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�TabD
Examples of Comparative Performance Reports
1.
Magazine: "Health Pages."
2.
A Consumer's Guide to Coronary Artery Bypass Graft Surgery.
Pennsylvania Health Care Cost Containment Council, 1992.
3.
Summary Report: "Cleveland Health Quality Choice," April 28, 1993.
4.
Press Release and other materials on "Health Care, Performance
Indicators for Choosing A Health Care Delivery System," United
HealthCare Corporation, 1993.
�For Official Use Only
5/11/93
Title: A Consumer's Guide to Coronary Artery Bypass Graft Surgery
This booklet was prepared by the Pennsylvania Health Care Cost Containment Council
(PHCCCC) for people considering coronary artery bypass graft surgery. The PHCCCC
is an independent state agency responsible for addressing the cost and quality of health
care in Pennsylvania. This booklet presents information to consumers for comparing
hospitals and cardiac surgeons. It also includes information about cardiac procedures
and coronary artery bypass surgery.
Implication for Health Care Reform
This is an example of a state's effort to collect and present comparative information to
consumers about the quality of a particular service.
�••••••••••••<
A Consumer Guide to
Coronary Artery Bypass
Graft Surgery
PENNSYLVANIA HEALTH CARE
COST CONTAINMENT COUNCIL
mm
Pennsylvania s Declaratn > n
of Health Care Intormation
�Foreword
•••••••••••••••••••••»••••••••••••»•••••••••••••»•••••»»»•»••••»••»•
The Pennsylvania Health Care Cost Containment Council has prepared this booklet for people
considering coronary artery bypass graft surgery. Ask your doctor questions about the
information in it. If you have questions that aren't covered in this booklet, again, ask your
doctor. You may also wish to discuss the contents of this booklet with your hospital
representative and the insurance benefits person where you are employed.
The Pennsylvania Health Care Cost Containment Council is an independent state agency
responsible for addressing the cost and quality of health care in Pennsylvania. The Council
promotes health care competition through the collection, analysis, and public distribution of
uniform cost and quality health care information.
In the mid-1980's, the major interest groups in Pennsylvania which were involved in health
care financing became increasingly concerned about the rising cost of health care. Businesses
were devoting an increasing portion of their resources to costly health benefits for their
employees. Labor union members were struggling, often going on strike, to prevent the
erosion of valued health care benefits. Health care providers were concerned that payments for
services were not covering their costs. The Commonwealth also recognized that health care
costs were consuming a staggering portion of the state's annual budget. These same groups
were also concerned that efforts to contain costs should not undermine access to health care in
Pennsylvania.
The combined support of these groups, as well as insurers and consumers, encouraged the
Pennsylvania General Assembly to pass Act 89 in 1986 which created the Health Care Cost
Containment Council. This report is the latest in a series of reports designed to assist the
public in making more informed health care choices.
A technical report with a detailed explanation of the research methods used to prepare this
information may be obtained by contacting the Council office at the address listed below. In
addition, hospitals and physicians may have elected to comment on the information
presented in this booklet. A free copy of those comments may also be obtained by contacting
the Council office.
Pennsylvania Health Care Cost Containment Council
Harrisburg Transportation Center
Harrisburg, PA 17101
(717) 232-6787
>••••••••••••••••••••••••••••••<••••••••••••••
�Table of Contents
I.
Introdu
-n
II.
•,
Listing of Hospitals
III. Listing of Physicians
IV. Hospital Information
17
V.
Physician Information
22
„
�Introduction
••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••
About 68 million Americans have some form of heart-related disease. It is the leading cause
of death in the United States. This booklet is designed to provide consumers with
information on the surgical procedure used to treat one type of heart disease known as
atherosclerotic coronary artery disease.
This booklet will help you make comparisons among hospitals and cardiac surgeons
should you require surgical treatment for coronary artery disease. It can also help you
know which questions to ask your doctor, and to make a more informed choice when
selecting a hospital or surgeon for coronary artery bypass graft surgery (CABG). Please use
this information in conjunction with your doctor and hospital.
The information is based on reports from the 35 of the 36 Pennsylvania hospitals certified to
perform coronary artery bypass graft surgery during 1990. (Conemaugh Valley Memorial
Hospital did not perform enough procedures in 1990 to be included in this report, since
their coronary bypass surgical unit just opened that year.)
The charts show the average charge and the number of CABG surgery patient deaths for
each hospital in Pennsylvania where at least 30 coronary bypass operations were performed.
The charts also show the number of CABG surgery patient deaths for each cardiac surgeon
who performed at least 30 coronary bypass operations. Thirty is considered a minimum
number in order for the information to be statistically meaningful.
What is athersclerotic coronary artery disease?
Atherosclerotic coronary artery disease occurs when the arteries which supply blood
to the heart muscle become lined with fatty deposits, harden, and become partially
blocked. The amount of blood reaching the heart is reduced. This reduced flow of
blood can cause chest pain (angina), or a heart attack.
What is cardiac catheterization?
Cardiac catheterization is a diagnostic test procedure performed with the aid of xrays to identify blockages or narrowed areas in the heart vessels. This test helps
determine if coronary artery bypass graft surgery is needed. A long, thin tube called
a catheter is inserted into a blood vessel in the arm or groin and threaded into the
coronary arteries. Dye is injected through the catheter, and x-rays of the vessels are
taken.
What methods are used to treat heart disease?
/ \ It is important to discuss this with your physician. Depending on a patient's
w \ x condition and the doctor's recommendation, the following are among treatment
^
methods that might be used: changes in lifestyle habits such as diet or smoking,
medication, balloon angioplasty, laser angioplasty, and coronary artery bypass graft
surgery. This report deals with coronary artery bypass graft operations, which are
performed by a cardiac surgeon. However, when seeking treatment for heart disease,
a physician known as the cardiologist is usually involved in the diagnosis of heart
disease. In general, it is the cardiologist who will diagnose the problem, and refer
the patient to a cardiac surgeon if surgerv is being considered or recommended. Thireport can be used in conjunction with the advice of your cardiologist in selecting a
cardiac surgeon.
�What is coronary artery bypass graft surgery?
An alternate path for blood, or "bypass," is made around the narrowed or blocked part
\ A y of the coronary artery that has been identified during cardiac catheterization. The
surgeon removes or diverts a section of blood vessel from another part of the body and
attaches it around the blockage in the coronary artery. The blood flows through the
inserted section, bypassing the blockage, to restore the blood flow to the heart muscle.
How is the information organized in this report?
The information is provided in two different ways. A table listing each hospital's
x A x number of patient deaths compared to an expected number as well as the average
charges appears on page 17. This table has been converted to an easy-to-read bar chart
on pages 18 and 19.The physician information, combined with the hospital information,
begins on page 22 and appears in the following way:
1. The information is listed according to region. For example, hospitals and
physicians in Western Pennsylvania are grouped together, as are those in
Southeastern Pennsylvania and so on.
2. The hospitals within each region are listed alphabetically and all of the
physician information is grouped alphabetically by practice group under the
lospitals where the physicians practice.
3. The hospital information is listed first. Following that, the name and overall
average score of the physician practice group practicing in that hospital is
listed (There may be more than one group). The information for each
individual member of the practice group appears next. Physicians practicing
alone are aligned in the table with the practice groups to separate them from
the individual physicians who practice within a group.
This allows you to see - in a single table - the following information:
1. The number of patients who died compared to expected numbers for each
hospital.
2. The number of patients who died compared to expected numbers for each
practice group in that hospital.
3. The number of patients who died compared to expected numbers for each
surgeon practicing within a practice group.
4. The information for each physician practicing alone and performing
coronary bypass surgery in that hospital.
What are practice groups and why are they important?
A practice group is a group of affiliated health professionals, including physicians, who
are in practice together. This is common, although many physicians practice alone.
Physicians practicing alone are referred to in the report as "solo practitioners." In some
groups, more than one surgeon mas be involved in the patient's treatment or
operation. Therefore, it may be important to know the practice group's overall average
score. It may also be important to ask \ our cardiac surgeon if other members of his or
her practice group will be involved in \ our surgery and if so, what their role will be.
<>
6
�Why does the Council report the number of patients treated, but not the
information regarding patient deaths, for certain physicians?
For this report, the Council has set a minimum number of 30 procedures in order for the
information to be statistically meaningful. If a physician performed less than 30
operations, only the number of patients treated is reported. Some physicians may have
less than 30 procedures because in 1990 - the period covered by this report - they were
just starting their practice, scaling back their practice, had privileges at multiple
hospitals, or for other reasons. It may be important to ask about this, as well as the
number of procedures thev are currentiv performing. In addition, it is important to note
that since this report covers the year 1990, some physicians currently may be practicing
at different hospitals than the hospitals listed.
What do the charts in this booklet show?
In this booklet, the Pennsvlvania Health Care Cost Containment Council is reporting a
measure of treatment effectiveness by determining for each hospital and cardiac
surgeon an expected number of patient deaths following coronary bypass surgery.
The Council then compares each hospital's and surgeon's actual number of patient
deaths to their expected number to see if the hospital or surgeon had fewer deaths than
expected, more deaths than expected, or had the same number or a similar number of
deaths as expected.
The average amount each hospital charged for coronary bypass surgery is reported as
well. The average charges for cardiac surgeons were not available for inclusion in this
booklet.
How is the expected number of patient deaths determined?
The expected numbers are determined using patient information from all Pennsylvania
hospitals and surgeons performing coronary bypass surgery and by taking into
account:
the patient's medical condition at the time of hospital admission
the age of patients
the sex of patients
What do the symbols in the charts mean?
The symbols are simply the result of a statistical comparison between a hospital's or
surgeon's actual number of deaths with an expected number. The expected number is
expanded in the charts and shown as an expected range, or group, of numbers. When
the actual number exceeds the range, the hospital's or surgeon's number is statistically
different.
[ + ] The hospital or surgeon had significantly fewer deaths than expected.
[ - ] The hospital or surgeon had significantly more deaths than expected.
[ A ] The hospital's or surgeon's number of deaths was within the expected
range.
Examples: If the expected range for patient deaths is 8.4 -12.2, and the hospital
or surgeon'> actual number is.
4
this means significantly fewer deaths than expected (plus sign);
not within the expected range.
�12
this means the number of deaths is within the expected range
(triangle symbol), and similar to or the same as expected.
20
this means significantly more deaths than expected (minus sign);
not within the expected range.
Note: If a hospital's number falls within the expected range, it is not noteworthy
where that number falls. In the example above (8.4 - 12.2), a 9 would be no different
statistically than an 11. They are both within the range.
What does the "Average Charge" column mean?
This column shows the average amount a hospital charged for coronary artery
bypass graft surgery in 1990. The charges do not include physician fees, and are
usually more than actual pavments received by hospitals from the payor (such as
your insurance company). For example, for Medicare patients, the actual payment to
a hospital is based on a different formula and may be lower. Charges are, however,
a reasonable and consistent basis for comparison.
Where does the information contained in this report come from?
/^S The information is collected from actual hospital discharge and billing reports.
MediQual Systems, Inc., assisted the Pennsylvania Health Care Cost Containment
Council in analyzing the data.
What questions should I ask my doctor?
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
Are there alternatives to surgery?
Is the heart surgeon board-certified?
Is the anesthesiologist board-certified?
How many cardiac catheterizations are performed each year at the
hospital?
How many coronary artery bypass graft surgeries are performed each
year at the hospital?
How many surgeries has the cardiac surgeon performed?
How many cardiac catheterizations has the cardiologist performed?
Does the surgeon accept Medicare patients, if applicable?
Does the surgeon accept Medicaid patients, if applicable?
What is an estimate of your charge, the hospital's charges, and any
other medical charges (other doctors, medication, etc.)
Is the surgeon a participating doctor with my insurance plan?
Does the surgeon accept mv health plan's reimbursement as payment
in full?
What is my estimated recovery time?
How soon after the operation can I return to work?
What should 1 expect before and after surgery?
How soon will I be able to resume routine activities?
What kind of rehabilitation do vou recommend?
What other information is available on the treatment and prevention of
heart disease?
�Is the number of coronary bypass operations performed by a hospital an
important factor to consider?
*£l Some health care review organizations have suggested that each doctor or hospital
yJ^Y perform at least a minimum number of procedures each year to ensure that the
provider has enough experience. Ask your doctor about the following guidelines:
Cardiac Catheterization:
The Pennsylvania Department of Health and the Inter-Society Commission for Heart
Disease Resources suggest that hospitals performing cardiac catheterizations perform
a minimum of 300 procedures per year. Each physician performing a cardiac
catheterization should perform 150 annually (PA Dept. of Health).
Coronary artery bypass graft surgery:
The American College of Surgeons suggests that at least 200-300 open heart
operations should be performed by the hospital each year. The Pennsylvania
Department of Health states that within three years of starting the service, a facility
should be performing 450 cases annually. (Patients treated in the first year should
number 150; the second year at least 300). Coronary bypass operations are one of
several types of open heart surgeries. In Pennsylvania, while coronary bypass
operations represent about 63% of all open heart surgeries, this percentage varies
from hospital to hospital. In addition, a hospital may have a comparatively low
number of coronary bypass operations, but a high number of total open heart
surgeries. Please note that the guidelines of the American College of Surgeons and
the Pennsylvania Department of Health refer to all open heart operations, not just
coronary bypass surgery. In addition, if a physician practices at more than one
hospital, or performs operations at hospitals outside of Pennsylvania, that should be
taken into account when looking at the total number of surgeries performed. The
listings which begin on page eight indicate which physicians practice at more than
one hospital. The Council does not report on surgeries performed outside of
Pennsylvania. The numbers for both coronary bypass operations and total open
heart operations for each hospital in this report are listed on pages six and seven.
The American College of Cardiology/American Heart Association Task Force
recommends that in general, a yearly minimum of 100 to 150 open heart operations,
the majority of which are coronary bypass operations, should be performed by each
surgeon caring for patients with heart disease.
•••••••••««••«•••••••»<«»«••••••••••••••••••<
�Hospitals Performing Coronary Artery Bypass Graft Surgery
Total Open Heart Procedures and
Coronary Artery Bypass Graft Procedures
Number of Patients
Hospital Name
Albert Einstein Medical Center
Location
All Open Heart
Procedures
Coronary Bypass Procedures
Numbers
Percent
Philadelphia
Pittsburgh
893
582
65%
1,705
1,010
431
424
333
Bryn Mawr Hospital
Altoona
Bryn Mawr
59%
77%
300
71%
Central Medical Center & Hospital
Pittsburgh
380
335
88%
Episcopal Hospita)
Geisinger Medical Center /Danville
Philadelphia
421
286
Danville
803
68%
40%
Graduate Hospital
Hahnemann University Hospital
Philadelphia
461
323
287
Philadelphia
1,239
847
68%
Hamot Medical Center
Erie
Harrisburg
645
444
69%
Philadelphia
Lancaster
681
799
1,049
467
354
Philadelphia
Allentown
1,445
Allegheny General Hospital
Altoona Hospital
Harrisburg Hospital
Hospital of the University of Pennsylvania
Lancaster General Hospital
Lankenau Hospital
Lehigh Valley Hospital
Medical College Hospitals /Main Clinical
Mercy Hospital of Pittsburgh
Philadelphia
Pittsburgh
Mercy Hospital /Scranton
Scranton
Montefiore University Hospital
Pennsylvania Hospital
Polyclinic Medical Center
852
286
676
585
923
174
62%
^
69%
44%
64%
69%
64%
61%
1,081
617
264
682
63%
419
Philadelphia
Harrisburg
200
90
475
330
68%
78%
45%
69%
Philadelphia
Pittsburgh
663
440
479
177
Readng Hospital and Medicai Center
Robert Packer Hospital
Reading
Saint Francis Medical Center
Pittsburgh
736
628
724
526
386
464
Saint Luke's Hospital of Bethlehem
Bethlehem
472
338
- -*c.
429
1.197
305
71%
718
60%
Philadelphia
Philadelphia
399
507
258
65%
Hershey
Pittsburgh
595
292
204
1,018
327
580
214
505
335
65%
66%
23,791
14,928
63%
Presbyterian Medical Center of Phfla
Presbyterian-University Hospital
Saint Vincent Health Center
Shadyside Hospital
Temple University Hospital
Thomas Jefferson University Hospital
University Hospital Milton S. Hershey
Western Pennsylvania Hospital
Wilkes-Barre General Hospital
York Hospital
STATEWIDE TOTAL
Pittsburgh
Sayre
Erie
Pittsburgh
Wilkes-Barre
1 York
205
40%
71%
6'%
C
-
Q
c
z. "*:
m
Hospitals and Physicians may have commented on this report. Copies are available upon re
Source: Pennsylvania Health Care Cost Containment Council, 1990 data.
�Number of Patients by Hospital
Coronary Artery Bypass raft Surg ry
& Other Open Heart Procedures
[Listed by number of CABG procedures from high to low]
Other
CABG
Allegheny Gen Hosp
^1705
I
Lehigh Valley Hosp
1445
Hahnemann Univ Hosp
1239
Shadyside Hospital
] 1197
Mercy Hosp of Pitt
1081
Lancaster Gen Hosp
Lankenau Hospital
1049
852
it.
