-
https://clinton.presidentiallibraries.us/files/original/7f2efe20b4a6dba9cc82eb11a0c32ab3.pdf
141c67cab44285868549373ff2c12a8f
PDF Text
Text
FOIA Number:
2006-0885-F
FOIA
MARKER
This is not a textual record. This is used as an
administrative marker by the William J. Clinton
Presidential Library Staff.
Collection/Record Group:
Clinton Presidential Records
Subgroup/Office of Origin:
Health Care Task Force
Series/Staff Member:
Jamieson
Subseries:
OA/ID Number:
4786
FolderlD:
Segment 3
Folder Title:
[Interest Groups] [loose] [2]
Stack:
Row:
Section:
Shelf:
Position:
S
53
3
3
3
�-0 U
&
Hepworth Associates
660 HIGHLAND DRIVE
PT. ROBERTS, WASHINGTON 98281
206/945-1370 TELEPHONE
206/945-1371 FAX
R. Gordon Hepworth
MD, FACS, FRCSC
. „„ , . .
ArriLiAi IUINO.
Buckingham, Doolitile
& Burroughs
Altorncys
Jack Diamond. J.D.
216/376-5300
T
n N <
Medical Management
Development Assoc.
1-800/25 LEARN
April 27 1993
Ira Magaziner,
Senior Aide Health Care Task Force,
The White House,
1600 Pennsylvania Avenue,
Washington, D.C. 20500
Page 1 of 2
Dear Mr. Magaziner:
The enclosed Universal Health Care Act written for the United States has
been prepared by myself and colleagues. We are not a lobby group and the Act is not
in any way connected with any branch of organized medicine, any group or groups who
maybe considered to have vested interests, including insurance companies, and it will not
help our group work in any way. Also, I have no fiscal interest in any aspect of the Act
or the computer system proposed for cost control. The Act takes the profit out of
managing ill health.
The Act is an enabling Act for introduction of Universal Health Care and is
based on the President's enunciated requirements for a health care plan: Universal
coverage, limitation of costs, global budgeting, cost control. It gives significant flexibility
to States as long as they operate within federal guidelines.
As you know there are at least four different standards of care in the U.S
today:
Private Sector: In general high quality care.
Medicaid:
The standards are disgraceful and many providers refuse
to handle medicaid patients.
Medicare:
The standards are almost as bad as medicaid. Senior
citizens deserve a decent standard of care equivalent
to that in the Private Sector. Currently, they do not
even have the right to be private patients.
HMO/PPO/GROUP: These limit the choice of physician and in most cases
limit care to a specific geographic region.
�Page 2 of 2
There are four criteria enunciated in the plan:
Public Administration
Comprehensiveness
Universality
Portability
Accessibility
The Act covers financing, cost containment and utilization issues. A
government already has in effect a computerized system which processes claims,
pays accounts, and initiates peer review. The system is very effective in printing out
standard deviations and has massive abilities in cost containment without impacting the
quality of care. It is attached as an addendum to the Act and is available.
A summary of the Act is at the beginning of the document and there is an
index covering all aspects of the Act. Although the Act will stand alone as it is presented,
I believe a different system would use large pieces of the proposed legislation as there
is the unique cost control aspect.
The Act has not been circulated to any group or to the public and is
submitted only to help you in finalizing the legislation for presentation to congress.
A great deal of work including research, has gone into preparation of this proposed
legislation, for which no return is expected. The Act has not been released to the media.
The Act has an initial summary, a table of contents, and is prepared as
though it was going directly to congress. It will stand alone.
My own interest was sparked by the fact I practiced under the British
system, under the Canadian system, and under various different group, university, HMO
and other systems in the United States, so I have a great deal of understanding about
what each means.
My request is that the enclosed Act be read and be given consideration in
the preparation of your proposed legislation. It would be disappointing if this was ignored
because it did not come from a pushy political lobby group,
R.Gordon Hepworth M.D., FRCSC, FACS
Enclosed: Universal Health Care Act for
the United States
�uumn
HEALTH
T
To be enacted by the Senate ^ House of Representatives of
the
United States
R
Hepworth Associates
He
w
G
- £2?!} P orth, M.D.
660 Highland Drive
Point Roberts, WA 98281
�(UHMMiiai&iL mmm ©mm
To be enacted by the Senate & House of Representatives of
the
United States
�RICHARD GORDON HEPWORTH, M.D.
660 HIGHLAND DRIVE
POINT ROBERTS, WA 98281
206/945-1370 FAX 206 945/1371
ACADEMIC QUALIFICATIONS' • • •
Vie Grammar School, Batley, England
University of Leeds, Leeds, England
Member Royal College Surgeons, England
License Royal College of Physicians
License Medical Council of Canada
Certified Specialist in Urology
Fellow Royal College of Surgeons
Fellow American College of Surgeons
Licenses: Arkansas, Calif., Iowa, Tennessee
EXPERIENCE OVERVIEW
Doctor/Medical Superintendent
Family Practitioner
Urology Training
Urologist/Management Positions
Teaching/Management/Clinical
Health Maintenance Organization (HMO)
Medical Director, Whittaker Health Plans
Hospital Medical Director
Medical Director (PRO)
Faculty Member:
University British Columbia
University Tennessee
C.O.M.P. College, California
Medical Management Development Assoc.
Medicare: Hospital/Physician Advocate
HEPWORTH ASSOCIATES (est 1989)
Graduated with Scholarships
(Equivalent of M.D.)
(M.R.CS.)
(LR.C.P.) London
(LM.C.C.)
Canada
United States
Government Hospital
Arctic, Prairies
Toronto Western Hospital
British Columbia, Tennessee
British Columbia, Tennessee, California
CIGNA Health Plan, California
California
California
Professional Peer Review Organization
Health Care Financing Admin.
PRESENT
OTHER APPOINTMENTS/HONORS
Chairman, Vancouver Board of Trade Health Commission
President, Corporate Medical Practice and Alexard Holdings
President, International Flying Physicians Association
Hospital Positions, Various Hospitals (QA/UR)
Publicatiotts: Professional papers and novel "Making of A Chief"
�To be enacted by the Senate & House of Representatives of
the
United States
�SUMMARY OF PROVISIONS IN THE HEALTH CARE ACT
The intent of the Act is to ensure as a right that all American citizens, or legally
designated permanent residents of the United States, be entitled to health care at any
given time if they so choose, without financial or other barriers.
Each state of the United States and the District of Columbia will provide a
Comprehensive Medical Plan. Administration will be carried out by a public body and
each State will be subject to criteria established by Federal guidelines ensuring a
comprehensive and universal plan with complete freedom of choice of physician.
Financing of the plan will be achieved from Federal and State funds using
existing revenue bases plus employers' contributions and contributions from individuals
designated as insured persons with exceptions as set out the Act.
The plan will be portable in structure so as to allow insured persons of one
State to obtain health care in any other State with certain restrictions as detailed in the
Act. Health care services must be on a uniform basis and be accessible to all
Americans with benefits and exclusions as outlined in the plan.
All recipients of Social Security payments will be assessed the amount to
cover Medicare Part B, which will be collected by the Federal government. All persons
will be required to pay a deductible for services as outlined in the plan. Individuals who
have no taxable income however, will not be required to make any payment towards
provision of their health care, nor will they be required to pay any deductible.
For persons requiring emergency admission to hospital the deductible will be waived.
Cost containment is of critical importance to the plan. Each State shall
determine a per diem for each hospital who will be required to participate in the plan
as outlined in the Act. Licensed physicians and other licensed practitioners
participating in the plan will have a uniform fee schedule worked out by negotiation
between the State Medical Association and The State Health Care Authority as
outlined in the Act.
Payment of accounts to providers by each State Health Care Authority will be
managed and controlled by a computerized system capable of processing claims while
at the same time the system will be assimilating other statistical information as
outlined in the Act. The system has the ability to print out data, as required, to permit
monitoring of all fiscal aspects medical practice as well as utilization of services
based on material collected and entered into the computerized system. This ensures
meaningful peer review and identifies aberrant patterns of practice which allows Peer
Review Committees to evaluate performance as outlined in the Act.
�TABLE OF CONTENTS
PAGE
SECTION
SECTION I
INTENT OF THE ACT
CITIZENS RIGHTS
PROFIT MOTIVE
1
1
1
SECTION II
COVERAGE & EXCEPTIONS
ARMED SERVICES
VETERANS
WORKMEN'S COMPENSATION
RESPONSIBILITY OF THE STATES
2
2
2
2
2
CRITERIA
"THE HEALTH CARE AUTHORITY"
ADMINISTRATION
COMPREHENSIVE
UNIVERSALITY
PORTABILITY
ACCESSIBILITY
PUBLIC ADMINISTRATION
THE HEALTH CARE ADMINISTRATION CRITERION
DELEGATION OF AUTHORITY OF THCA
3-8
3
3
3
3,5
3,5
3,5,6
3,7
4
4
4,5
DEFINITIONS
AMERICANS
BIRTHING CENTER
CHRISTIAN SCIENCE SANATORIUM
CONVALESCENT FACILITY
CUSTODIAL CARE
DRUG & ALCOHOL
HEALTH CARE PLAN
HEALTH CARE PRACTITIONER
HOME HEALTH CARE AGENCY
HOSPICE AGENCY
HOSPICE CARE
HOSPICE FACILITY
HOSPITAL
INSURED
MEDICAL PRACTITIONER
MEDICAL SUPPLIES
NON-OCCUPATIONAL DISEASE
8-16
8
8,9
9
9,10
10
10,11
11
11
11,12
12
12
12,13
13
13
14
14
14
SECTION III
SECTION IV
�NON-OCCUPATIONAL INJURY
NURSE ANESTHETIST
NURSE MIDWIFE
OCCUPATIONAL ILLNESS
PHYSICIAN ASSISTANT
PHYSICIAN OR SURGEON
PER DIEM
PHYSICIAN SERVICES
PROSTHbllC DEVICE
SECRETARY
SKILLED NURSING FACILITY
THE HEALTH CARE AUTHORITY
14
14
14
14,15
15
15
15
15,16
16
16
16
16
16-35
SECTION V
COMPREHENSIVE MEDICAL EXPENSE BENEFITS
COVERED SERVICES
AMBULANCE
PRE-ADMISSION TESTING
SURGICAL PROCEDURES
SECOND OPINION
DURABLE MEDICAL EQUIPMENT
MEDICAL SUPPLIES
DRUGS & PRESCRIPTIONS
PROSTHETIC DEVICES
BOARD & ROOM
REHABILITATION SERVICES
HOSPITAL EMERGENCY ROOM SERVICES
ALCOHOL & DRUG REHABILITATION SERVICES
PREGNANCY BENEFITS
BIRTHING CENTER EXPENSES
CONVALESCENT FACILITY
HOME HEALTH CARE
HOSPICE CARE
SKILLED NURSING FACILITY
INSTITUTES OF EXCELLENCE
SPECIAL SERVICES
MEDICAL SERVICES OUTSIDE THE U.S.A.
SPECIAL SERVICES: CHILDREN
SPECIAL SERVICES: SENIORS
PUBLIC HEALTH BENEFITS
SCREENING
IMMUNIZATION
SECTION VI
Page 2
16
16
16,17
17
18
18,19
19,20
20
20,21
21,22
22,23
23,24
24
24,25
25,26
26
27
27,28
28,29
29,30
30,31
31,32
32
33
33
34
34
34
PLAN SUMMARY OF COVERED SERVICES
35-37
�SECTION VII
FINANCING
PAYMENTS TO STATES
REVENUE BASE
STATE REVENUES
INSURED'S RIGHTS & OBLIGATIONS
MEDICAID, MEDICAL, MEDICARE
INDIAN HEALTH SERVICES
EMPLOYERS
MATCHING CONTRIBUTIONS
TAXABLE INCOME
MEDICARE PART B
DEDUCTIBLE
EXCLUSIONS FROM DEDUCTIBLE
FAMILY MEMBERS
EMPLOYMENT, STATUS CHANGES
SMALL, L^RGE EMPLOYER
TERMINATION
INDEPENDENT CONTRACTORS
MULTIPLE EMPLOYERS
DIVORCE, SEPARATION
NEW BORNS
CUSTODY, ADOPTION, FOSTER CHILDREN
PRIVATE PATIENT RIGHTS
NON-PARTICIPATING PRACTITIONER
PENALTIES
38-46
38
38,39
39,40
40-45
40,41
41
41
41
41
41
42
42
42
43
43
43,44
44
44
44
44,45
45
45
46,5^
46
SECTION VIII
PAYMENT, COST-CONTAINMENT,
DISCIPLINARY ACTION
HOSPITAL CONTRACTS
PER DIEM & THCA
DEFICITS
AUDITS
FRAUD
SPECIALIZED HOSPITALS
PRIVATE BENEFACTORS
NEW EQUIPMENT
APPROVAL OF THCA
APPLICATIONS BY HOSPITALS
NEW CONSTRUCTION
LICENSED PHYSICIANS
FEE SCHEDULE AND THCA
BILLING
PRIVATE PATIENTS
NON-PARTICIPATION
46-57
46,47
47
48
48
48
48,49
49
49
49
50
50
50-52
50,51
51
51
52
Page 3
�52
52
52
52
52
FAILURE TO AGREE
GLOBAL BUDGET
ILLEGAL BILLING
GROUPS, PARTNERSHIPS
HEALTH MAINTENANCE ORGANIZATIONS
RESTRICTION ON EMPLOYERS CHOOSING
PARTICIPANTS' PHYSICIANS
OTHER LICENSED PRACTITIONERS
PAYMENT OF ACCOUNTS
COMPUTERIZED SYSTEMS
PEER REVIEW
COMPLIANCE
RE-REVIEW
RESPONSIBILITY FOR MONITORING
HEARINGS FOR INFRACTIONS
OFFICE OF THE INSPECTOR GENERAL
ABERRANT VALUES & STANDARD DEVIATIONS
DISCIPLINARY ACTION
PHYSICIAN
HOSPITAL
52,53
53
53
53,54
54
54,55
54,55
55
55
55
55
56
56
56
SECTION IX
MALPRACTICE
57
SECTION X
PREPONDERANCE O F PROVISIONS
OVER OTHER LEGISLATION
57
ADDENDUM
C O S T CONTAINMENT
COMPUTER SUPPORT FOR UNIVERSAL HEALTH CARE
SYSTEM:
Registration
Submission of Claims
Payment of Claims
Monitoring & Utilization
Per diem Cost System
Communication & Inquiries
DIAGRAMATIC SUMMARY OF PROFILE SYSTEM
Manual for use of system
Statistical Printouts
Page 4
�1
2
Page 1
SECTION I
INTENT OF THE ACT
3
1. To ensure as a right that all American Citizens, or legally designated
4
permanent residents of the United States ("Americans") be entitled to all preventive,
5
diagnostic and therapeutic measures available in the health care field at any given
6
time, and that access to quality health care shall be universal and without financial or
7
other barriers.
8
9
2. That Americans achieve further improvement in their well being by combining
10
lifestyles which emphasize prevention of disease, preservation of good health, and
11
promotion of programs to ensure good health, using collective action against social,
12
environmental and occupational causes of disease. Moreover, Americans desire a
13
system of health services which will promote action to protect them against physical or
14
mental disease.
15
16
3. That there be a cooperative partnership between government, health
17
professionals, insurance bodies, and voluntary organizations as well as individual
18
Americans.
19
20
21
22
23
4. That the profit motive be eradicated from the health care system.
�1
Page 2
2
3
4
SECTION II
COVERAGE AND EXCEPTIONS
1. All Americans, irrespective of age, cultural or ethnic background, fiscal
5
viability, who have congenital or acquired disease, or who have sustained injury or
6
disability through injury, poisons, drugs, chemicals, or other noxious substances, be
7
entitled to health care without financial or other barriers.
8
9
2. Exceptions:
-
Members of the armed services and their
10
families, veterans and where applicable their families, who are entitled to programs
11
established for those services.
12
13
- Those falling under Workmen's Compensation.
3. Responsibility to establish coverage.
14
Each State of the United States or District of Columbia shall
15
provide for bona fide residents of that State, a Comprehensive Medical Plan which
16
shall be funded by Federal and State contributions to ensure the basic intent of the
17
plan is carried out. Each State shall be subject to criteria and Federal guidelines as
18
stated in this Act.
19
20
21
22
23
�1
2
SECTION III
3
4
5
CRITERIA
1. Administration shall be carried out by a public body:
"The Health Care Authority" (THCA).
6
7
2. Comprehensive.
8
9
3. Universal.
10
11
4. Portable.
12
13
14
15
16
17
18
19
20
21
22
23
Page 3
5. Accessible.
�1
2
3
4
Page 4
(1)
PUBLIC ADMINISTRATION
In order to satisfy the criterion respecting public administration,
The Health Care Administration (THCA) of a State must be:
5
(a) Administered by Commissioners appointed by
6
the State government.
7
(b) Operated on a non-profit basis.
8
(c) Responsible to the State government for
9
administration and operation of the State plan.
10
(d) Subject to audit of its accounts or those of
11
12
any contracting agency.
The criterion respecting public administration is not contravened if the
13
THCA designates any agency, group, insurance company or other body is designated
14
by the THCA to:
15
(e) Receive on its behalf any amounts under the
16
State comprehensive insurance plan; or
17
(f) Carry out any and all responsibilities on its
18
behalf the receipt or payment of accounts rendered for insured
19
health services provided it is a requirement that all such
20
accounts are subject to assessment and approval by the THCA
21
and that public authority shall determine the amounts to be
22
paid in respect thereof.
23
(g) Conduct reviews for utilization and quality of care.
�1
Page 5
2
(h) Provide the THCA with statistical information
3
obtained by use of the Federal Statistical Evaluation Methods
4
for cost containment as laid out in Section VIII of the Act.
5
6
(II)
7
COMPREHENSIVE
In order to satisfy the criterion of the
comprehensive nature of the
8
plan the THCA must ensure that all insured health services provided by hospitals or
9
health care practitioners licensed by the State are available to all insured recipients.
10
11
12
(III) UNIVERSAL
In order to satisfy the criterion respecting universality, the health care insurance plan
13
of the State must entitle one hundred per cent of the insured persons in the State to
14
any and all insured health services provided for by the plan on uniform
15
terms and conditions.
16
17
(IV)
PORTABLE
18
In order to meet the criterion of portability the THCA of the State must:
19
(a) Not impose any minimum period of residence in the State, or
20
waiting period, in excess of 90 calendar days before residents
21
of the State are eligible for or entitled to insured health
22
services.
23
(b) Must provide for the payment of amounts incurred by residents
�1
Page 6
2
who are temporarily absent from the State on the following
3
basis:
4
(i) Payment for services will be at the rate
5
approved by the THCA for residents of the
6
State in which the services would
7
ordinarily be provided, unless special arrangements have
8
been made between the States to apportion the costs.
9
This will apply to emergency or elective services
10
provided in one of the States of the United States.
11
12
(ii) Where insured services are provided
13
outside the United States, as provided under Section V
14
(XIX), payment will be made on the basis of the amount
15
that would have been paid by the State for
16
similar services rendered in the State
17
itself, with due regard to the size of hospital,
18
standards of care rendered therein,and such other
19
relevant factors as the THCA may determine to be
20
pertinent in the circumstances.
21
(c) Must provide for the payment of any health
22
care services rendered by another State, during the waiting
23
period imposed by the other State, for any permanent resident
�1
Page 7
2
of the former State, who has taken up
3
permanent residence in the new State chosen by the insured
4
for permanent residency.
5
6
(V)
ACCESSIBLE
7
In order to meet the criterion of accessibility, the THCA must:
8
(a) Provide insured health services on a uniform
9
basis which does not impede or preclude, on a fiscal or any
10
other basis, reasonable access to those services available to
11
insured persons.
12
(b) Provide payment for insured health services in
13
accordance with the fee schedule established with practitioners,
14
and the per diem designated to be paid to hospitals.
15
16
17
18
19
20
21
22
23
�1
SECTION IV
2
DEFINITIONS
3
"Americans" means those who are citizens or legal permanent residents of the United
4
5
Page 8
States.
"Birthing Center" means a free standing facility which meets the following tests:
6
1. It is licensed as such by the jurisdiction of location.
7
2. It is set up and equipped to run as a setting for prenatal care,
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
delivery, and immediate post partum care.
3. It ordinarily charges for services and supplies it provides.
4. It is run under the direction of at least one physician specializing
in obstetrics and gynecology.
5. It has a physician or certified nurse mid-wife present at all births
and during the immediate post partum period.
6. It extends staff privileges to physicians who have privileges to provide
obstetrical and gynecological care in a hospital.
7. It has a minimum of two beds or two birthing rooms for use by patients
while in labor and during delivery.
8. It provides full time skilled nursing services by registered nurses
or certified nurse mid-wives in the delivery and recovery rooms.
9. It has diagnostic X Ray and laboratory equipment needed to perform
tests on the mother and child
10. It has equipment and supplies needed to perform minor surgery including
episiotomy and repair of perineal tear.
�1
Page 9
2
11. Equipment and supplies are available to administer local anesthetics.
3
12. Equipment and trained personnel are available to handle medical
4
emergencies and to provide immediate supportive measures to sustain
5
life should complications arise during labor or if a child is born with
6
7
8
abnormalities which impair function or impair life.
13. Admission policies determine that only patients with low risk pregnancy
are admitted.
9
14. There is a written agreement with an area hospital for immediate transfer
10
of a patient or child in case of emergency and all members of staff are
11
aware of the procedures to effect such a transfer.
12
13
14
15. On-going quality of care programs carried out with reviews by physicians
other than those who own or direct the facility.
16. Medical records are kept on each patient and child.
15
"Christian Science Sanitorium" is an institution operated or listed and certified by
16
the First Church of Christ, Scientist, is considered a hospital but only for
17
an individual admitted for healing (not rest or study) while he is under the
18
care of a practitioner listed in the Christian Science Journal as an
19
authorized practitioner.
20
"Convalescent Facility" means an institution or part thereof which meets one of the
21
following tests:
22
1. It has been approved by the Secretary of Health Education and Welfare
23
for participation as an extended care facility.
�1
Page 10
2
2. It meets all of the standards for, and has been certified to be, an
3
accredited Extended Care Facility by the Joint Commission of Accreditation
4
of Hospitals and Organizations.
5
In no event will an approved Convalescent Facility include any institution or part
6
thereof which is other than incidentally a place for rest, custodial care, for educational
7
care, for the care of mental disorders, or a place for the aged. An approved
8
Convalescent Facility will be treated the same as a Hospital as the term is used in
9
determining benefits for physicians' services.
