks collectively trace the evolution of the certifying boards, the appearance of the Joint Commission on Accreditation of Hospitals, the Residency Review Committee, and the early worries about the fragmentation of general surgery. Later, they described the intrusion of the regulatory agencies, with the passage of the Medicare laws, the Professional Standards Review Organization legislation, and then the appearance of the Health Planning agencies. These earlier addresses are a wonderful source of information about influences that society and government have had on American surgical training and practice. This year there is a new array of influences that we must understand and deal with. For some time, I have been fascinated by the relationship between the quality of medical

Evaluating health planning: empirical evidence on HSA regulation of prepaid group practices.

The regulation of HMOs by health planning agencies serves as a "tracer" to aid in evaluating HSAs, and as a source of empirical evidence for the heretofore largely theoretical health policy debate between market reformers and regulators. Two complementary studies (the authors' 1979 survey investigating the hospitalization policies of prepaid group practices, and AMPI 's study of all HMO applications submitted to HSAs from 1975 through mid-1978) provide information about the extent of HMO applications to planning agencies, the rate of rejections, the burden of the planning process of HMOs, and the possibility that negative perceptions of regulation may have led HMOs to refrain from activities requiring planning approval. Both studies reveal that health planning review was detrimental to 20 to 30 percent of HMOs. Thus data collected during the period of extensive HSA regulation of HMOs seem to justify the current policy that gives HSAs only very limited authority over HMOs.

Sounding Board. The evolution of health planning.

Public Law 93–641, the National Health Planning and Resources Development Act of 1974, provided direct federal financial support for both state and local health-planning agencies. It mandated the d...

A model for assessing patient education

Patient education is becoming a more visible activity. The Michigan Hospital Association and the Michigan state health planning and resource development agency (Office of Health and Medical Affairs) agreed to jointly pursue a patient-education project to determine its effectiveness. The overall goal of the project is to determine generically what constitutes a quality hospital-based patient-education program. This paper focuses on the development of a model for assessing patient-education programs. Through a multistep process 18 criteria were ultimately selected to serve for patient-education assessment. An analysis and description of the utility of the criteria is presented. The need for establishing and maintaining quality in patient-education programs has been established. The criteria developed for the project offer the potential of meeting this need.

Health Systems Agencies and Planning of Pediatric Hospital Services

Health Systems Agencies (HSA) are the official national health planning and regulatory agencies in the United States. This case study examines three HSA activities: determination of need, review and approval of federal grants, and appropriateness review. The article raises questions about planning assumptions and suggests the need to simplify regulatory process and strengthen standards of pediatric care in community hospitals.

Public participation in health planning agencies: promise and practice.

Federal legislation provided an opportunity for health planning to "catch up" with the expanding citizen participation movements of recent years. Although the literature on health planning is mounting, there as yet has been no comprehensive, systematic effort to inventory the status of participation on a national scale. This note reports on a national study of Health Systems Agencies designed to inventory the participation objectives and methods in use, identify major participants and obstacles, and analyze impacts and factors influencing practice in the field. Among the findings are that agencies have favored "safe" participation methods that satisfy minimum federal requirements and provide information and public relations without transfer of power to consumers; and have broadened the base of participation in planning without mobilizing consumers or reducing the dominance of providers, who remain the most active, organized, and influential participants.

Strategies for building representative HSAs: the impact of legal structure.

The goal of having local health planning agencies represent their communities is considered. A basic premise is that the legal structure of an agency is related to how well a community is represented. This premise is tested, and two strategies are presented for building HSAs which will include strong representation of traditionally under-represented or under-served groups: (1) increasing competition for governing-body membership by requiring all planning agency governing bodies to be small (30 members or less); and (2) increasing the organizational simplicity of the HSA.

Conditions on Certificates of Need: Approval at What Price?