1 893
Albert Ein Med Ctr
Western Penn Hosp
1018
Read Hosp & Med Ctr
Presby Med Ctr/Phlla
736
flSf-XT'
Harrisburg Hospital
St Francis Med Ctr
Hamot Medical Center
Mercy Hosp/Scranton
Robert Packer Hosp
Hosp of Univ of PA
St Luke s Hosp/Beth
Ctrl Med Ctr & Hosp
York Hospital
Altoona Hospital
Polyclinic Med Ctr
Gels Med Ctr/Oanvill
St Vincent Hlth Ctr
429
Bryn Mawr Hospital
424
Thomas Jeff Unlv Hosp
|
Graduate Hotpital
461
Episcopal Hospital K g v y ^
Temple Univ Hospital
f,.
:
".' 1 , ^
421
1^1399
327
Wilkes-Barre Gen Hosp
Montefiore Univ Hosp
264
Univ Hosp MSH Med Ctr
595
Presby-Univ Hospital
440
Med Col Hosp/MCC
Pennsylvania Hosp
286
200
500
Source: PHC4. 1990 data
507
1000
Number of Patients
1500
2000
�Physicians Performing
Coronary Artery Bypass Graft Surgery
Medical Practice Group & Hospitals where Practiced
Physician Name
Ablaza. Sariel G.
Practice Group
S.G.G. Ablaza. MD PC
Hospitals where practiced
ALBERT EINSTEIN MEDICAL CENTER
MEDICAL COLLEGE HOSPITALS /MAIN CLINICAL
Addonizio, V. Paul
Temple Cardb-Thoracic Associates
TEMPLE UNIVERSITY HOSPITAL
Agster. Bruce E.
Bruce E. Agster, MD, Cardiovascular Associates
SAINT FRANCIS MEDICAL CENTER
'
Solo Practitioner
EPISCOPAL HOSPITAL
Alpem, Jeffrey B.
Temple Cardo-Thoracc Associates
TEMPLE UNIVERSITY HOSPITAL
Anastasi, John
Cardiovascular & Thoracic Surgery of Altoona, Inc.
ALTOONA HOSPITAL
Anderson, John Edward
Solo Practitioner
WILKES-BARRE GENERAL HOSPITAL
Angelico. Richard J.
Soto Practitioner
SAINT LUKE'S HOSPITAL OF BETHLEHEM
Armenti, Frederick R.
Edie/Mannion/Armenti
PRESBYTERIAN MEDICAL CENTER OF PHIL
Imtiaz
THOMAS JEFFERSON UNIVERSITY HOSPTTAL
Armitage, John M.
University Surgical Associates, Inc.
PRESBYTERIAN-UNIVERSITY HOSPITAL
SHADYSIDE HOSPITAL
Ashworth & Gregory, MD • Cardiac Surgery
READING HOSPITAL AND MEDICAL CENTER
B^ada, Bicher
Bruce E. Agster. MD, Cardiovascular Assoctales
SAINT FRANCIS MEDICAL CENTER
Beatty, Albert C.
Solo Practitioner
EPISCOPAL HOSPITAL
Bel-Thomson, John
PhtetMphia Heart Center, PC
ALBERT ENSTEIN MEDICAL CENTER '
Benckart, Daniel H.
Cardio-Thoracic SurgicaJ Assoc., Inc.
ALLEGHENY GENERAL HOSPITAL
^ ^ M , Habert E.
i
SAINT FRANCS MEDCAU
Bennett, Edward Virdell Jr.
Guthrie Clinic, Ltd.
ROBERT PACKER HOSPITAL
Benoil, Charies
Department ol Cardtovasoiar and Thoracic Surgery
GEtSWGER MEDICAL CBOBt/
Bonchek, Lawrence I.
Cardiothorabc Surgeons of Lancaster, PC
LANCASTER GENERAL HOSPITAL
Boova, Robert S.
Robert S. Boova. MD, Cardtothoradc Surgery
BRYN MAWR HOSPITAL
Boyer, Joseph H.
Panebianco - Yip Heart Surgeons
LEHIGH VALLEY HOSPITAL
Brockman, Stanley K.
Catfac & Thoracic Surgeons, PC
HAHNEMANN UNIVERSITY HOSPITAL
Burkholder, John A.
Cardio-Thoracic Surgical Assoc.. Inc.
ALLEGHENY GENERAL HOSPITAL
SAINT FRANCIS MEDICAL CENTER
Buriingame; Mark W.
Cardiothoraac Surgeons ol Lancaster, PC
LANCASTER GENERAL HOSPITAL
Campbell, David B.
Division of Cardiothoraac Surgery
UNIVERSITY HOSPITAL MILTON S. HERSHEY
Carter. Craig Steven
Solo Practitioner
EPISCOPAL HOSPITAL
M- K v
en
i
Tomaselk) & Casey, PC
LANKENAU HOSPITAL
avarocchi, Nicholas
Solo Practitioner
ALBERT EINSTEIN MEDICAL CENTER
H
,.,
�Physicians Performing
Coronary Artery Bypass Graft Surgery
Medical Practice Group & Hospitals where Practiced
Physician Nairn
Practice Group
Hospitals where practiced
Cimodiowski, George Eugene
Cardiac Surgery Associates ol Northeast Pennsylvania
WILKES-BARRE GENERAL HOSPITAL
Cuig, Michael H.
RAJ Cardiovascular Associates
MERCY HOSPITAL OF PITTSBURGH
SAINT FRANCIS MEDICAL CENTER
SHADYSIDE HOSPITAL
WESTERN PENNSYLVANIA HOSPITAL
D'Angelo, George J.
D'Angelo Clinic
DarreH, John C.
CENTRAL MEDICAL CENTER & HOSPITAL
Three Rivers Cardiac Institute
David, Irving
MERCY HOSPITAL OF PfTTSBURGH
SHADYSIDE HOSPITAL
Allegheny Cardiovascular Surgical Associates
Davis. Paul Kunkei
WESTERN PENNSYLVANIA HOSPITAL
HARRISBURG HOSPfTAL
Capiat Area Cardiovascular Surgical Institute
Deshpande, Anil Shriram
Devineoi, Rajsekhar
HAMOT MEDICAL CENTER
POLYCLMC MEDICAL CENTER
EPISCOPAL HOSPITAL
Solo Practitioner
Lear Von Koch, MD & Assoctales
MERCYHospm^aii^Hi^'-.
WLKE&BARRE GfMERftL HOfiPIWL •
Dietl, Charles Albert
Department ot Cardiovascular and Thoracic Surgery
DtMarco, Ross F.
Three Rivera Cardac Institute
DiPaola, Douglas J.
Three Rivers Cardiac Institute
GEISINGER MEDICAL CENTER /DANVILLE
CENTRAL MEDICAL CENTER & HOSPITAL
MERCY HOSPITAL OF PITTSBURGH
DiSesa, Venf J.
Solo Practiioner
Edie, Richard N.
Edie/Mannion/Armenti
THOMAS JEFFERSON UNIVERSITY HOSPITAL
Edmunds, Louis Henry Jr.
John RhM Barton Surgical Associates
HOSRTALOf t ^ U N W e ^ ^ P A
Fazi, Burl
Cardiovascular & Thoracic Surgery ol Altoona, Inc.
ALTOONA HOSPITAL
Feaster, Marshal M. Ill '
Arfmorth & Gregory. MD - Cardiac Surgery
READMQ HOSPITAL
Figueroa, Prter R.
Solo Practitioner
EPISCOPAL HOSPITAL
Fox, Stewart
Soto Practrtwner
LEHIGH VAtL^f HOSPfTAL
Gardner, Robert S.
Cardiac Surgeons Inc
SAINT FRANCIS MEDICAL CENTER
t^BXifL^B^
SHADYSIDE HOSPITAL
WESTERN PENNSYLVANIA HOSPITAL
George, Jacob
Cardiopulmonary & Peripheral Vascular Associates
SAINT VNCBfT HEALTH CENTER
Gheissari, Ali
Solo Practitioner
HAHNEMANN UNIVERSITY HOSPITAL
�Physicians Performing
Coronary Artery Bypass Graft Surgery
Medical Practice Group & Hospitals where Practiced
Practice Group
Physician Name
Ghosh. Surosh C.
Solo Practitioner
Hospitals where practiced
ALBERT EINSTEIN MEDICAL CENTER
MEDICAL COLLEGE HOSPITALS /MAIN CLINICAL
Goel, Inder P.
HAHNEMANN UNIVERSITY HOSPITAL
Goel, Inder P., MD PC
PRESBYTERIAN MEDICAL CENTER OF PHIL
Goldenberg, Marc R.
PIzak/GoMenbergWoody
GRADUATE HOSPITAL
Goldman. ScoQ M.
Main Une Cardtolhoracic Surgeons PC
LANKENAU HOSPITAL
Gomez. Fernando
Solo Practitioner
MEDICAL COLLEGE HOSPITALS /MAIN CLINICAL
Gordon, David A.
J.C. Rex Thoracic Surgical Group
LEHIGH VALLEY HOSPITAL
Grana, Vmcente P.
S.G.G. Ablaza. MD PC
ALBERT EINSTEIN MEDICAL CENTER
MEDICAL COLLEGE HOSPITALS /MAIN CLINICAL
Giant, Kathleen J.
Three Rivers Cardiac Institute
CENTRAL MEDICAL CENTER & HOSPITAL
MERCY HOSPITAL OF PITTSBURGH
^ ^ e g o r y . George William
Ashworth & Gregory. MD - Cardiac Surgery
READING HOSPITAL AND MEDICAL CENTER
Barlley P.
^Bwiffth. I
University Surgical Associates, Inc.
PRESBYTERlAN-UMVERSfTY HOSPITAL
SHADYSIDE HOSPITAL
Grunwald, Karl E.
Cardiac & Thoraac Surgeons. PC
HAHNEMANN UNIVERSITY HOSPITAL
Hamzavi, StamakA.
OMSI & Cardiovascular Associates, PC
MERCY HOSPITAL /SCRANTON
.......
Hanson. Ebert Lawrence
Hanson & Associates. Inc.
Hardesty, Robert L.
University Surgical Associates, Inc.
:<w£tVJ
• .vuv-ii. '• ^'i^rajMr..'.::.:-:.
HAMOT MEDICAL CENTER
PRESBYTERWUMVERSfTY HOBPTOttr:
SHADYSIDE HOSPITAL
Hargrove, Walter Clark III
Soto Practitioner
HOSPITAL OF THE UNIVERSITY OF PA
PENNSYLVANIA HOSPITAL
PRESBYTERIAN MEDICAL CENTER OF PHIL
Hart, James C.
Capiat Area Cardiovascular Surgical Institute
Hattler, Brack G.
University Surgical Associates. Inc.
Helman, Arthur A.
Solo Practitioner
Hendren, William G.
Solo Practitioner
Hoffman, William S.
Bethlehem Cardiothoraac Surgical Assobales. PC
Hong-Barco, Pablo
Thoracic Cardiovasc-.j! *ssociaies
lams, Wiliam B.
Capiat Area Cardiovascular Surgcai InstHuie
HARRISBURG HOSPITAL
POLYCLMIC MEDICAL CENTER
MONTEFIORE UNIVERSITY HOSPITAL
PENNSYLVANIA HOSPITAL
PRESBYTERIAN MEDICAL CENTER OF PHIL
SAINT LUKES HOSPITAL OF BETHLEHEM
SHADYSIDE HOSPITAL
HARRISBURG HOSPITAL
POLYCLINIC MEDICAL CENTER
10
�Physicians Performing
Coronary Artery Bypass Graft Surgery
Medical Practice Group & Hospitals where Practiced
Practice Group
Physician Name
Jalari, Nercy
LEHIGH VALLEY HOSPITAL
Solo Practitioner
HARRISBURG HOSPITAL
Jorge, Eduardo
Capital Area Cardiovascular Surgical Institute
POLYCLINIC MEDICAL CENTER
HARRISBURG HOSPITAL
Judson, John P.
Cardiovascular & Thoracic Associates. Inc
POLYCLINIC MEDICAL CENTER
ROBERT PACKER HOSPITAL
Kalkunte, Jagdish R.
Kay, Harold R.
Hospitals where practiced
Guthrie Cinic, Ltd.
PRESBYTERIAN MEDICAL CENTER OF PHIL
Keagy, Gregory S.
Solo Practitioner
YORK HOSPITAL
Kerth, William J.
Solo Practitioner
HAMOT MEDICAL CENTER
KNndri, Chelan D.
Hanson & Associates, Inc.
LEHIGH VALLEY HOSPfTAL
Kish, George F.
Khindri Cardiovascular Specialists
D'Angelo Clinic
Cardiac Surgeons, Inc.
HAMOT MEDICAL CENTER
Klay, John WhUaker
SHADYSIDE HOSPITAL
\
WESTERN PENNSYLVANIA HOSPITAL
Koch. Lear Von
Lear Von Koch, M & Associates
D
MERCY HOSPITAL /SCRANTON
Kolfl. Jacob
Temple Cardio-Thoracic Associates
TEMPLE UNIVERSITY HOSPITAL
Kortnos, Roberl L.
University Surgical Associates. Inc.
PRESBYTERIAN-UNIVERSITY HOSPITAL
Kuretu, Mwazhuwa L. R.
Cardiac & Thoracic Surgeons. PC
HAHNEMAM* UMVEBSITY HGSPPfc.
Larheu, Alberto J.
Solo Practitioner
ALBERT EINSTEIN MEDICAL CENTER
Larberg, David B.
Cartfiac Surgeons, Inc.
S H A D Y S O E H O S P I W f e l f " •.'
W S E N PEW^IMlteS^ML
ETR
Levin. Bradley H.
Queen Surgical Associates
YORK HOSPITAL
Liebter, George A.
Canfo-Thoracic Surgical Assoc., Inc.
ALLEGHENY GB4ERAL HOSPITAL "
-
SAINT FRANCIS MEDICAL CENTER
Lima, Claudio A. B.
RAJ Cardiovascular Associates
SAINT FRANCIS MEDICAL CENTER
SHADYSIDE HOSPITAL
WESTERN PENNSYLVANIA HOSPITAL
Lolley, David M.
Allegheny Cardiovascular Surgical Associates
SAINT FRANCIS MEDICAL CENTER
WESTERN PENNSYLVANIA HOSPITAL
Long, Richard W.
Cardiopulmonary & Penpheral Vascular Associates
SAINT VINCENT HEALTH CENTER
Lough, Frederick C.
Ashworth & Gregory. MD - Cardiac Surgery
READING HOSPITAL AND MEDICAL CENTER
Lundy, Edward F.
Cardiothoraac Surgeons ol Lancaster. PC
LANCASTER GENERAL HOSPITAL
Lyons, Gary W.
Cardiopulmonary & Peripheral Vascular Assodales
SAINT VINCENT HEALTH CENTER
11
�Physicians Performing
Coronary Artery Bypass Graft Surgery
Medical Practice Group & Hospitals where Practiced
Practice Group
Physician Name
Machiraju, Venkat Ralnam
RAJ Cardiovascular Associates
Hospitals where practiced
SAINT FRANCIS MEDICAL CENTER
SHADYSIDE HOSPITAL
WESTERN PENNSYLVANIA HOSPITAL
MacVaugh. Horace III
Solo Practitioner
GRADUATE HOSPITAL
Magovem, George J. Jr.
Cardio-Thoracic Surgical Assoc., Inc.
ALLEGHENY GENERAL HOSPITAL
SAINT FRANCIS MEDICAL CENTER
Magovem. George J. Sr.
Cardio-Thoracic Surgical Assoc., Inc.
ALLEGHENY GENERAL HOSPITAL
Magovem, James A.
Cardio-Thoracic Surgical Assoc.. Inc.
ALLEGHENY GENERAL HOSPITAL
Maher, Thomas 0.
Cardio-Thoracic Surgical Assoc., Inc.
ALLEGHENY GENERAL HOSPITAL
SAINT FRANCIS MEDICAL CENTER
Manjoney, Deborah Lynn
Cardiopulmonary & Peripheral Vascular Associates
SAINT VINCENT HEALTH CENTER
Mannion, John D.
EdieAlannion/Armenti
THOMAS JEFFERSON UNIVERSITY HOSPITAL
Manzetti, Gene W.
Solo Praditioner
MERCY HOSPITAL OF PITTSBURGH
MaquAan, Jose March
Goel. Inder P., MD PC
HAHNEMANN UNIVERSITY HOSPITAL
PRESBYTERIAN MEDICAL CENTER OF PML
Marrone, Gary C.
MONTEFIORE UNIVERSITY HOSPITAL
University Surgical Associates, Inc.
PRESBYTERIAN-UNIVERSITY HOSPITAL
Uvshal. WBamGeneJr.