10
"Custodial Care" is care which consists of services and supplies including board and
11
room and other institutional services, furnished to an individual primarily to
12
assist the individual in activities of daily living whether or not the individual is
13
disabled. These services and supplies are custodial care regardless of the
14
practitioner or provider who prescribed, recommended or performed them.
15
When board and room and skilled nursing services are combined with other
16
necessary therapeutic services, and supplies in accordance with a generally
17
accepted standards to establish a program or medical treatment, they will
18
not be considered "Custodial Care".
19
"Drug and Alcohol Treatment Facility" means an institution or part thereof which fully
20
meets the following criteria:
21
22
23
(a) Is primarily engaged in providing on a full time basis a program for the
diagnosis, treatment and evaluation of alcoholism and/or drug abuse.
(b) Provides detoxification services on the premises twenty four (24) hours a
�1
2
3
Page 11
day.
(c) Provides, or has an arrangement with, an acute hospital in the area to
4
provide medical services other than those related to drug and alcohol abuse and has
5
the necessary staff and equipment to provide emergency services for conditions other
6
than conditions produced by drug and alcohol abuse.
7
8
9
10
11
12
13
14
15
16
(d) Provides a staff of physicians and licensed skilled nurses to be available on
a twenty four hour basis.
(e) Provides a written medical record which must also contain a treatment plan
specific to the drug and alcohol related problem(s).
(f) Provides psychological, social as well as medical needs under the direction
of a licensed physician.
(g) Meets the licensing standards of the jurisdiction in which it is located.
"Health Care Plan" means the plan established by each State in conformance with
medical guidelines contained in the Federal Act.
"Health Care Practitioner" means a person who is licensed as :
17
(I) A physiotherapist
18
(II) A psychologist
19
(III) A podiatrist
20
(IV) A chiropractor
21
(V) A dentist
22
23
"Home health Care Agency" means an agency which:
(a) is primarily engaged in and licensed to provide skilled nursing services and
�1
2
3
Page 12
other therapeutic services.
(b) It has policies established by a professional group associated with the
4
agency or organization - this group must include at least one physician and at least
5
one registered nurse to govern the services provided it also:
6
(i) Provides full time supervision of services by a registered nurse.
7
(ii)Maintains a complete medical record on each patient.
8
(e) Has a full time Administrator.
9
10
"Hospice Agency" means an agency or organization which supplies care twenty-four
hours a day, meets licensing standards in the jurisdiction in which it is
11
located, and provides the same services on an out-patient basis as
12
those required for a "Hospice Facility".
13
14
15
"Hospice Care" means care rendered as part of a hospice care program to a terminal
ill individual by or under arrangements with a hospice care facility.
"Hospice Facility" means a facility or part of a facility which meets the following
16
parameters:
17
1. Hospice care is available twenty-four hours a day.
18
2. It is licensed by the jurisdiction in which it is located.
19
3. Provides skilled nursing services, social services, psychological
20
and dietary counseling and bereavement counseling.
21
4. Keeps medical records on each patient.
22
5. Provides a quality of care program with reviews by physicians other
23
than those who own or direct the facility.
�1
Page 13
2
6. There is a staff of physicians one of whom is on call at all times.
3
7. A registered nurse is present to supervise nursing services twenty-four
4
5
hours a day.
8. There is a full time administrator.
6
"Hospital" means an institution established and licensed by the State and approved by
7
the Joint Commission of Accreditation of Hospitals and Organizations and is
8
primarily engaged in providing medical, surgical, and obstetric facilities for
9
the diagnosis, treatment and care of injured and sick persons under the
10
supervision of a group of physicians. The surgical requirement may be
11
waived for a mental institution in which the insured or a family member is
12
confined as in patient. Hospitals provide twenty-four hour registered
13
graduate nursing service and are not, other than incidentally, a place or rest
14
for the aged, drug addicts, alcoholics or a nursing home.
15
16
"Insured" means a beneficiary who has been a resident of a State for the required
minimum time (not more than 90 days) to obtain health services under the plan
17
established by The Health Care Authority of each State, but who is not:
18
(a) A member of the armed services or veteran or a dependent thereof who
19
is covered by alternate health care services provided by the Federal
20
government.
21
(b) A person covered by an alternate health care plan established by the
22
Federal or State government and rendering equivalent benefits to those
23
provided by this Act.
�1
2
3
4
Page 14
"Medical Practitioner" means a person licensed to practice medicine in a State and
who is a graduate of a school of medicine or school of osteopathy.
"Medical supplies" means supplies ordered by a physician and considered
5
medically necessary for treatment of a condition but does not include
6
adhesive tape, antiseptics, or other common First Aid supplies.
7
"Non-Occupational Disease" means a disease which did not arise out of, or in the
8
course of any work for pay or profit, unless it is not covered under a worker's
9
compensation law or other law of similar purpose, for a particular disease
10
under such law, in which circumstances that disease shall be considered
11
"non-occupational" regardless of its cause. For benefits, the term "Non-
12
occupational Disease" shall include any congenital abnormality or
13
hereditary complication including those of a newborn child.
14
"Non-occupational Injury" means an accidental bodily injury which does not arise out
15
of (or in the course of) any work for pay or profit nor, in any way results
16
from an injury that does.
17
18
19
20
21
"Nurse Anesthetist" means a registered nurse who has become certified to give
anesthetics.
"Nurse Midwife" means a registered nurse who has had special training and is
certified as qualified to perform normal deliveries.
"Occupational Illness" means an illness sustained in the course of employment which
22
is covered by any federal or state workers' compensation, industrial insurance
23
law, employer's liability contract, special insurance, or self insurance program.
�1
Page 15
2
Sole proprietors, partners, and elected corporate officers are eligible for the
3
health plan if they are not covered under such labor or industrial coverages.
4
"Physician Assistant" means a qualified person who has taken a special training to
5
assist a physician in the office or hospital environment.
6
"Physician or Surgeon" a legally qualified physician. The following medical
7
practitioners are recognized under this definition, so long as they have a license
8
under applicable state licensing laws and they are acting within the scope of their
9
license when rendering any service for which they are remunerated under the plan:
10
Doctors of:
11
1.
Medicine
12
2.
Osteopathy
13
3.
Podiatry
14
4.
Chiropractic
15
5.
Optometries
16
6.
Dentistry (for covered dental surgical procedures only)
17
7.
Licensed or certified Psychologists.
18
"Per diem" means a specific sum paid to a hospital to cover costs on a daily basis to
19
be inclusive of all services as listed in Section V A and B (II through XIV) with the
20
exception of "exclusions" listed in Section V IX B (a^b) of the Act, but with the
21
addition of such other items as The Health Care Authority of each State may
22
determine appropriate for that State.
23
"Physician Services" means any medically necessary services rendered by medical
�1
23
Page 16
2
practitioners.
3
"Prosthetic Devices" are artificial parts used to replace natural parts of the body.
4
"Secretary" ("The Secretary") means the Secretary of Health and Human Services.
5
"Skilled Nursing Facility" is a specially qualified facility which has the staff and
6
equipment to provide skilled nursing care or rehabilitation services and other
7
related services and is so registered with the State.
8
"The Health Care Authority" means a Board of Commissioners appointed by the State
9
government to form the Public Administration Authority under the Health Care
10
Plan.
11
SECTION V
12
A. COMPREHENSIVE MEDICAL EXPENSE BENEFITS
13
The plan will pay COMPREHENSIVE MEDICAL EXPENSE BENEFITS incurred
14
in connection with a non occupational disease or injury as defined under the Act. If,
15
however, any of the expenses incurred are excluded from coverage as described in
16
the medical expenses benefits exclusion Section V (XXII), these expenses will not be
17
allowed.
18
B. COVERED MEDICAL SERVICES:
19
(I) AMBULANCE TRANSPORTATION
20
Ambulance transportation is medically necessary transportation which is used
21
when the transportation of a patient by other means would endanger the patient's
22
health. It is provided by a licensed commercial entity (including air ambulance)
23
to transport a patient as follows:
�1
2
3
Page 17
(i) To a hospital or skilled nursing facility that can provide the type of care
required for treatment of the emergency condition resulting from either:
4
(a) An accident.
5
(b) Acute illness occurring in the patient's home, temporary or other
6
residence.
7
(ii) From a hospital or skilled nursing facility to the patient's home.
8
(iii) From a hospital to a skilled nursing facility or convalescent facility.
9
10
(II) PRE-ADMISSION TESTING:
Testing conducted prior to surgery by a hospital, surgery center, or licensed
11
diagnostic laboratory facility for the outpatient testing of the insured or the family
12
member related thereto, and performed within seven days prior to scheduled
13
admission to a hospital or surgery center is a covered benefit if:
14
(i)
The patient undergoes the scheduled admission to a hospital or
15
surgery center. However, this does not apply if testing shows
16
that the surgery should not be performed or the confinement is
17
not necessary because of the insured or family member's physical
18
condition.
19
20
21
22
23
(ii)
The patient has not already been admitted to the hospital as an
in-patient.
(iii) The tests are not unnecessarily repeated in or by the hospital or
surgery center where the surgery is performed or confinement occurs.
�1
2
3
Page 18
(III) SURGICAL PROCEDURES:
A.
(i)
All charges made by the operating surgeon and any approved
4
assistant, for the performance of the surgical procedures and
5
all necessary postoperative care for twenty-one days following
6
the surgical procedure.
7
(ii)
8
Charges of the anesthesiologist or physician administering
the anesthetic.
9
(iii)
All charges for drugs, medications, intravenous infusion, blood,
10
X ray or other laboratory services incurred during the
11
performance of surgery.
12
B.
Out patient surgical expenses furnished in a hospital, free standing
13
licensed surgical center, or physician's office as stated in Section V III A,
14
but a surgical procedure should not performed on an outpatient basis if
15
such a procedure is expected to:
16
(i)
Result in extensive blood loss.
17
(ii)
Require major or prolonged invasion of a body cavity.
18
(iii) Involve any major blood vessels.
19
C. SECOND SURGICAL OPINION:
20
!
A second surgical opinion shall be mandatory when required by the
21
hospital or free standing surgical center as stated in the institution's
22
by-laws or regulations or as required by the operating surgeon the only
23
restriction being that the second opinion shall be given by a physician
�I
I
1
Page 19
2
or surgeon who is not associated in practice with the first physician who
3
recommended and proposed the surgery.
4
5
(IV) DURABLE MEDICAL EQUIPMENT
Durable medical equipment (DME) is equipment that is medically necessary for
6
treatment of an illness or injury, or to improve function of a malformed body member
7
or members which meet the following criteria: The equipment or device...
8
I Can stand repeated use
9
II Must be related to the physical disorder
10
III Is not useful in the absence of illness or disorder
11
IV Must be ordered by a physician who will give an estimate of the period for
12
which the device or equipment is needed.
13
The plan pays for the use or rental of the following provided they are
14
ordered by a licensed medical practitioner as defined under the Act:
15
16
V Necessary casts, splints, crutches, braces, surgical and orthopedic
appliances.
17
VI Dialysis equipment or Iron Lung.
18
VII Wheel chair, seat lift chairs, or other devices approved by the Secretary.
19
VIII Other DME whose only function has been determined to be necessary for
20
medical treatment of an illness or accidental injury not covered under the
21
Workmen's Compensation Act, which can be expected to improve the
22
functions of one or more malformed body members.
23
IX
Equipment for the administration of oxygen.
�1
2
Page 20
Benefits do not include payment for the following:
3
(i) Environmental control devices or equipment such as particle arresting
4
devices, air cleaner purifiers, humidifiers, or other atmospheric control devices.
5
(ii) Precautionary or hygienic equipment and comfort or convenience items not
6
primarily medical in nature such as jet or whirlpool baths, wheel chair lifts etc.
7
(V) MEDICAL SUPPLIES
8
The plan pays benefits for the following medical supplies:
9
I Surgical dressings for wounds, burns, diabetic and decubitus ulcers.
10
II Splints and casts.
11
III Catheters
12
IV Syringes and needles for administering insulin.
13
V Blood & blood plasma
14
VI Anesthetic agents and oxygen
15
* Benefits do not include the following :
16
Supplementary supplies such as batteries, tape, gauze,
17
alcohol pads, tubing, gel, crutch tips etc.
18
19
20
21
(VI) DRUGS AND PRESCRIPTIONS
Drugs or medications if approved by the prescription of a licensed physician
may be obtained but only by the physician's prescription provided that:
(i)
Where available "a generic drug or medication" is used. This meets the
22
following requirements:
23
(a)
It is manufactured and marketed under the chemical name or a
�1
Page 21
2
3
shortened version thereof.
(b)
4
5
It is approved by the U.S. Food and Drug Administration for
safety and effectiveness.
(c)
It is manufactured after the original patent expires by a
6
company different from the company that originally patented
7
the chemical formulation.
8
9
10
(d)
It is less expensive than the product manufactured by the
company that patented the chemical formulation.
(ii) Where no generic equivalent is available, patented drugs are covered for the
11
insured or family members provided they have no taxable income.
12
(VII) PROSTHETIC DEVICES
13
Prosthetic devices will be paid for provided they are medically necessary. The
14
following devices are covered under the health plan:
15
I Approved corrective lenses following cataract surgery.
16
II Breast prosthesis following mastectomy for disease.
17
III Colostomy, ileostomy, urinary diversion bags and related supplies.
18
IV Heart pacemakers, or other devices of a similar nature when they are
19
approved by the Secretary.
20
V Artificial limbs and eyes.
21
VI Arm, leg, back and neck braces.
22
VII Orthopedic shoes necessary to correct a congenital abnormality.
23
�1
, 2
Page 22
(VIII) DIAGNOSTIC TESTS AND OTHER TESTING PROCEDURES:
3
4
Diagnostic tests and other procedures that lead to treatment are covered for the
insured and family members as follows:
5
(i)
6
X Ray, covering CAT scans, MRI and all other radiological services
including nuclear medicine.
7
(ii)
8
(iii) All pathological services including biopsy and consultative work on blood
9
10
All laboratory work.
smears.
(IX)
11
BOARD AND ROOM
This is a comprehensive medical expense benefit limited to:
,12
(i)
An institution which is a hospital, including a mental hospital, drug
13
and rehabilitation center, licensed convalescent facility or hospice
14
facility depending on the benefit described.
15
(ii)
16
17
That admission to the institution is to a room not containing more
than four beds.
A.
Benefits include:
'18
(a)
All meals including special diets.
19
(b)
Use of operating room, recovery room and all other areas
20
21
relating to the operating suite.
(c)
22
23
Use of the intensive care unit and "step down units" as
considered medically necessary.
(d)
All beds in the hospital except that the insured may be required to
�1
Page 23
2
pay for a Private Room in the institution should such a room be
3
requested.
4
5
(e)
B.
All regular and specialized nursing services.
Exclusions are:
6
(a)
Use of a telephone and charges incurred.
7
(b)
Use of any other facilities such as radio or television or other
8
items which may be considered for the comfort of the patient
9
or the patient's family and not directly related to treatment.
10
11
12
(X) REHABILITATION SERVICES
Rehabilitation services are medically necessary services which meet the
13
following criteria:
14
(a)
Must be prescribed by a licensed physician.
15
(b)
The physician alone, or in consultation with a therapist,
16
17
sets up a documented plan of treatment.
(c)
18
19
20
The physician must review the treatment plan as considered
necessary but not less than twice weekly.
(d)
The therapist must keep a daily record of progress.
Services Included:
21
(i)
Physical therapy or restoration services.
22
(ii)
Occupational therapy.
23
(iii)
Speech therapy.
�1
Page 24
2
(iv)
3
4
5
Any other services which fall under a physical rehabilitation
of the patient.
(XI) HOSPITAL EMERGENCY ROOM SERVICES:
These services shall be all inclusive for any type of diagnostic tests and
6
therapeutic regime as required under the regulations of the Joint Commission of
7
Hospitals and Organizations.
8
9
Services shall include all minor surgical procedures, stabilization of
acutely ill patients, but shall not include care beyond twenty-four hours from the time
10
of the insured or family member's admission to the emergency room.
11
(XII) ALCOHOL AND DRUG REHABILITATION PROGRAMS
12
13
Comprehensive benefits are included for effective treatment of alcoholism or
drug abuse when they are rendered in:
14
(i)
A hospital.
15
(ii)
A licensed alcohol and drug treatment facility.
16
However, the maximum number of days coverage will be given for effective
17
treatment of alcoholism and/or drug abuse for each family member during his life time
18
is one hundred thirty-five days.
19
20
21
Effective treatment and drug abuse shall mean a program of therapy that meets
the following conditions:
(a)
It is prescribed and supervised by a physician who certifies that a
22
follow-up program has been established prior to discharge from the
23
facility.
�1
2
Page 25
(b)
3
4
It begins within two weeks following release from the hospital or
treatment facility.
Treatment solely for de-toxification or primarily for maintenance care although
5
covered by the plan is not considered complete and effective treatment.
6
(XIII) PREGNANCY BENEFITS
7
Comprehensive medical expense benefits are payable under the plan during the
8
whole of the pregnancy and for hospital confinement and such other medical services
9
and supplies furnished to a female due to the pregnancy and will be on the same
10
basis as any non-occupational disease. Pregnancy related conditions are covered
11
under each benefit subject to any other provisions of the act or limitations herein.
12
All services and supplies if provided on the recommendation of a licensed
13
physician shall be covered under the plan. All hospital care including nursery care or
14
care in a neo-natal intensive care unit shall be covered under the plan. The newborn
'15
16
shall be covered automatically as of the date of birth and shall be enrolled in the plan.
The plan provides when one of the following complications occurs,
17
comprehensive medical expense benefits are payable under the plan on the same
18
basis as any other non-occupational disease.
19
(i)
Surgical operations for extra-uterine pregnancy or other complications
20
requiring intra-abdominal surgery after termination of pregnancy
21
(including repair of a ruptured uterus or a hysterectomy because
22
or placenta accreta, or a similar cause).
23
(ii)
Pernicious vomiting of pregnancy.
�Page 26
1
2
(iii)
Toxemia with convulsions.
3
(iv)
Toxemia without convulsions in hospital but only if the diastolic
4
blood pressure is elevated to 100 or more and the urine reveals
5
an albumin of 4+. On an outpatient basis coverage is provided
6
as for any other non-occupational disease.
7
(v)
Pelvic abscess.
8
(vi)
Acute renal failure.
9
(vii)
Acute yellow atrophy of the liver.
10
(viii)
Cerebral thrombosis or cerebral hemorrhage.
11
(ix)
Extra uterine pregnancy.
12
(x)
Hydatidiform mole.
13
(xi)
Any type of malignancy.
14
(xii)
Placentia abruptio, placentia preavia, marginal or premature
separation of the placentia.
15
16
(xiii) Post partum hemorrhage.
17
(xiv)
Psychosis requiring hospitalization and shock therapy.
18
(XV)
Puerperal sepsis and all complicating conditions.
19
(xvi)
Pulmonary embolism infarct.
20
(xvii) Thrombophlebitis.
21
A.
BIRTHING CENTER EXPENSES
22
The plan pays for services and supplies furnished by a birthing center or
23
hospital birthing room for all services up to twenty-four hours following delivery.
�1
Page 27
2
XIV CONVALESCENT FACILITY
3
The insured or family member who is confined in a licensed convalescent facility and
4
receives skilled nursing and physical restoration services from an injury or disease.
5
Admission to the facility must be approved and recommended by a licensed
6
physician and the patient must:
7
(i)
Be recovering from an acute disease or injury.
8
(ii)
Require professional and practical nursing care.
9
(iii)
Remain under the active medical supervision of a physician.
10
Exclusions:
11
No benefits are covered for:
12
(i)
Confinement principally for custodial care.
13
(ii)
Care for alcoholism or drug addiction.
14
(iii)
Care for senility, mental deficiency or mental retardation.
15
(iv)
Care for mental or nervous disorder other than short term convalescent
16
care where the prognosis for recovery or improvement is deemed
17
favorable.
18
(v)
Care which cannot be provided by a licensed facility.
19
(vi)
Care that could be managed by an licensed Home Health Care Agency
20
where such agency is available.
21
(XV) HOME HEALTH CARE
22
As defined under Section IV of the act home health care will be paid for by the Health
23
Care Plan established under The Health Care Authority when such is required for part
�1
Page 28
2
time or intermittent skilled nursing care which can include up to eight hours of
3
reasonable and necessary care per day as determined by a licensed medical
4
practitioner for a period determined by the medical practitioner.
5
The following services are available:
6
(i) Physical therapy.
7
(ii) Speech therapy.
8
(iii) Occupational therapy.
9
(iv) Medical Social Services.
10
Medical supplies and DME shall not be excluded from the services provided.
11
Exclusions under the health care plan:
12
(i) General household services.
13
(ii) Meal preparation, shopping services.
14
(iii) Services performed to meet purely personal or family or domestic
15
16
needs.
(XVI) HOSPICE CARE
17
Hospice care is covered under the act as follows:
18
(i)
Board and room and other services and supplies furnished to the
19
insured and family member while confined as full time patient for
20
pain control and other acute and chronic symptom management.
21
22
23
(ii)
Services and supplies furnished to a patient who is not confined as
a full time inpatient.
(iii) Full time, part time or intermittent nursing care by a registered
�1
Page 29
2
nurse or a licensed practical nurse.
3
(iv)
Medical social services when ordered by a physician.
4
(v)
Psychological and dietary counseling.
5
(vi)
Physical and occupational therapy.
6
(vii)
Part time or intermittent home health aid services which consist
7
of caring for the patients for up to any eight hours in any one
8
day.
9
(ix)
10
prescribed by a physician.
11
12
Medications, medical supplies, drugs and other therapies as
Also included are all charges by a physician.
(XVII) SKILLED NURSING FACILITY
13
The plan will pay a benefit following hospital stay provided that daily
14
skilled nursing or rehabilitation services are considered essential and that these
15
services can only be provided by such a facility, and if the following conditions are
16
met:
17
18
19
20
21
22
23
(i) The stay in hospital has been for at least three consecutive days not
including the day of discharge before transfer is made to the facility.
(ii) Care is required following admission for a condition that required
hospitalization.
(iii) Skilled nursing services or rehabilitation must take place within twenty one
(21) days of leaving the acute care hospital.
(iv) A licensed medical practitioner certifies that skilled nursing or rehabilitation
�1
Page 30
2
services are necessary, that they are needed on a daily basis, and should the services
3
be necessary for more than seven (7) days, recertification is carried out by a licensed
4
medical practitioner every seven (7) days.
5
6
The following benefits will be provided when ordered by a licensed medical
practitioner:
7
(i) Payment for a room containing not more than four (4) beds
8
(ii) All meals including special diets.
9
(iii) Regular nursing services.