Providers and health planning agencies familiar with the federaily mandated Section 1122 and certificate of need (CON) programs had mixed reactions to the passage of the 1979 amendments to the National Health Planning and Resources Development Act (the 1979 Planning Act Amendments), especially the addition of Section 1527 which prescribes specific federal requirements for state CON programs. One of the most controversial provisions of Section 1527 is the so-called conditions amendment, often referred to as the “Satterfield amendment.” The conditions amendment has crystalized by statute a power that many planning agencies had previously assumed and that most hospitals had feared: state health planning and development agencies (SHPDAs) have the legal authority to issue CONs subject to conditions that require applicants to undertake actions unrelated to those for which they sought approval. At the same time, however, the conditions amendment vindicates a notion long held by providers and rejected by some planning agencies: the SHPDA's conditioning power is not unlimited; while some conditions are permissible, others are not.

A case-mix method for developing health planning criteria for hospital services.

The principal concern of this article is the inadequacy of the planning criteria currently being used by existing federally funded health planning agencies. A case-mix method was created for developing appropriate criteria. Chart-abstract data from New Jersey were used to create a list of those diagnoses eligible for treatment in the cardiac care unit (CCU), select a sample of hospitals for study and analyze the relationship between CCU bed need and CCU clinical practice. It was shown that existing bed-need criteria for CCU planning represent current CCU clinical practice patterns, which are probably not cost effective. The method was also used to develop empirical values of these criteria, which do represent cost-effective practice. It is recommended that the method be used to strengthen and update continuously all hospital-service need criteria used in current planning activities, including Plan Development and Certificate of Need Review.

Functional fiefdom, poverty model or individualism? Development of intergovernmental relations in health planning

The United States national government has the power under the National Health Planning and Development Act of 1974 to establish and exercise legal control over a system of Health System Agencies, State Health Planning and Development Agencies, and State Health Coordinating Councils. Although the national government appears to have the legal powers necessary to direct and control the health planning process, a federal system has difficulties in the implementation of planning which has centralized goals or direction. The states and regions have the potential power to weaken the strength of the national government. Three trends in the developing relationship between the national, state, and regional units in health planning are discussed. The first, the functional fiefdom, consists of self-perpetuating, narrow purpose agencies which are not responsible to local or state-wide elected officials. These are professional bureaucracies which create and reinforce cozy relationships with supportive interest groups. The second trend, the poverty model, includes the lack of control by local elected officials, a large role to nongovernmental actors, and a direct relationship between Washington and the regional planning agencies. The last trend appears to be an individualistic one with every unit fending for itself. A case study of Massachusetts along with supplemental materials from other states is presented to illustrate the trends.

Nurses as Health Planners

Nursing leaders have the knowledge and responsibility to serve on the boards of health planning agencies. This article provides suggestions and strategies for developing your role as an active and articulate member of a health systems agency.

Pharmacy and health planning: A national survey of health planners

The extent of pharmacy involvement in area health planning, and the perception of health planners on pharmacy and drug-related issues, were assessed. Health Systems Agencies (HSAs) (135, or 66%) and State Health Planning and Development Agencies (SHPDAs) (25, or 45%) responded to a 34-item mail questionnaire on pharmacy planning issues. Pharmacists were involved in developing health plans in 39% of the HSAs and 18% of the SHPDAs. Pharmaceutical services were mentioned in 50% of the local and 58% of the state plans. Thirty-two percent of the HSAs and 42% of the SHPDAs believed there was a poor distribution of pharmacies in health service areas. The respondents also answered questions on the need for pharmaceutical services in given areas and among special populations, drug reimbursement procedures, and the kinds of data health planners need when planning pharmaceutical services. Numerous respondents noted that increased participation by pharmacy groups in health planning would be desirable and welcomed.

Health care planning: acts, agencies, and activities of the federal government.

Healthh care planning and provision are societal responsibilities supported by the federal government since 1798. To maximize benefits of money spent on health care during the past two decades, the federal government created in succession Regional Medical Programs, Medicare and Medicaid, area-wide Comprehensive Health Planning Agencies, and Professional Standards Review Organizations, and enacted the National Health Planning and Resources Development Act of 1974. Health care planning consists of three phases: assessment, planning, and implementation. Intrinsic to these activities are decisions concerning the extent to which society is willing to devote its resources, the types of health care to be given, and to whom services will be rendered.