D'Angelo Cinic
HAMOT MEDICAL CENTER
Martz. Mark N.
Solo Practitioner
LEHIGH VALLEY HOSPITAL
Math* John M.
Queen Surgical Associates
YORK HOSPfTAL
McCabe, John S.
Solo Pract itiow
ALLEGHENY GENERAL HOSPITAL
McClurken, Jamas B.
Temple Cardto-Thoracc Associates
TEMPLE UNIVERSITY HOSPITAL
Michalak, Dennis M.
Guthne Clinic. Ltd
ROBERT PACKER HOSPITAL
Morris, Joel
Department of Cardiovascular and Thoracic Surgery
GEISINGER MEDICAL CENTER /DANVUE
Mundth, Eldred D.
Solo Practrtioner
BRYN MAWR HOSPITAL
Myers. John L.
Division of Cardothoraoc Surgery
UNIVERSITY HOSPITAL MILTON S. HERSHEY
Olearchyk, Andrew S.
Solo Practrtioner
EPISCOPAL HOSPITAL
Pae, Walter E. Jr.
Division ot Cardiothorabc Surgery
UNIVERSITY HOSPITAL MILTON S. HERSHEY
Palanisamy, Subramanlan
Senan Cardo-T'yjfaac Associates
SAINT FRANCIS MEDICAL CENTER
WESTERN PENNSYLVANIA HOSPITAL
Panebianco, Antonio C.
Panebianco • Yip Heart Surgeons
LEHIGH VALLEY HOSPITAL
12
�Physicians Performing
Coronary Artery Bypass Graft Surgery
Medical Practice Group & Hospltal^where Practiced
Physician Name
Park, Sang B.
Practice Group
Cardio-Thoracic Surgical Assoc.. Inc
Hospitals where practiced
ALLEGHENY GENERAL HOSPITAL
SAINT FRANCIS MEDICAL CENTER
Peiias, Anastasi John
Solo Practitioner
PRESBYTERIAN MEDICAL CENTER OF PHIL
Pellegrini, Ronald V
Three Rivers Cardiac Institute
CENTRAL MEDICAL CENTER 4 HOSPITAL
MERCY HOSPITAL OF PITTSBURGH
Pen nock, John L.
Capital Area Cardiovascular Surgical Institute
HARRISBURG HOSPITAL
POLYCLINIC MEDCAL CENTER
Peter, Mohan
Soto Practitioner
YORK HOSPITAL
Pett, Stephen D.
Cardiopulmonary & Peripheral Vascular Associates
SAINT VINCENT HEALTH CENTER
Pharr, William F.
Department of Cardiovascular and Thoracic Surgery
GEISINGER MEDICAL CENTER /DANVILLE
Pierce, Wittiam S.
Division of Cardcthoracic Surgery
UNIVERSITY HOSPITAL MILTON S. HERSHEY
Plzak, Louis F. Jr.
Plzak/Goldenberg/Woody
GRADUATE HOSPITAL
THOMAS JEFFERSON UNIVERSITY HOSPITAL
Proctor, Michael S.
Solo Practitioner
MERCY HOSPITAL /SCRANTON
Reitknecht, Felice L.
Guthrie Clinic. Ltd.
ROBERT PACKER HOSPITAL
Robinson, John N.
Cardiovascular & Thoracic Surgery Associates
WESTERN PENNSYLVAMA HOSPITAL.
Ross, Patrick Jr.
Division of Caxdiothoracic Surgery
UNIVERSITY HOSPITAL MILTON S. HERSHEY
Russefl. Richvd L.
Cardiovascular & Thoracic Assodales, Inc.
HARRISBURG HOSPfTAL
^ ~ >:
:
P L C W M DC L COITm W i r
OY L C E I A
Sadr, Farrokh S.
Panebianco - Yip Heart Surgeons
LEHIGH VALLEY HOSPITAL
Samadani, Siroos R.
Association ol Thoracic & Cardnvascular Surgeons
SHADYSOE HOSPITAL
^
WESTERN PENNSYLVANIA HOSPfTAL
Sardesai, Prabhaker G.
D'Angelo Clinic
HAMOT MEDICAL CENTER
Senan, Pushpendra
Senan Cardio-Thoracic Associates
SAINT FRANCIS MEDICAL CENTER
Seto, Robb S.
Soto Practitioner
EPISCOPAL HOSPITAL
Shatter, Carolyn W.
Shafter-Oreochta Associates
HARRISBURG HOSPITAL
POLYCLNIC MEDICAL CENTER
• Sharitt. HajiM.
EPISCOPAL HOSPITAL
Solo Praditione<
MEDICAL COLLEGE HOSPITALS /MAIN CLINICAL
Sherafat, Mostala
Solo Practitioner
EPISCOPAL HOSPITAL
Silverman. Edward M.
Solo Practitioner
GRADUATE HOSPITAL
Sinclair, Michael C.
J.C. Rex Thoracic Surgical Group
LEHIGH VALLEY HOSPITAL
13
�Physicians Performing
Coronary Artery Bypass Graft Surgery
Medical Practice Group & Hospitals where Practiced
Physician Name
Practice Group
Hospitals where practiced
Sink, James D.
Solo Practitioner
PRESBYTERIAN MEDICAL CENTER OF PHIL
Smith, John Henry
Cardiac Surgeons, Inc.
SHADYSIDE HOSPITAL
WESTERN PENNSYLVANIA HOSPITAL
Spagna. Paschal M.
Solo Practitioner
MEDICAL COLLEGE HOSPITALS /MAIN CLINICAL
Slept. Larry L.
Cardiac Surgeons, Inc.
SHADYSIDE HOSPITAL
WESTERN PENNSYLVANIA HOSPITAL
Strong, Michael 0. Ill
Cardiac 4 Thoracic Surgeons. PC
HAHNEMANN UNIVERSITY HOSPITAL
Stuart, Richard
University Surgical Associates, Inc.
PRESBYTERIAN-UNIVERSITY HOSPITAL
Sullivan, Lawrence X. Jr.
Thoracic Cardiovascular Associates
SHADYSIDE HOSPITAL
Sutter, Francis P.
Main Une Cardiothoracic Surgeons PC
LANKENAU HOSPITAL
Tabaie, Harold A.
Solo Practitioner
GRADUATE HOSPITAL
Tan, WMredo S.
D'Angelo Cfinic
HAMOT MEDCAL CENTER
Theman, Terrill E.
Bethlehem Cardiothoraac Surgical Associates, PC
SAINT LUKE S HOSPITAL OF BETHLEHEM
y ^ e d o . Donald N.
TomaseDo A Casey, PC
LANKENAU HOSPITAL
^ ^ H e r . Frank Geoflrey
Solo Practitioner
LEHIGH VALLEY HOSPITAL
Capiat Area Cardiovascular Surgical Instiute
HARRISBURG HOSPITAL
Travisano, Frank J.
.
POLYCLNC MEDICAL CENTER .
Tyson, George S.
Solo Practitioner
HOSPITAL OF THE UNIVERSITY OF PA
Vazaies, Brad E
Caniothoracic Surgeons ol Lancaster, PC
LANCASTER GENERAL W S P m ^ ^ S ^ -
Villars, Frederick
Tomasello 4 Casey, PC
LANKENAU HOSPITAL
Waidhausen, John A.
Division ol Cardnttwracic Surgery
UNIVERSITY HOSPITAL MLTON
Weiss, Steven J.
Main Line Cardiothoracic Surgeons PC
Whitman, Glenn Joseph
Soto Practitioner
Wilcox, Kenneth R.
Solo Practitioner
ALBERT EINSTEIN MEDICAL CENTER
MEDICAL COLLEfljE HOSPITALS AMft CLMCft.
SAINT LUKE'S HOSPITAL OF BETHLEHEM
WILKES-BARRE GENERAL HOSPITAL
W m n Craig B.
o a,
Capiat Area Cardiovascular Surgical Institute
HARRISBURG HOSPITAL
POLYCLINIC MEDICAL CENTER
Woelfel, George Frederick
CENTRAL MEDICAL CENTER 4 HOSPITAL
Three Rivers Cardiac insiiiute
MERCY HOSPITAL OF PITTSBURGH
Woods, Edward Lawson
i, Daniel J.
Department of Cardiovascular and Thoracic Surgery
GEISINGER MEDICAL CENTER /DANVLLE
GRADUATE HOSPITAL
Plzak/Goldenberg/Woody
THOMAS JEFFERSON UNIVERSITY HOSPITAL
#
14
�Physicians Performing
Coronary Artery Bypass Graft Surgery
Medical Practice Group & Hospitals where Practiced
Practice Group
Physician Name
Hospitals where practiced
Yeistey, Geary L.
Panebianco - Yip Heart Surgeons
LEHIGH VALLEY HOSPITAL
Yip. LukeChor
Panebianco - Yip Heart Surgeons
LEHIGH VALLEY HOSPITAL
Zikria, Emir A.
Solo Practitioner
SHADYSIDE HOSPITAL
15
�"HOW TO READ THE CHARTS"
This chart is presented as a guide to helpreadersunderstand intonnation in the charts
Please note that these are not actual data, but used for reference purposes only.
Hospitals Performing Coronary Artery Bypass Graft Surgery
Treatment Effectiveness & Average Charge
2
Actual
"
i•
1
Hospital
6
Average
Charge
4
Number
Patients Who Died
3&
O doitara)
n
*f
7 Hospitals With Fewer Number of Deaths Than Expected
a*
,50
Hospital A
8.44 - 12.23
8
•
+
|
$59,438
A
I
$39,946
_
||
$44,789
8 Hospitals With Similar Number of Deaths as Expected
Hospital G
1
6.21 - 9.20
276
9
9 Hospitals With Greater Number of Deaths Than Expected
^feital M
|
1.
Name of hospital where surgery was performed.
2.
Actual number of patients treated at the hospital
in 1990 for coronary bypass surgery.
i.
Actual number of patients admitted to the
hospital for coronary bypass surgery, who died.
•.
The expected range of patient deaths at the
hospital, taking into account the age, sex, and
medical condition of that hospital's patients.
5.
Compares the actual number of patient deaths
to the statistically expected number of patient
deaths for that hospital:
18.67 - 28.15
31
508
A
the hospital's number of patient deaths
was not significantly different than
expected.
6.
7.
hospital had significantly fewer deaths
than expected;
16
Hospitals with similar numbers of deaths as
expected (triangle symbol) are grouped together.
9.
hospital had significantly more deaths a.
than expected;
Hospitals with significantly fewer deaths than
expected (plus symbol) are grouped together in
this table.
8.
+
The average amount billed tor the stay in the
hospital for coronary bypass surgery.
Hospitals with greater number of deaths than
expected (minus symbol) are grouped together.
�Hospitals Performing Coronary Artery Bypass Graft Surgery
Treatment Effectiveness & Average Charge
Average
Charge
Rating
if
Statiatlcal
Actual
Number
Total
Hospital
Patlanta
Patient* Who Died
(In dollars)
Hospitals with Fewer Number ot Deaths than Expected
1,010
25
29.32 - 52.60
Allegheny General Hospital
4
332
5.35 - 18.08
•
Altoona Hospital
847
29.44 - 53.49
26
Hahnemann University Hospital
12
526
15.99 - 33.76
Reading Hospital and Medical Center
+
$46,704
$27,333
$65,825
$21,063
Hospitals With Similar Number ol Deaths as Expected
23
20.85 - 41.08
Albert Einstein Medical Center
581
A
300
15
5.63-17.69
Bryn Mawr Hospital
A
14
335
8.45 - 23.18
Central Medical Center & Hospital
A
8.05-21.64
285
18
Episcopal Hospital
A
323
15
Geisinger Medical Center /Danville
3.91 - 15.30
A
444
Hamot Medical Center
16
6.21 - 19.82
A
17
Lancaster General Hospital
673
13.75-31.79
A
584
15.57 - 33.74
25
Lankenau Hospital
A
174
7
Medical College Hospitals /Main Clinical Campus
1.61 - 10.73
A
Mercy Hospital ol Pittsburgh
682
17.62 - 36.42
20
A
204
11
Montefiore University Hospital
1.67-11.23
A
1
Pennsylvania Hospital
90
0.72 - 7.79
A
Polyclinic Medical Center
330
2.28-12.75
8
A
14
Presbyterian Medical Center of Philadelphia
13.58 - 30.74
478
A
171
Presbyterian-University Hospital
6
.
2.37-12.59
Robert Packer Hospital
386
10
5.04-17.96
14
337
7.84-21.67
Saint Luke's Hospital of Bethlehem
A
304
Saint Vincent Health Center
11
4.10 -16.25
A
714
22.07 - 42.50
Shadyside Hospital
23
H
Temple University Hospital
258
20
8.12 - 22.44
14
Thomas Jefferson University Hospital
292
6.45 -19.05
A
3.27 -13.44
University Hospital Milton S. Hershey Medical
201
6
A
Western Pennsylvania Hospital
9.29 - 24.87
579
10
A
214
4
2.32 -12.23
Wilkes-Barre General Hospital
A |
Hospitals With Greater Number of Deaths Than Expected
287
Graduate Hospital
20
4.71 • 17.00
1
Harrisburg Hospital
467
21
6.42 - 20.09
354
Hospital of the University of Pennsylvania
33
8.50 - 22.38
Lehigh Valley Hospital
920
46
20.67 - 40.69
27
7.90-21.79
Mercy Hospital /Scranton
415
Saint Francis Medical Center
463
31
13.26 - 29.03
York Hospital
325
13
2.23 - 11.96
*J
$61,971
$49,309
$46,544
$44,081
$30,202
$34,769
$24,307
$48,261
$56,530
$39,002
$54,479
$51,164
$39,314
$42,408
$70,069
121.246
$33,245
$45,667
S6M15
• sewra
STATEWIDE TOTAL
14.895
580
$52,464
$33,282
$67,569
$29,746
$83351
$39,587
$76,928
$39,186
$23,885
$48,808
$26,334
$44,649
Hospitals and Physicians may have commented on this repon Copies are available upon request.
Source: Pennsylvania Health Care Cost Containment Ccunci '990 data.
17
�Chart of Hosp
Charges and F
Coronary Artery By
Listed Lowest to Hi
90
80
70
60
S
O
$39
40
$33
$24
30
$21
$39
$39
$40
$33
$24
$21
20
10
0
Rating
Deaths
Haap
1.
a
.+;..' :.A
.* .
4
me
i
tap
•
7
Neap
•
-
+
A
A
•
A -
;
A,; '
Hospital Kay
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
'6
"
•8
Reading Hospital and Medical Center
Roberl Packer Hospital
Mercy Hospital/Scranton
Lancaster General Hospital
York Hospital
Altoona Hospital
Wilkes-Barre General Hospital
Geisinger Medical Center/Danv. e
Saint Luke's Hospital of Betniener
18
University Hospital Milton S. Hershey Medical Center
Hamot Medical Center
Mercy Hospital of Pittsburgh
Lehigh Valley Hospital
Polyclinic Medical Center
Harrisburg Hospital
Presbyterian Medical Center of Philadelphia
Es'scopai Hospital
Samt Vmcent Health Center
3QB
�pital Average
~"ient Deaths
ypass Graft Surgery
Highest by Charge
otp Hop
1
8
19
20
H«p Ho*
22
21
23
Hov
M
28
ft*
Hov Hov Hov Hov Hov Hov HOV
26
21
30
27
29
31
32
JJ
Nov
A
19
20
21
22
23
24
25
!6
Central Medical Center & Hospital
Allegheny General Hospital
LanKenau Hospital
Saint Francis Medical Center
Bryn Mawr Hospital
Pennsylvania Hospital
Thomas Jefferson University Hospital
Montefiore University Hospital
Shadyside Hospital
28 Medical College Hospitals/Mam Clinical Campus
29 Western Pennsylvania Hospital
30 A.oe'i Emstem Mecucai Center
31 Temoie University Hospital
32 Hamemann University Hospital
33 '?sDvre'an-University Hospital
3-1 -csD'tai;!
Unives-'y of Pennsylvania
35 G'acwase -icsp'ta^
3
,
r
19
Statistical Rating Key
- fewer deaths than expected
A same as/similar to expected
-
more deaths than expected
�Physician Data Listed by Hospital Alphabetically within
Geographic Regions as Listed Below
Western Pennsylvania Area
Allegheny General Hospital
Central Medical Center & Hospital
Hamot Medical Center
Mercy Hospital of Pittsburgh
Montefiore University Hospital
Presbyterian-University Hospital
Saint Francis Medical Center
Saint Vincent Health Center
Shadyside Hospital
Western Pennsylvania Hospital
Central & Northeastern Pennsvlvania Area
Altoona Hospital
Geisinger Medical Center /Danville
Harrisburg Hospital
Lancaster General Hospital
Mercy Hospital /Scranton
Polyclinic Medical Center
Robert Packer Hospital
University Hospital Milton S. Hershey Medical Center
Wilkes-Barre General Hospital
York Hospital
Southeastern Pennsvlvania Area
Albert Einstein Medical Center
Bryn Mawr Hospital
Episcopal Hospital
Graduate Hospital
Hahnemann University Hospital
Hospital of the University of Pennsylvania
Lankenau Hospital
Lehigh Valley Hospital
Medical College Hospitals /Main Clinical Campus
Pennsylvania Hospital
Presbyterian Medical Center of Philadelphia
Reading Hospital and Medical Center
Saint Luke's Hospital of Bethlehem
Temple University Hospital
Thomas Jefferson University Hospital
20
�HOW TO READ THE CHARTS"
This chart is presented as a guide to helpreadersunderstand information in the charts.