10
(iv) Rehabilitation therapy, physical, occupational or speech.
11
(v) Drugs furnished by the facility as ordered by the medical practitioner.
12
(vi) Blood transfusions.
13
(vii) Other medical supplies.
14
(Viii) Use of durable medical equipment.
15
(XVIII) INSTITUTES OF EXCELLENCE
16
In so far as major costs are incurred in the treatment of various serious
17
diseases, for example, transplants, The Health Care Authority shall make application
18
to the Secretary for certification of Regional Hospitals for specific transplant services
19
should a proposal to utilize services other than those regional services already
20
approved in this act. These institutes of excellence approved are:
21
Baylor University Medical Center
22
Dallas, Texas.
23
Bone marrow, heart &
liver transplants
�1
Page 31
2
Massachusetts General Hospital
3
Heart & liver transplants
Boston, MA.
4
5
Rush-Presbyterian St. Luke's
6
Medical Center,
7
Bone marrow & liver
Chicago, Illinois.
transplants
8
9
10
Cedars-Sinai Medical Center
Los Angeles, California
Heart, liver & lung
transplants
11
12
13
14
(XVIII) SPECIAL SERVICES
1. Voluntary Sterilization
This is a covered benefit when done on an out-patient basis. However, if
15
the patient is an in-patient at a licensed health care facility, and is in the hospital for
16
reasons other than sterilization, this is deemed a covered benefit whether or not this is
M7
118
19
a vasectomy or tubal ligation.
2. Mental or Nervous conditions
For patients who are not confined to hospital payments will made as for
20
any other condition and are applicable after the deductible as described in
21
Section VII 3 I (f). This will apply to treatment of mental illness not related to or
122
23
accompanying alcoholism or drug abuse.
3. Alcohol and drug abuse treatment as an out-patient
�1
2
Page 32
Expenses for out-patient treatment of drug or alcohol abuse are a
3
covered benefit if they are supervised by a physician and to the extent that the are
4
recognized by the medical profession as appropriate methods of treatment and meet
5
accepted standards of medical care.
6
4. Optometric Services
7
The health plan pays for the services of a licensed optometrist only after
8
cataract surgery or as provided for on the recommendation of a physician in
9
Section V (XX) of the Act.
10
11
(XIX) MEDICAL SERVICES OUTSIDE THE UNITED STATES
The plan does not pay for medical services or hospitalization outside the United
12
States or the District of Columbia. However, under certain circumstances benefits will
13
be considered in approved Canadian or Mexican hospitals as follows:
14
(i) Where the insured or family member is in the United States and an
15
emergency arises and a Canadian or Mexican hospital is closer than the nearest
16
United States hospital provided this hospital can provide the emergency services
17
needed and meets professionally recognized standards of care.
18
19
20
21
22
23
(ii) The insured or family member's ordinary domicile is the United States but
the closest medical facility is located in Canada or Mexico.
(iii) The insured is travelling between Alaska and the United States and
requires medical service in Canada.
�1
2
3
4
Page 33
(XX) SPECIAL SERVICES FOR CHILDREN OR SENIOR CITIZENS
(i) Children up to the age of eighteen (18) shall be entitled to the following
benefits without charge:
5
(a) Annual "clothes off" physical examination to include testing of hearing
6
and eyes.
7
(b) Referral to special educational facilities where this is determined to be
8
indicated.
9
(c) Supply of eyeglasses or deaf aids as approved by the Secretary
10
where the determination for such is made on the recommendation of a
11
physician licensed in these areas of expertise.
12
(d) Annual dental examination and teeth cleaning and report to the
13
parent or authority responsible for the care of the child.
14
(ii) Senior citizens aged sixty five (65) or more shall be entitled to a "clothes off"
15
physical examination once each year and on reaching the age of seventy (70) the
16
following services without charge:
17
(a) Special testing for sight and hearing by a qualified physician
18
specializing in these areas.
19
(b) On the recommendation of such a physician, as designated in (ii) (a),
20
Senior citizens of seventy (70) or over shall be entitled to eyeglasses
21
and hearing aids as determined acceptable by the Secretary.
22
23
�1
2
Page 34
(XXI) PUBLIC HEALTH BENEFITS
3
A. SCREENING SERVICES
4
All screening services which meet reasonable standards of medical care shall be
5
provided by the Federal Government without charge to the recipient of such services.
6
7
(i) All innoculations, immunizations or vaccinations for children of any
age, the age of commencement of such services to be determined by the Secretary.
8
9
10
11
12
13
14
15
16
(ii) All screening services to men, women and children as determined
desirable by the Secretary but including as a minimum:
(a) Screening services annually for colo-rectal cancer for persons of forty years
or above.
(b) Screening services annually for women of thirty years or above for cervical
cancer (Papaniculou smears).
(c) Screening services for breast cancer by mammography for all women over
fifty years.
(d) Screening services for men over the age of forty for prostatic cancer, to
17
include at least a digital rectal examination and blood evaluation of serum acid
18
phosphatase and Prostatic Specific Antigen.
19
20
21
22
23
(iii) Innoculations or immunizations for senior citizens for the prevention of
influenza or any other communicable disease.
�1
2
Page 35
(XXII) EXCLUSIONS UNDER THE HEALTH PLAN
3
1. Occupational disease or injury which is covered by Workmen's
4
Compensation or other equivalent insurance.
5
2. Members of the armed services or families thereof who are covered.
6
3. Veterans of the armed services and their family members provided they are
7
also covered.
8
4. Services which are not medically necessary for treatment of the disease or
9
injury.
10
5. Charges for intentionally self-inflicted injuries unless they fall under a
11
diagnosis of mental health disease made by a licensed medical practitioner.
12
6. Charges for custodial care.
13
7. Charges in connection with dental work other than work related to congenital
14
defects or major injury and as provided elsewhere in the Act for child care.
15
8. Charges in connection with eye examinations, glasses, hearing aids, or the
16
fitting of such devices, except as otherwise provided.
17
9. Charges for services or supplies provided primarily for educational purposes.
18
SECTION VI
19
COVERED MEDICAL SERVICES PLAN SUMMARY
20
1.PHYSICIANS'OFFICE:
21
(i)
All initial and follow up office visits.
22
(ii)
Diagnostic tests and procedures.
23
(iii)
Drugs and biologicals which cannot be self administered.
�1
Page 36
2
(iv)
Medical supplies ordinarily used in a physicians' office.
3
(v)
Rehabilitation services which are ordinarily supplied therein.
4
(vi)
Services of the physicians' nurse.
5
(vii) Surgical procedures ordinarily performed on an out-patient basis.
6
(viii)
7
8
Written prescriptions, or where prescriptions are issued out of the clinic
or office, the law related to prescriptions shall be followed.
2. HOSPITAL OUTPATIENT:
9
(i)
Diagnostic test and procedures.
10
(ii)
Drugs and biologicals which cannot be self-administered.
11
(iii) Emergency room services.
12
(iv)
Medical supplies ordinarily used in a physicians'office.
13
(v)
Surgical procedures.
14
(iv)
Written prescriptions.
15
3. HOSPITAL INPATIENT:
16
(i)
Ambulance transportation to and from the hospital.
17
(ii)
Board and room.
18
(iii) Diagnostic tests and procedures including pre-
19
admission testing.
20
(iv)
Drugs, medications including oral and injectable.
21
(v)
Durable medical equipment and prosthetic devices.
22
(vi)
Medical supplies.
23
(vii) Rehabilitation services.
�1
2
3
Page 37
(viii) Surgical procedures.
4. SKILLED NURSING FACILITY:
4
(i)
Ambulance transportation to and from the facility.
5
(ii)
Board and room.
6
(iii) Drugs and medications.
7
(iv)
8
(v)
9
Durable medical equipment.
Medical supplies.
5. HOME HEALTH CARE:
10
(i)
Durable medical equipment.
11
(ii)
Medical supplies.
12
(iii) Intermittent skilled nursing care.
13
(iv)
14
Rehabilitation services.
6. CONVALESCENT FACILITY:
15
(i)
Ambulance transportation to and from the facility.
16
(ii)
Board and room.
17
(iii) Drugs and medications.
18
(iv)
Durable medical equipment.
19
(v)
Medical supplies.
20
(vi)
Rehabilitation services.
21
22
23
�1
2
Page 38
SECTION VII
3
FINANCING
1
1. The Secretary of Health and Human Services ("the Secretary") shall be
2
required to pay to each State per fiscal year, an amount determined by the Secretary
3
based on:
4
(a) The population of the State.
5
(b) The total contributions received from the individual residents,
6
corporations, or other taxable entities ordinarily subject to taxation by the Federal
7
government and the contributions made by residents of the State to the State, as
8
reported annually by the State to the Health Care Financing Administration.
9
(c) The demographic aspects of health care as related to the age groups
10
of the population in the State, based on experience over the previous twelve month
11
period.
12
2. Revenue Base:
13
(I) Federal:
14
(a) Contributions from taxes on substances which may adversely
15
affect the health of Americans such as alcohol and tobacco.
16
(b) Revenue from taxation on oil, gasoline, or other energy related
17
18
19
20
resources.
(c) Revenue ordinarily derived from general
taxation.
�1
Page 39
2
(d) Revenue derived from contributions received from Medicare
3
beneficiaries.
4
(II) State:
5
This relates to the measure of relative capacity for that state to derive revenue for that
6
fiscal year.
7
(a) Personal Income Tax.
8
(b) Corporation Income Taxes, revenues from government
9
business enterprises.
10
(c) General and miscellaneous sales taxes and amusement taxes.
11
(d) Tobacco and alcohol taxes.
12
(e) Fuel taxes derived from the sale of gasoline or diesel fuel.
13
(f) Non-commercial or commercial motor vehicle licensing
14
revenues.
15
(g) Hospital and Medical Care insurance premiums.
16
(h) Succession duties and gift taxes.
17
(i) Race track taxes.
18
(j) Taxes from gambling or any other legal form of entertainment.
19
(k) Forestry Revenues.
20
(I) Revenues identified as oil revenues and consisting of royalties,
21
22
23
license fees, taxes, rentals, levies, or payments that are
�1
Page 40
2
derived in respect of any person, persons, corporations, State
3
or Federal government within the rights of the State.
4
(m) Revenues identified as natural gas revenues and consisting of
5
royalties, license fees, taxes, rentals,levies and payments or
6
remittances that are derived in respect of any person, persons,
7
corporations, State or Federal government within the rights of
8
the State.
9
(n) Sales of leases and reservations on oil and/or natural gas
10
lands.
11
(o) Oil and gas revenues other than those described heretofore.
12
(p) Metallic and non-metallic mineral revenues.
13
(q) Water power rentals.
14
(r) Insurance premium taxes.
15
(s) Payroll taxes.
16
(t) State property and all other State purpose taxes.
17
(u) Lottery Revenues.
18
(v) Miscellaneous State taxes from any source.
19
20
3. INSURED PERSONS OBLIGATIONS AND RIGHTS
21
I.
Under this section "individuals" means insured persons receiving covered
22
benefits and includes all persons as defined in Section IV of the Act and includes
23
persons previously designated as "medicaid," "mediCal," "medicare," recipients of
�1
Page 41
2
Indian Health Services ("native Americans"), state or civic employees or any other
3
group not excluded by Section II 2 of the Act.
4
(a) All employers who make Social Security payments for their employees are
5
required to make a contribution for each employee and his dependents to the health
6
care plan of the State in an amount to be determined by the THCA.
7
(b) All persons who are gainfully employed shall make a matching contribution
8
to the health care plan in the amount determined in Section VII 2 (II) (g). Such
9
contribution shall cover the insured and dependent family members up to the age of
10
twenty one (21) years provided they are not gainfully employed and provided they
11
have no other coverage.
12
(c) Individuals who have no taxable income shall not be required to make any
13
payment towards the provision of health care but shall be entitled to health care
14
provided they meet the residency requirements of the State in which they reside and
15
are not covered by any other insurance. Students who are enrolled at a licensed
16
school, college or university shall be entitled to coverage without premiums provided
17
they are twenty one (21) years of age and meet the residency requirements of the
18
State and are not covered by any other insurance.
19
(d) Under the Social Security system Medicare (Part B) all persons receiving
20
Social Security payments excepting those who have no taxable income as stated
21
under Section VII 3 (c) shall be assessed the amount required to cover Part B and
22
such payments will continue to be collected by the Federal government and will be
23
forwarded to the THCA of the state of residence of the individual as part of the
�1
Page 42
2
payment made by the Federal government to the State THCA under the plan. All
3
persons receiving Social Security shall be covered by the plan and shall be entitled to
4
all benefits of the plan without any other premium than that required under Part B
5
Medicare.
6
7
8
(e) All insured persons shall have access to equivalent care as provided
under Section I (5) "Accessible."
(f) All persons shall be required to pay a deductible for services. The
9
deductible will be determined by the THCA but will be not more than five hundred
10
dollars ($500) per person per fiscal year or not more than fifteen hundred dollars
11
($1,500) per family per year except that:
12
(i) Should the insured have no taxable income the deductible fee will be
13
14
waived.
(ii) Should the insured be admitted to an acute care hospital as a genuine
15
16
emergency, the fee shall be waived.
(iii) Should the insured be determined to require pre-natal care the deductible
17
18
19
20
shall be waived.
(g) THCA shall provide for appropriate changes in the coverage of family
members to take into account:
(i)
Changes in family composition, including marriage, divorce (or legal
21
separation), birth or adoption of children and the ageing of children into
22
adulthood.
23 '
�1
2
Page 43
(ii)
Changes in employment status:
3
A. The terms: "Employee, employer, employment, wages" shall have the same
4
meaning as such terms have for purposes of Chapter 21 of the Internal Revenue
5
Code of 1986. Where an employee normally performs for his employer at least 25
6
hours of service for that employer, he shall be designated "full time."
7
An employee who performs less than 25 hours work per week for the employer shall
8
be designated "part time."
9
B. The term "small employer" means, with respect to the calendar year, any employer
10
who employs not more than five (5) employees on a full time basis on a typical
11
business day during the calendar year. Such employers are excepted from making
12
contributions to the state THCA.
13
C. The term "Large Employer" applies to any employer who employs more than five
14
(5) full time employees on a typical business day during the calendar year, or for
15
purposes of the Act, an employer who employs ten (10) or more part time employees
16
during the year. Such employers are required to make contributions to the State THCA
17
in amounts determined by the State THCA.
18
D. Where an employer terminates an employee, or where an employee terminates his
19
employment voluntarily, the employer and employee must inform the state THCA who
20
will, within the thirty day period following such termination, make a determination as to
21
how the coverage of the terminated employee and, where applicable, members of his
22
family, shall be covered under the Health Plan. If the employer terminates the
23
�1
Page 44
2
employee he shall be deemed responsible for any contributions due to the state THCA
3
for not more than thirty days from the termination of employment. If the employee
4
voluntarily terminates his employment, the employer shall not be responsible for
5
further contributions to the state THCA from the date the THCA receives notification
6
that the employee voluntarily terminated employment.
7
E. Consultants and Independent Contractors shall be regarded as individuals under
8
the Act and shall be responsible for the payment of premiums to the State THCA. The
9
state THCA has the authority to determine whether a "Consultant" or "Independent
10
Contractor" is correctly designated, or is in fact an employee of one or more
11
individuals, partnerships or corporations.
12
F. In families where there are multiple employers and more than one income is
13
taxable, the employers shall be liable for the same payment to the state THCA as
14
though there was only one employer employing a family member. However, only one
15
family contribution shall be required from the head of the family which member
16
contribution shall be elected by the head of the household.
17
Where changes in the above take place the THCA shall cause changes to be made in
18
thirty days of the event and shall give notice to all persons affected in not more than
19
thirty days after the event. The THCA is charged with ensuring there are no periods of
20
non-coverage for the insured and will provide, in the case of change of family status
21
such as marriage, divorce or legal separation, for proper cost-sharing among the
22
individuals concerned in an equitable and administrable manner. Newborns are
23
immediately covered as under Section V (XIII) of the plan and, should a woman not be
�1
Page 45
2
covered under the plan by reason of any exclusions as to birth, nationality, legality of
3
residence, the newborn shall automatically be covered for benefits provided an
4
application is made to the THCA within sixty (60) days of the birth.
5
(h) Any child voluntarily relinquished to a public or private agency, or any
6
child removed from family custody to an agency pursuant to a court order or
7
otherwise, shall be deemed to be automatically enrolled in the Health Plan upon
8
notification of the state THCA.
9
(i) Any child placed for adoption shall, as of the date of placement for
10
adoption, shall be treated as the child of the individual and be enrolled and covered
11
under such plan. Similarly, a child placed as a legal ward or foster child shall be
12
treated as the child of the person or persons with custody and be automatically
13
enrolled in the health plan upon notification of the state THCA.
14
4. PRIVATE PATIENT RIGHTS
15
The insured may seek the services of a medical practitioner on a private patient
16
basis but should the insured do so he or she must:
17
(a) Declare his or her intention at the commencement of service and sign a
18
declaration that the fee or fees for services will be paid directly to the practitioner.
19
(b) Should the practitioner be a participating practitioner in the health plan
20
operated under the THCA, the patient may claim the amount that would ordinarily
21
have been paid to the practitioner under the fee schedule negotiated with the
22
physicians, also hospital costs incurred should admission have been determined to be
23
necessary will be covered as provided in the plan. In no circumstances will payment
�1
Page 46
2
be made unless the deductible determined by the State under Section III I (f) has
3
been met.
4
(c) Should the practitioner be a non-participating practitioner the insured shall
5
be entitled only to expenses incurred by hospitalization and not to any expenses
6
incurred for physician services.
7
5. PENALTIES
8
Should an insured person who is required to make contributions to the plan, or is
9
required to make a deductible payment for services, fraudulently fail to do so, on
10
complaint of the State or Federal Authorities, the court may issue a fine or fines of up
11
to two thousand dollars ($2,000) or impose six months imprisonment plus any costs
12
incurred by the State or Federal Authorities incurred in the collection of the sums due
13
or the prosecution of the case. The THCA may determine that such persons are not
14
entitled to receive benefits for services rendered under the plan and they shall then
15
become personally indebted to those who rendered the services in any reasonable
16
amount determined by the supplier of those services.
17
SECTION VIII
18
A.
19
(I)
PAYMENT, COST CONTAINMENT, DISCIPLINARY ACTION
HOSPITAL CONTRACTS
The Health Care Authority in each State shall determine a per diem for such
20
hospitals who meet the criteria for participation in the plan. To participate in the plan
21
a hospital must be accredited by the Joint Commission of Accreditation of Hospitals
22
and Organizations and must meet all the requirements of the Act as laid out
23
heretofore.
�1
2
Page 47
The per diem shall be based on the following criteria:
3
(a) The number of licensed beds in the hospital.
4
(b) The capabilities of the hospital to take care of multiple disciplines
5
eg. Surgery, medicine, obstetrics, pediatrics, mental health etc.
6
(c) The number of admissions to the hospital in the last twelve calendar
7
months.
8
(d) The level of care offered in the institution: Primary, secondary or
9
tertiary or special care eg. Mental Health.
10
(e) The geographic location of the hospital in relation to other institutions.
11
(f) Demographic makeup of the area served by the hospital
12
(g) Any other factors considered pertinent by the State.
13
The per diem as defined in Section IV of the Act shall be determined annually
14
by The Health Care Authority by evaluation of the productivity and cost-effectiveness
15
of the institution. The figures for this determination will be obtained from the computer
16
cost containment program in each State and submission by the hospital of the audited
17
expenses of each hospital. The fixed per diem for each institution determined by the
18
State shall be final for the year of that determination and there shall be no appeal
19
process.
20
The hospital shall supply to the Health Care Authority any and all figures
21
required for evaluation of fiscal performance, evaluation of clinical performance and
22
such other figures as may be determined by THCA at anytime.
23
�1
2
Page 48
If a hospital is in a deficit position at the end of the year the Health Care
3
Authority shall cause an audit to be conducted by auditors approved by the State
4
and the results of the audit shall be published. The Health Care Authority shall
5
determine in not more than sixty (60) days:
6
(i)
The deficit is justifiable and will be financed by the State.
7
(ii)
The deficit is not justified in which case the hospital shall lose its
8
mandate to participate in the Universal Health Care Plan.
9
If the hospital has exercised effective cost control, the Health Care Authority shall take
10
this into account when they approve a proposed budget. Under no circumstances shall
11
a hospital be penalized for cost effective management unless:
12
(a)
Auditors in the health care field have determined serious quality of
13
care issues in the institution.
14
(b)
15
owners, whether corporate, individual, community, partnership or any
16
other organized or unorganized entity having any part in control of the
17
institution.
There is evidence of fraudulent practices by the hospital, it's
18
B. THCA shall not pay sums, per diem or other payments, to any hospital which has
19
not been approved to participate in the Health Care Plan by the THCA.
20
C. SPECIALIZED HOSPITALS
21
A hospital with specialized facilities, limiting practice to mental health, drug and
22
alcohol rehabilitation, or any other facilities as described in Section V of the Act, shall
23
�1
Page 49
2
receive a per diem by determination of their audited overall costs for the previous
3
year.
4
D. PRIVATE BENEFACTORS
5
Bequests or moneys voluntarily given to hospitals shall be declared to the
6
THCA but shall be the sole property of the hospital for their exclusive use as
7
determined by the hospital board and shall in no way affect the per diem determined
8
by the THCA.
9
E. NEW EQUIPMENT
10
I
If a hospital has a surplus in their annual budget they may use that
11
surplus in one of the following ways subject to the approval of the THCA who will
12
determine if the proposed usage is in the public interest:
13
(i)
Purchase of new equipment of any kind.
14
(ii)
Upgrading or replacement of old equipment.
15
(iii)
Refurbishing and refurnishing.
16
(iv)
Expansion or extension of the institution.
17
18
II
(a) A hospital without a surplus may apply to the THCA for any of the
19
above Section VIII E (i) through (iv). THCA will establish a panel of not less than nine
20
persons consisting of at least two physicians who shall not be employees of the
21
government and are not involved in the hospital making the application or any other
22
institution in the same area, one nurse who fulfills the same criteria, one person
23
receiving Social Security benefits, one individual resident within five miles of the
�1
2
Page 50
applicant hospital and four experts designated by the THCA.
3
(b) Within one hundred and twenty (120) days the panel shall report to
4
the THCA recommendations regarding the validity of the application, the results of any
5
hearings they may have held relating to the application, and their final
6
recommendations to the THCA. The THCA must make a final determination within
7
ninety (90) days of receipt of the report. The decision of the THCA is final and cannot
8
be appealed.