The Paradoxes of Health Planning

The National Health Planning Act of 1974 designated 200 Health Systems Agencies (HSAs) nationally and a State Health Planning and Development Agency in each state. Components of the law are analyzed to illustrate its ambiguities and contradictions. The components analyzed are: the findings which led to the passage of the law; the law's purpose; the ten national health priorities; the National Guidelines for Health Planning; the purposes of the HSAs and the data they are to assemble and analyze. The major contradiction is that agencies designated to focus on cost containment in health care are expected to make health care services more accessible and acceptable, and improve their quality. These agencies are also expected to improve the health of the population, including ill health attributable to environmental factors.

The confrontation between national health planning and the federal anti-trust laws.

The confrontation was inevitable. The Federal Government has for many generations since 1890 been dedicated under the Anti-Trust Laws to competition among enterprises and to the prevention of business monopoly and monopolistic practices. recent years, however, the health planning programs enacted by Congress and by many states have embarked upon course in exactly the opposite direction. It has been decided that competition on price, availability, and quality of clinical services in the health care industry is not generally in the best interests of the people of this country. Cooperation even to the extent of monopoly is being encouraged and mandated by health planning agencies established under federal grants and controlled tightly by increasingly detailed federal regulations. Competition among similar clinical services has been determined to be waste of scarce resources. Monopoly has been found to be cost efficient and is therefore promoted. These may seem to be severe statements. They are not. the most important of the court cases to face this issue, the Court found that there was a plain repugnancy between the National Health Planning and Resources Development Act of 1974 (Public Law 93-641) and Anti-Trust Laws. The Court quoted Representative Paul Rogers, the law's most prominent sponsor, speaking on the floor of Congress: In enacting Public Law 93-641, . . . the Congress made specific judgment that control of the development of health care facilities was needed even though price and service competition might be restrained, and created health planning system that could promote the efficient use of health resources through the regulation of and voluntary action of providers.' The most direct control mechanism utilized by the health planning agencies in regard to capital development and acquisition has been the requirement of certificate of need-a concept borrowed from the field of public utilities, field of monopoly business. the first major court confrontation on this issue, the North Carolina Supreme Court found the State Certificate of Need Law to be unconstitutional as violation of the anti-monopoly provisions of the North Carolina Constitution.2 Most of the anti-trust laws in this country, both federal and state, are statutory, not constitutional. Therefore the North Carolina decision did not have great impact in other states or upon the federal program. It remained for the issue to be joined directly between the two opposed federal legal policies in Federal Court reviewing an application of the programs of Public Law 93-641. That has now happened in two Federal District Courts in different parts of the country. These Courts are at the trial level, the first level, of the federal system and cannot be considered at all the last word on the subject. It is very important, however, that both Courts found that the Health Planning Law was clearly in conflict with the Anti-Trust Laws and also ruled that the application of the earlier Congressional enactments were impliedly repealed in relation to the activities of health provider organizations acting in compliance with the health planning program. The latest case, National Gerimedical Hospital and Gerontology Center v. Blue Cross ofKansas City, 3 follows similar conclusion reached in Port Huron Valley Hospital, Inc. v. City ofPontiac.4 There were number of other issues examined and decided in the National Gerimedical Hospital case, including the ruling that Blue Cross contracts with providers are covered under the Anti-Trust Laws and are not exempt as the business of insurance. this respect, the Court was following the quite recent ruling of the U.S. Supreme Court in the Royal Drug case.5 the particular case, Blue Cross of Kansas City had refused to accept National Gerimedical Hospital as participating hospital in the Blue Cross program. The reason for the refusal was that the Hospital had not sought and had not received voluntary certificate of from the local health planning agency acting under Public Law 93-641. Blue Cross therefore refused to recognize the Hospital as filling a clearly evident need in the geographic area being served. The Hospital was not allowed to bring evidence to Blue

The effects of regional planning on a rural hospital: A case study

The growth of regional health planning in the Rochester region is described, and it is pointed out that much of the impetus came from cost-conscious industrial leaders. Then the impact of the increasing regulatory powers of various health planning agencies on one local community attempting to build a new hospital is discussed. The successful effort to build the new hospital has resulted in the attraction of new physicians to the community, which had until then been in danger of losing the few physicians who still provided care to local residents. The new physicians were necessary in order to enlarge the hospital catchment area, attract more patients and pay for the new hospital. Other important consequences for the community were related to the infusion of jobs and money that the new and enlarged hospital provided. Moreover, along with the school system, availability of health care is important if suburbanizing communities are to attract new residents and become economically viable. Thus, the fact that this community was able to build a new hospital gives it a competitive edge over other subdominant communities within the regional economy.