Please noto that these are not actual data, but used for reference purposes only
W e s t e r n P e n n s y l v a n i a Area H o s p i t a l s
Physician Practice Groups and Cardiac Surgeons
for Coronary Artery Bypass Graft Surgery
--
Treatment Effectiveness Measure
Patients Who Died
2
6 HOSPITAL NAME
367
14
11.25-18.62
A
7 Practice Group Name
203
190
13
164
8
6
6.91 - 9.73
6.20- 8.64
A
A
8 Physician 1 *
Physician 2
9 Solo Practitioner Name
1. Actual number of patients treated by the hospital,
practice group, and individual physician in 1990 with
coronary bypass surgery. The number of patients
treated by each individual physician is listed next to
their name.
Statistical
3
Rating
*"
Total Patients
5
Hospital
Physician Practice Group
and
Surgeons
less than 30 patients treated
6
5.69- 7.23
A
5. The physician information is grouped first by one of
three geographic areas in Pennsylvania (example:
Western Pennsylvania area). Secondly by hospital
name, then practice group name (or physician name if
surgeon is a solo practitioner). The physicians within a
practice group are listed alphabetically, under the
practice group name.
2. Actual number of patients treated with coronary bypass
surgery, who died during hospitalization.
6. Name of the hospital in which the following practice
groups and individual physicians perlormed surgery.
3. The expected number of patient deaths for the hospital,
practice group, and individual physician taking into
account the age, sex, and condition of that practice
group's patients.
7. Name of the physician practice group responsible for
the surgery, followed by the individual surgeons who
belong to the practice group.
4. Compares the actual number ol patient deaths to the
statistically expected number of patient deaths for that
hospital, practice group or individual physician:
8. Individual surgeons who belong to the practice group.
An asterisk means this physician performed surgery at
more than one hospital.
+ significantly fewer deaths than expected:
9. individual surgeons practicing alone - not in a group.
- significantly more deaths than expected:
A the actual number of patient deaths *as not
significantly different than expected
21
�Western Pennsylvania Area Hospitals
Physician Practice Groups and Cardiac Surgeons
for Coronary Artery Bypass Graft Surgery
Treatment Effectiveness Measure
Patients Who Died
Hospital
Physician Practice Group
and
Surgeons
ALLEGHENY GENERAL HOSPITAL
Carcfio-Thoraoc Surgical Assoc., Inc.
Benckart, Daniel H. *
Burkholder, John A. •
Liebler, George A. *
Magovem, George J. Jr.'
Magovem, George J. Sr.
Magovem, James A.
Maher, Thomas 0. *
Park, Sang B. •
McCabe. John S., M
O
CENTRAL MEDICAL CENTER & HOSPITAL
Three Rivers Cardiac Institute
Darrell, John C.'
DiMarco, Ross F.'
DiPaola. DougtasJ.*
Grant KaWeenJ.*
Pelegrirt, Ronald V.*
WOBMBI, George Frederick *
HAMOT MEDICAL CENTER
D'Angelo Clinic
D'Angelo, George J.
Kish, George F.
Marshal, Vtiliam Gene Jr.
Sardesai, Prabhaker G.
Tan, VWfredsS.
Hanson & Assoca|H».kic.
Hanson, Elbvtlawrence
Kerth, Wiliam J.
ll
1,010
1,004
153
11
2
146
147
18
133
11
5
135
25
29.32 - 52.60
•
24
29.05 - 5223
A
2
1.45-10.76
A
2
1.72-10.01
A
5
0.78 - 852
A
4
155-10.30
less fftan 30 patients treatetf
4
1.34-10.31
A
5
154-10.99
A
2
126- 9.58
A
lessthwXpaQertstomd
335
335
72
14
81
53
23
92
444
413
149
57
58
55
94
31
15
16
1
4
14
1
8.45 • 23.18
iAS • 23.18
Pi
less Vm ttpMMrftuar ^
less than X pttlmm )
less than 30 paterts i
Statistical Rating Key
+ fewer deaths than expected
- more deaths than expected
A the number of deaths was not different " - j - ~>:>?c:ed
' This surgeon has privileges at another ncsonai ana sere :' --i^er oatiems are listed under that hospital. Refer
on pages 8 through 15 to identity these ncsxais
Hospitals and Physicians may have commented on this report Cccies are available upon request.
�Western Pennsylvania Area Hospitals
Physician Practice Groups and Cardiac Surgeons
for Coronary Artery Bypass Graft Surgery
Treatment Effectiveness Measure
Padents Who Died
Hospital
Physician Practice Group
and
Surgeons
682
8
4
4
Manzetti, Gene W., M PC
O
RAJ Cardiovascular Associates
Culig. Michael H. *
Three Rivers Cardiac Institute
Darrell, John C. •
DiMarco, Ross F. *
DiPaola, Douglas J. *
Grant Kathleen J . '
Pellegrini, Ronald V. *
Woelfel, George Frederick *
33
33
61
2
22
20
RaUr
20
17.62-36.42
A
less than 30 patients treated
less than 30 patients treated
less than 30 patients treated
19
17.18 - 35.75
A
0.00 - 5.23
A
2
11
4.02 -13.93
A
1
0.00 - 4.33
A
1
0.00 - 5.01
A .
4
252 -12.80
A :
0
0.05 - 7.27
• •
11
A
1.67-11.23
11
1.67-11.23
A
0.44 • 823
7
A
4
0.00 - 4.93
A
2.37-12.59
A
6
A
6
237 ^ZM
2
; A
1
A
A
2
670
58
172
54
54
236
96
•204
204
134
70
171
171
MONTEFIORE UNIVERSITY HOSPITAL
University Surgical Associates, Inc.
Hattler, Brack G.
Marrone, Gary C . '
PRESBYTERIAN-UNIVERSITY HOSPITAL
University Surgical Associates, Inc.
Armitage, John M.'
Griffith, Bartley P. •
Hardesty, Robert L *
Komos, Robert L
Marrone, Gary C. *
Stuart, Richard
it
Statist
Actu
MERCY HOSPITAL OF PITTSBURGH
Numt
o5
less than 30 patMs tnaM
[
less than 30 pailents teabd
toss than 30 patients treated
* This surgeon has pnvileges at another hcsoitai and some of his.her patients are listed under that hospital. Refer to th
on pages 8 through 15 to identify these Hospitals.
Hospitals and Physicians may have commented on this repon. Copies are available upon request.
Source: Pennsylvania Health Care Cost Containment Council. 1990 data.
23
�Western Pennsylvania Area Hospitals
Physician Practice Groups and Cardiac Surgeons
for Coronary Artery Bypass Graft Surgery
Treatment Effectiveness Measure
Patients Who Died
Hospital
Physician Practice Group
and
Surgeons
I
2
463
SAINT FRANCIS MEDICAL CENTER
Allegheny Cardiovascular Surgical Associates
Lolley, David M.'
Bruce E. Agster, MD, Canfovasoiar Assodales
Aqstor. Bruce €.
oatmaoa, uener
Cardiac Surgeons, Inc.
Gardner, Roberl S. *
Cardto-Thoneic Sugfcat Asaoo, mc.
Benckart, OanWH.^
Buridvidar, John A. *
Liebler. George A.* •
192
123
«
1
1
38
3
8
7
5
U
4
Mahar, ThoniaaD.»; .7 "
1
1
1*
31
13.26 • 29.03
less than 30 patients treated
less than 30 patients treated
12
5
7 -.v
less
less
RAJ Cardiovascular Associates
Culig, Michael H. *
Lima, Claudio A. B. *
Machiraju, Venkat Ratnam *
SAINT VINCENT HEALTH CENTER
Cardiopulmonary & Peripheral Vascular Associates
George, Jacob
Long, Richard W.
Lyons, Gary W.
Manjoney, Deborah Lynn
Pelt, Stephen D.
304
90
64
52
33
65
Statistical Rating Key
+ fewer deaths than expected
- more deaths than expected
the number of deaths was not different than e^ciea
•
* This surgeon has privileges at another hospital and some ot hisher patients are listed under that hospital. Refer to th
on pages 8 through 15 to identify these hospitals.
Hospitals and Physicians may have commented on this report. Copies are available upon request.
24
�Western Pennsylvania Area Hospitals
Physician Practice Groups and Cardiac Surgeons
for Coronary Artery Bypass Graft Surgery
Treatment Effectiveness Measure
Patients Who Died
Hospital
Physician Practice Group
and
Surgeons
a
2
*1
1?
3
s
(A
714
"
22.07 - 42.50
23
less than 30 patients treated
less than 30 patients treated
233
233
53
1
5
38
5
4
156
16
55
85
174
116
58
SHADYSIDE HOSPITAL
Allegheny Cardiovascular Surgical Associates
David, Irving •
Association of Thoracic & CarcSovascular Surgeons
Samadani, Siroos R.'
Cardiac Surgeons, Inc.
Gardner, Robert S. *
Klay, John Whitaker'
Lerberg, David B.'
Smilh, John Henry *
Slept, Larry L. *
RAJ CardtovMcUar Associates
Cuflg, Michael H. * ~
LinMLQaudb A. B. *
Macttr^u, Venkat Ratnam
Thoracic Cardiovascular Associates
Hong-Barco, Pablo
Sulivan, Lawrence X. Jr.
11
11
1
71
433 • 16.73
433 -16.73
0.00 - 5.86
A
A
A
less than 30 patients treated
less than 30 patients treated
)
| 0.00 - 4.68
less than 30 patients treated
less than 30 patients treated
ffff
5
3
2
2.88 -13.20
1.13- 9.38
0.00- 542
A
A
A
••.-i-J
14 . ' I
• • 54 ^
. ••• ^
Hirtes^.JW»ert WW^;
•
3
Zikria, Emir A., MD
26
less than 30 patients treated
' This surgeon has privileges at another hospital and some ot higher patients are listed under that hospital. R
on pages 8 through 15 to identify these hospitals
Hospitals and Physicians may have commented on this repon. Copies are available upon request.
Source: Pennsylvania Health Care Cost Containment Council. 1990 data
25
�Western Pennsylvania Area Hospitals
Physician Practice Groups and Cardiac Surgeons
for Coronary Artery Bypass Graft Surgery
Treatment Effectiveness Measure
Patients Who Died
Hospital
Physician Practice Group
and
Surgeons
!
2
WESTERN PENNSYLVANIA HOSPITAL
Allegheny Cardiovascular Surgical Associates
David, Irving *
Lolley, David M *
.
Association ot Thoracic & Carcfiovascular Surgeons
Samadani, Siroos R. *
Cardiac Surgeons, Inc.
Gardner, Robert S. *
Klay, John Whitaker*
Lerberg, David B.'
Smith, John Henry *
Slept, Larry L. *
i H^rdtovascuiar& Thoracic Surgery Associates
fH£_Jtobinson John N.
Robinson,
RAJ Cardiovascular Associates
Culig, Michael H.'
Lima, Claudio A. B. *
Machiraju, Venkat Ratnam *
Senan Cardo-Thoradc Assodales
Palanisamy, Subramanian *
579
66
12
54
245
31
103
51
38
22
102
102
155
20
57
78
8
8
WESTERN PENNSYLVANIA AREA
PENNSYLVANIA STATEWIDE
-2
<
5
1
0
9.29 - 24.87
3
0.00 - 5.76
A
less than 30 patients treated
2
0.00 - 5.05 I A
less than 30 patiem treated
less than 30 patients treated
4
231 -13.39
A
0
0.00 • 2.30
A
2
0.17 - 7.57
A
0
0.00 - 3.33
A
1
0.00 - 3.47
A
less than 30 patients treated
0.00- 5.80
3
A
0.00- 5.80
3
A
0.00 • 7.28
less than X patients treated
167
580
1 "* I
*
Statistical Rating Key
+ fewer deaths than expected
- m r deaths than expected
oe
A the number o deaths was not different than expected
f
•
is surgeon has privileges at another hospital anp some ot higher patients are listed under that hospital. Refer to the ta
'pages 8 through 15 to identity these hospitals
Hospitals and Physicians may have commented on this repon. Copies are available upon request.
26
�Central & Northeastern Pennsylvania Area Hospitals
Physician Practice Groups and Cardiac Surgeons
for Coronary Artery Bypass Graft Surgery
Treatment Effectiveness Measure
Patients Who Died
Hospital
Physician Practice Group
and
Surgeons
1
1
S.
2'
ALTOONA HOSPITAL
Cardiovascular & Thoracic Surgery of Altoona, Inc.
Anastasi, John
Fazi, Burt
GEISINGER MEDICAL CENTER /DANVILLE
Department of Cardiovascular and Thoracic Surgery
Benoit, Charles
Died, Charles Albert
Morris, Joel
Pharr, William F.
Woods, Edward Lawson
HARRISBURG HOSPITAL
Capital Area Cardiovascular Surgical Institute
Davis, Paul Kunkei'
Hart, James C. *
lams, William B. *
Jorge, Eduardo *
Pennock, John L *
Travisano, Frank J. *
Wisman, Craig B. *
1
1
CardovascuiarftThoracic Assodales* Inc.
Judson, John P. *
.
"
Russel, Rfchard L '
.
Shaffer-Orecchia Associates
Shaffer, Carolyn W. *
LANCASTER GENERAL HOSPITAL
Cardiothoracic Surgeons of Lancaster, PC
Bonchek, Lawrence 1
.
Buriingame, Mark W.
Lundy, Edward F.
Vazaies, Brad E.
332
332
206
126
323
323
58
7
50
133
75
467
314
23
62
26
40
56
43
64
83
45
38
70
70
673
673
159
162
195
157
4
2
2
15
15
1
1
1
3
8
3
21
14
1
4
3
2
• 5-r\
0
0
17
17
4
8
2
3
15
5.35 • 18.08
5.35 -18.08
+
2.64-12.81
0.21 - 7.86
3.91 - 15.30
3.91 -15.30
A
0.00 - 4.05
less than 30 patients
A
0.00 - 3.26
0.00 - 6.82
024 - 6.34
A
6.42 - 20.09
337 -14.50
A
less than X patients
0.00 - 4.52 | A
less than X patients
Oflft- 4 #
W»-2J#*
OJO - 4;tr
050- 4.07
0.00 - 4.07
13.75-31.79
13.75-31.79
1.11 - 9.97
0.91 - 9.55
1.63-11.20
1.23-10.22
A
A
A
A
A
A
A
A
This surgeon has privileges at another hospnai ana sone ot higher patients are listed under that hospital. Refer
on pages 8 through 15 to identify these hospitals.
Hospitals and Physicians may have commented on this report Copies are available upon request.
Source: Pennsylvania Health Care Cost Containment Council. 1990 oata
27
�Central & Northeastern Pennsylvania Area Hospitals
Physician Practice Groups and Cardiac Surgeons
for Coronary Artery Bypass Graft Surgery
Treatment Effectiveness Measure
415
POLYCLINIC MEDICAL CENTER
Capital Area Cardiovascular Surgical Institute
Davis, Paul Kunkei *
Hart, James C. *
lams, William B.'
Jorge, Eduardo'
Pennock, John L.'
Travisano, Frank J . '
Wisman, Craig B.'
CartSovascubr & Thoracic Associates, Inc.
Judson, John P. * .
Russel, Richard L. *
Shaffer-Orecchia Associates
Shaffer. Carolyn W. *
ROBERT PACKER HOSPITAL
330
130
8
27
21 '
18
24
21
11
8
7
1
192
192
386
10
386
181
41
73
91
10
3
2
3
2
203
18
185
25
Guthrie Cfinic, Ltd.
Bennett, Edward Virdell Jr.
Kalkunte, Jagdoh R.
Michalak, Dennis M.
Reitknecht, Feta L
Statistical Rating Key
+ (fewer deaths than expected
- more deaths than expected
A the number of deaths was not different tna~
Rating
Statistical
Range
7.90-21.79
16
3.54 -13.68
3.54 -13.68
16
10
1.05- 950
less than 30 patients taafed
0.79-915 j A
9
less than 30 patients treated
27
MERCY HOSPITAL /SCRANTON
Chest & Cardiovascular Associates, PC
Hamzavi, Siamak A.