9
F. NEW HOSPITAL CONSTRUCTION
10
On application from a Community for the establishment of a new hospital in an
11
area, the THCA shall submit the application to the State government who shall make a
12
determination concerning the necessity of such construction taking into account:
13
(i)
The desires and needs of the community.
14
(ii)
Accessibility to other facilities by the members of the community.
15
(iii)
Cost effectiveness of such a facility.
18
(iv)
The written opinion of THCA concerning such construction.
17
18
(II) LICENSED PHYSICIANS
19
(i)
20
negotiate a State fee schedule with the THCA for the physicians
21
practicing in the State based on a fee schedule worked out by the
22
Medical Association in consultation with its various specialist
23
The Medical Association of the State shall be empowered to
�1
Page 51
2
components. The fee schedule proposed shall be presented to the THCA
3
within sixty (60) days of a written request to the Medical Association from
4
the THCA. Representatives of the Medical Association shall meet with
5
the representatives of the THCA and determine between them a cost
6
effective contract which shall be for a two year period. The contract shall
7
be renegotiated every two (2) years. Each physician shall then sign an
8
agreement of participation in the Universal Health Plan and be
9
designated a "participating physician."
10
(ii)
Participating physicians shall be entitled to bill the fiscal
11
intermediary appointed by the THCA directly for services rendered in the
12
amount determined by the fee schedule established by negotiation and
13
this shall be the full payment for services and the patient shall not be
14
billed for further fees other than as provided for in
15
Section VII 3 (f) (i), (ii), (iii), relating to deductibles. The patient shall
16
present proof of having met the deductible within thirty (30) days of the
17
service or shall be responsible for payment of the physician's fees.
18
(iii)
19
provided this is at the request of the patient. Under such circumstances
20
there must be a written request for private patient status signed by the
21
patient and a copy of the written request and the bill for the full amount
22
must be given to the patient and submitted to the THCA. The THCA will
23
pay to the patient only the amount allowed as determined by the
Participating physicians shall be entitled to accept private patients
�1
Page 52
2
negotiated schedule of fees and the patient will be responsible for any
3
extra fees.
4
(iv) Physicians who do not elect to become participants in the Universal
5
Health Care Plan shall be designated "non-participating" and shall not be
6
entitled to bill the THCA for any services performed by them whether or
7
not the patient has contributed to the Health Care Plan.
8
(iv) Should the Medical Association fail to reach an agreement with the
9
THCA within the period prescribed in Section VIII (II) (i), the THCA shall
10
determine a global budget for the fiscal year and the physicians will bill
11
the THCA until such time as the global budget is exhausted when no
12
further payments will be made. Under such circumstances it shall be
13
deemed illegal to bill the patient for services and fines of one thousand
14
($1000 dollars) a day may be imposed on any practitioner who bills any
15
patient and Section VIII (II) (iv) shall also be null and void.
16
(v) Nothing in the Act shall be construed as preventing physicians from
17
operating as a partnership, a group practice, a Health Maintenance
18
Organization (HMO) or other body legally organized for the management
19
of medical practice. Nothing in the Act shall be construed as changing
20
the internal fiscal structure of such partnerships, groups or HMO's,
21
provided that they do not offer services which are in conflict with the
22
basic intent of the Act. However, it shall be clearly understood that it is
23
the responsibility of the individual , not the employer, to select their own
�1
Page 53
2
physician and it is in contravention of the Act for any employer or other
3
organization to select a physician or medical services for an employee.
4
(vi) A patient shall have the right to go to the practitioner of his choice
5
and a practitioner, except under emergency circumstances, shall have
6
the right to refuse to treat a patient provided the practitioner refers the
7
patient for care elsewhere and provided the practitioner to whom the
8
patient is referred expresses willingness to undertake the care of the
9
patient.
10
(III) OTHER LICENSED PRACTITIONERS
11
The THCA shall determine a fee schedule for all other licensed
12
practitioners based on actuarial studies of usual and customary fees over the last
13
three (3) years. Their decision shall be final and there shall be no appeal from this
14
decision. The fee schedule shall be revised every two (2) years.
15
(IV) PAYMENT OF ACCOUNTS
16
Each State THCA shall use a computerized system selected by the
17
Health Care Financing Administration (HCFA). The system shall have the following
18
capabilities:
19
(i)
Processing of claims.
20
(ii)
Statistical tabulation of items billed per physician, amount paid
21
per procedure to each physician, and the number of procedures
22
performed by each physician, also the number of hospital or office
23
visits or any other services monitored by the system.
�1
2
Page 54
(iii)
The ability to print out on a quarterly, six monthly, or annual basis
3
a comparison of physicians in similar circumstances doing the
4
same or similar work in any geographic area in the State, and to
5
present to the THCA the results of such a study with standard
6
deviations printed out. Comparison between groups and
7
individuals inside and outside groups shall be
8
available.
9
10
11
12
(IV) PEER REVIEW
(i)
The existing contractual arrangements between government
authorities and all types of peer review organizations shall be cancelled.
(ii)
Hospitals shall be required to have their medical staff members
13
appoint a Peer Review Committee which shall meet monthly and evaluate at least ten
14
charts in each discipline in which the hospital is licensed to admit. A full report on
15
each case shall be submitted to the THCA on a monthly basis. Parameters for review
16
shall be determined by the State Medical Association in discussion with
17
representatives appointed by the THCA.
18
(iii)
Where there is one hundred per cent or less than fifty per cent
19
compliance with all parameters as set up by the Medical Association and THCA,
20
charts for a period of not less than three months shall be submitted to an external
21
authority for re-review, which authority shall:
22
(a) Not have any relationship to the hospital under review.
23
(b) May be selected from any state of the United States.
�1
Page 55
2
(c) May be physicians employed by a State or Federal agency, such as HCFA.
3
(d) May be a division of the Joint Commission of Accreditation of Hospitals and
4
organizations.
5
(iv)
Where the work of a physician, or the work of the hospital, is
6
determined to be of less than optimal caliber the THCA shall convene a hearing to
7
determine why the infraction(s) should not be reported to the office of the Inspector
8
General and disciplinary measures taken to remove the physician or an entity from the
9
program. The regulations as currently determined by HCFA for "gross and flagrant
10
violations" and "substantial violations in a substantial number of cases" shall apply
11
and the law related thereto shall remain in force except that on the recommendation of
12
the THCA, the HCFA will make recommendations to the Office of the Inspector
13
General as already enacted in law. All the appeals processes shall be available under
14
the same terms and conditions as provided in Section 1156 of the Social Security Act.
15
If it is considered by the Hearing Committee that the infraction(s) do not warrant such
16
action, the matter shall be reported to the State Board of Licensure who shall take
17
action on the matter within sixty days of notification and shall issue to the THCA a
18
report on the action(s) taken. This option shall only be available two (2) times. If the
19
problem(s) occur on a third occasion, the matter shall be reported to the Office of the
20
Inspector General who shall determine the action to be taken.
21
(v) Where an aberrant pattern of practice is determined by the statistical information
22
obtained from the computer print out, and specifically should any physician
23
�1
Page 56
2
or institution be any standard deviation from the norm, the acceptable or unacceptable
3
number of deviations will be determined by the State THCA and their advisors, but in
4
any case whenever a physician or institution or both are two or three standard
5
deviations from the norm, the THCA must take action as determined herein. In the
6
case of:
7
(a) A physician, within not more than sixty (60) days he shall be called before a
8
board which shall consist of two members of the State Board of Licensure, two
9
practitioners who practice in the same specialty and a similar geographic environment,
10
one physician appointed by THCA, one physician appointed by HCFA, and one
11
physician appointed at the request of the physician who has a number of standard
12
deviations from the norm, that number being unacceptable to the THCA. Disciplinary
13
action as determined in Section VIII (IV) (iv) may be taken on the recommendation of
14
this hearing.
15
(b) A hospital or other institution, within not more than sixty (60) days the hospital
16
governing authority or Administrator shall appear for a hearing before a panel
17
consisting of two hospital administrators from hospitals not in the immediate area of
18
the first hospital, two attorneys from an area over one hundred miles from the hospital
19
or institution under investigation, two physicians who are not connected with the
20
hospital or institution or a competing hospital or institution, two members appointed by
1
the THCA and one member appointed by HCFA. The laws and regulations as
2
determined under Section 1156 of the Social Security Act shall apply and the case
3
�1
Page 57
2
must be dismissed, a corrective action instituted, or a recommendation made to the
3
Office of the Inspector General.
4
Should a hospital be brought before a hearing committee on a subsequent occasion,
5
the evidence previously submitted in the previous case will be deemed admissible in
6
its entirety.
7
SECTION IX
8
9
MALPRACTICE
Where a claim of malpractice is filed in any State or in the District of Columbia, the
10
State shall cause a panel to be established which shall consist of licensed physicians,
11
nursing personnel, knowledgeable members of the public appointed by THCA, an
12
attorney and an Administrative Law Judge ("Hearing Officer") who shall chair the
13
panel. The panel shall consist of not less than seven (7) members. All cases claiming
14
malpractice shall be submitted for evaluation by the panel at a hearing. The panel
15
shall be empowered to subpoena witnesses, examine witness, hear arguments by
16
representatives of the parties and make a determination to dismiss or to assess
17
damages where indicated. Individuals or parties to the action shall have the right to
18
appeal to the Court of Appeal should the decision be unacceptable to them. In such
19
cases the transcripts of the hearing, and the written decisions and recommendations
20
as stated by the Hearing Officer shall be entered into evidence in the Court of
21
Appeals.
22
23
�1
Page 58
2
SECTION X
3
Where the provisions of this Act are in conflict with any other Act with respect to
4
medical care, including the Social Security Act, the law as enacted in this Act shall be
5
considered to be authoritative and binding. Where the provisions of the Act are in
6
conflict with legislation related to malpractice, the arbitration process proposed shall
7
substitute for any legislation which is in conflict with this Act.
8
�I
i
i
i
i
i
i
i
t
i
i
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
Addendum
Page 1
COMPUTER SUPPORT FOR UNIVERSAL HEALTH CARE SYSTEM
The management of Universal Health Care ("UHS") will be supported by a
comprehensive computer system. This is a system which is in place and manages a
similar system. This system is not a packaged system and can be tailored to fulfill the
requirements of the Act. The major sub-systems are:
REGISTRATION
Registration of all Americans, physicians, hospitals and all other care providers
("Providers") covered by the Act. The registration information will be used to ensure
claims made on the UHS by Providers for services are processed accurately and
promptly.
SUBMISSION OF CLAIMS
Although it is possible to process claims manually, claims should be submitted
electronically to minimize the processing costs associated with paper submissions and
minimize the time required to process a claim. The care providers should have an on
line computer to enter and validate claims prior to submission. This is to minimize the
submission of invalid claims and thus reduce the need for rejection and re-submission
of claims.
The validation of a claim will be based on the eligibility rules of the Federal and State
Acts. If a claim is denied the provider will be advised using an electronic method. This
minimizes inquiries by Providers requesting an explanation of why an individual claim
has not been paid. If a Provider cannot accept an electronic message then a letter will
be generated at the end of each month.
PAYMENT OF CLAIMS
Payments will be made to Providers for valid claims submitted in the previous
reporting period. The payment system can make the payment electronically to the
Providers bank account using direct deposit technology or a check can be issued. A
report will support the check or direct deposit indicating the number of claims received,
claims paid, and claims denied. The reason for the claim being denied will be given.
The system design will ensure claims denied will be kept to a minimum.
MONITORING AND UTILIZATION SYSTEM
An essential part of the system will be a Claims Utilization Provider System. This
system will have the capability of comparing the claims practice of an individual
Provider with the claims practice of other Providers. The system, using sophisticated
statistical analysis will "measure" how far the individual Provider differs from other
�1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
Page 2
similar Providers. Based on the analysis each Provider is ranked. The ranking and
points awarded to each Provider can then be reviewed and, based on this review,
Providers can be selected for detailed review. (Samples of this are attached; names
are fictitious.)
PER DIEM COST SYSTEM
Based on the costs associated with each intervention/procedure the system will
calculate a fee schedule. The cost module will include all relevant cost factors to
calculate a fee for each intervention or procedure. The system will also calculate an
index for any unusual situation to be applied to the fee: example, procedure or
intervention done after midnight in the patient's home.
COMMUNICATION AND INQUIRIES
A health care system is very complex and initially will generate many inquiries. The
system will be designed to minimize the need for inquiries and to provide on line
information to Providers on the status of a claim or the status of an American to
receive service under the plan.
* Attachments describe
- Provider Profile System information
- Example of Peer Review Profile with
ranking.
�DIAGRAMATIC SUMMARY OF PROFILE
SYSTEM
MANUAL FOR USE OF SYSTEM WITH
STATISTICAL
PRINTOUTS
�k
CONWAY>
INFORMATION SYSTEMS INC.
CONWAY
Provider
Profile
System
�Conway Health Support
�Conway's Provider Profile System
Claims/
Encounters
Parameters
Providers
Performance
Standards
Time Series
lily Service
Monitoring
Graphics
Profile
Enquiry
Provider
Profiles
Peer Group
Profiles
Rankings
�Provider Profile System
IComcare
.System
Providers
Claims/Encounters
Conway's
Provider
frofile
System
Peer Group
Reports
Provider
Reports
Ranking
Reports
�Conway's Provider Profile System
�Profile Reports
Peer Group
ilSlilPili
Summary
ISiiiliill
Distrlbufion
Age/Sex.
Adjusted
�CONWAY>
k
INFORMATION SYSTEMS INC.
CONWAY INFORMATION SYSTEMS INC
PROVIDER PROFILE
SYSTEM
"EXCELLENCE,
ON TIME...ON BUDGET"
�INTRODUCTION
The purpose of the manual i s t o i n t r o d u c e Medical D i r e c t o r s
and Research Analysts ( r e f e r r e d t o i n t h e manual as USERS)
t o CONWAY'S PROVIDER PROFILE SYSTEM.
The PROVIDER PROFILE SYSTEM i s a c l a i m s u t i l i z a t i o n
m o n i t o r i n g system. The System i s designed t o a s s i s t Medical
D i r e c t o r s i n Health Maintenance Organizations, P r a c t i t i o n e r
Provider Organizations and H o s p i t a l s t o m o n i t o r P r o v i d e r s
u t i l i z a t i o n o f m e d i c a l s e r v i c e s . T h i s i s achieved i n a
very unique way.
PROVIDERS a r e g r o u p e d i n t o PEER GROUPINGS. The P e e r
Groupings can be by one, o r a
combination
of s i x
c h a r a c t e r i s t i c s t h a t describe a Provider. A l l claims made by
the Providers i n the group are then selected from t h e CLAIM
FILE and AVERAGE STATISTICS a r e c a l c u l a t e d f o r t h e group.
The group s t a t i s t i c s are then c a l c u l a t e d f o r a l l P r o v i d e r s
i n c l u d e d i n t h e g r o u p . The c l a i m s p r a c t i c e o f e a c h
i n d i v i d u a l w i t h i n the group i s t h e n compared t o t h e group
"NORM".
The comparisons are based on seven CLAIM STATISTICS.
RANKING STATISTICS are:
1.
2.
3.
TOTAL COST OF SERVICE
TOTAL NUMBER OF SERVICES PROVIDED
TOTAL NUMBER OF PATIENTS SEEN
4.
5.
6.
COST PER SERVICE
COST PER PATIENT
NUMBER OF SERVICES PER PATIENT
7.
These
NUMBER OF EXCEPTION FLAGS
By RANKING each PROVIDER compared t o t h e GROUP NORM, t h e
u t i l i z a t i o n p r a c t i c e o f the Providers can be "MEASURED".
PERCENTILE and STANDARD DEVIATION S t a t i s t i c s a r e used t o
d e t e r m i n e t h e degree a P r o v i d e r i s o u t s i d e t h e EXPECTED
VALUE (AVERAGE) o f t h e Group.
Based on t h e d e g r e e a
Provider i s outside the norm, EXCEPTION FLAGS are s e t .
The above s t a t i s t i c s are reported by various "views" o f t h e
DATA. The views a r e r e p o r t e d i n t h r e e s e t s o f PROFILE
REPORTS.
CONWAY INFORMATION SYSTEMS INC.
�PROFILE REPORTS
There are three sets of REPORTS.
p a r t s . Each p a r t
provides
Each s e t has a number of
a different
view of t h e
u t i l i z a t i o n service pattern of the Provider.
1.
PROVIDER PROFILES
PROVIDER SUMMARY
GENERAL INFORMATION SUMMARY
SPECIAL SERVICE SUMMARY
MONTHLY DISTRIBUTION SUMMARY
AGE/SEX SUMMARY
FEE ITEM SUMMARY
2.
PEER GROUP PROFILES
PEER GROUP SUMMARY
GENERAL INFORMATION SUMMARY
SPECIAL SERVICE SUMMARY
MONTHLY DISTRIBUTION SUMMARY
AGE/SEX SUMMARY
FEE ITEM SUMMARY
3.
RANKING PROFILE
Providers
i n t h e Peer Group a r e s o r t e d by one of t h e
Rankings.
As there are seven rankings, seven reports can be
requested.
CONWAY INFORMATION SYSTEMS INC.
�SYSTEM HIGHLIGHTS
1.
P r o f i l e s use two input f i l e s .
1.
2.
CLAIMS
PROVIDERS
2.
The CLAIMS FILE contains information on the services
provided and charged by the Providers.
3.
The PROVIDER F I L E contains c h a r a c t e r i s t i c data on
a l l Providers. S i x c h a r a c t e r i s t i c s can be used t o
define the Provider. This f e a t u r e makes the system
very f l e x i b l e .
4.
Based on t h e P r o v i d e r c h a r a c t e r i s t i c s , P e e r
Groupings can be automatically created. For example,
i f the f i r s t c h a r a c t e r i s t i c s were the P r o v i d e r ' s
s p e c i a l i t y a Peer Group could be created f o r a l l
Providers whose s p e c i a l i t y i s surgery.
5.
The P r o f i l e user can define the c h a r a c t e r i s t i c s of
the c l a i m data t o t h e s y s t e m .
F o r example t h e
AGE/SEX groupings can be t a i l o r e d for the Peer Group
being reviewed.
6.
The system can produce P r o f i l e s using actual data or
adjusted data. The user has the option to request
adjusted data.
7.
The system produces a great d e a l of i n f o r m a t i o n .
However, the user can request the information a t the
summary and d e t a i l l e v e l .
8.
The Provider S e r v i c e s can be reported by PERSONAL
and REFERRED s e r v i c e s .
9.
The main components of the Provider P r o f i l e ,
Group and Provider reports a r e :
Peer
SUMMARY INFORMATION
GENERAL INFORMATION COMPONENT
SPECIAL SERVICE SUMMARY
MONTHLY DISTRIBUTION COMPONENT
AGE/SEX SUMMARY COMPONENT
PROCEDURE SUMMARY COMPONENT
10. The AGE/SEX and MONTHLY DISTRIBUTION of a P r o v i d e r s
data can be adjusted to the GROUP AVERAGE.
CONWAY INFORMATION SYSTEMS INC.
�SYSTEM BENEFITS
1.
UTILIZATION PATTERNS of
monitored.
P r o v i d e r Groups can
The m o n i t o r i n g
c a n be by
one
or
be
a
combination of the Provider c h a r a c t e r i s t i c s .
2.
PROVIDERS CLAIMS PRACTICE can be MONITORED a g a i n s t
the PEER GROUP AVERAGE.
3.
PROVIDERS c a n be a s s i g n e d
to
one
o r more
PEER
GROUPS.
4.
The system can i d e n t i f y :
D e v i a t i o n s from the PEER GROUP average.
V a r i a t i o n s i n c l a i m p a t t e r n s by:
SPECIAL SERVICE SUMMARY
AGE/SEX
MONTHLY DISTRIBUTION
CPT CODE
FEE ITEM
5.
The system can be t a i l o r e d to measure
the degree a
PROVIDER v a r i e s from the AVERAGE PROVIDER i n t h e
PEER GROUP.
6.
The PROVIDER PROFILES can be used f o r PEER GROUP
reviews.
7.
The Provider information can be reported a t v a r i o u s
degrees of d e t a i l .
: N A INFORMATION SYSTEMS INC.
OWY
�#**»**
«»«#»*
•«*»»
## *
*»
C O N W O Y
H E P L T H
S Y S T E M S
PAGE t
* * » * * # » * * * # » # « » * * * * * » # # * « * * # • # » * * * » » « # # * » # » » * « « « » # • # *
«
PEER GROUP PROFILE
*
» « * * «•*««**« « « » * * » » # » * * * » » * «
*
SUMMOHY
#
*
INFORMATION
*
PRINTED
PEER GROUP t V I C T O R I A GENERAL PROCS
ON OS OCT 19fl5
< VICGP
REPORT PERIOD JAN 8 6 - DEC 8 6
***«*»**«*******«****•**»»»*
**» PEER GROUP D E T A I L S * » #
3
NUMBER OF MEMBERS CURRENTLY I N GROUP
NUMBER OF A C T I V E MEMBERS I N GROUP
PROVIDER EARNINGS NEEDED TO Q U A L I F Y
PROVIDERS Q U A L I F I E D FOR S T A T I S T I C S
3
DETAILS *»#
AVERAGE
LOWEST
HIGHEST
TOTAL FLAGS
I
£503
1945
3046
TOTAL COSTS
TOTAL SERVICES
TOTAL PATIENTS
j
I
I
COSTS PER SERVICES
COSTS PER PATIENTS
SERVICES PER PATIENTS
:
:
t
* O
3
*** SERVICING
«
*
7,300
74
8
• 6, 9 0 0
61
4
« 100
1,095
10
* 88
* 690
7
*
7,700
88
10
ACTIVE
£1,900
223
24
*
TOTAL
21,900
223
24
REFERRED
TOTAL
#*»**
PRINTED
GENERAL INFORMATION
DEFINED GENERAL INFORMATION
MONTHLY DISTRIBUTION
MONTHLY DISTRIBUTION ADJUSTED
AGE/SEX DISTRIBUTION
AGE/SEX DISTRIBUTION ADJUSTED
SERVICE GROUP TOTALS
FEE ITEM DETAILS
C O N W A Y
*
TOTAL
* 120
* 770
15
PERSONAL
***** PRINT OUT D E T A I L S
QUALIFIED
H E A L T H
<
<
YES
NO
YES
NO
YES
YES
S Y S T E M S
AVG FLAGS
N/A
N/A
>
>
164
O
371
O
92
208
PRINTED
<
<
YES
NO
YES
NO
YES
YES
AVG FLAGS
N/A
N/A
PEER GROUP
>
>
161
O
439
O
93
229
PRINTED
YES
NO
YES
NO
YES
NO
<
<
AVG
FLAGS
117
O
163
O
466
O
N/A
N/A
)
)
SUMMARY INFORMATION
V I C T O R I A GENERAL PRACS
( VICGP
)
�CONWAY
*
PEER GROUP PROFILE
*
«*«***»**«*****«*»««««#**««*
*
GENERAL
*
*
INFORMATION
*
***»•*»*»***********•***»«**
H E A L T H
S Y S T E M S
PAGE £
PRINTED ON 08 OCT 1985
PEER GROUP s VICTORIA GENERAL PRACS
( VICGP
REPORT PERIOD JAN 86 - DEC 86
-JL.