Decisionmaking in regional health planning agencies.

Health Systems Agencies (HSAs), the new regional health planning agencies established by the National Health Planning and Resources Development Act of 1974, have as their major goals quality, accessibility, continuity and cost containment. One of the tools for cost containment available to HSAs is their active participation in the statewide certificate-of-need (CON) program. To help anticipate how HSAs may play their CON roles, this article reviews the CON decisionmaking processes of two Comprehensive Health Planning (CHP) agencies, the predecessors of HSAs. While most CHPs lacked specific health plans and powers. the two California agencies examined have had both regional plans and roles in CON programs comparable to the present HSAs'. Our focus is on the decisionmaking process rather than the effectiveness of CON programs. A simple descriptive model is developed based on the assumptions that the planners seek satisfactory, rather than optimal solutions and that the data available are extremely limited. The cases analyzed suggest that, while most projects exceed the bed need standards, institutions were almost always able to demonstrate a need through various special circumstances. Once a need has been shown, the agency was able to deny an application only if a better alternative were available. This study suggests two approaches to improving regional health planning decisionmaking. First, identified needs can be better met either by increasing the agency's ability to generate alternatives or by encouraging health facilities to submit competing applications. Second, a regional health care budget would force the agency to make choices among competing needs.

Guidelines for Pediatric Cardiology Diagnostic and Treatment Centers

This document describes the clinical and physical environment in which infants and children with heart disease can undergo accurate and safe diagnostic procedures and cardiac surgery. Guidelines in this statement are in concert with previous guidelines developed by the Intersociety Commission for Heart Disease Resources.1-4 These guidelines have been developed for use by health planning agencies and health service organizations to evaluate existing pediatric cardiac centers and to establish the need for the development of new centers. Young patients with heart disease have identifiable needs that can only be adequately met by a team of experts with training and experience in the management of pediatric cardiovascular disease. Accurate anatomic diagnoses, hemodynamic and electrophysiologic assessments of acquired and congenital cardiovascular disease, and the treatment of these diseases are the responsibilities of a pediatric cardiologist in association with the primary physicians and other health professionals. There is a need for guidelines so each center can assess its performance and be assessed by peer review in the context of regional and national guidelines. The purpose of this document is to recommend guidelines by which this evaluation can be accomplished and offer mechanisms by which the quality of pediatric cardiology care can be assured. Background Pediatric Cardiology Patients. To allow for continuity and expertise of patient care, the Section on Cardiology of the American Academy of Pediatrics believes that infants, children, and adolescents (from birth to age 21 years) with major heart disease should have access to the care of a pediatric cardiologist who, along with the child's primary physician, should provide a continuing care program for the patient.

Regional differences in surgical care based upon uniform physician and hospital discharge abstract data.

Population based surgical rates for various common surgical procedures were analyzed on a regional basis by examining select uniform hospital discharge abstract data from Wisconsin hospitals. The surgical asbracts of nearly 64,000 procedures were compared to the supply of physicians and showed a significant variation in the rates of common procedures even within rather large planning districts. In general, the volume of surgery correlated with the supply of surgeons. Exceptions were noted; for example, primary appendectomy, tonsillectomy and adenoidectomy (T & A), and inguinal herniorrhaphy did not correlate with the supply of surgeons, but did correlate with the supply of general practitioners. Further, T & A had a strong negative correlation to the supply of ear, nose and throat specialists. Information of this type has significance both for Professional Standard Review Organizations (PSROs) and Health Planning Agencies (HPAs). Further work will be necessary to define optimal surgical rates.