Lear Von Koch, MD & Associates
Devineni, Rajsekhar'
Koch, Lear Von
Proctor. Michael S., M
D
187
187
Expected
Actual
Number
Total
Patients
Patients Who Died
Hospital
Physician Practice Group
and
Surgeons
A
8
2.28 - 12.75
1
A
0.00 - 653
less than 30 patients treated
less than 30 patients treated
less than 30 patients treated
less than 30 patiem treated
less than 30 patients treated
less than 30 patients treated
less than X patients treated
L-y- -vi w.r,*:.,
.. J-V • ^ ; . ;
";-
7
7
• t
•• *
'
A;
OJO - 8.1»
5.04-17.96
5D4-1756
0.70- 9.t60.00-354
0.00 - 5.28
0.00- 6.24
•"•Al
A
A ;
A
A
A
A
>?::*;::
' This surgeon has privileges at another hos^i J-C see:' - i
on pages 8 through 15 to identify these hcsxa'S
:J: ers are listed under that hospital. Refer to the tables
Hospitals and Physicians may have commenteo :r this reocn Ccz^es are available upon request.
28
�Central & Northeastern Pennsylvania Area Hospitals
Physician Practice Groups and Cardiac Surgeons
for Coronary Artery Bypass Graft Surgery
Treatment Effectiveness Measure
Rating
Statistical
Range
Expected
Actual
Numbar
Patients Who Died
Hospital
Physician Practice Group
and
Surgeons
201
3.27- 13.44
A
6
3.27- 13.44
A
51
Division of Cardiothoracic Surgery
Campbell, David B.
Myers, John L.
Pae, Walter E. Jr.
Pierce, William S.
Ross, Patrick Jr.
Waidhausen, John A.
6
201
UNIVERSITY HOSPITAL MILTON S. HERSHEY MEDICAL
1
0.00- 5.02
A
less than 30 patients treated
18
48
2
0.00- 4.63
A
44
0
0.00- 4.02
A
31
2
0.00- 3.58
A
less than 30 patients treated
9
31
4
1
2.32- 12.23
0.00- 2.76
A
A
42
0
0.00- 4.05
A
42
0
ODO- 4.05
A
81
2
0.00- 5.29
A
81
2
0.00- 5.29
A
I
1
0.QO- 5-08
A
|
13
1
2.23 - 11.96
0.00- 2.01
A
WILKES-BARRE GENERAL HOSPITAL
Anderson, John E., MD
Cardiac Surgery Associates ot Northeast Pennsylvania
Cimochowski, George Eugene
Lear Von Koch, M & Associates
D
Devineni, Rajsekhar *
Wilcox, Kenneth R., M *
D
214
YORK HOSPITAL
Keagy, Gregory S., MD
Peter, Mohan, MD
Queen Surgical Associates
Levin, Bradley H.
Mathai, John M.
335
30
22
I
60
imamxpmmm
11
3,676
1
L
I
14,895
1 50
8
283
141
142
CENTRAL PENNSYLVANIA AREA
PENNSYLVANIA STATEWIDE
I
-
5
155- lOJT
024- 6.56
6
0.00- 5.70
is
.•
A
-
' This surgeon has privileges at another hospnai ana some ot hisher patients are listed under that hospital. Re
on pages 8 through 15 to identify these ncspr.ais
Hospitals and Physicians may have commented on this report Copies are available upon request.
Source: Pennsylvania Health Care Cost Containment Council. '990 data.
29
�Southeastern Pennsylvania Area Hospitals
Physician Practice Groups and Cardiac Surgeons
for Coronary Artery Bypass Graft Surgery
Treatment Effectiveness Measure
— = = = 5
Patients Who Died
ALBERT EINSTEIN MEDICAL CENTER
Cavarocchi, Nicholas C, MD
Ghosh, Suresh C.MDPC*
Larrieu, Alberto J., M
D
Main Line Cardtothoracic Surgeons PC
Weiss, Steven J.
Philadelphia Heart Center, PC
Bell-Thomson, John
S.G.G. Ablaza. MD PC
Ablaza, Sariel a *
Grana, Vmcente P. *
BRYN MAWR HOSPITAL
Mundth, Eldred D., M
D
Robert S. Boova, MD, Cardtothoracic Surgery
Boova, Robert S.
EPISCOPAL HOSPITAL
Ahmad, Imtiaz. M
D
Beatty, Albert M
O
Carter, Craig, M
D
Deshpande, Anfl Shriram, M
O
Figueroa, Peter R., M
D
Rating
ii
Statistical
Actual
581
74
47
14
Numbar
Total
m
Patlanl
Hospital
Physician Practice Group
and
Surgeons
154
146
146
285
12
23
5
0
20.85 - 41.08
A
0.74 - 8.45
A
0.00 • 5.15
A
less than 30 patients treated
6
2.08-1156
A
6
2.08-1156
A
9
5.52 -18.03
A
9
5.52 -18.03
A
3
0J3O - 7.44 • A
2
0.00- 848; • : A>
•
less than 30 paliam
mti£?i
15
5.63-17.69
A
136
136
234
234
76
59
17
300
90
79
I * |
I
I 5
II 1 i
1
5
Olearchyk. Andrew S., MO
Seto, Robb S., MD
Sharlfl,H^M.,MO*
Sherafat. Mostata, MD
41
19
I
immmmmmBBM
i lest f|wm^om^m^!
i ifiwS'wHHBfSH
less ttm 30 patients teelBd
|
Statistical Rating Key
+ fewer deaths than expected
- more deaths than expected
A the number of deaths was not different than ex^ectea
This surgeon has privileges at another hospital ano some ot his her patients are hsted under that hospital. Refer to
on pages 8 through 15 to identify these hospitals
Hospitals and Physicians may have commented on this repon. Copies are available upon request.
30
�Southeastern Pennsylvania Area Hospitals
Physician Practice Groups and Cardiac Surgeons
for Coronary Artery Bypass Graft Surgery
Treatment Effectiveness Measure
Patients Who Died
si
6
IM
11
4
2.51- 12.76
0.00- 5.46
5
0.03-
7
7
10
25
11
3
8
0.00- 833
0.00- 633
-
A
A
2
0.00- 4.93
' A
5
0.00- 6.18
A
less than 30 patients treated
lesst) 30 patents treated
vn
29.44- 53.49
26
+
+ .
16
17.99- 37.76
6
1.28- 10.49
A \
2.07- 11.48
3
A
4
1.32- 10.47
A
3.67- 1524
3
•
teat imSD patien mM
551- 1858
9
A
6
A
2.46- 1239
0.463
A
33
8.50- 22.38
63
64
80
9
15
847
589
139
133
122
195
18
240
152
88
354
Sutler, Francis P.
Tomasello & Casey, PC
Casey, Kevin
Tomasello, Donald N.
Villars, Frederick
4.71 •17.00
0.00- 5.41
Actual
56
207
96
103
88
88
67
584
307
158
149
277
95
144
38
U
20
287
GRADUATE HOSPITAL
MacVaugh, Horace III, MD
Ptzak/GoldenbergMOody
Goldenberg, Marc R.
Plzak, Louis F. Jr. *
Woody, Daniel J . '
Silverman, Edward M., MD
Tabaie, Harold A., MD
HAHNEMANN UNIVERSITY HOSPITAL
Cardiac & Thoracic Surgeons, PC
Brockman, Stanley K.
Grunwald, Karl E.
Kuretu, Mwazhuwa L. R.
Strong, Michael D. Ill
Gheissari, Ai, MD
Goel, Inder P., MD PC
Goel, Inder P.'
Maquilan, Jose March *
HOSPITAL OF THE UNIVERSITY OF PENNSYLVANIA
DiSesa, Verdi J., MD
Hargrom, Watter c m W, I C V
John Rhea Barton Surgical Associates
Edmunds, Louis Henry Jr.
Tyson, George S^ftfl)
LANKENAU HOSPITAL
Main Line CanMhoraoc Surgeons PC
Goldman, Scott M.
j.
Numbar
Hospital
Physician Practice Group
and
Surgeons
|
H
4
8
2
7J06
15.57 33.74
7.34- 2034
2.97- 1236
1.63- 1031
453. 1638
0.00- 6.52
157- 1034
0.00- 3.70^
A
•A
A
A
A
A
A
A
A
This surgeon has privileges at another ~:;:-:a j^c sere :t r.^her patients are listed under that hospital. Refer to the ta
on pages 8 through 15 to identify these xspitais
Hospitals and Physicians may have commented on this repon. Copies are available upon request.
Source: Pennsylvania Health Care Cost Containment Council. 1990 data.
31
�Southeastern Pennsylvania Area Hospitals
Physician Practice Groups and Cardiac Surgeons
for Coronary Artery Bypass Graft Surgery
Treatment Effectiveness Measure
Actual
LEHIGH VALLEY HOSPITAL
Fox, Stewart. M
D
J.C. Rex Thoracic Surgical Group
Gordon, David A.
Sinclair, Michael C
Jalari, Nercy, M
D
Khindri CanSovasoiar Speriafists
Khhdrt, Chetan D.
Martz, Mark Noel. MD
Panebianco - Yip Heart Surgeons
Boyer, Joseph H.
Panebianco, Antonio C.
^
Sadr, Farrokh S.
A
Yeistey, Geary L
W
Yip, LukeChor
Toonder, F. Geoffrey, M
D
MEDICAL COLLEGE HOSPITALS /MAIN CLINICAL CAMPUS
Ghosh, Suresh C , MD PC *
Gomez, Fernando, MD
S.G.G. Ablaza, MD PC
Ablaza, Sariel G. *
Grana, Vincente P. *
Shariff, Hap M., MD *
Spagna. Paschal M., M
D
Whitman, Glenn Joseph. MD
PENNSYLVANIA HOSPITAL
Hargrove, Walter Clark III, MD*
Hellman, Arthur A.. MD
^
920
2
157
61
96
4
23
23
54
632
60
165
141
165
101
48
1 14
7
|
7
|
40
36
4
64
28
30
90
1
89
Numbar
Patients Who Died
Hospital
Physician Practice Group
and
Surgeons
It
20.67 - 40.69
46
less than 30 patients treated
8
157-1056
A
2
0.00 - 518
A
6
011 - 7.18
A
less Ihan 30 patients treated
less than X patients tnaied
less than X patients tmatod
i
0.00- 5.25
A
31
12.03 - 28.18 i.
0.4*- fctt
5
^ A -/:
0.86' S J l '
5
0.00 - 7 . * ^
8
- 03O- 8.1«^«
3
10
0.73- im^
4
0.00- 3.69
1.61 - 10.73
A
lesstIan 30 patients treatsd
j
:
;
1 7
1
i
|
0.00- 34f >
0.00- 350
1
tad
tosstfan X patients tna
3
|
1
\
0
|
mm
•
less than X patients treatad
1
(
|
0.72- 7.79
less than X patients treated
1
| 0.67- 73BS
Statistical Rating Key
+ fewer deaths than expected
- more deaths than expected
A the number of deaths was not different than expectea
0
i/'s surgeon has pnvileges at another hospital anc some ot hisher patients are listed under that hospital. Refer to the tables
pages 8 through 15 to identify these hospitals.
Hospitals and Physicians may have commented on this repon. Copies are available upon request.
32
�Southeastern Pennsylvania Area Hospitals
Physician Practice Groups and Cardiac Surgeons
for Coronary Artery Bypass Graft Surgery
Treatment Effectiveness Measure
nacttetQiosp
y
PRESBYTERIAN MEDICAL CENTER OF PHILADELPHIA
478
D
1
4
I 13.58 - 30.74 I A
READING HOSPITAL A D MEDICAL CENTER
N
I SAINT LUKE'S HOSPITAL OF BETHLEHEM
This surgeon has privileges at another hospital and some ot histier panenfs are listed under that hospital. Refe
on pages 5 through 15 to identify these hospitals.
Hospitals and Physicians may have commented on (h/s report. Copies are available upon request.
Source: Pennsylvania Health Care Cost Containment Council. 1990 data.
33
�Southeastern Pennsylvania Area Hospitals
Physician Practice Groups and Cardiac Surgeons
for Coronary Artery Bypass Graft Surgery
Treatment Effectiveness Measure
Statistical Rating Key
+ fewer deaths than expected
- more deaths than expected
A the number of deaths was not different than expected
^ This surgeon has privileges at another hospital and some ot h/sfter paflenrs are listed under that hospital. Refer to th
on pages 8 through 15 to identify these hospitals.
Hospitals and Physicians may have commented on this report. Copies are available upon request.
34
�Cardiac Surgeoi Who Are No Longer Practicing At
Hospitals Where Listed
Western Pennsylvania Area
Pttysician
Practice Group
Hospital
Armitage, John M., M
D
University Surgical Assoc., Inc.
Shadyside Hospital
David, Irving, M
D
Allegheny Cardiovascular Surgical
Associates
Shadyside Hospital
Western Pennsylvania Hospital
DiPaola, Douglas J., M
D
Three Rivers Cardiac Institute
Central Medical Center & Hospital
Mercy Hospital ol Pittsburgh
Hardesty, Robert L, M
D
University Surgical Assoc., Inc.
Shadyside Hospital
Marshall, William Gene Jr., M
D
D'Angelo Clinic
Hamot Medical Center
Smith, John Henry, M
D
Cardiac Surgeons, Inc.
Shadyside Hospital
Western Pennsylvania Hospital
Stuart, Richard, M
D
University Surgical Assoc., Inc.
Presbyterian-University Hospital
•
Central and Northeastern Pennsvlvania Area
Anderson, John Edward, M
D
solo practitioner
Wilkes-Barre Hospital
Bennett, Edward Virdell Jr., M
D
Guthrie Clinic, Ltd.
Robert Packer Hospital
Devineni, Rajsekhar, M
D
Lear Von Koch, M & Associates
D
Mercy Hospital /Scranton
Wilkes-Barre General Hospital
Kalkunte, Jagdish a , M
D
Guthrie Clinic, Ltd.
Robert Packer Hospital
Keagy, Gregory S., M
D
solo practitioner
York Hospital
Michalak, Dennis VL, M
D
Guthrie Clinic, Ltd.
Robert Packer Hospital
Morris, Joel, M
D
Department of Cardiovascular and
Thoracic Surgery
Geisinger Medical Center /Danville
Peter, Mohan, M
D
solo practitioner
York Hospital
Ross, Patrick Jr., M
D
Division of Cardiothoracic Surgery
University Hospital Milton S.
Hershey Medical Center
Wilcox, Kenneth R., M
D
solo practitioner
Wilkes-Barre General Hospital
35
�Cardiac Surgeons Who Are No Longer Practicing At
Hospitals Where Listed
Southeastern Pennsylvania Area
Alpem, Jeffrey B., M
D
Temple Cardio-Thoracic Associates
Temple University Hospital
Bell-Thomson, John, M
D
Philadelphia Heart Center, PC
Albert Einstein Hospital
Boyer, Joseph H., M
D
Panebianco - Yip Heart Surgeons
Lehigh Valley Hospital
Fox, Stewart, M
D
solo practitioner
Lehigh Valley Hospital
Gheissari, All, M
D
solo practitioner
Hahnemann University Hospital
Gomez, Fernando, M
D
solo practitioner
Medical College Hospitals /Main
Clinical Campus
Hargrove, Walter Clark III, M
D
solo practitioner
Hospital of the University of
Pennsylvania
Hendren, William G., M
D
solo practitioner
Presbyterian Medical Center of
Philadelphia
Kom, Jacob, M
D
Temple Cardio-Thoracic Associates
Temple University Hospital
MacVaugh, Horace III, M
D
solo practitioner
Graduate Hospital
Mundth, Eldred D., M
D
solo practitioner
Bryn Mawr Hospital
Sitverman, Edward M., M
D
solo practitioner
Graduate Hospital
Spagna, Paschal M, M
D
solo practitioner
Medical Colege Hospitals /Main
Clinical Campus
Tabaie, Harold A, M
D
solo practitioner
Graduate Hospital
Tyson, George S., M
D
solo practitioner
Hospital of Ihe University of
Pennsylvania
Villars, Frederick, M
D
Tomasello & Casey, PC
Lankenau Hospital
Weiss, Steven J., M
D
Main Line Cardiothoracic Surg. PC
Lankenau Hospital
Wilcox, Kenneth R., M
D
solo practitioner
Saint Luke's Hospital of Bethlehem
36
�For Official Use Only
5/11/93
Title: Health Pages
This consumer's guide to local doctors and hospitals is published in Wisconsin by the
National Small Business United in affiliation with the Independent Business Association
of Wisconsin and the Council of Small Business Executives in the Greater Milwaukee
Chamber of Commerce. Health Pages is designed to be kept in the home as a guide to
bereferredto over and over again. It will be published in Wisconsin on a semi-annual
basis, eventually expanding to quarterly publication. Health Pages' premier issue was in
Florida and is expected to publish in an additional 3 to 5 states within a year. National
affiliates include the Washington Business Group on Health, the National Small Business
United and the American Association of Retired Persons.
Implication for Health Care Reform
This is an example of the kind of infonnation that is becoming available to help
consumer decisionmaking.