6RP AVR
t- O. A S. D.
I GROUP 91
I PERCENT
COSTS I
PERSONAL COSTS
SELF-REFERRED COSTS
REFERRED-OUT COSTS
TOTAL REFERRED COSTS
3,981
1,929
2,1A2
3,703
TOTAL COSTS
PERCENT OF COSTS REFERRED
7,431
50
SERVICES :
PERSONAL SERVICES
SELF-REFERRED SERVICES
REFERRED-OUT SERVICES
TOTAL REFERRED SERVICES
38
23
20
41
TOTAL SERVICES
PERCENT OF SERVICES REFERRED
79
51
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I GROUP
t AVERAGE
I
I
4,300 I
2,500 I
2,900 I
4, 300 I
I
7, 700 I
56 I
I
I
I
• I
41 I
30 I
29 I
47 I
I
88 I
53 I
PATIENTS :
PERSONAL PATIENTS
SELF-REFERRED PATIENTS
REFERRED-OUT PATIENTS
TOTAL REFERRED PATIENTS
6
6
6
7
I
I
I
I
i
9 I
90 I
I
TOTAL PATIENTS
PERCENT OF PATIENTS REFERRED
CONWAY
H E A L T H
S Y S T E M S
7
7
7
8
I
I
I
I
10 I
lOO I
I GROUP
! STD DEV
I
I
3,833 I
1, 700 I
1,767 I
3,467 I
I
7,300 I
47 I
I
I
I
I
37 I
21 I
16 I
37 I
I
74 I
49 I
I
I
I
I
6 I
5 I
5 I
7I
i
a:
87 !
I PROVIDER
i COUNT
368
572
939
591
327
6
11
6
1
2
1
2
3
9
I
I
I
I
I
I
I
i.
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I GROUP
I MEDIAN
3, 800
1, 400
3
3
3
3
3, lOO
3
3
7, 300
45
i , aoo
3
3
3
3
36
18
11
39
3
3
74
53
3
3
3
3
6
6
4
8
3
3
10
SO
GENERAL INFORMATION
PEER GROUP : VICTORIA GENERAL PRACS
( VICGP
)
�C O N W A Y
«
PEER GROUP PROFILE
H E A L T H
S Y S T E M S
PAGE 3
*
##**«#«**#»•**»****##**«*»*#
*
GENERAL
*
INFORMATION
PRINTED ON 08 OCT 1965
#
*
P E E R GROUP i
REPORT PERIOD JAN 86 - DEC 86
^
COSTS PER SERVICES s
PERSONAL COSTS / PERSONAL SERVICES
REFERRED COSTS / PERSONAL SERVICES
REFERRED COSTS / REFERRED SERVICES
TOTAL COSTS / TOTAL SERVICES
COSTS PER SERVICES :
PERSONAL COSTS / PERSONAL PATIENTS
REFERRED COSTS / PERSONAL PATIENTS
REFERRED COSTS / REFERRED PATIENTS
TOTAL COSTS / TOTAL PATIENTS
^
2^
-2k
GRP AVR
• O. 4 S. D.
2L-
I GROUP 91
I PERCENT
I
I
110 I
96 t
104 I
I
106 I
I
I
I
' I
831 I
665 I
618 I
I
1,30a i
i
I GROUP
I AVERAGE
I
I
119 I
105 I
iao i
I
1 SO I
I
I
I
I
1,073 I
750 I
750 I
I
1,825 I
I
I
SERVICES PER PATIENTS I
PERSONAL SERVICES / PERSONAL PATIENTS
REFERRED SERVICES / PERSONAL PATIENTS
REFERRED SERVICES / REFERRED PATIENTS
TOTAL SERVICES / TOTAL PATIENTS
C O N W A Y
H E A L T H
< VICGP
V I C T O R I A GENERAL PRACS
S Y S T E M S
7I
7I
6 I
I
ia i
9 I
7I
6 I
I
15 t
I GROUP
I STD DEV
I
I
104 I
92 I
97 I
I
100 I
I
I
I
I
731 I
627 I
558 I
I
1,095 I
I
I
I
I
7 I
6 I
I
10 t
I
I PROVIDER
I COUNT
15
9
17
14
250
96
149
517
1
0
1
3
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
!
I
I
I
I
I
t
I GROUP
I MEDIAN
I
109
89
91
3
3
3
93
633
614
538
3
3
3
770
6
7
6
3
(
GENERAL INFORMATION
PEER GROUP : VICTORIA GENERAL PRACS
( VICGP
)
�C O N W A Y
»#*#****»**« ***##*«#*##**«#*
*
PEER GROUP PROFILE
#
H E A L T H
S Y S T E M S
PAGE 4
PRINTED ON OS OCT 1985
#**«•##*##*###*«**#*»•*«*»##*
*
*
PERSONAL
MONTHLY
I MONTHS
1
!
1
!
i
1
1
!
i
1
1
1
1
*
DISTRIBUTION
1
GROUP
i
VICTORIA
COSTS
1
t
1
1
1
1
1
:
1
i
1
1
550
982
499
1, 3 9 8
849
286
0
0
0
0
0
O
GENERAL
( VICGP
PRACS
*
REPORT PERIOD JAN 86 - DEC 86
GROUP AVERAGE + 0.4 STANDARD D E V I A T I O N
1
JAN
FEB
MAR
APR
MAY
JUN
JUL
AUG
SEP
OCT
NOV
DEC
PEER
SERVICES P A T I E N T S
5
10
6
13
a
3
O
o
o
o
0
o
1
2
1
3
2
1
O
0
0
o
o
o
GROUP 9 1
1
C/S
C/P
S/PI
COSTS
ISO
122
70
119
148
74
O
O
O
O
•O
0
325
400
301
516
486
158
O
O
0
O
0
O
31
41
4(
41
51
21
01
Ol
01
Ol
Ol
Ol
900
1, 4 0 0
aoo
1, 6 0 0
1, ooo
SOO
0
o
0
o
0
o
===================
1 TOTAL
1
l
SERVICES P A T I E N T S
c/s
C/P
S/Pi
2
3
2
4
2
2
O
O
300
ISO
89
130
200
125
O
0
O
O
O
O
450
467
400
650
500
250
0
O
0
O
O
0
51
51
51
5!
61
3!
Ol
Oi
01
Ol
0!
Ol
IO
15
9
13
10
4
0
O
O
O
O
O
o
o
o
0
=========== = = = = a = =± = = = = = = =
3,981
=================== =
PERCENT
38
6
110
= = = = = = = = = = = = = = = = = = = E = = = = = a = = = = = = =
831
======
71
4, 3 0 0
41
=========== ==========
7
=
======== ======
119
1, 0 7 5
=
91
= = = ======
MONTHLY DATA ACCUMULATED BY PAID DATE
C O N W A Y
H E A L T H
S Y S T E M S
PERSONAL MONTHLY DISTRIBUTION
PEER GROUP : VICTORIA GENERAL PRACS
( VICGP
)
�**#******#*
# *« *#**
»* # # »
•
C O N W O Y
»***«*««»**•***»»•««*****•*•
*
PEER GROUP PROFILE
*
»«»*«**«*#•******»«**•******
*
PERSONAL
»
*
MONTHLY
DISTRIBUTION
H E A L T H
S Y S T E M S
PEER GROUP t VICTORIA GENERAL PRACS
PAGE 5
PRINTED ON OS OCT 1985
( VICGP
REPORT PERIOD JAN 86 - DEC 86
»
#*****#*«**#*»***»**##*»»#**
i MONTHS
1
t
1
GROUP STANDARD DEVIATION
1
1
COSTS
SERVICES PATIENTS
400
JAN
FEB
MAR
APR
MAY
JUN
JUL
AUG
SEP
OCT
NOV
DEC
1
1
I
1
I
I
I
I
1
I
1 TOTAL
1
1
1
1
1
1
1
1
1
1
!
!
!
GROUP AVERAGE
1
1
367
1, 300
767
£00
0
0
4
8
4
1£
7
2
0
0
B/Pt
COSTS
130
1 IO
55
110
128
53
O
O
0
£1
41
31
41
41
21
Ol
01
01
01
Ol
01
374
455
330
£45
£05
£16
0
O
0
0
0
O
4
5
4
1
2
2
0
O
0
71
368
1
O
0
0
0
0
o
o
o
250
372
233
461
467
117
O
0
O
0
O
0
37
6
104
731
o
o
o
o
o
o
3,833
1
£
1
3
C/P
0
,•
aoo
1
C/S
o
0
SERVICES PATIENTS
C/S
C/P
1
1
1
1
0
1
0
o
0
0
0
126
£8
39
24
52
53
O
O
0
O
O
O
187
70
170
136
47
103
0
O
O
O
0
O
21
11
21
1 1
21
11
01
01
Ol
Ol
OI
Ol
3
1
15
250
1 1
o
0
o
o
S/PI
MONTHLY DATA ACCUMULATED BY PAID DATE
C O N W A Y
H E A L T H
S Y S T E M S
PEER
GROUP
PERSONAL MONTHLY DISTRIBUTION
VICTORIA GENERAL PRACS
( VICGP
>
�C O N W A Y
*
MONTHLY D I S T R I B U T I O N
H E A L T H
S Y S T E M S
******•*******»»««*»*««*•«*••»»***•«**»»»*»***»»«**»«
*
PEER GROUP PROFILE
*
*#*****#***»#«»##»#*#«»«**#*
*
PERSONAL
»
PAGE 6
PRINTED ON OS OCT 1985
PEER GROUP I VICTORIA GENERAL PRACS
< VICGP
#
REPORT PERIOD JAN 86 - DEC 86
«**»********»***«"»**•»•«****
1 MONTHS
(
1
1
1
1 PROVIDER
i
1
1
1
COSTS
300
TOO
, 300
1, 3 0 0
800
lOO
0
0
0
0
0
0
JAN
FEB
MAR
APR
MAY
JUN
JUL
AUG
SEP
OCT
NOV
DEC
,
a i
1
1
1
I
1
1
!
!
1
1
3 1
1
O
O
O
0
0
O
! TOTAL
i
3 1
!
!
i
t
1
1
!
!
!
!
1
!
GROUP MEDIAN
1
r*ni IKIT
L.LJLJIN 1
a i
3 1
3 1
a t
1
1
1
1
1
1
3, aoo
SERVICES
PATIENTS
C/S
C/P
11
41
41
41
51
21
01
Ol
01
Ol
Ol
Ol
61
1
1
a
a
0
90
93
75
123
lOO
33
0
O
0
o
•0
0
300
350
300
400
SOO
lOO
0
O
0
0
O
O
4
13
6
3
0
0
0
0
0
i
3
633
a
i
o
o
o
o
0
O
36
6
109
S/PI
MONTHLY DATA ACCUMULATED BY PAID DATE
CONWAY
H E A L T H
S Y S T E M S
PERSONAL MONTHLY DISTRIBUTION
PEER GROUP : VICTORIA GENERAL PRACS
( VICGP
)
�C O N W O Y
»*««****•«**•**«*****»#•**«*
»
PEER GROUP PROFILE
*
H E A L T H
S Y S T E M S
PAGE IO
##*****#*#*****»##*****##«******#*******###*»****#*##
PRINTED ON OS OCT 1385
•*«*«###*»#***•****####»*##»
*
*
TOTAL
MONTHLY
DISTRIBUT'ION
PEER GROUP i VICTORIA GENERAL PRACS
*
( VICGP
»
REPORT PERIOD JAN 86 - DEC 86
**«***********«*#*»»********
X
1
GROUP AVERAGE + O.4 STANDARD D E V I A T I O N
1
COSTS
i
1
!
!
!
1
!
!
1
1
!
i
MONTHS
1,112
1,941
1,194
1,847
1,582
1,016
O
O
O
0
O
0
GROUP 9 1
1
1
PERCENT
i
! JAN
! FEB
1 MAR
: APR
! MAY
! JUN
1 JUL
: AUG
! SEP
! OCT
! NOV
1 DEC
=== = = =
: TOTAL
11
20
16
18
15
11
0
0
O
O
0
O
7,431
79
9
C/S
C/P
S/P!
204
120
64
1 16
153
125
0
0
0
0
0
0
3
4
3
4
5
4
0
0
O
O
O
O
= = = = = = = = === = = = = a=) 3 : = B = = = = S B i = EsaES = =
=
:= =
:
1
.
SERVICES PATIENTS
370
503
298
576
371
254
0
O
0
0
0
0
31
51
41
51
31
31
Ol
Ol
Ol
Ol
Ol
Ol
s
COSTS
SERVICES P A T I E N T S
1, 9 0 0
19
2, aoo
i , aoo
2a
24
20
20
13
0
O
0
O
O
O
2, 30O
1, 9 0 0
1, 2 0 0
O
O
o
0
o
o
========= ========== ======= =
106
1, 3 0 2
121
4
4
4
4
7
4
O
O
O
O
O
O
C/S
C/P
300
ISO
75
130
200
171
0
0
0
O
0
O
475
700
450
650
400
300
0
O
O
O
0
O
S/PI
51
7!
61
51
41
3!
01
Ol
01
Ol
01
Ol
================ = = = = = =
=======
= S3 = = = = = = =
aa
7, 7 0 0
IO
120
1, 8 2 5
151
MONTHLY DATA ACCUMULATED BY PAID DATE
C O N W A Y
H E A L T H
S Y S T E M S
PEER
GROUP
TOTAL MONTHLY DISTRIBUTION
VICTORIA GENERAL PRACS
( VICGP
>
�C O N W A Y
**«**#»»#**»««**#«#***«**»**
*
PEER GROUP PROFILE
*
**#*#*#**#*##*###»***#»#*#**
*
TOTAL
«
*
MONTHLY D I S T R I B U T I O N
H E A L T H
S Y S T E M S
PAGE 11
# • * * * * * * # * # * * # * * * * * » » # * * # » * » * * * » » * * * * # * # * * * # » * » * * # # # *
PRINTED ON OS OCT 1985
PEER GROUP « VICTORIA GENERAL PRACS
< VICGP
REPORT PERIOD JAN 86 - DEC 86
*
X
! MONTHS
!
:
!
1
!
!
!
!
i
1
!
!
!
GROUP AVERAGE
!
1
JAN
FEB
MAR
APR
MAY
JUN
JUL
AUG
SEP
OCT
NOV
DEC
COSTS SERVICES PATIENTS
i
1
i
1
l'
1
1
1
1
1
1
1
aoo
1,600
900
1,667
1, AOO
933
O
0
O
O
O
O
1
C/S
C/P
7
16
IS
16
13
IO
0
O
O
O
O
0
S
A
3
3
A
A
0
O
0
O
O
0
167
0
O
0
325
ASS
SS5
525
3A9
233
0
O
0
0
O
0
7A
a
lOO
1, 095
ioa
50
108
13A
105
0
O
0
S/PI
31
Al
31
51
31
31
01
Ol.
01
Ol
Ol
Ol
GROUP STANDARD DEVIATION
COSTS
779
852
735
ASO
A55
205
0
O
O
0
O
0
SERVICES PATIENTS
a
1
0
2
9
IO
A
7
2
O
O
2
o
o
o
o
o
o
o
o
r
o
o
0
1
7,300
C/B
C/P
9A
32
35
22
A7
A9
O
O
O
O
O
O
1 IA
195
IBA
127
56
51
O
O
O
O
O
O
S/PI
21
21
21
Ol
11
1 1
01
Ol
0!
Ol
Ol
O!
=."=========== ===,====,
= E=£= = = = = = = = i a = S K c : = s s s s s = 3 s a s = 3 = B S
1 TOTAL
1
lOI
327
11
3
IA
517
31
MONTHLY DATA ACCUMULATED BY PAID DATE
CONWAY
H E A L T H
S Y S T E M S
TOTAL MONTHLY DISTRIBUTION
PEER GROUP : VICTORIA GENERAL PRACS
( VICGP
)
�C O N W O Y
»«##»
*####
»»#«»
** * •
** *
»*»**««***«*«*«*•«*«•*«»**•*
*
PEER GROUP PROFILE
*
*#«#»*#»*##*»»**»*»«»»»«*#«*
*
TOTOL
»
*
MONTHLY
! MONTHS
!
!
DISTRIBUTION
S Y S T E M S
( VICGP
REPORT PERIOD JON 86 - DEC 86
GROUP MEDIAN
I
1
COSTS
SERVICES PATIENTS
300
2
1, 100
15
900
12
1, AOO
18
1, SOO
IA
900
IO
0
0
O
O
0
0
0
0
O
0
0
0
=========== ========== =
7, 300
7A
3 1
==== S E 1 S = = C S = =3 = = = =
3
3
2
3
3
3
0
O
O
O
0
O
POGE 12
PRINTED ON OS OCT 1985
PEER GROUP I VICTORIO GENERAL PROCS
»
PROVIDER
COUNT
: JON
! FEB
I MOR
! OPR
I MOY
! JUN
! JUL
! RUG
I SEP
! OCT
I NOV
I DEC
========
I TOTOL
H E O L T H
**«»***»**»******»*****«»»*»•»****»**«***»»#***«**«**
t
t
1
1
1
1
1
1
1
1
1
1
1
A
A
A
A
A
O
0
O
O
0
O
= a = = = = = = = =
10
C/S
C/P
S/PI
300
21
300
At
2£5
31
575
51
375
31
225
31
0
01
O
Ol
o
0
Ol
o
0
O
Ol
0
Ol
o
0
Ol
0
======= = a = =5=s =
770
91
93
====== ======= es = = = = =
100
lOO
75
115
107
go
0
MONTHLY DATA ACCUMULATED BY PAID DOTE
C O N W A Y
H E O L T H
S Y S T E M S
PEER
GROUP
TOTAL MONTHLY DISTRIBUTION
VICTORIA GENERAL PROCS
( VICGP
>
�C O N W A Y
*
PEER GROUP PROFILE
*
«***#*•#**#***»##**##**»*#«#
*
PERSONAL FEMALE
*
*
AGE/SEX DISTRIBUTION
#
! AGE/SEX
: GROUPS
- 10
-20
- 30
- 40
- 50
- 99
! TOTAL
CONWAY
S Y S T E M S
261
998
794
O
626
O
< VICGP
REPORT PERIOD JAN 86 - DEC 86
SERVICES PATIENTS
C/S
C/P
1
1
1
37
78
91
O
70
O
261
998
794
O
626
O
4
11
a
o
o
5
o
o
2, 090
H E A L T H
PAGE 13
PRINTED ON OB OCT 1985
PEER GROUP t VICTORIA GENERAL PRACS
GROUP AVERAGE + O.4 STANDARD DEVIATION
COSTS
O
11
21
31
41
51
H E A L T H
1
103
S Y S T E M S
GROUP 91 PERCENT
S/PI
COSTS
4I
11I
81
Ol
51
Ol
SOO
1, 400
1, 200
O
1, 200
O
lOI
2, 400
SERVICES PATIENTS
7
14
11
O
9
O
1
1
1
O
1
O
C/S
C/P
71
10O
500
1, 400
log
i , aoo
o
i , aoo
o
o
133
O
120 1,200
I
S/PI
71
141
11 I
01
91
Ol
== ==
=
lOI
PERSONAL FEMALE AGE/SEX DISTRIBUTION
PEER GROUP : VICTORIA GENERAL PRACS
( VICGP
)
�C O N W A Y
H E A L T H
S Y S T E M S
*
PEER GROUP PROFILE
«
*
*
PERSONAL FEMALE
AGE/SEX D I S T R I B U T I O N
*
#
PEER GROUP
PAGE 14
***»»»»*****•********»**#**»»*»#*##**»»*****•#*#*#***
»«««»*»*««**•«««»««•****«***
PRINTED ON OS OCT 1985
VICTORIA GENERAL PRACS
( VICGP
REPORT PERIOD JAN 86 - DEC 86
* # • * * • * * * # # * * * * * * « » » # * * * » * * »
! AGE/SEX
! GROUPS
;•
!
: o - io
: i i - so
l
21
-
SO
! 31 - 40
! 41 - 50
! 51 - 99
COSTS
i
!
1
!
!
1
GROUP AVERAGE
167
767
633
O
400
O
1
C/S
C/P
S/PI
COSTS
0
1
1
0
0
24
61
84
0
44
O
167
767
633
0
400
0
2-1
81
71
01
31
Ol
236
579
403
O
566
O
2
8
7
O
3
O
1,967
========== ================ =
c a N U) A Y
H E A L T H
GROUP STANDARD D E V I A T I O N
SERVICES PATIENTS
- - - - - — ================ ============= =
! TOTAL
1
o
= = = = =» = S3
£1
= = = =
======= =
a = =
a
========
SERVICES P A T I E N T S
3
6
3
O
4
O
C/S
1
C/P
S/PI
0
O
O
O
O
O
34
236
31
43
579
61
18
403
31
O
Ol
0
63
566
41
0
O
O!
=================== = = = = = = = = = ====== =======
309
O
1
IS
£59
11
96
889
91
=s = = = s s z 3 a = ======== = = = = = = = ===== ======== =========== =================== ============== =======
S Y S T E M S
2
PEER
GROUP
PERSONAL FEMALE AGE/SEX DISTRIBUTION
VICTORIA GENERAL PRACS
< VICGP
)
�*«#*«##*****»»«**#»#»#****»*
#*#*»**
**« »#
*#• #
#
*
PEER GROUP
PROFILE
»
«*#*#*«##*##***»###**
*
*
PERSONAL F E M A L E
AGE/SEX D I S T R I B U T I O N
! AGE/SEX
: GROUPS
1
H E A L T H
1
2
3
0
1
0
!
< VICGP
REPORT PERIOD JAN 86 - DEC 86
GROUP MEDIAN
1
1
1
O - 10
: n - ao
PAGE 15
PRINTED ON OB OCT 1985
COSTS
1
1
1
1
1
1
SERVICES PATIENTS
0
0
0
900
11
1
AOO
6
1
! 21 - 30
1
O
O
0
: 31 - AO
1
0
O
0
! A l - 50
1
0
! 51 - 99
o
o
;
=
:=.
============ ============ =3 = = = =5c==scan= « ====== = = = = = = = = = = = = = = = = = = ! =
£0
2
1
3 1
! TOTAL
i.aoo
!
S Y S T E M S
PEER GROUP > VICTORIA GENERAL PRACS
1
1 PROVIDER
1 COUNT
[
*
»
C O N W A Y
» * * * * * * * # » * * * # * # • » » * * » # * * * * * » * * # * # * # » * * * # * » » • # * * » # * » »
C/S
C/P
S/PI
0
82
75
0
0
.O
O
900
AOO
O
O
O
90
90O
01
11 1
61
Ol
Ol
01
= = = = =!
101
==========
C O N W A Y
H E A L T H
S Y S T E M S
PEER
GROUP
PERSONAL FEMALE AGE/SEX DISTRIBUTION
: VICTORIA GENERAL PRACS
( VICGP
>
�C O N W A Y
»
PEER GROUP PROFILE
#
*«#««*««*««*«*•**«*«#«•««***
*
PERSONAL MOLE
»
*
AGE/SEX DISTRIBUTION
»
H E A L T H
S Y S T E M S
PAGE 16
*#**»#»**»*»#*#**»»#*»»•»*»#•»»»»*»****#»**##»*##»#»#
PRINTED ON OS OCT 1985
PEER GROUP I VICTORIA GENERAL PRACS
< VICGP
REPORT PERIOD JAN 86 - DEC 86
**«*##*•**-****»*****»*»*»«**
.A.
i AGE/SEX
GROUP AVERAGE
O.4 STANDARD DEVIATION
GROUP 91 PERCENT
: GROUPS
1
!
1
:
f
!
1
1
!
O
i i
21
31
41
51
-
IO
20
30
40
50
99
-=
C O N W A Y
!
i.oai
!
1
!
!
0
386
531
O
1,917
SERVICES PATIENTS
301
:
i
TOTAL
- -—------
COSTS
C/S
1
1
0
1
1
0
183
121
0
100
79
O
2
9
O
3
6
O
17
4
========== ========= E3 =
= = = = = = s=s= = := = =3 = = s::
H E O L T H
S Y S T E M S
C/P
301
i.oai
0
386
342
O
121
=S = SX =
718
======= =
=
COSTS
S/PI
C/S
C/P
S/P I
400
1, 4 0 0
O
500
400
O
41
11 1
Ol
51
61
Oi
400
1, 4 0 0
0
500
SOO
O
61
=
4
11
0
5
7
O
1
1
0
1
2
O
300
129
O
133
114
O
2, OOO
21
91
01
31
41
01
= 19 = = = =
SERVICES P A T I E N T S
19
4
133
950
=========== =========> = = = = = = = = = =
:
====== ======= =
PEER
GROUP
8!
= = = = = z=
PERSONAL MALE AGE/SEX DISTRIBUTION
VICTORIO GENEROL PROCS
( VICGP
)
�»»•»»###»#
**»#»#»#»#»
# »###»#»#
** * * * *** *
»
#
*
C O N W O Y
**«*#*»##**## # » » * » » * * » * * * « * *
»
PEER GROUP PROFILE
*
* * # * » * # # # * * * » * * * » * * * # » * # • » * »
*
*
PERSONAL MOLE
OGE/SEX D I S T R I B U T I O N
H E O L T H
S Y S T E M S
PEER GROUP i VICTORIO GENEROL PROCS
»
«
POGE 17
PRINTED ON OS OCT 1985
< VICGP
REPORT PERIOD JON 86 - DEC 86
###»***#**»***#*#********»*#
-X
GROUP OVEROGE
I OGE/SEX
j
!
!
!
!
!
!
0 - 1 0
11 - 2 0
21 - 30
3 1 - AO
A l - 50
51 - 9 9
1
!
1
1
1
1
233
933
0
300
AOO
0
|
2
0
3
A
O
o
17
3
= = = = = = = = = = = = = = =========
==
! TOTOL
1
==================
=
C O N W A Y
=
=
=
=
=
=
=
H E A L T H
=
=1 =
.
=SS5=SS33S3
=
=
=
=
=
=
=!
=
=
=
=
=
=
S Y S T E M S
=
1 IA
=
C/S
C/P
S/PI
O
O
0
O
1
O
125
21
O
57
A7
0
170
368
O
216
189
O
21
21
Ol
==»=.==============
=
=
SERVICES P A T I E N T S
233
933
0
300
267
O
=========
1,867
COSTS
C/P
133
1 13
0
78
60
0
1
1
0
1
1
a
S/PI
C/S
SERVICES PATIENTS
COSTS
1
GROUP STONDORD DEVIATION
= = = ssss = = = =
625
=======
21
81
Ol
31
31
Ol
61
170
368
0
216
327
O
2
2
O
2
3
O
125
i
21
Ol
==============================
2
=========a=========
PEER GROUP
1
==========
232
18
21
= as = = = =
=======
PERSONAL MALE AGE/SEX DISTRIBUTION
VICTORIA GENERAL PRACS
( VICGP
)
�*#*****#»**«•«**»*#» #»»***###
*
PEER
GROUP
PROFILE
C O N W A Y
H E A L T H
S Y S T E M S
PAGE
*««#**«««•*«****««*«««•»****
*
*
PERSONAL MALE
AGE/SEX D I S T R I B U T I O N
* » * # * * * » **«-»**•*»**#«•»
AGE/SEX
GROUPS
O
11
£1
31
41
5 1
- IO
- £0
- 30
- 40
- 50
- 9 3
1
PRINTED ON 08 OCT 1985
PEER
*
«
C O N W A Y
i
VICTORIA
GENERAL
PRACS
<
VICGP
REPORT
GROUP M E D I A N
1
PROVIDER
PERIOD
JAN 8 6
-
DEC 8 6
1
!
.
COSTS
SERVICES
PATIENTS
C/S
£ t
1
1
1
300
900
0
400
400
O
1
7
0
3
6
O
1
1
O
1
1
100
1£7
0
lOO
67
O
3
0
£
£
1
1
1
1
O 1
==== ========== ======= =
=========
TOTAL
GROUP
» * * • » *
1 COUNT
1
1
1
1
18
* » * * # » * * * # * * * » * * * * * * * * * * * * * * » * « » * * * * » » » » * • » » * * * » * # » * *
*
3 1
1
H E A L T H
o
============;
n = =: = =3 = = s = s = s
1, 9 0 0
S Y S T E M S
== = = = 3 = =
16
4
= CC = = = = =
119
C/P
300
900
0
400
400
O
d
S/PI
11
71
Ol
31
41
01
====== = = = = = = =
!
500
51
PERSONAL MALE AGE/SEX DISTRIBUTION
PEER GROUP : VICTORIA GENERAL PRACS
( VICGP
)
�H E A L T H
CONWOY
«*•*»«**•«*******«•»*»**«***
#
PEER GROUP PROFILE
*
PAGE 19
PRINTED ON 08 OCT 1985
ft«ti« * * * • » * * * * * * * * * * * * * * * • * # «
PEER GROUP i VICTORIO GENEROL PROCS
»
PERSONAL TOTOL
»
*
AGE/SEX DISTRIBUTION
*
«**#****##*#**»##**####»*»»»
i AGE/SEX
i
a m inc
! GHUUMb
!
:
!
!
!
!
!
o - io
11 £1 31 41 51 -
£0
30
40
50
99
! TOTAL
CONWOY
1
( VICGP
REPORT PERIOD JAN 86 - DEC 86
GROUP AVERAGE + O.4 STANDARD DEVIATION
1
GROUP 91 PERCENT
1
i
1
1
!
COSTS
SERVICES PATIENTS
1
1
1
1
1
550
1,870
794
386
931
O
6
18
3
8
O
1
£
1
1
£
0
1
3,981
38
6
H E A L T H
a
S Y S T E M S
C/S
C/P
S/PI
COSTS
178
114
91
lOO
1 16
O
3£5
1, 199
794
386
818
O
31
lOI
81
31
71
Ol
900
£, 300
1 10
71
831
SERVICES PATIENTS
C/S
C/P
a
450
1, 400
1, 075
i , aoo
o
11
£1
11
5
9
O
a
o
300
1£7
109
133
133
O
4, 300
41
7
1 19
1, aoo
SOO
£
1
1
i , aoo
SOO
i , aoo
O
S/PI
61
11 i
11 1
51
91
Ol
91
PERSONAL TOTAL AGE/SEX DISTRIBUTION
PEER GROUP : VICTORIA GENERAL PRACS
< VICGP
)
�CONWAY
*«**#*#»*»#»#**»»*»*»***»*#»
*
PEER GROUP PROFILE
«
***********»»*#*#*##*#*»»»**
»
PERSONAL TOTAL
*
«
AGE/SEX DISTRIBUTION
*
»**«*****«»****«*•**«•**«•**
H E A L T H
S Y S T E M S
PRINTED ON OS OCT 19S5
PEER GROUP : VICTORIA GENERAL PRACS
COSTS
< VICGP
REPORT PERIOD JAN 86 - DEC 86
GROUP AVERAGE
I AGE/SEX
! GROUPS
PAGE SO
SERVICES PATIENTS
GROUP STANDARD DEVIATION
C/S
C/P
1S/PI
COSTS
SERVICES PATIENTS
!
!
C/S
C/P
127
18
18
57
28
O
187
290
403
216
377
O
2!
1 I
3!
SI
SI
Ol
15
250
1 I
S/P!
4
: o - io
: i i - so
!
!
!
!
SI
31
41
51
-
30
AO
50
99
400
1, 7 0 0
633
300
800
0
4
16
7
3
7
O
1
1
1
1
O
127
106
84
78
105
0
3, 8 3 3
37
6
104
£
==============
! TOTAL
C O N W A Y
H E A L T H
S Y S T E M
S
250
1, 0 8 3
633
300
667
O
£1
101
71
31
61
374
434
403
S16
327
O
5
4
3
1
O
O
£
o
1
O
0
368
3
1
0
Ot
======== =========== ======= =============== ==== ======= ======
731
71
PEER
GROUP
PERSONAL TOTAL AGE/SEX DISTRIBUTION
VICTORIA GENERAL PROCS
( VICGP
)
�*
PEER GROUP PROFILE
C O N W O Y
H E O L T H
S Y S T E M S
*****************************************************
#
PRINTED ON OB OCT 1985
«*«#«*»****#**##»***»***##•*
*
«
PERSONAL TOTOL
OGE/SEX DISTRIBUTION
******
*
*
PEER GROUP i VICTORIO GENEROL PROCS
REPORT PERIOD JAN 86 - DEC 86
PROVIDER
COUNT
GROUP MED ION
i
- 10
- £0
- 30
- AO
- 50
- 99
t
£
3
3
£
3
O
COSTS
1
1
1
1
1
1
300
1, AOO
AOO
AOO
BOO
O
= = = = = . ==================
====*=
3 1
3, aoo
SERVICES PATIENTS
1
17
6
3
7
O
1
£
1
1
1
0
36
6
= = s = ; = =s = = = = = = =3 = =
! TOTOL
= = = = =
CONWOY
1
f
1
o
11
£1
31
41
51
< VICGP
it***«*»ft**************
! OGE/SEX
! GROUPS
:
!
1
:
1
!
PAGE £1
H E O L T H
C/S
8£
HO
75
lOO
1 IA
O
C/P
300
1, 150
AOO
AOO
AOO
O
S/PI
1 1
11 1
61
31
61
01
====================
109
633
61
SSS
S Y S T E M S
PERSONOL TOTOL OGE/SEX DISTRIBUTION
PEER GROUP : VICTORIO GENERAL PROCS
( VICGP
)
�C O N W A Y
«'*««****«#»«»**•»*****«*«**»
*
PEER
GROUP
PROFILE
TOTAL FEMALE
AGE/SEX D I S T R I B U T I O N
S Y S T E M S
PAGE 31
PRINTED ON 08 OCT 1985
««•*«*»*»**«*«•«»»*«««**•«»»
*
*
H E A L T H
* * » * * # # « * * * * * * * * • * * * * » • » * # * * • * » # * * * * « - * + * » * * * * » # * « • » * #
»
PEER GROUP : VICTORIA GENERAL PRACS
»
*
( VICGP
REPORT PERIOD JAN 86 - DEC 86
* * * # # * * « * » # • * # • » * * * * # # • * * # # *
1 AGE/SEX
GROUP AVERAGE + 0.A STANDARD DEVIATION
•
1
i
!
1
!
1
1
1
O - 10
11-20
21 - 30
31 - AO
A l - 50
51 - 99
! TOTAL
C O N W A Y
COSTS
GROUP 9 1 PERCENT
SERVICES PATIENTS
C/S
C/P
S/PI
COSTS
37
73
9A
26
7A
72
261
1,290
1, 350
IOA
1,253
688
Al
151
1AI
21
91
81
500
1, 70O
1, 70O
200
2, AOO
900
7
18
17
A
17
10
103
1, 537
1AI
A, lOO
A7
1
1
i
1
1
1
261
1,290
1, 350
IOA
1, 253
688
A
15
IA
2
9
a
1
1
1
1
1
1
1
3, 866
A2
A
H E A L T H
1
S Y S T E M S
SERVICES PATIENTS
PEER
GROUP
1
C/S
C/P
S/P!
1
1
1
1
1
1
71
9A
100
SO
1A1
90
500
1, 700
1, 700
200
2, AOO
goo
71
18!
17!
Al
17!
IO!
5
121
2, 050
17 1
TOTAL FEMALE AGE/SEX DISTRIBUTION
VICTORIA GENERAL PRACS
( VICGP
)
�C O N W A Y
H E A L T H
S Y S T E M S
PAGE 32
# » # * * * * » # # * # * » » » # # # * # * # * # * » * » » * • * » » * » » * * » » # » # * * » » » * * *
#»#»
*#»»»
####
*****
* **
•
1 AGE/SEX
1 .
PEER
GROUP
COSTS
PROFILE
SERVICES
»
167
!
0 - 1 0
1
**###*»**»»#»#«#*»*#«»*#**«*
1 41 - 50
! 51 - 99
1
1
800
533
1 TOTAL
!
3, 7 6 7
67
: * 1 - AO
i
# # 3* * * * » * * * * » » * » * * # * * # * » » » * *
C O N W A Y
H E A L T H
GROUP STANDARD D E V I A T I O N
C/S
C/P
S/PI.
COSTS
O
1
1
0
0
1
24
57
91
17
A7
56
167
1, OOO
1, 2 0 0
67
SOO
533
21
121
131
11
61
61
236
726
37A
9A
1, 1 3 1
386
3
96
1,319
131
2A9
AO
*
*
1
PATIENTS
2
12
13
1
6
6
1
0
* 11 - 2 T O T A L 1 F E M A L E 1, OOO
1, 2 0
!
* 2 1 G E /3 0 X D 1S T R I B U T I O N 0
A - SE
I
( VICGP
REPORT PERIOD JAN 86 - DEC 86
GROUP AVERAGE
1
1
*
PRINTED ON OB OCT 1985
PEER GROUP I VICTORIA GENERAL PRACS
S Y S T E M S
1
SERVICES
PATIENTS
C/S
C/P
3
2
8
A
O
O
0
O
0
0
34
41
6
24
67
40
236
726
374
94
1, 1 3 1
386
31
81
31
21
5
1
18
546
3!
a
3
PEER
GROUP
S/PI
a:
41
TOTAL FEMALE AGE/SEX DISTRIBUTION
VICTORIA GENERAL PRACS
( VICGP
)
�«####
#»«»«
»•*###
*«* *
*
*
»
*
PEER
GROUP
PROFILE
*
»
TOTOL FEMOLE
OGE/SEX D I S T R I B U T I O N
C O N W O Y
H E O L T H
S Y S T E M S
POGE 33
»
» # * * » * » * * * * * * # » * * * * # * * # * » * # # * * * * » * * * * * # * • * * * * * * * # * * » *
*
*
PEER GROUP : VICTORIO GENEROL PROCS
PRINTED ON OB OCT
1985
< VICGP
REPORT PERIOD JON 86 - DEC 86
*****»#**»»#*##**********»»»
! OGE/SEX
! GROUPS
:
!
!
!
1
!
1
O 1121 31 41 51 -
IO
20
30
40
50
99
! PROVIDER
1 COUNT
SERVICES POTIENTS
'
1
1
t
1
1
1
O
1, 300
1, 100
0
0
700
O
17
13
O
0
9
3
H E A L T H
COSTS
1
2
3
1
1
2
i
1
1
I
I
TOTAL
C O N W A Y
GROUP MEDION
1
I
3, 700
40
S Y S T E M S
0
1
1
0
0
1
1
C/B
C/P
S/PI
0
76
89
0
O
78
O
1, 300
1, lOO
0
0
700
01
171
131
01
01
91
88
1,167
131
PEER
GROUP
TOTAL FEMALE AGE/SEX DISTRIBUTION
VICTORIA GENERAL PRACS
( VICGP
)
�C O N W O Y
#»»##*
*»«»»#
#»##»
* ****
•*
»«««**««»**»****»«•**»******
*
PEER GROUP PROFILE
»
»#•«•*»•**•«•**»****•**«****
*
TOTOL MOLE
*
*
OGE/SEX D I S T R I B U T I O N
o - io
1 1
21
31
41
51
- 2 0
- 30
- 40
- 50
- 93
PAGE 34
PRINTED ON OB OCT 1985
PEER GROUP i VICTORIO GENERAL PROCS
( VICGP
*
REPORT PERIOD JAN 86 - DEC 86
X
GROUP 91 PERCENT
9
21
0
9
12
5
1
3
0
1
2
1
36
5
109
1, 150
lOI
4, OOO
41
7
1
3, 6 6 9
a
111
118
0
ISO
200
1, OOO
2, 3 0 0
0
900
650
600
91
21 1
0!
91
61
51
119
1, 6 0 0
ioa
1
-
1 TOTAL
ll
ll
S Y S T E M S
il
H E O L T H
ll
II
CONWOY
-
1 , OOO
2, 3 0 0
0
900
1, 3 0 0
600
1
61
161
01
61
51
31
S/PI
1
663
1,618
0
728
457
398
6
17
0
6
C/P
1
84
110
0
104
76
120
663
1,799
0
728
784
398
C/S
1
3
1
2
0
1
1
1
!
1
1
1
1
1
SERVICES POTIENTS
II
COSTS
ll
S/PI
SERVICES POTIENTS
1
C/P
COSTS
1
C/S
1
:
S Y S T E M S
GROUP AVERAGE + 0 . 4 STANDARD DEVIATION
AGE/SEX
!
I
!
!
!
H E O L T H
* » * * * # * * # * * * » * * * * # * » » * * * » * * # » » * * * * # » # # * • » • » * * * * # * * * * * #
TQTOL MOLE OGE/SEX DISTRIBUTION
PEER GROUP : VICTORIO GENEROL PROCS
( VICGP
)
�C O N W A Y
##»#*»#********«***«##**#**»
*
PEER
GROUP
PROFILE
*
»
TOTAL MALE
AGE/SEX D I S T R I B U T I O N
H E A L T H
S Y S T E M S
PAGE 35
***•*•»*«•**•*»*»»**•***••****•***************»•*«*««
»
PRINTED ON 08 OCT 1985
PEER GROUP l VICTORIO GENERAL PRACS
#
•
< VICGP
REPORT PERIOD JAN 86 - DEC 86
****•*«»»*•*****««***•****•»
1
1
1
i
!
1
!
1
0
11
£1
31
41
51
-
IO
£0
30
40
50
99
! TOTAL
C O N W A Y
-X.
GROUP AVERAGE
AGE/SEX
COSTS
1
1
1
1
1
1
SOO
1, 6 0 0
0
567
567
300
5
15
• O
5
6
3
1
3, 5 3 3
34
H E A L T H
SERVICES PATIENTS
S Y S T E M S
GROUP STANDARD DEVIATION
C/S
C/P
S/PI
COSTS
0
1
1
1
65
104
O
80
58
87
500
1, 3 1 1
O
567
350
300
SI
131
Ol
51
41
31
408
497
O
403
544
£45
4
4
O
4
5
£
O
1
O
O
1
0
5
105
96£
91
340
6
£
1
£
SERVICES P A T I E N T S
PEER
GROUP
:
C/S
C/P
47
14
O
45
84
408
766
0
403
£68
£45
4 1
71
01
41
31
£1
9
469
41
&£
S/PI
TOTAL MALE AGE/SEX DISTRIBUTION
VICTORIA GENERAL PRACS
( VICGP
)
�C O N W O Y
«•**»*«*«**********»»««****»
#
PEER GROUP PROFILE
*
##»***»*»####***#*#»*#«*»»*#
#
TOTOL MOLE
*
#
OGE/SEX
DISTRIBUTION
H E O L T H
S Y S T E M S
PRINTED ON 08 OCT 1385
PEER GROUP i VICTORIO GENEROL PROCS
( VICGP
«
REPORT PERIOD JON 86 - DEC 86
***#»****#*»#***##»##»******
1 OGE/SEX
! GROUPS
1
1 PROVIDER
1 COfjNT
!
1
1
1
1
!
I
GROUP MEDION
1
COSTS
2
3
O
2
2
2
1
1
1
1
1
1
500
1, 3 0 0
O
800
AOO
300
6
IA
0
6
6
3
3
I
3 , AOO
3A
1
O - IO
1 1 - 20
21 - 30
3 1 - AO
A l - 50
51 - 93
,
1
I
(
1
1
TOTAL
C O N W O Y
H E O L T H
POGE 36
* * * • * * * * * # * * * * # * * # * * » * » * # * * * # # # # » * • * • » * » # * » # « » « * » » # * *
S Y S T E M S
SERVICES POTIENTS
1
1
0
1
1
1
1
C/S
C/P
S/PI
83
110
0
89
67
60
500
1, 2 0 0
O
800
AOO
300
61
1AI
Ol
61
61
31
lOO
SOO
81
TOTOL MOLE OGE/SEX DISTRIBUTION
PEER GROUP : VICTORIO GENEROL PROCS
( VICGP
)
�CONWOY
««««*«»««*»»**•»**»*»»«**««*
*
PEER GROUP PROFILE
*
*#»*»*»#»##»**«»**##*»#*»»»*
*
TOTOL
»
*
OGE/SEX DISTRIBUTION
»
«**»*»*«******«**»**»*#»**»•
! OGE/SEX
i
fSOni IDG
i urtuuHo
i
( VICGP
)
REPORT PERIOD JON 86 - DEC 86
1
GROUP 91 PERCENT
1
1
i—
t
COSTS
SERVICES POTIENTS
:
o - io
i
11 - £0
£1 - 30
31 — AO
A l - 50
51 - gg
1
1
1
1
i
316
£, 718
1, 350
813
1, 63A
1, 083
10
29
IA
13
12
1
3
1
1
2
2
1
7, A31
79
9
a
==========================
CONWOY
POGE 37
PRINTED ON OB OCT 19fl5
GROUP OVEROGE + O.A STONDORD DEVIOTION
1
S Y S T E M S
PEER GROUP i VICTORIO GENEROL PROCS
!