»
�YOUR FAMILY'S GUIDE TO LOCAL DOCTORS AND HOSPITALS
GREEN BAY/MADISON/MILWAUKEE EDITION
•Tit
SPRING 1993 • $3.95
m
m
1
3^
\>7T
A CONSUMER'S GUIDE
31
74A70 82264
EVERYTHING YOU
ALWAYS WANTED
TO KNOW ABOUT
PREGNANCY
• Prenatal care,
labor and delivery
• A comparative guide
to obstetricians
and hospital
maternity services
• Doctor and hospital
C-section rates
�Dear Reader:
Thank you for picking up this copy of Health Pages.
Reading this publication can help you become a
better consumer of health care in Wisconsin. As
more individuals begin to examine and challenge
the American health care system, costs will go
down, quality of care will improve, and
NATIONAL SMALL BUSINKSS UNITED
more people will be served more appropriately.
1155 15TH STREET, N.W
SUITE 710
Many small business owners and their
WASHINGTON. D.C. :(XK)5
employees are becoming very aware of skyrocketFAX: 202-K7:-854.'
ing heaJth care costs. They are frightened and
overwhelmed by the impact of these costs on their
businesses and their jobs. The average cost of
health insurance for a small business employee and his or her family has grown
from an annual premium of $890 in 1980 to nearly $4,500 in 1992.
Health Pages is responding to these concerns by teaching consumers how to get
the most from their health care. National Small Business United (NSBU) is proud
to be a major sponsor of this publication. NSBU is a national not-for-profit association of small businesses and small business organizations with more than 65,000
members from around the United States. NSBU is especially pleased to be affiliated with the Independent Business Association of Wisconsin and the Council of
Small Business Executives in the Greater Milwaukee Chamber of Commerce.
Together, we are making every effort to advocate on the federal level in the best
interests of small businesses and their employees concerning issues like health
care reform.
As such NSBU is participating in discussions on the national level, focusing on
the need for cost containment and greater personal responsibility in our health
care system. We seek your ideas, your input, and your support of our efforts. You
can join us by contacting any one of our organizations. You are needed to educate
and inform members of Congress how changes will affect you, your business,
and/or your employees. So please make time to call or write us now!
We encourage you to take charge of your health care and act more like a consumer of health care instead of simply a patient of the health care system. You
can make wise and valuable decisions regarding your health. All you need is more
information about the care you are being delivered. Tell others to purchase this
publication, too. It is so important that more people learn about our health care
system. NSBU wishes you a long and healthy life!
(/'
John Paul Galles, Executive Vice President
�UEALTH P G S
AE
n
IN THIS ISSUE
2
3 HOW TO USE
LETTER FROM THE
PUBLISHER
SPECIAL
HEALTHY PREGNANCY
8 YOUR GUIDE TO A ^
THE HEALTH PAGES
d
MEN S HEALTH
O ft
ALERT
J m ^ # Prostate cancer is eveiy
man's nightmare. But it doesn't
have to be. The key is early
detection. Here's how to tell if
you've got a problem. Plus a guide
to local urologists.
WOMEN'S
>
^
^
How high are Wisconsin's"^^
health care costs compared to the'
rest of the country? Plus tips on
how to stretch your health care
dollar and get the most out of
your insurance.
PROSTATE
>
. Answers to the most commonly asked questions
about pregnancy • Choosing an obstetrician
.and a hospital that are right for you based on
local options, complete with prices • A look at
Wisconsin's
Cesarean rate,
.local hospital
Much of the information you'll find
in these pages about your loca
doctors and hospitals has never
been published before. Here's
how to make sense of it.
,<M
6 MONEY TALK
REPORT
HEALTH^
O C BREAST CANCER:
O D WHAT YOU NEED
TO K N O W Information on prevention, detection,
diagnosis and treatment that could
save your life. Plus
a comparative
guide to mammography
facilities,
oncologists
and surgeons in
your area.
Addilional copies of lilt Health Pages can
be ordered by sending a check or money
order for $3.95 (plus $2.00 shipping and
handling) to Health Pages, 36 West 15th
St., 12th Floor, New York, N.Y. 10011.
For information about bulk purchase discounts contact 212-929-6131.
SENIORS'
HEALTH
S.^ . WELLNESS ISSUES,
L
« •.>
>.
C J t WEIGHTY MATTERS
44
... ... A ^ b A M M —
MEDICARE & MEDIGAP
MADE EASY
New government regulations make
it easier than ever for Medicare
patients to buy supplemental
health insurance. This E A L T H
CHILDREN'S H comparative
guide to statewide Medigap insurC | TONSILS: IN OR OUT?
ance options helps you be a smart
^ I Tonsils aren't necessary.
insurance shopper.
Right? Wrong. Today's thinking on
whether your child's tonsils should
come out could surprise you. Plus a
guide to ENT-Otolaryngologists in
your area.
How can you differentiate
between a snake oil treatment and
a weight loss program that really
works? Here's a reality check
along with a guide to local weight
management programs.
C A
GUIDELINES FOR
DOCTORS & PATIENTS
If you haven't got time for the
pain, check out this section for the
latest government recommendations on pain control after surgery.
C Q
PHYSICIANS' FILE
Useful background
information on doctors and the
office services they provide.
H E A L T H iCARE OPTIONS
.—ji"
. -
... ..-v
A Q HOUSE CALLS:
ALL ABOUT
HOME HEALTH SERVICES
If someone says homemaker
do you think housewife?
Here's a look at home
nursing options, with a list of
home nursing agencies close
to your home.
PAGE 1
PHOTOGRAPHS BY BOB KRAMER
�E L H PAGES'
AT
H
E LH
AT
PAGES
A Letter
from the
Publisher
Publisher/Editor
MARTIN I . SCHNEIDER
Executive Editor
RACHELHAGER
W
n (OMi.
io i m. WISCONSIN
HI.Aim I'At.r.v Because we
believe that all health care
consumers are entitled to accurate
inlormation about their health care,
the HEALTH PAGES educates readers
about illness, provides price and service information on local doctors,
hospitals and other medical professionals and offers helpful service-oriented tips. We hope the information
will help you to be a more inlormed
and responsible consumer of medical
services.
The HEALTH PAGES does not recommend that you use our information as your sole source for choosing a
doctor, picking a hospital or deciding
on a home nursing service. Our listings are simply meant to help you
take a more active role in these decisions. We hope they lead you to ask
more questions of your doctors and to
think of yourself not only as a patient
but also as a health care customer.
Clearly we are not suggesting that
patients act as their own doctors. That
would be ridiculous. Medical professionals know infinitely more about
health care than consumers.
However, that does not mean that
pricing, services and quality should
w m a i n a mystery to the public.
Traditionally, as consumers, we have
not required of the medical profession what we have come to expect
from other sellers of products or ser-
Art Director
ALEX SILBERMAN
Researchers
vices we purchase. The first step in
demystifying health care is being
informed. After all, how can you be a
responsible consumer if you are not
equipped with the facts? The HEALTH
PAGES provides you with the basicfacts about health care and your local
health care providers.
Our goal is to make the health care
industry more open so that consumers can learn about the services
they receive, the relative prices they
are charged, the alternatives available
to them and, someday, the quality of
the services they are receiving.
This is a tall order for the HEALTH
PAGES. We want to bring democracy to
our nation's largest and perhaps most
important industry. We want to bring
the public the most pertinent information available on its local medical
providers. People around the country
are working to make these goals a
reality, and we are excited to be part
of that effort.
We welcome you as a co-participant and hope you enjoy this issue.
V
Martin I . Schneider
Publisher/Editor
PAGE 2
VICTORIA CHIN
CHRISTINE MARCUCCI
HELAINE NEIMAN
Senior Advisor
CAROL CRONIN
.36 West 15th Street
12th Floor
New York, N.Y. 10011
212-929-6131
Health Pages-Wisconsin, 1993, Volume
1, Number 1 . Copyright © 1 9 9 3 by
Health Pages, 36 West 15th St., New
York, NY 1 0 0 1 1 . All rights reserved.
Published by Health Pages, New York.
Printed in the U.S.A. Reproduction in
whole or part without written permission
is prohibited.
The editor and publisher of Health
Pages is not a physician and is not
licensed to give medical advice. All material in this magazine is provided for
information only, and may not be construed as medical advice or instruction.
No action should be taken based upon
the contents of this magazine; instead,
appropriate health professionals should
be consulted.
The listings in this magazine have
been collected for the convenience of the
reader: Listings are not presented as
inclusive. The listings of health care
providers do not constitute a recommendation or endorsement of any individual,
institution or group. The publisher disclaims any liability arising directly or
indirectly from the use of Health Pages
and advises users of the publication to
exercise their own informed judgment in
the selection of medical care.
While the editor has attempted to
publish the information as accurately as
possible, Health Pages regrets any omissions or errors and cannot be held
liable. The reader is strongly advised to
contact the individual providers to verify
the information.
�I A T PAGES'
E LH
How to Use
The Health Pages
ost magazmes don't come w . t h —
magazines
wi
S S ^ * * * '
instructions on how to read them.
You sit down, you open them up and
i n s t r u c t i o n s O n h o w tO r e a d t h e m .
We urge you to carefully review
you read. But .the HEALTH PAGES is a little bit. the listings in the I l i u m PAGLS
.
different.You sit down, vou ooen them interest- friendsconsult with you. family,
Although it's chock full of up and d to and others who might
M
an
.
.
.
.
,
.
.
,
have experience with a particular
physician for additional background information. While the
ing articles and service-oriented tips, it also HEALTH P C S is valuable guide
AE
lows is a brief explanation of the various sections of
your needs.
ontains lots you interpret and information that you y ' "
;
the magazine to helpof data and better undera
in
ou
K
stand the information they contain.
Use it as your guide be used to most What the
as a consumer might not to get the seeing.out of foiHEALTH PACES and vour health care.
N E S A DN T E G I E
D R T N I G H UD
T PHYSICIANS
O
U
The "Guide to Physicians" sections throughout the
magazine provide you with basic factual information
about doctors' fees, services and educational backgrounds.
Patients can use the information to compare doctors' prices before services are rendered and to search
for a new physician based upon his or her background
and ihe services olleied.
Physicians and other health care providers can use
the information to learn how their prices compare
with their colleagues', and as a source book for specialist referrals Ibr their patients. Employers can use the
ata to help their employees reduce their health care
xpenses.
rhe information in the "Guide to Physicians" is
not intended to endorse or recommend any individual physician. There is little objective information
s
r c h
t o lea,
n
1
mo ,
e
1
/
about health care providers,
UNDERSTANDING YOUR DOCTORS' FEES ultimately, only you can determine if a physician meets
• Why do prices vary so much?
There is no easy answer to this question. Physicians
often do not know what their peers charge. Some are
unaware that their fees are at the high or low end of
the scale.
Lower fees might indicate that a doctor is comfortable charging a lower than average price and limiting
his salary. A higher fee schedule may indicate that a
doctor has new office equipment, a high rent, or additional medical staff to help with insurance billing procedures. Or it may be that no one has ever questioned
the doctor's higher price policy.
Since patients have been kept uninformed about
price differences among physicians, and rarely know,
or ask, the charge for a particular procedure until
after it has been performed, it is difficult lot patients
to do any price comparison shopping when looking
for a doctor. Consequently, there is little incentive for
physicians to compete for business based on their fee
schedules.
The HEALTH PACES' physician fee listings make the
price variations among physicians public. If you have
a question about your doctor's fees, ask.
PAGE 3
�-
E L H PAGES
AT
H
• What do the fee listings tell me about the quality of
the individual doctor?
Unfortunately, nothing. The price schedules give
no information about quality of care and are not
meant as an endorsement or recommendation of any
individual physician.
HOW ACCURATE ARE THE LISTINGS?
Because there is an inevitable delay between the
time information was collected (October and November 1992) and the time of publication, we suggest you
call the offices of the physicians you are considering to
verify' the information printed here. We also encourage you to speak with the physicians about any information in the listings you do not understand.
The data on office services, doctors' backgrounds
and fees were generally compiled from the returned
surveys. In some instances, the HEALTH PACES contacted the provider's office directly by phone.
It should be noted that the prices listed are for
1992. Most providers will have increased their fees for
1993. You can assume, though, that a doctor's prices
will remain the same, relative to what other physicians
are charging.
tion does not guarantee high quality and that some
qualified physicians may not be board certified. New
physicians, for example, may not have spent enough
years in private practice to be able to have taken their
boards.
Up until recently, certification was good for life. But
now, some specialties, including obstetrics/gynecology,
have started placing a ten year limit on certification
standing. Consequently, some doctors have applied for
and received recertification. This is why in going
through the listings, you will notice that some doctors
have two separate certification dates.
A NOTE OF THANKS
We thank the physicians who responded to our surveys and would like to point out to our readers that
these doctors are eager to have you, the consumer,
learn about their backgrounds and practices. Their
openness demonstrates a fundamental respect for
patients and their right to be informed health care
consumers.
We hope that future editions of the HEALTH PACES
will include inlormation on an even greater number of
doctors as physicians come to understand the value of
this information to their patients.
HOW WERE THE DOCTORS INCLUDED
IN THE LISTINGS CHOSEN?
OB/GYN: In an attempt to present information on the
obstetricians with the busiest practices in the three
metropolitan areas, the HEALTH PACES requested from
the state's Department of Health a listing of all physicians who had delivered at least 50 babies a year in
both 1990 and 1991. These physicians were then
mailed a survey by the H E A L I H PACES that queried
them about their backgrounds and office services.
They were told their responses would be published
f ree of charge.
DOCTORS' FEES
GO PUBLIC
I
n 1992, the American Medical Association
(AAAA) adopted a policy that physicians be
required to make information on the prices
they charge for frequently provided services
readily available to consumers. As one way
Urology/ENT/General Surgery/Oncology: The
of implementing this policy, the A M A has
sent mailings to physicians in these
specialties whose names we received from the state's
Department of Professional Regulation. If your doctor is not listed in our pages, it means that either he
or she chose not to return the written survey or
respond to our phone surveys, or, very likely, was
never contacted —he or she may have simply slipped
through our system of finding providers in a particular specialty.
suggested that physicians make their prices
waiting rooms. The goal: To enable patients
WHAT IS BOARD CERTIFICATION?
tories and other health care providers follow
A board certified physician is one who, after completing a residency program, passes an examination
administered by a group of specialists or board. It is
important to remember, though, that board certifica-
their lead in recommending that price infor-
HEALTH PACES
PAGE 4
available for publication in directories and
that prices for services be posted in doctors'
to compare costs more easily and benefit
from increased competition among doctors.
The A M A would like to see hospitals, labora-
mation be made available to the public.
�H
E L H PAGES'
AT
tory tests, medications); hospital room;
medical supplies used in treatment; and
routine personal care items such as surgical gowns. The fees listed do not include
physician fees for services billed directly
to the patient by his or her physician.
I"
""
• Will my bill be exactly the amount listed?
Your bill may be higher or lower than
the amount listed in the table. I f you
enter the hospital less sick than the average patient and you require fewer tests or
a shorter hospital stay, then your bill will
probably be lower. If, however, your illr
ness is more severe and you require a
longer stay and/or more tests, your bill
will probably be higher. Your doctor's
style of practicing medicine (how many
tests he or she typically orders, how much
care he or she thinks is routinely appropriate) may
also affect the size of your bill.
N E S A DN
DRTNIG
THE HOSPITAL LISTINGS
U
Much of the responsibility for choosing a hospital
rests with your doctor, but you, too, must play an
important role. You should keep in mind that differnt hospitals have different strengths and weaknesses,
he right hospital for one patient may be the wrong
one for another.
Your choice of hospital will generally be more limited if your family doctor wants to admit you to a hospital under his or her own care. Most doctors have
admitting privileges at only a few hospitals or a single
hospital.
There is a good chance, though, that your doctor
will refer you to a specialist who will arrange for your
admission. Still, the specialist will probably be one who
practices at one of your doctor's hospitals, since these
are usually the specialists your doctor knows best. Also,
your doctor may want to see you in the hospital and
work with the specialist.
But your choices need not be limited to your doctor's hospitals. In many cases, it is not necessary for
your doctor to remain active in your case while you are
under a specialist's care. You may then be referred to a
hospital where your doctor does not have attending
privileges.
• Why do prices vary for the same procedure?
Several factors influence a hospital's fee schedule,
including the cost of supplies, material and equipment; the wages paid to employees; the percent of
occupancy at the hospital; how many services are provided free of charge and overall hospital management
efficiency.
• What do the prices say about the quality of the care I
will receive?
Nothing. Unfortunately there is still no easy way of
evaluating the quality of care a hospital provides. It is
important to understand that there are legitimate differences in rates while keeping in mind that higher
prices do not necessarily mean better care.
EADING THE CHARTS:
AVERAGE HOSPITAL PRICES
The fees listed are the average prices charged by
^ ^ ^ vvarious hospitals from January 1 to December 31,
an
1991 for specific procedures. The prices include: hospital services ordered by the physician (x-rays, laboraPAGE 5
HOW INFORMATION WAS GATHERED
The HEALTH PAGES requested maternity, mammography, weight center and home health care
information from 20 hospitals in the Green Bay,
Madison and Milwaukee areas. The response was
very positive—18 of the hospitals provided us with
information. We thank the hospitals for their
cooperation.