!
I
1
I
1 TOTOL
H E O L T H
H E O L T H
C/S
C/P
S/PI
76
103
9A
100
118
81
5A1
1, 69£
1, 350
61A
1, 506
5A1
61
171
1AI
51
121
61
=======
106
=======a==
1, 302
121
COSTS
1, SOO
3, OOO
1, 700
1, OOO
2, AOO
1, 500
= = = = = = = 1=5=
7, 700
SERVICES POTIENTS
16
31
17
13
17
IA
£
A
1
2
2
2
C/S
9A
no
100
ISO
1A1
1 15
C/P
750
£, 300
1, 700
goo
2, AOO
750
S/PI
81
£1 1
17!
7!
17!
71
========================== ==============
88
IO
120
1,825
15!
========== = = = =
S Y S T E M S
TOTOL OGE/SEX DISTRIBUTION
PEER GROUP : VICTORIO GENEROL PROCS
< VICGP
)
�CONWOY
*
PEER GROUP PROFILE
*
•***•««•»***»»*****«*«•««*•*
*
TOTAL
*
»
OGE/SEX DISTRIBUTION
*
1
COSTS
H E A L T H
POGE 38
PRINTED ON 08 OCT 1985
PEER GROUP I VICTORIO GENEROL PROCS
( VICGP
REPORT PERIOD JON 86 - DEC 86
SERVICES POTIENTS
r
7
1
1 0 - 10
1
667
: i i - £0
1
£,60O
£7
1 £1 - 30
13
1
!
1,£00
1
! 31-40
!
633
6
! 41 - 50
!
1,367
1£
1
1 51 - 99
1
833
9
1
========== ================ =====================
74
8
1
7,300
! TOTOL
C O N W O Y
S Y S T E M S
GROUP OVEROGE
! OGE/SEX
!
H E O L T H
S Y S T E M S
GROUP STONDORD DEVIOTION
C/S
C/P
S/PI
COSTS
SERVICES POTIENTS
51
7
59
417
6a4
1
98 1, 433
151
394
4
1
131
374
3
O
91
1, aoo
41
450
5
76
467
1
105 1, 150
101
818
4
0
6£4
6£
51
6
1
417
===== ======= ============ ======= =====================
101
327
100 1, 095
11
3
PEER
GROUP
C/S
C/P
S/PI
4a
312
3f
12
646
61
6
374
31
61
368
31
30
890
51
48
312
3:
======= ===== =======
14
517
31
TOTAL AGE/SEX DISTRIBUTION
VICTORIA GENEROL PRACS
( VICGP
>
�C O N W O Y
»
PEER GROUP PROFILE
H E O L T H
S Y S T E M S
*
»*»*»#***»**»»#**»##**»*****»***»»»**#*#*##»»*»*»»*#*
*
PEER GROUP I VICTORIO GENEROL PROCS
POGE 33
PRINTED ON OB OCT 1985
*
*
TOTOL
OGE/SEX DISTRIBUTION
i OGE/SEX
! GROUPS
:
1
1
»
1 PROVIDER
1 COUNT
1
!
1
!
t
!
0 - 1 0
1 1 - 2 0
£1 - 3 0
31 - 40
41 - 50
51 - 99
! TOTOL
C O N W O Y
REPORT PERIOD JON 86 - DEC 86
1
1
GROUP MEDION
|
1
£ 1
COSTS
SERVICES POTIENTS
C/9
1
3
3
2
3
2
1
I
1
1
I
500
2, 5 0 0
1, 100
900
1, 3 0 0
1 , OOO
6
29
13
6
12
13
1
2
1
1
1
2
83
103
89
77
108
71
i
3 1
7, 3 0 0
74
10
93
1
:
H E O L T H
( VICGP
S Y S T E M S
C/P
500
1, 2 5 0
1, 1 0 0
SOO
650
500
770
S/PI
61
161
131
61
61
71
91
PEER GROUP
TOTOL OGE/SEX DISTRIBUTION
VICTORIO GENEROL PROCS
( VICGP
)
�»«**««**«*»»**»***•********«
*
PEER GROUP PROFILE
*
##**•***«##**#*#**####*
* PERSONAL SERVICE GROUPS *
*
AND F E E I T E M S
C O N W A Y
H E A L T H
S Y S T E M S
PAGE 40
#***»*##»*»*##*»##*»*****#**##*****»*»*##»#»»#»*#»»»#
PRINTED ON OS OCT 1985
PEER GROUP t VICTORIA GENERAL PRACS
( VICGP
REPORT PERIOD JAN 86 - DEC 86
*
*****«***«**»*«*»****»•.»*»**
X
: SERVICE
: GROUPS
!
FEE
ITEMS
:
1
i
!
!
ORTHO
ORTHO
ORTHO
ORTHO
ORTHO
1328
3622
6621
8445
TOTAL
!
!
1
!
PEDS
PEDS
PEDS
PEDS
3389
5613
7213
TOTAL — >
! XRAY
1 XRAY
1 XRAY
<
1327
8331
TOTAL — >
GROUP AVERAGE + 0.4 STANDARD D E V I A T I O N
«
COSTS
SERVICES
PATIENTS
C/B
C/P
1
1
1
1
603
317
104
657
1, 5 4 9
9
3
1
5
17
4
2
1
2
5
64
106
104
170
96
195
269
104
328
372
31
31
11
21
4!
604
583
433
1,586
7
4
4
14
3
2
3
5
123
272
125
123
239
358
181
370
31
21
11
31
471
483
949
4
4
9
2
2
4
135
119
127
236
352
275
21
31
31
> (
p
t
!
i
i
1
i
i
i
C O N W A Y
H E A L T H
GROUP 9 1 PERCENT
S/PI
:
COSTS
SERVICES
PATIENTS
C/S
C/P
S/P!
800
AOO
200
11
3
1
6
17
4
2
1
2
6
73
133
200
200
lOO
267
AOO
200
400
425
41
31
11
3!
41
a
167
400
133
142
250
AOO
200
425
E
4!
31
2!
31
167
133
ISO
250
400
300
1
3!
4I
3!
aoo
1 700
1
1
700
700
500
1, 7 0 0
5
4
15
4
2
3
5
500
600
1, 1 OO
5
5
9
2
2
4
1
= = = = = = = = = s = = =: = = = = = =: = = s = s==i = = = s 3 a
! TOTAL
1
3, 9 8 1
=============
S Y S T E M S
38
=
=
=
=
=
i
6
=
=
======= ======== ========
no
831
============= ======= ======= ======== =====
•
=
=
•
=
71
A, 3 0 0
PEER
GROUP
41
7
1 19
1, 0 7 5
9!
PERSONAL. SERVICE GROUPS AND FEE ITEMS
VICTORIA GENEROL PRACS
( VICGP
)
�«***»»###»*«*#«**»#**»«#»***
C O N W O Y
H E A L T H
S Y S T E M S
#***»»*##****»»*#*#»**»#*f»*»*»#**»#**»##*#»#»*»*»*»#
*#****#**
* *«# *#
###»#
•
*
PEER
GROUP
PROFILE
»
PAGE 4 1
******#***#«**»**#*##*#«**»#
#
«
!
!
P E R S O N A L S E R V I C E GROUPS
AND F E E I T E M S
SERVICE
GROUPS
FEE
ITEMS
PRINTED
*
*
PEER
GROUP
:
VICTORIA
GENERAL
PRACS
<
ON 0 8 OCT 1 9 8 5
VICGP
REPORT
PERIOD
JAN 8 6 -
^L
!
GROUP A V E R A G E
•
GROUP
STANDARD
1
DEVIATION
COSTS
! ORTHO
SERVICES
PATIENTS
C/S
C/P
S/PI
COSTS
SERVICES
PATIENTS
C/S
C/P
189
125
94
141
£05
2
0
0
1
1
0
0
0
0
1
9
42
94
49
14
72
131
94
71
96
94
125
82
216
2
2
O
1
1
44
126
14
18
35
62
21
55
94
125
205
1
1
1
! ORTHO
! ORTHO
! ORTHO
1328
3622
6621
8445
TOTAL
I
I
I
> 1
533
267
67
600
1, 467
9
3
0
4
16
3
1
O
2
5
60
89
67
ISO
90
167
£17
67
300
333
31
31
01
£1
41
1
!
1
1
PEDS
PEDS
PEDS
PEDS
3389
5613
7213
TOTAL
|
1
1
> 1
567
533
400
1 , SOO
6
3
3
13
3
2
2
4
106
222
119
116
225
333
172
348
31
£1
1 1
31
!
XRAY
1327
8331
TOTAL
|
1
> 1
433
433
867
4
4
2
1
3
117
109
113
217
333
258
£1
31
£1
!
ORTHO
DEC 8 6
S/PI
1 1
1 1
Ol
11
11
|
1
o
0
o
11
11
Ol
01
f
! XRAY
! XRAY
============ = = = = = = s = s = = c==a = =x = =
! TOTAL
1
C O N W O Y
H E O L T H
I
&s : s = a = = = = =
=
a
=============
3, 833
S Y S T E M S
37
= Bic: = = s = a
6
104
==================
731
71
= = = = = s= = s : s s == =a = = = = = = =
368
3
47
01
47
i:
42
Ol
o
======== ======= ======== = = = = =
250
1
15
i:
0
0
44
25
35
PERSONOL SERVICE GROUPS OND FEE ITEMS
PEER GROUP : VICTORIO GENEROL PRACS
( VICGP
)
�C O N W A Y
«**»»**»
#*<#»
•* )- •
*
*
!
SERVICE
FEE
P E E R GROUP P R O F I L E
!
GROUP
t
VICTORIA
GENERAL
GROUP
PROVIDER
*
1 —
1
!
!
3
3
1
3
3
!
!
!
!
PEDS
PEDS
PEDS
PEDS
3
3
3
3
!
!
PRACS
(
COSTS
SERVICES
1
1
1
1
1
AOO
300
O
SOO
1, 5 0 0
8
3
0
A
17
1
1
1
> 1
500
500
AOO
1,600
a
f
i
!
1
1
1
1
1327
8331
TOTAL
1
1
> 1
3
3
3
1
1
1
PERIOD
JAN 86 -
DEC 8 6
MEDIAN
1
PATIENTS
C/S
C/P
S/PI
57
lOO
O
167
lOO
133
ISO
250
375
31
31
01
21
Al
A
IAO
125
107
250
350
167
320
21
21
21
31
2
1
3
125
120
122
250
300
275
21
31
21
31
0
2
A
o
1
1
A
3
12
2
£
2
aa
i
i
f
1
XRAY
ON 0 8 O C T 1 9 8 5
VICGP
|
I
3389
5613
7213
TOTAL
PAGE A2
REPORT
P E R S O N A L S E R V I C E GROUPS *
AND F E E I T E M S
#
S8
1
» * * * • # 1»3 * » # * * # # * * * * *
ORTHO
3622
1
6621
1
ORTHO
ORTHO
BAAS
1
ORTHO
TOTAL
> 1
! ORTHO
* « * * * * * * #
S Y S T E M S
PRINTED
PEER
GROUPS
ITEMS
1 COUNT
#*«#«***»#»*##«#****###»»»«#
*
«
H E A L T H
* * # # » * # * * » » # * * * » * » * # » • * » # * # # * » * » » * # * * » # * # * # » » * # » * # » * »
500
AOO
900
A
! XRAY
A
! XRAY
9
========= = = a = = = = = = = = = = = = = = a = = = = = = =====================B ss BS ssor saaa ata
=================s = = = = = = = =====
! TOTAL
3 , SOO
109
1
3 1
36
6
633
61
C O N W A Y
H E A L T H
S Y S T E M S
PERSONAL SERVICE GROUPS AND FEE ITEMS
PEER GROUP : VICTORIA GENERAL PRACS
< VICGP
)
�PROVIDER PROFILU
PRINTED O 24 M R 1987
N
A
SUMMARY
INFORMATION
PROVIDER
: DR. JOHN A. GALT
- 1000
REPORT PERIOD JAN 86 - DEC 86
- VICGP
PEER GROUP t VICTORIA PRACS
DR. JOHN A. GALT
STATUS
SPECIALITY
TOP
QUALIFIED FOR INCLUSION IN THEPEER GROUP STATISTICS
_
-
I
1
I
* • SERVICING DETAILS *
'*
TOTAL FLAGS
RANK
t
TOTAL COSTS
TOTAL SERVICES
TOTAL PATIENTS
1
COSTS PER SERVICES
COSTS PER PATIENTS
SERVICES PER PATIENTS
1
1
'
|
VALUE
3
ZONE
LHA
RHD
$ 7.700
88
10
3
2
2
$ 88
$ 770
9
FLAG VALUE
0
0.4
0.8*
1.2
1.2 t V 1.6
2
1.6 t 6 N\
2/to \2.4
2.f to ^2.8
2.8 to 3.2
3.2 to 3.6
above
3.6
&«TOH
1
2
3
4
5
6
7
8
9
$ 7.300
74
8
$ 100
t 1.095
10
STD DEV
\
u
PERSONAL
'"\'
i
t
i
AVERAGE
Q
1
1
2
NUMBER OF ACTIVE MEMBERS IN GROUP
0.4\to
0.8 \o
REFERRED
PERCENTILE
be 1 OM
91 to
92 to
93 to
94 to
95 to
96 to
97 to
98 to
above
91
92
91
94
9'i
96
97
98
99
99
TOTAL
PRINT OUT DETAILS
PRINTED
GENERAL INFORMATION
DEFINED GENERAL INFORMATION
MONTHLY DISTRIBUTION
MONTHLY DISTRIBUTION ADJUSTED
AGE/SEX DISTRIBUTION
AGE/SEX DISTRIBUTION ADJUSTED
SERVICE GROUP TOTALS
FEE ITEM DETAILS
CONWAY
HEALTH
<-<-N
O
N
O
N
O
N
O
N
O
N
O
S Y S T E M S
FLAGS
N/A
NA
/
->
->
0
0
0
0
0
0
PRINTED
<-<-N
O
N
O
N
O
N
O
N
O
N
O
FLAGS
NA
/
NA
/
->
->
0
0
0
0
0
0
PRINTED
FLAGS
N
O
N
O
N
O
N
O
N
O
N
O
<--
PROVIDER
: DR. JOHN A. GALT
PEER GROUP : VICTORIA PRACS
NA
/
N/A
SUMMARY I Nl I) KM A I I U
N
- 1001)
- VICCP
�CONWOY
»
PROVIDER PROFILE
*
»«•••*««*•»»*«»**»**•**»«••*
*
GENEROL
•
*
INFORMOTI ON
*
H E O L T H
S Y S T E M S
PRINTED ON 08 OCT 1985
PROVIDER
I DR. JOHN A. GALT
( I OOO
REPORT PERIOD JAN 86 - DEC 86
PEER GROUP I VICTORIO GENERAL PRACS
I FLAG
I
COSTS I
TOTAL COSTS
PERCENT OF COSTS REFERRED
I
I
I
I
I
39
39
39
39
PROVIDER
VALUE
TOTAL SERVICES
PERCENT OF SERVICES REFERRED
POTIENTS :
PERSONOL POTIENTS
SELF-REFERRED POTIENTS
REFERRED-OUT POTIENTS
TOTOL REFERRED POTIENTS
TOTOL PATIENTS
PERCENT OF PATIENTS REFERRED
C O N W A Y
H E A L T H
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
3,AOO I
1,AOO I
£,900 I
A,300 I
I
7,700 I
56 I
3,981
1,9£9
£,1A£
3,703
7 A31
50
t
39
£9
Al
18
£9
A7
39
19
88
53
I
I
I
I
I
I
I
I
I
£9
£9
39
IO
7
7
7
8
I
I
I
I
6
6
6
7
IO
IO I
80 I
9
90
39
S Y S T E M S
I GROUP
I AVERAGE
GROUP AVG
I GROUP 9 1
+ O. A S. D. I PERCENT
SERVICES :
PERSONAL SERVICES
SELF-REFERRED SERVICES
REFERRED-OUT SERVICES
TOTAL REFERRED SERVICES
( VICGP
X
^
PERSONOL COSTS
SELF-REFERRED COSTS
REFERRED-OUT COSTS
TOTOL REFERRED COSTS
PAGE £
38
£3
20
Al
79
51
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
A,300
S,SOO
£,90O
A,300
7,700
56
Al
30
£9
A7
88
53
7
7
7
8
IO
100
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
t
I
t
I GROUP
I STD DEV
I
I
3,833 I
1,700 !
1,767 I
3, A67 I
I
7,300
A7
37
£1
16
37
7A
A9
6
5
5
7
8
87
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
t
I
I
I
I
f
t
I
I PROVIDER
I COUNT
368
57£
939
591
I
1
I
I
I
I
I
!
I
3
3
3
I
I
:
:
I
-»
t
I
:
I
3£7
6
I
I
I
I
I
I
3
3
3
7
9
9
I
I
I
I
I
3
3
3
3
11 I
6 I
I
I
I
3
3
1
£
t
I
1 I
£
t
3
3
3
3
3
3
GENERAL INFORMATION
PROVIDER
: DR. JOHN A. GALT
< lOOO
)
PEER GROUP : VICTORIA GENERAL PRACS
( VICGP
)
�C O N W O Y .
««*«**•«•«•«*•*«**«•««#«««*•
*
*
PROVIDER PROFILE
GENERAL
INFORMOTION
H E O L T H
S Y S T E M S
PRINTED ON OB OCT 1985
PROVIDER
*
*
i DR. JOHN A. GALT
< lOOO
REPORT PERIOD JON 86 - DEC 86
PEER GROUP i VICTORIA GENEROL PROCS
FLOG
PROVIDER
VALUE
39
TOTAL COSTS / TOTAL SERVICES
83
105
91
88
COSTS PER SERVICES I
PERSONAL COSTS / PERSONAL PATIENTS
REFERRED COSTS / PERSONAL PATIENTS
REFERRED COSTS / REFERRED PATIENTS
486
614
538
TOTAL COSTS / TOTAL PATIENTS
770
SERVICES PER PATIENTS I
PERSONOL SERVICES / PERSONOL POTIENTS
REFERRED SERVICES / PERSONOL POTIENTS
REFERRED SERVICES / REFERRED POTIENTS
29
TOTOL SERVICES / TOTAL PATIENTS
H E A L T H
S Y S T E M S
-y.
1 GROUP 91
I + O. 4 S.D. I PERCENT
COSTS PER SERVICES I
PERSONOL COSTS / PERSONOL SERVICES
REFERRED COSTS / PERSONAL SERVICES
REFERRED COSTS / REFERRED SERVICES
( VICGP
-X
I GROUP AVG
A.
C O N W A Y
POGE 3
»»»«•»*•*•»**•**«»»»«*•«•«•**»*»*»*»**»••••««•**»*«•«
»
6
7
6
9
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I GROUP
I AVERAGE
I
I
no i
96 I
104 I
I
106 I
I
831
665
618
1,302
7
7
6
I
I
I
I
I
I
I
I
I
I
I
I
I
I
12 I
I
119
105
120
120
1,075
750
750
1,825
9
7
6
15
I
I
I
I
I
I
I
I
I
I
I
t
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I PROVIDER
I COUNT
I GROUP
I STD DEV
104
92
97
lOO
731
627
558
1,095
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
7 »
6 I
6 I
I
10 I
I
I
I
15 I
9 I
17 I
3
3
3
14 I
250
96
149
517
1
0
1
3
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
3
3
3
3
3
3
GENERAL INFORMATION
PROVIDER
: DR. JOHN A. GALT
< lOOO
)
PEER GROUP : VICTORIA GENERAL PRACS
< VICGP
)
�C O N W A Y
**#»»**#«**##*#»#»*##**#»»*»
*
PROVIDER PROFILE
#
»**«**«•»»«»•*»••••*•«*»•»**
*
PERSONAL
*
»
MONTHLY DISTRIBUTION
*
H E A L T H
S Y S T E M S
PRINTED ON OS OCT 1985
PROVIDER
I DR. JOHN A. GALT
< lOOO
I
1
)
REPORT PERIOD JAN 86 - DEC 86
COSTS
1
SERVICES
1
PATIENTS
1
C/8
1
C/P
1
S/P
1
i1
7^
1 FLAG
1
1
!
1
1
1
1
1
1
1
1
1
1
1
)
( VICGP
PEER GROUP i VICTORIA GENERAL PRACS
1 MONTHS
PAGE 4
JAN
FEB
MAR
APR
MAY
JUN
JUL
AUG
SEP
OCT
NOV
DEC
1 TOTAL
I 39
1
1
1
1
1
1
I
1
1
1
1
1
VALUE
900
700
300
1,000
SOO
O
O
O
O
O
O
O
3,400
XTC 1 FLAG
ae 1 39
ai
s
29
15
O
O
O
O
O
O
O
1
1
1 10
1
1
1
1
1
1
1
1
lOO 1 39
VALUE
10
a
4
13
6
0
O
o
o
o
o
o
41
*T9 1
24
20
IO
32
15
O
O
O
O
O
O
O
1 39
1
1
1
1
1
1
1
1
1
1
1
lOO 1 29
VALUE 1 FtAG
VALUE 1 FLhG
VALUE 1
FtfAG
VALUE 1
21
21
1 t IO
31
11
Ol
Ol
Ol
Ol
Ol
Ol
Ol
901 29
SSI
751
771
831 10
01
Ol
Ol
Ol
Ol
Ol
Ol
4501 39
3501
3001 10
3331
5001 29
Ol
01
01
01
Ol
Ol
Ol
51
41
41
41
61
Ol
01
Ol
Ol
Ol
O1
01
71
831
4861
6!
MONTHLY DATE ACCUMULATED BY PAID DATE
C O N W A Y
H E A L T H
S Y S T E M S
PERSONAL MONTHLY DISTRIBUTION
PROVIDER
» DR. JOHN A..GALT
( lOOO
>
PEER GROUP : VICTORIA GENERAL PRACS
< VICGP
>
�C O N W A Y
*#»»••#«»*#»»»*##«*#*»#*#»«*
*
PROVIDER PROFILE
H E A L T H
S Y S T E M S
PAGE 6
*
PRINTED ON OB OCT 1985
*
TOTAL
»
*
MONTHLY DISTRIBUTION
*
«««»»******•****»••»«***»*»•
1 MONTHS
1
1
PROVIDER
1 JAN
1 FEB
1 MAR
1 APR
1 MAY
! JUN
1 JUL
! AUG
i SEP
1 OCT
1 NOV
1 DEC
1 39
1
1
1
1
t
1
1
1
I
I
1 TOTAL •
1 39
1
< lOOO
)
< VICGP
)
REPORT PERIOD JAN 88 - DEC 88
PEER GROUP I VICTORIA GENERAL PRACS
COSTS
1
1 FLAG
I DR. JOHN A. GALT
VALUE
1, 900
1, lOO
900
1, AOO
1,500
900
O
0
0
0
0
0
7, 700
SERVICES
1
-1XTC 1 FLAG
VALUE
25
IA
12
18
19
12
O
O
O
O
O
O
1 39
1
1
1 10
1
1
1
1
1
1
1
1
19
15
12
IB
IA
IO
' O
O
O
O
O
0
lOO 1 39
88
1
1
S/P
PATIENTS
1
C/S
C/P
1
1
-11
1
1
1
VALUE1 FLAG
VALUE1 FLAG
VALUE 1
XT8 1 FLAG
VALUE1 FLAG
22
17
IA
20
16
11
0
O
0
O
O
O
1
1
1
1
1
1
1
1
1
1
1
1
39
10
IO
10
100 1 10
Al
Al
Al IO
Al
Al
Al
01
01
01
Ol
01
Ol
lOI
lOOl 39
731
751
781
1071 10
901
Ol
Ol
Ol
Ol
Ol
Ol
881
A75I 39
2751
2251
3501
3751 29
2251
Ol
Ol
01
Ol
Ol
Ol
51
Al
3!
51
AI
31
Ol
Ol
01
Ol
01
Ol
7701
91
MONTHLY DATE ACCUMULATED BY PAID DATE
C O N W A Y
H E A L T H
S Y S T E M S
TOTAL MONTHLY DISTRIBUTION
PROVIDER
> DR. JOHN A. GALT
( 1000
)
PEER GROUP : VICTORIA GENERAL PRACS
< VICGP
>
�C O N W A Y
H E A L T H
S Y S T E M S
»
PROVIDER PROFILE
*
**•«««»*»***»*««*»••*«**•*»*
*
»
PROVIDER
PAGE 7
•»*»»»*»*»**»•*»*•«»*•*«»*•«•***»«*«»««»»*«••»»*****»
PERSONAL FEMALE
AGE/SEX D I S T R I B U T I O N
PRINTED ON OS OCT 1985
*
*
i DR. JOHN A. GALT
< lOOO
REPORT PERIOD JAN 88 - DEC 86
PEER GROUP I VICTORIA GENERAL PRACS
1 AGE/SEX
1 GROUPS
1
1
1
1
1
1
1
O
11
21
31
41
51
-
IO
20
30
40
SO
99
1
TOTOL
C O N W A Y
COSTS
1 FLAG
1
1
1
H E A L T H
XTC
500
900
300
O
0
O
lOO
1 FLAG
29
53
1,700
1 39
1
1
1
1
VALUE
SERVICES
VALUE
1 39
1 10
ia 1
O 1
O 1
O 1
7
11
4
0
0
1 39
22
S Y S T E M S
o
( VICGP
1
PATIENTS
1
1
C/S
C/P
S/P
1
1
1-I11
XT9 1 FLOG
VALUE 1 FLAG
VALUE 1 FLAG
VALUE1 FLAG
VALUE!
32
1 39
1 IO
18 t
o 1
0 1
o 1
so
lOO
1 39
1 1 39
1 1 IO
1t
01
01
01
71 1
821
75 t
Ol
Ol
31
771
Ol
39
SOOI 3 9
9 0 0 I IO
3001
01
01
01
5671
71
11 1
41
Ol
01
Ol
71
PERSONAL FEMALE AGE/SEX DISTRIBUTION
PROVIDER
i DR. JOHN A. GALT
< lOOO
)
PEER GROUP s VICTORIA GENERAL PRACS
( VICGP
)
�C O N W A Y
*
PROVIDER PROFILE
H E A L T H
S Y S T E M S
.
•*«**»••»#•*•*»•«•****«»«•«•*•**•#*«**«»**•*«***•*•*»
*
»***•««••*»•»**•**«»•••*»*«•
»
#
PERSONAL MALE
AGE/SEX D I S T R I B U T I O N
PRINTED ON OB OCT 1985
»
»
PROVIDER
i DR. JOHN A. GALT
< lOOO
1
1
1
1
1
1
o
11
21
31
41
51
-
10
20
30
40
50
99
COSTS
1 FLAG
1 29
1
1
1 IO
1
C O N W A Y
SERVICES
VALUE
400
500
0
AOO
400
O
1,700
I TOTAL
H
^
A L T H
)
< VICGP
)
REPORT PERIOD JAN 86 - DEC 86
PEER GROUP i VICTORIA GENERAL PRACS
I AGE/SEX
I GROUPS
1
PAGE a
XTC 1 FLAG
24
29
O
24
24
0
PATIENTS
VALUE
1 39
1
1
1
1 IO
1
4
6
0
3
6
O
lOO I 39
19
S Y S T E M S
XTS 1 FLAG*
SI
32
0
16
32
O
1 IO
1
1
1 10
1
1
lOO I 10
C/8
VALUE 1 FLAG
1 1
1 1
Ol
1 1 29
1 1
Ol
41
C/P
S/P
VALUE 1 FLAG
VALUE 1 FLAG
lOOl 29
83 1
Ol
1331 IO
671 10
Ol
4001 39
SOOI
01
4001
4001 29
Ol
41
61
01
31
61
Ol
4251
51
891
VALUE 1
PERSONAL MALE AGE/SEX DISTRIBUTION
PROVIDER
: DR. JOHN A. GALT
< lOOO
)
PEER GROUP : VICTORIA GENERAL PRACS
< VICGP
)
�C O N W O Y
»
PROVIDER PROFILE
H E O L T H
S Y S T E M S
POGE 3
•••»**•»»••»*•»***•»»*«»»*•««»»••••«•***•*»»•«••»»**«
#
*#*»*##*##*»»*»#»»»##*#**»*»
»
*
PERSONOL TOTOL
OGE/SEX D I S T R I B U T I O N
PRINTED ON OS OCT 1985
#
»
PROVIDER
I DR. JOHN O. GOLT
( lOOO
1
1
1
1
1
1
O
11
21
3 1
41
51
-
IO
20
30
4 0
50
99
1 TOTOL
CONWOY
1
COSTS
1
1 FLOG
VOLUE
1 39
I
I
1 10
1
'
900
1,400
300
400
400
O
1
3, 4 0 0
H E O L T H
( VICGP
)
REPORT PERIOD JON 86 - DEC 86
PEER GROUP i VICTORIO GENEROL PROCS
1 OGE/SEX
1 GROUPS
1
)
XTC 1 FLOS
26
41
9
12
12
0
1 39
1
1
1
1
1
100 1 3 9
S Y S T E M S
SERVICES
VOLUE
11
17
4
3
6
0
41
1
POTIENTS
1
S/P
1
C/S
1
C/P
1
11
-IXTS 1 FLOG
VOLUE1 FLOG
VOLUE1 FLOG
VOLUE1 FLOG
VOLUE1
27
41
10
7
15
0
1 39
1 io
1
1 IO
1
1
21
21
11
1 1 29
11
Ol
lOO
1 29
71
821 2 9
821
751
1331 I O
671
Ol
831
4501
7001
3001
4001
4001
01
4861
39
61
91
4!
31
61
Ol
61
PERSONOL TOTOL OGE/SEX DISTRIBUTION
PROVIDER
I DR. JOHN O. GOLT
< lOOO
)
PEER GROUP : VICTORIO GENEROL PROCS
< VICGP
)
�CONWOY
»«««**•***»»«***»»**•«•»««**
*
PROVIDER PROFILE
»
*#**#*«**»**»*»#»*#**#»****»
*
TOTOL FEMOLE
*
*
OGE/SEX DISTRIBUTION
»
*»****«**«***«*«*»***»***»»»
! OGE/SEX
! GROUPS
!
!
I
I FLAG
! O - IO
I 11 - 20
I 21 - 30
I 31 - 40
I 39
I IO
I
I 39
I 41
I
-
SO
I 51 - 99
TOTAL
C O N W A Y
POGE 13
( lOOO
>
< VICGP
)
REPORT PERIOD JON 86 - DEC 86
I
SERVICES
I
XTC I FLAG
VALUE
VALUE
SOO
1,300
800
200
900
3,700
H E O L T H
I DR. JOHN O. GOLT
PEER GROUP i VICTORIO GENEROL PROCS
0
I
S Y S T E M S
PRINTED ON OB OCT 1985
PROVIDER
COSTS
I 29
H E O L T H
14
35
22
5
0
I 39
I IO
I
I 39
7
17
9
4
24 I 29
IO
I
PATIENTS
I
C/S
I
C/P
I
S/P
I
I
I
I
I
I
XTS I FLAG
VALUE I FLAG
VALUE I FLAG
VALUE I FLAG
VALUE I
1
lOO I
0
39
S Y S T E M S
47
15
36
19
9
0
I 39
I IO
I
I 39
1
Ol
21 I 10
100
1 I 33
11 IO
11
1 I 39
I 39
711 39
761 IO
891
501 39
Ol
SOOI 39
1,3001 IO
8001
2001 39
Ol
11 29
901 29
9001 29
SI
791
7401
71
171
91
41
01
lOI
91
TOTAL FEMALE AGE/SEX DISTRIBUTION
PROVIDER
i DR. JOHN A. GALT
< lOOO
>
PEER GROUP i VICTORIA GENERAL PRACS
( VICGP
)
�C O N W O Y
»*####»*#***#*#*»***»*»#»#»#
*
PROVIDER PROFILE
»
*«««««*«**»«*»**»»****•«***»
*
TOTOL MOLE
»
*
OGE/SEX
DISTRIBUTION
I
I
I
I
!
!
O
11
21
31
41
51
-
IO
20
30
AO
50
99
I TOTOL
C O N W A Y
( 1000
POGE 14
)
( VICGP
)
REPORT PERIOD JON 88 - DEC 86
PEER GROUP I VICTORIO GENEROL PROCS
COSTS
SERVICES
VOLUE
I 39
I
I
I 10
I
I 39
1, 000
1,200
O
800
400
600
!
4,OOO
H E A L T H
I DR. JOHN 0. GOLT
#
I
I FLOG
39
S Y S T E M S
PRINTED ON OS OCT 1985
PROVIDER
• « » * * * * * » # * * * » * * # * » * » » * » » » * *
! OGE/SEX
! GROUPS
H E O L T H
•*»»»**»***«•*»•***»*»*«*«»»•*•••**«*»*•*««**«***»«•*
•IXTC I FLOG
25
30
O
20
IO
15
I 29
I
I
I 29
I
I
lOO I 3 9
S Y S T E M S
VALUE
POTIENTS
C/S
C/P
S/P
•I•I•I1
XTS I FLOG
VALUE I FLAG
VALUE I FLAG
VALUE I FLAG
VALUE I
9
14
O
9
6
3
22
34
O
22
15
7
I 10
I
I
I IO
I
I 10
41
lOO I
1 t 29
1I
Ol
1I
1I
1 I 39
51
1 1 1 I 39
861
Ol
891 IO
671
2001 39
981
l,OOOI 29
1,200 I
Ol
SOOI 29
4001 10
6001
SOOI
91
141
01
91
61
31
81
TOTAL MALE AGE/SEX DISTRIBUTION
PROVIDER
: DR. JOHN A. GALT
< 1OOO
)
PEER GROUP i VICTORIA GENERAL PRACS
< VICGP
>
�«**#**##»#»*#**»*•««*****»*»
*
PROVIDER PROFILE
*
**»*»***##*#•*##**#»»#«#**»*
*
TOTOL
«
*
OGE/SEX DISTRIBUTION
»
*•»•***»*««*•»••«••*»***»«#*
CONWOY
H E O L T H
S Y S T E M S
«******•••»»•*»**•**#•**»*«**•***»*«»»••#*#»*«»»**«**
PRINTED ON OS OCT 1985
PROVIDER
I
I
I
I
(
I
I 39
I
I
I 29
I
I 29
1,500
2,500
800
l.OOO
400
1,500
I 39
7,700
C O N W A Y
COSTS
H E A L T H
< lOOO
)
< VICGP
)
REPORT PERIOD JON 86 - DEC 86
I
I
I FLOG
I TOTOL
I DR. JOHN O. GOLT
PEER GROUP i VICTORIO GENEROL PROCS
i OGE/SEX
! GROUPS
!
O - 10
11 - £0
21 - 30
31 - 40
41 - SO
51 - 99
POGE 15
VOLUE
I
SERVICES
I
XTC I FLOG
VOLUE
19
32
10
13
S
19
I
I
I
I
I
I
39
29
10
16
31
9
13
6
13
lOO I 39
88
39
S Y S T E M S
I
POTIENTS
I
C/S
I
I
XTS I FLOG
VALUE I FLOG
18
35
IO
15
7
15
I 39
I
I
I 39
1
I 10
lOO I 10
21 £9
21
11
21
11
21 29
lOI
I
C/P
I
VALUE I FLAG
94 1 23
811
891
771
671
1151 29
881
I
S/P
I
I
I
VALUE I FLAG
VALUE I
7501 £9
1,2501
8001
SOOI 19
4001
7501 IO
7701
81
161
91
71
61
71
91
TOTAL AGE/SEX DISTRIBUTION
PROVIDER
: DR. JOHN A. GALT
( lOOO
)
PEER GROUP : VICTORIA GENERAL PRACS
( VICGP
)
�CONWOY
H E O L T H
S Y S T E M S
POGE 16
PROVIDER PROFILE
PRINTED ON 08 OCT 1985
PROVIDER
» PERSONOL SERVICE GROUPS *
*
OND FEE ITEMS
«
*»##*»»#»»#*»#*»*»#»»»»**»*»
I SERVICE
I GROUPS
I
ORTHO
ORTHO
ORTHO
ORTHO
ORTHO
PEDS
PEDS
PEDS
PEDS
3389
5613
7213
TOTAL
XRAY
XRAY
XRAY
1327
8331
TOTAL
FLOG
VALUE
39
400
lOO
200
500
1, 200
39
>
>
10
)
( VICGP
)
REPORT PERIOD JON 86 - DEC 66
COSTS
1328
3622
6621
8445
TOTAL
( lOOO
PEER GROUP i VICTORIO GENEROL PROCS
FEE
ITEMS
I
!
!
!
!
I
I
I
i
I
I
!
I
I
t DR. JOHN O. GOLT
700
SOO
40O
1,600
300
300
600
SERVICES
*TC I FLAG
12
3
6
15
I
I
I 39
I 39
I IO
I
21 I IO
15 I
12 I
I 39
I
I 39
I
I IO
C/8
POTIENTS
VALUE
7
3
1
6
17
8
4
3
15
5
4
9
XTS I FLAG
17
7
2
15
I 39
I
I 39
I
I 39
I
20 I 39
10 t IO
7 I
I 39
12 I
10 I
VALUE I FLAG
41
1I
1 I 39
21
61
I
41
21
21 29
51
I
21
1I
31
C/P
S/P
•I
I1
VALUE I FLAG
VALUE I FLAG
VALUE I
571
331
2001 39
831
71 I
I
881
1251
1331 39
1071
I
601
751
671
lOOl
1OOI
2001
2501
200i
I
1751
2501
200 I
3201
I
ISO I
3001
2001
1O
39
39
10
21
31
1 !
31
31
t
21
21
2 I
3 I
!
39
39
39
3!
4 I
3 I
===
3,400
I TOTAL
C O N W A Y
H E O L T H
S Y S T E M S
100 I 39
41
lOO I 29
71
831
4861
6!
PERSONOL SERVICE GROUPS OND FEE ITEMS
PROVIDER
i DR. JOHN O. GOLT
< lOOO
)
PEER GROUP : VICTORIO GENEROL PROCS
( VICGP
)
�C O N W A Y
**«•**#»##******»#*•###*»*•*#
#
•
#
»
RANKING REPORT
*
*
H E A L T H
S Y S T E M S
PAGE
PRINTED
PEER GROUP i VICTORIA GENERAL PRACS
( VICGP
3000
lOOO
SOOO
REPORT
DR. WILLIAM C. FRAZER
DR. JOHN A. GALT
DR. JAMES R. BURKE
PERIOD
JAN 8 6 -
PATIENTS
1 C/S
COSTS
1
SERVICES
1
FLAGS
1
1
11.
1.
, 1 RANK
1VALUE 1 RANK
VALUE 1
VALUE 1 RANK
VALUE 1 RANK
1 RANK
1
1
1
1
S
3
3046 1
£518 1
1945 1
£
1
3
7300 1
7700 1
6900 1
3
1
61 1
88 1
74 1
£
3
£
1
41
10 1
IO 1
C/P
RANK
H E A L T H
S Y S T E M S
PEER
GROUP
:
VICTORIA
GENEROL
PRACS
DEC 8 6
S/P !
RANK !
:
1
3
£
1
£
3
RANKING
C O N W A Y
1985
)
*#***##*•»**»•*»»***»##»»»**
T a b l e i n f o r m a t i o n based o n TOTAL
data f o r t h e f o l l o w i n g providers i
ON OB O C T
1
(
VICGP
1 !
£ !
3 ;
REPORT
)
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Health Care Task Force Records
Creator
An entity primarily responsible for making the resource
White House Health Care Task Force
Is Part Of
A related resource in which the described resource is physically or logically included.
<a href="https://catalog.archives.gov/id/10443060" target="_blank">National Archives Catalog Description</a>
Description
An account of the resource
<p>This collection contains records on President Clinton’s efforts to overhaul the health care system in the United States. In 1993 he appointed First Lady Hillary Rodham Clinton to be the head of the Health Care Task Force (HCTF). She traveled across the country holding hearings, conferred with Senators and Representatives, and sought advice from sources outside the government in an attempt to repair the health care system in the United States. However, the administration’s health care plan, introduced to Congress as the Health Security Act, failed to pass in 1994.</p>
<p>Due to the vast amount of records from the Health Care Task Force the collection has been divided into segments. Segments will be made available as they are digitized.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+1"><strong>Segment One</strong></a><br /> This collection consists of Ira Magaziner’s Health Care Task Force files including: correspondence, reports, news clippings, press releases, and publications. Ira Magaziner a Senior Advisor to President Clinton for Policy Development was heavily involved in health care reform. Magaziner assisted the Task Force by coordinating health care policy development through numerous working groups. Magaziner and the First Lady were the President’s primary advisors on health care. The Health Care Task Force eventually produced the administration’s health care plan, introduced to Congress as the Health Security Act. This bill failed to pass in 1994.<br /> Contains 1065 files from 109 boxes.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+2"><strong>Segment Two</strong></a><br /> This segment consists of records describing the efforts of First Lady Hillary Rodham Clinton to get health care reform through Congress. This collection consists of correspondence, newspaper and magazine articles, memos, papers, and reports. A significant feature of the records are letters from constituents describing their feelings about health care reform and disastrous financial situations they found themselves in as the result of inadequate or inappropriate health insurance coverage. The collection also contains records created by Robert Boorstin, Roger Goldblatt, Steven Edelstein, Christine Heenan, Lynn Margherio, Simone Rueschemeyer, Meeghan Prunty, Marjorie Tarmey, and others.<br /> Contains 697 files from 47 boxes.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+3"><strong>Segment Three</strong></a><br /> The majority of the records in this collection consist of reports, polls, and surveys concerning nearly all aspects of health care; many letters from the public, medical professionals and organizations, and legislators to the Task Force concerning its mission; as well as the telephone message logs of the Task Force.<br /> Contains 592 files from 44 boxes.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+4"><strong>Segment Four</strong></a><br /> This collection consists of records describing the efforts of the Clinton Administration to pass the Health Security Act, which would have reformed the health care system of the United States. This collection contains memoranda, correspondence, handwritten notes, reports, charts, graphs, bills, drafts, booklets, pamphlets, lists, press releases, schedules, newspaper articles, and faxes. The collection contains lists of experts from the field of medicine willing to testify to the viability of the Health Security Act. Much of the remaining material duplicates records from the previous segments.<br /> Contains 590 files from 52 boxes.</p>
<p><strong><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+5">Segment Five</a></strong><br /> This collection of the Health Care Task Force records consists of materials from the files of Robert Boorstin, Alice Dunscomb, Richard Veloz and Walter Zelman. The files contain memoranda, correspondence, handwritten notes, reports, charts, graphs, bills, drafts, booklets, pamphlets, lists, press releases, schedules, statements, surveys, newspaper articles, and faxes. Much of the material in this segment duplicates records from the previous segments.<br /> Contains 435 files from 47 boxes.</p>
<p><strong><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+6">Segment Six</a></strong><br /> This collection consists of the files of the Health Care Task Force, focusing on material from Jack Lew and Lynn Margherio. Lew’s records reflect a preoccupation with figures, statistics, and calculations of all sorts. Graphs and charts abound on the effect reform of the health care system would have on the federal budget. Margherio, a Senior Policy Analyst on the Domestic Policy Council, has documents such as: memoranda, notes, summaries, and articles on individuals (largely doctors) deemed to be experts on the Health Security Act of 1993 qualified to travel across the country and speak to groups in glowing terms about the groundbreaking initiative put forward by President Clinton in his first year in the White House. <br /> Contains 804 files from 40 boxes.</p>
Publisher
An entity responsible for making the resource available
William J. Clinton Presidential Library & Museum
Identifier
An unambiguous reference to the resource within a given context
2006-0885-F
Text
A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text.
Original Format
The type of object, such as painting, sculpture, paper, photo, and additional data
Paper
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
[Interest Groups] [loose] [2]
Creator
An entity primarily responsible for making the resource
White House Health Care Task Force
Health Care Task Force
Paul Jamieson
Identifier
An unambiguous reference to the resource within a given context
2006-0885-F Segment 3
Is Part Of
A related resource in which the described resource is physically or logically included.
Box 24
<a href="http://clinton.presidentiallibraries.us/items/show/36148" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/12093080" target="_blank">National Archives Catalog Description</a>
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: White House Staff and Office Files
Publisher
An entity responsible for making the resource available
William J. Clinton Presidential Library & Museum
Format
The file format, physical medium, or dimensions of the resource
Adobe Acrobat Document
Medium
The material or physical carrier of the resource.
Reproduction-Reference
Date Created
Date of creation of the resource.
3/16/2015
Source
A related resource from which the described resource is derived
42-t-12093080-20060885F-Seg3-024-003-2015
12093080