NOTE: St. Joseph Hospital and Elmbrook
Memorial Hospital chose not to provide us with
information. We regret this decision and hope that
in the future they will see the value of their current
and prospective customers learning about their
services in the HEALTH PAGES.
�E L H PAGES'
AT
H
Money Talk
I
n this time of rising health care costs it makes P
0
, m
o l
'
l a b
t e s t s
i n
>
0 l , , 1,1 c : i
-
you'll find a surprising difference
sense to try to save money where you can. You in fees for the s m tests. For
a e
,
i - i
-^i
example, medical laboratories in
can cut down on your medical expenses without
cutting corners on quality of care. Here's the latest
0
1
;
.
Mi
|J ^ ^
..
. ,
( - ' Medical Center) to
diarg
J3fi
Sl
1l l k e
t
d anywhei
e fl
)m
s
r
$i:'.. ) (St. Joseph's Hospital) loi a
on the cost of saving tips. in Wisconsin along with charged $28 for an AFP test, while
PSA test'in 1992 (see p. 30).
helpful money health care
THE GOOD NEWS: How much you can expect to
pay for your health insurance benefits depends a great
deal on where you live, according to a sun'ey of insurance rates conducted by Milliman & Robertson, a New
York City actuarial firm. The sun'ey found a wide disparity in costs for a typical package of group health
insurance benefits in the 400 largest U. S. metropolitan areas. On a positive note, Gram Bay's package was
tlw second leasl. expensive. The monthly cost ol group
health insurance benefits in Green Bay was only
$266/month, or 27 perceni less than the national average of $365 per person. The cities of Madison and
Milwaukee also faired well, with Madison's costs 18
percent below the national average at $299 (ranking
the city 324) and Milwaukee's costs 1 1 percent below
the national average at $325 (ranking the city 227).
Some factors that account for the difference in
costs: T he frequency with which various services are
used, how expensive those services are and how much
it costs to do business (rent, salaries, etc.) in the city in
general. Costs tend to be highest in the largest cities.
Lab costs vary as well—even locally. If you check the
W
isconsin has the third healthiest population in the U.S., according to a 1992
study by Northwestern National Life Insurance
Co. in Minneapolis. That moves the state up
from a ranking of seven two years ago. This is
largely due to greater support for public health
care, a reduced risk of heart disease and better
employment rates. The rankings are based on
an evaluation of 17 components that measure
disease, lifestyle, access to health care, mortality and occupational safely and disability.
Milwaukee Countv Medical
Damon Laboratories charged $113 (see p. 25). So, if
saving money is important to you, compare lab fees
and discuss them with your doctor.
THE NOT SO GOOD NEWS: For mid-sized employers, the total cost ol providing employee health benefits
in 1991 averaged $3,546 per employee, up 15.2 percent from 199()'s $3,079, according to a study by Foster
Fliggins, a Costa Mesa, CA benefits consulting firm.
Health care benefits accounted for 10.9 percent of total
payroll expenses. The cost of corporate health care
benefits as a percentage of corporate earnings is rising
quickly, too—almost doubling between 1989 and 1990
from 26 percent to 48 percent.
Companies are passing along these rising health
care costs to their employees. According to a Husnmss
and Health survey, more than 75 percent of companies
have increased employee deductibles and 69 percent
have raised their employees' share of health insurance
premiums. In fact, in 1992, consumers spent 14.6 percent of their incomes on medical care, up from 13.5
percent in 1991 and only 9 percent in 1980.
MEDICAL COSTS FOR EMPLOYEES
400
Health premium rates per month
Single Employee
300
• Family
8.200
100
1980
PAG t 6
m
1985
1990
1991
�[ H PAGES
E
HALTONSUMER TIP: UNDERSTAND YOUR
•c
MEDICAL BILLS AND SAVE M N Y
OE
Perhaps the easiest way to save money on soaring
health care costs is to carefully review both your medical bills and the explanation of benefits forms you
receive from your insurer.
INSURANCE C O M P A N Y ERRORS
One of the most common errors made by insurance
companies is miscalculation of the family deductible.
For example, your plan may have a deductible of $200
per person and $400 per family. But the claims office
may neglect to add up all of your family's bills, so individual family members might still be dishing out
money toward their deductibles even if the family has
already met the $400 requirement.
A similar error can occur if the claims office neglects
to calculate your annual total out-of-pocket limit, or
what the industry refers to as the "family stop-loss
limit." Once you have paid this amount—generally
between $1,000 and $2,000—the insurance company
pays 100 percent of all other costs for the remainder of
the year. So be sure to keep a careful tally of individual
as well as total family payments.
the day you are admitted to the hospital. I f not, ask
your doctor i f it's possible to schedule your surgery
early in the week, so you won't have to spend the weekend in the hospital if you're well enough to go home. I
• Try to have the necessary x-rays, lab tests and
blood work done outside the hospital, before you're
admitted. This can save you at least a day or two of hos'pital charges.
• When you get your bill, check it carefully to make
certain that you are not being charged for a procedure
you didn't have or equipment you didn't use. I f you get
a bill with just summary charges ask the hospital for an
itemized breakdown that includes a description of each
procedure.
• To make sure the charges are correct, start with the
obvious: The room rate and number of days, plus
charges for major procedures, operating room, recovery
room, etc. Then, compare the remaining itemized
charges against your medical records. Although this
might take some time, it could very well save you money!
1
FIVE SMART MONEY-SAVING TIPS
1
Don't'repeat medical tests needlessly. If you change doctors or dentists, have your new practitioner obtain copies
of your past records and x-rays.
H( W T O S A V E M O N E Y
HO
N Y O U R D O C T O R S ' FEES
9f
If your health insurance covers 80 percent of doctors' fees, that means your costs are 80 percent covered.
Right? Wrong!
Eighty percent coverage means 80 percent of the
insurance company's "reasonable and customary" doctors' fees. Your insurance company will only pay 80 percent of the amount it considers reasonable. But what if
your doctor is more expensive? What i f he or she
charges $4,000 for a procedure your insurance company
thinks should cost $3,500? Your insurer will only pay 80
percent of the $3,500, or $2,800. That leaves you with
$1,200 to pay! So find out ahead of time how much your
insurance company will pay for a procedure—and if the
procedure is covered to begin with—otherwise your bill
may surprise you. Also, tell your doctor, that you want to
make sure his or her fee is covered by your insurance.
Many physicians will agree not to charge more than the
reasonable and customary charge.
H O W T O S A V E M O N E Y AT THE HOSPITAL
• I f you can, keep a log. Assuming you're up to it,
you—or a family member—should attempt to keep a
daily record of the services, medications and other supplies you receive. You can find forms for logging tests
and medication in Take This Book to the Hospital With
'ou (The People's Medical Society).
If you need surgery, ask your doctor if it can be
performed on an ambulatory, outpatient-basis or on
k
PAGE 7
2
Buy generic drugs, both over-the-counter and prescription,
and shop around for the best price, if possible. Generics,
which have the same active ingredients as their brand-name
equivalents, ai;e almost always as safe and effective as name
brands—butthey .are usually a lot cheaper. Ask your doctor to
prescribe generics when they're available.
3
Consider buying prescription drugs from mail-order phar•'. macies. Mail order firms often charge less than your local
•druggist. .One caveat: They can't fill prescriptions as quickly. But
. they're perfect for patients taking medication for long-term con, ditions,.such as high blood pressure or heart disease, in which
timeliness .is not such an issue. Some resources that offer idisxounted mail-order :drugs: Pharmail, 800-237-8927; Action
:'Mdil Order Drug, 800-452-1976; Medi-Mail 800-331 -1458;
and.the American iAssociation of Retired Persons (AARP), 800; 284-2277. The'AARP service is available only to members (you
must be 50 or older and pay a $7 annual fee).
;
;
v
:
< ''-jA ' Ayo'd emergency, rooms except in true emergencies. Show
up at an emergency room at midnight with a problem ithat
can wait until morhing and you lose twice: You pay top dollar,
and you wait for hours while the real emergencies are taken
care of. If your doctor is not available, try one of the 24-hour
urgent-care.cehters that have sprung up in recent years.
5
Get your children vaccinated, and make sure you are protected, too. Although insurance may not cover their costs,
immunizations are among the biggest bargains in medicine.
'Keep records and get boosters when needed. Get flu shots, too,
especially if.you can't afford to miss work for a week or more.
v
�I
E
HALTH PAGES
SPECIAL REPORT
Your Guide to a
Healthy Pregnancy
our doctor tells you that you're pregnant.
If you're like most women, you go from
unrestrained euphoria to high anxiety in
the span of a few minutes or less. Hundreds of
questions and concerns take control of your
mind: What should you eat or not eat? Are there
Y
things you can do to help your baby develop properly?
What should you expect once the big day arrives?
Learning about pregnancy and good prenatal care
(including proper nutrition and exercise) can reduce
or eliminate serious risks for both mother and child.
Complications during labor can be averted. And risk
factors like low birth weight (under five and a half
pounds), which is associated with an estimated 300
percent increase in other birth defects, can often be
prevented.
Another good reason to learn about pregnancy:
Education provides options. It makes choices appear
where superstition, dictates and customs previously
ruled.
Lastly, learning about pregnancy can help alleviate
the fear of the unknown that often accompanies a
woman's discovery that she is pregnant. We are all
frightened of things we do not understand. Once
understood, pregnancy can not only be better managed, it can actually be enjoyed.
GOOD DIET: BUILDING BLOCK
A F R I F N HAT !
O NA T E L H
Some people believe that the fetus will get all the
nutrients it needs from the mother's body. This is both
true and untrue at the same time. The foods a pregnant woman eats are the foods her baby eats.
The special nutritional needs
of the growing baby make it particularly important for the mother's diet to be nutritionally sound.
If, for example, you're not eating
enough calcium-rich foods, the
baby will sap your own stores of
the mineral to get the amount he
or she needs.
If you're lacking certain nutrients, the baby will, too. Through her diet and the
care she takes, a mother-to-be gives her child a poorly or well-nourished body.
DIET DOS A N D D O N T S
1. Eat a wide variety of foods. A well-balanced diet
means eating a variety of good foods like fruits, vegetables and grains, as well as dairy products (milk
and cheeses) and proteins (meats, fish, eggs, nuts
and beans). It is important to eat foods from each of
these groups every day to ensure that the baby gets
all the nutrients he or she needs in order to develop
properly.
2. Avoid added sugars and fatty or fried foods, and
eat whole grains only. Foods lose many important
nutrients when they are processed.
3. Eat smaller meals more frequently. During pregnancy, your stomach and intestines are pushed up and
back by your expanding uterus and the growing baby.
You may find that you no longer have room for large
meals. Smaller meals, eaten more frequently, will leave
you feeling far more comfortable since they are more
easily digested.
By nibbling throughout the day. you can also help
forestall nausea, a common complaint of pregnancy.
Morning sickness (nausea in the morning) can sometimes be prevented by eating a light snack in the middle of the night or a little something, like crackers,
before getting up in the morning.
PAGE 8
�I
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HALTH PAGESWEIGHT GAIN
The weight you gain during
pregnancy helps your body
nourish your growing baby and
produce the milk you'll need for
breastfeeding. There's no magic
number when it comes to the
amount of weight a woman
should gain while she's pregnant, but the average healthy
woman gains between 25 and
35 pounds. Expect to gain about
10 pounds during the first 20
weeks and about one pound per
^JJ^rp"
weel<f o r , h e r e m Q i n t l e r o f
our
y
' J k ' J ^ P ? *<H\ pregnancy.
I S l ^ M
However, don't take the
^ p f p ^ need to gain weight as a
license to binge on junk
food. Remember, the important thing is not how much
weight you gain, but the
kinds of foods you're
eating to gain it.
Here's how the
weight breaks
down:
7 POUNDS
Maternal stores
(fat, protein and
other nutrients)
4 POUNDS
Increased fluid
volume
4 POUNDS
Increased blood volume
2 POUNDS
Breast enlargement
2 POUNDS
Uterus
6-8 POUNDS
Adapted from the American College
ol Obstetricians and Gynecologists.
Nutrition During Pregnancy. ACOG
I'atiem Kducaiion Pamphlet
#AP001. Washington, DC, ©1992.
4. Drink plenty offluids, especially water and juices.
Doctors recommend pregnant women drink at least
eight glasses of water each day. More fluids are needed
during pregnancy in order to support the increase in
the mother's blood volume and maintain the amniotic
fluid surrounding the baby. Increased fluid intake also
helps prevent constipation. Avoid caffeinated drinks
like coffees, teas and colas. And stay away from all
alcoholic beverages.
ANGER: ALCOHOL, DRUGS, SMOKING
A D YOUR BABY
N
D
One out of every 14 babies born in the U.S. in 1990
was born with a birth defect, according to the March of
Dimes. Many of these birth defects could have been
prevented.
Pregnant women who use tobacco, alcohol, or other
drugs often have nutritional problems as well as other
complications that can result in birth defects. There is
no better time than when you are pregnant to quit or
cut down on harmful habits. Don't worry about past
uses; just make sure they are your last.
Here are some important points to keep in mind:
• Wine, beer and hard liquor can cause serious harm
to a growing fetus. When you drink, your baby drinks.
Since nobody knows how much is too much, most
experts feel it's best not to drink any alcohol during
pregnancy.
'Illegal drugs, such as marijuana, cocaine, crack,
heroin and PCP have all been shown to pose serious
health risks to both the pregnant woman and her
unborn child. Even legal drugs can have harmful
effects. So avoid all medications except those prescribed by your doctor. This includes drugs that can be
bought over the counter.
• Research has shown that smoking during pregnancy raises the risk of premature delivery, low birthweight
and intellectual deficiencies in childhood. Why?
Nicotine constricts uterine blood vessels, decreasing
the amount of nutrients and oxygen the fetus receives.
The American Lung Association (ALA) offers a quitsmoking program called "Freedom From Smoking for
You and Your Baby" especially designed for pregnant
women. The program lays out distinct daily goals for
the smoker and stresses the importance of reward
whenever a goal is met. It also includes breathing and
relaxation exercises to help reduce the stress that
often accompanies quitting.
To receive the "Freedom From Smoking for You and
Your Baby" step-by-step manual and audio tape ($8.00
for the set) call your local ALA at: 414-782-7833.
PAGE 9
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H T IS P E A A CARE
A
RNTL
A D W Y IS IT SO IMPORTANT?
N
H
w
Prenatal tare is the term used to refer to regular
visits to a doctor, midwife or clinic throughout pregnancy. These checkups help safeguard your health as
well as the health and well-being of your baby.
Regular prenatal visits help your doctor or midwife
discover and treat or prevent problems such as anemia.
(low levels of iron and oxygen in the blood), gestational
diabetes (diabetes which only occurs during pregnancy)
and pre-edampsia (a potentially dangerous condition
signaled by abnormal swelling, high blood pressure
and protein in the urine). These and other conditions
are often easily corrected when discovered early, but
left untreated, they can threaten your health as well as
the health and even the life of your baby. The schedule of your prenatal visits will vary, depending on your
practitioner, but usually will include:
1) An overall physical exam. This exam is generally
done early in pregnancy; it should be scheduled within
a week or two of discovering you're pregnant. Your
practitioner will confirm your pregnancy, determine
the state of your general health and pinpoint any possible problems that need treatment or monitoring.
2) Regular monthly checkups f o r the 1st through the
7th month. Your doctor will listen to the baby's heartbeat and measure your uterus (from the outside) to
ensure that your baby is growing normally. He or she
will determine whether you are gaining enough weight
and will check your blood pressure, test your blood (for
anemia) and urine (for sugar and protein), and examine your hands and feet for signs of abnormal swelling
(edema). This is also when you should alert your doctor
to any physical problems you might be having. Be sure
to write down any questions before your checkup.
FINDING DOCTOR RIGHT
I
n order to choose a doctor who is right for you, you
need information. A good place to start is tne HEAtTH
PAGES. "Your Guide to Obstetricians" (p. 18)
provides specific information about local doctors and
their practices.
In addition to checking the listings, ask for referrals from
friends and relatives ana, if possible, from nurses and
other medical personnel. Surveying friends and strangers
may not sound terribly scientific, but it's actually a great
way to get helpful information you can't get any other
way. The more people you talk to, the better. There's no
magic number, just keep asking for names until you start
hearing the same two or three being highly recommended
over and over again.
Some questions you may want to ask people about the
doctors they recommend:
•Do you feel confident about his or her medical
judgment?
•Does the doctor listen attentively when you tell him or her
what's wrong, without interrupting or rushing you?
•Does he or she take enough time to explain the problem and its treatment?
•Is the doctor easy to talkto?Do you feel comfortable
discussing small worries or embarrassing problems?
•Is the doctor reachable by phone? Is he or she willing
to give simple advice over the telephone?
If a doctor who has been recommended to you is not listed in the HEALTH PAGES and you'd like to double check his
or her credentials, contact your local medical society. The
staff can tell you about a member's training and area of
specialty.
SCHEDULE A "GET-ACQUAINTED" APPOINTMENT
All right. So you've constructed a list of potential doc-
tors based on conversations with friends and medical
professionals. You checked out each doctor by learning
about him or her through the HEALTH PAGES or your local
medical society. You've narrowed the field to one or two
candidates. There's one more step you should take to
help you reach a final decision-make an appointment to
meet with the doctor. (If the doctor does not offer free
initial consultations, request an appointment for a short
consultation.)
Your evaluation should start before you even step into
the doctor's consultation room:
•Is the office staff courteous and helpful when you call?
The way the staff treats you often reflects the way the doctor will treat you.
•Do you have to wait long past your scheduled appointment time? Fifteen minutes or more without an explanation
is unreasonable.
To get the most out of the meeting, come prepared to
discuss your top three health concerns about your pregnancy. Be brief and note the doctor's reactions and comments. Let the doctor know you want to play an active
role in your health care. Tell him or her that you want to
hear al available options in the event of a problem. Be
honest about the kind of doctor-patient relationship
you're looking for, and the doctor will usually respond
openly as wef.
It is tremendously important to like the doctor. If you are
not comfortable and/or do not trust or have confidence in
the doctor, continue your search. You must be able to confide in your physician. If you can't, you are setting yourself
up for poor medical care. Respect is also a critical piece of
the formula; if you don't respect your doctor, you will
always have doubts about his or her recommendations
and you will be less likely to comply with treatment.
PAGE 10
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IEALTH PAGES
3) Regular checkups every 2 weeks in the 8th month,
once a week in the 9th month, until the baby is bom.
Checkups will be similar to earlier exams except that
your practitioner will also carefully examine the size
and position of the baby as well as check your cervix to
see if it is softening or thinning out in preparation for
birth. Some practitioners refer to the cervix as "green"
when it is firm and "ripe" when it is soft. A soft, "ripe"
cervix means the babv will be born soon!
ESTS TO EXPECT
DURING P E N N Y
RGAC
T
,
Experts agree that a woman should begin to undergo routine screening tests either before conception or
at her first prenatal visit. These tests alert doctors to
potential problems and provide a basis for comparison
as the pregnancy progresses. Here are some straightforward answers to questions about the most common
tests during pregnancy, their risks and why they are
necessary-
FIRST TRIMESTER TESTS
Tests f o r glucose, protein and blood in the urine to
etect problems such as impaired kidney function and
'diabetes
d
A cervical culture for gonorrhea and chlamydia
• Blood tests to determine blood type and Rh type
(to test for Rh incompatibility, which can result in a
disease that can be prevented with a vaccine) and to
check for anemia
'Tests f o r rubella and toxoplasmosis (a parasitic
infection) and hepatitis B
'Chorionic Villus Sampling (CVS) can detect defects
in the fetus as early as the ninth week of pregnancy.
The problem: The possible risk the test poses. Studies
conducted in 1992 yielded conflicting results concerning the safety of CVS. Researchers at Michael ReeseHumana Hospital in Chicago found a higher incidence of limb defects in babies born to women who
had undergone CVS. However, most other studies,
including a later one conducted by researchers at
Jefferson Medical College in Philadelphia, found CVS
to be safe. Before having CVS, discuss the benefits and
risks ol the procedure with your doctor, and don't be
afraid to request a second opinion.
m
SECOND TRIMESTER TESTS
'Ultrasound (or sonography) is a procedure that can
performed from the fifth week ol pregnancy up until
elivery, but it is generally done after the sixteenth
week. The test uses sound waves to produce a picture of
the fetus (sonogram) without the hazards of x-rays. Most
ultrasound machines have a TV-like screen that pro-
ncriscirc i
It
r:i.:, en;; cc i»ft8^™
B • •' a •
* LCflr
Ml ST
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i
rtk'CH-T
• >
UIILUHC
1
r.
NCXT
A SONOGRAM (ultrasound picture) of the publisher's son,
Jordan, iv the 18th week of his development.
vides parents-to-be a unique opportunity to see their
baby. Often they can even get a copy of the sonogram to
show to family, friends and their child in later years.
Ultrasound is done for a variety of reasons. If performed early, it can be used to date a pregnancy.
Later, it can be used to identify possible causes of a
problem such as vaginal bleeding, determine the condition of the placenta, diagnose a multiple pregnancy,
determine whether the baby is growing properly and
verify' breech presentation or another uncommon fetal
or cord position prior to delivery.
Although in 25 years of clinical use and study, no
harmful effects have been associated with ultrasound,
the American College of Obstetricians and
Gynecologists (ACOG) still recommends the procedure be performed only when necessary — not on a
routine screening basis. Many obstetricians provide
ultrasound services in their offices. Check the annex
section of "Your Guide to Obstetricians" on p. 58 to
see whether your doctor offers ultrasound.
'Alpha-Fetoprotein (AFP) Screening, performed
between the fifteenth and eighteenth week of pregnancy, analyzes the mother's blood to detect the possibility
of abnormalities in the baby's brain or spinal cord or a
chromosomal disorder such as Down's syndrome. The
problem with the AFP test is the high number of false
positives it produces. I f you have an AFP screen,
remember, it is only a screening test. Any abnormal
results require further testing to confirm the existence
of a problem. Because the test can detect possibly serious illnesses and poses no danger to the mother or the
fetus, experts recommend AFP screening for all pregnant women.
• Amniocentesis, usually performed between the
fourteenth and eighteenth week of pregnancy, is a
diagnostic test that can identify a number of fetal
PAGE 11
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AT
H
problems, including the existence of Down's syndrome
and the possibility of Tay-Sachs disease or sickle-cell
anemia. Since Down's syndrome is most prevalent
among children of older women, amniocentesis is usually recommended for all women over age 35.
How it works: the doctor inserts a slender needle
through the abdomen and into the amniotic sac surrounding the fetus to extract fluid for examination.
Through chromosome analysis the test can also reveal
the sex of the fetus.
THIRD TRIMESTER TESTS
A number of the tests performed earlier, such as
those for glucose tolerance, are repeated or updated
in the third trimester . If your doctor suspects a problem, he or she may also recommend additional testing.
I
T'S TIME:
THE D A A OF BIRTH
RM
For most new parents childbirth is not a sequence
of orderly stages, but rather a blur of new physical and
emotional experiences. Emotions seesaw from excitement to apprehension. The more you learn about the
process of labor and delivery, the better prepared
you'll be. Here's a preview of what to expect.
LABOR: WHAT IS IT?
Make no mistake, as its name implies, labor is hard
work. During labor, the muscles of your uterus amtracl
(tighten) and relax at increasingly shorter intervals.
These contractions cairse the cervix, the entrance of
the uterus, to dilala (open). Once the cervix is fully
dilated, the contractions help move the baby through
the birth cava I. (vagina).
FIRST STAGE OF LABOR
Hie first, and longest stage of labor- is fortunately
also the least intense. During this per iod, which can
last many hours, the cervix begins to dilate.
Contractions at this stage are usually mild to moderately strong. In most cases ther e's no need to be at the
hospital urrtil contractions increase in intensity and
come about five minutes apart.
WHAT WILL HAPPEN AT THE HOSPITAL?
Once you've been admitted to the hospital, your
nurse or physician will check your blootl piessure,
pulse, respiration and temperature, and will listen to
your heart and lungs. Your doctor will feel your
abdomen to assess the weight and position of the baby
and may do a vaginal examination to learn how much
the cervix has dilated. By this time, your cei-vix pr obably
will have dilated between four and seven centimeters.
Your doctor may also check your
baby's heartbeat with a fetal stethoscope or an external fatal monitor. The
monitor is strapped around the mother's abdomen to record the baby's
heartbeat and the pr essur e of labor
contractions. If fetal distress is suspected, the doctor may opt for internal fetal monitoring, in which an electrode is inserted through the cervix
and attached to the baby's scalp.
EASING LABOR PAINS
Everyone responds differently to
discomfort and pain. "Fo combat the
pain of labor and delivery, you may
find that all you need are your relaxation techniques and the support ol
the people around you. Or you may
feel you need pain relievers.
Although many women believe natural childbir th (in which no drugs are
used) is a wonderful experience, yoi
should not feel guilty if you can't or
don't want to go through labor' without pain relievers. There are a number of medications from which to
choose. Some, such as the pain reliev-
PAGE 12
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er Demerol, are injected. Others, such as Phenergan,
which can help reduce anxiety and nausea, are taken
orally. An epidural, which is a regional anesthetic,
blocks sensation from the waist clown. Talk to your
doctor about each drug's pros and cons.
Transition — This term refers to the final three centimeters of dilation, to a lull 10 centimeters. I l is the
most exhausting and demanding phase of labor. Your
coach's support and reassurance will be especially welcome at this time.
SECOND STAGE OF LABOR:
HERE COMES THE BABY!
Active labor, or the actual BIRTH of the baby usually
lasts about an hour or two for first-time mothers, 30 minutes for women who've given birth before. Pushing is
always exciting, and hard as it is, a terrific emotional
thrill. In pushing, the woman uses her abdominal muscles to move the baby down the birth canal. Between
contractions, when both the uterine and abdominal muscles are relaxed, the baby usually slips back a little. Pushing is a 2 down, 1 back, 2 down, 1 back process until the
baby's head starts toamnn.—is visible in the vagina.
If necessary, your doctor will perform an episiotomy
—an incision that widens the vaginal opening to pre-
vent teat ing or to speed delivery—before crowning. A
local anesthetic may be administered to numb the area
before the cut is made. Stitches will dissolve by themselves a few days after the birth. Whether you need an
episiotomy will probably depend upon your skin's elasticity and the baby's size. Find out how your doctor
feels about episiotomies before labor begins.
THIRD STAGE OF LABOR:
THE "AFTERBIRTH"
This is the shortest stage of labor, usually lasting less
than 30 minutes. After the baby is born, you will continue to have mild contractions which will help push out
thc afterbirth (placenta, umbilical cord, and amnion).
While this is happening, your baby will undergo
several routine procedures, including weight and
height measurements, foot printing, and the administration of silver nitrate eye drops to prevent infection.
A nurse will observe the baby's heart rate, breathing,
muscle tone, reflexes and color at one and five minutes after delivery and give him or her an Apgar
(Appearance, Pulse. Grimace, Activity, Respiration)
score. T hese post birth examinations assess the baby's
condition on a scale of zero to 10. Vigorous babies
score 7 or higher.
CHILDBIRTH CLASSES 101
The more prepared you are for labor and delivery, the
better. That's why many couples take childbirth education
classes before the big day. In addition to getting you ready
for labor and delivery, childbirth classes offer much needed
moral support for parents-to-be. During the emotionally
intense months before delivery, it helps to have the camaraderie of people in the same manic/panic state. Often it is
in these classes that lifelong friendships are forged.
There are several approaches with varied philosophies
from which you can choose. Many instructors combine elements of each in their classes. Lamaze, the most commonly
used method, prepares women to cope with the stress of
labor and delivery through education and relaxation techniques which include a series of breathing exercises to be
used during contractions. Bradley, another popular teaching philosophy, emphasizes the father's role as labor
coach. When shopping around for a class, ask your doctor
or health care practitioner for recommendations and visit
prospective classes to determine what's right for you (see
page 24 for some local options).
PAGE 13
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Cesarean Section: The Most Common
Surgical Procedure in the United States
uterus does not contract as it
should. You can improve your
contractions by staying relaxed
and confident — try the relaxation methods you lear ned in
your- childbirth education classes
— breathing normally, and experimenting with d i f f e r e n t
birthing positions to help your
cervix dilate. Move around as
long as you can or try lying on
your side. But know that even if
you do your best, a Cesarean may still be necessary.
Some physicians will try to give sluggish contractions a
boost with oxytocin (a drug used to initiate or speed up
labor) befor e r esor ting to a Cesar ean.
3. Breech birth—When the baby's feet or bottom
appear f i r s t . The usual position of engagement is
head-down. But some babies are in the breech position—feet or buttocks first. This makes a vaginal delivery difficult for both mother and child, especially in
the case of a first birth or when the baby is prematur e
or very large. Many breech babies turn head down by
themselves. Some car egivers may suggest daily exercises to help the baby turn or offer to try to turn the baby
before labor starts. Although some caregivers will
deliver a breech baby vaginally, most breech babies are
delivered by C-section.
4. The baby shows signs of "fetal
stress." This can happen if
the baby is not getti
enough oxygen. Ont
possible sign of fetal
stress is a change in
the baby's heart
rate. Another sign
is a meconium slain.
fins occurs when
the baby has a
bowel movement in
utero, causing the
color of the f l u i
around the baby to
change color from cleargreen, yellow or brown.
REASONS
If fetal stress is detectFOR C-SECTIONS (1989)
ed, work with your caregiv-
n 1984, Cesarean section (often called a Csection), in which the baby is taken from the
womb through an abdominal incision,
became the most common operation in the
United States. In fact, nearly one out of every
four babies in this country — a full 23.5 percent
— is delivered via C-section. Since that time
I
there have been a number of published reports criticizing C-sections as one of the most over-performed
procedures. Critics argue that C-sections needlessly
risk the mother's life or health without benefit to the
baby. But the fact is a Cesarean is called for when a
natural vaginal delivery is thought to be hazardous to
either the baby's or mother's health.
HOW CAN YOU KNOW IF A CESAREAN
IS REALLY NECESSARY?
The more you learn about Cesareans before delivery, the more easily you'll understand and accept the
surgery if it becomes necessary. A look at the most frequently given reasons for Cesarean sections will help
equip you with information as well as provide you with
tips on how you and your caregiver can reduce your
chances of needing a Cesarean. Some of those reasons:
/. You have had a previous Cesarean delivery. Up
until very recently, if a woman had one Cesarean delivery, her doctor would almost always deliver subsequent
children by Cesarean as well. Why? Doctors were concerned that the woman's uterus would rupture during
labor. It is now known that the risk of that happening is
very small, especially if the uterine incision made during the Cesarean was of the low, horizontal (low transverse) rather than vertical type (see figure p. 16). The
good news: Many doctors now support the use of
Vaginal Birth After Cesarean (VBAC) if the mother and
baby have no medical problems (see p. 16 ).
2. Dystocia—When the baby's head is too big to pass
through your pelvis or when labor does not progress.
Nature, in its wisdom, generally matches the baby's
size with that of the mother's uterus. If this is not the
case, a Cesarean may be necessary. Much depends on
how well you labor . Labor may not progr ess i f the
PAGE 14
�H
I A T PAGES'
E LH
National
Rates
As the charts
show, after almost
two decades of
steady growth,
the national
C-section rate
appears to be
leveling off.
At the same time,
the number of
Vaginal Births
after Cesarean
(VBACs) is
steadily
increasing.
VAGINAL BIRTH A T R C S R A
FE E A E N
C-SECTION R T S P R HUNDRED BIRTHS
AE E
25%rT
25%
20%
20%
15%
15%
10%
10%
5%
5%
n
1970
1975
1980
er to increase the supply ot oxygen to the baby.
Sometimes fetal stress ceases to be a problem when the
mother changes position or is given more intravenous
uid, or when the flow of oxytocin is slowed or
'stopped. Your caregiver may also want to monitor the
baby more closely using continuous internal electronic
monitoring or by examining a small drop of blood
from the baby's scalp (fetal blood sampling). Test results
may eliminate the need for a Cesarean delivery.
5. Maternal medical problems, such as premature
labor, premature rupture of membranes, high blood
pressure and diabetes may make a vaginal birth too
risky to attempt.
ft
WHAT HAPPENS WHEN
A CESAREAN IS NECESSARY?
When a Cesarean is necessary, the mother is usually
given a regional anesthetic (such as an epidural),
which is injected into the spinal area, to numb the
lower body. She is awake and aware of what's happening and the baby's father can usually remain at her
side. Nowadays, general anesthesia, which puts the
mother to sleep, is typically reserved for complicated
or emergency Cesareans.
After the anesthetic is administered, the doctor usually makes a side-to-side incision called a bikini cut in
the lower abdomen and a low-transverse incision in
".he uterus. The obstetrician then punctures the amnitic sac, drains the fluid and lifts out the baby. The
'ime from the first incision to delivery is usually five to
ten minutes; closing the cut takes about 45 minutes.
A C-section generally costs $3,000 more than a
vaginal delivery and requires a longer hospital stay —
1985
1990
'85 '86 '87 '88 '89 '90
usually an additional two days. Women may feel
greater physical discomfort, including nausea, pain
and abdominal gas after a Cesarean birth than after a
vaginal birth, and should refrain from strenuous activity for several weeks.
WHY HAVE C-SECTION RATES
INCREASED SO DRAMATICALLY?
Technology. The increase in C-sections corresponds
to advances in medical technology that enable doctors
to detect fetal problems that were undetectable twenty
years ago. Consequently, the good news about C-sections is that they are largely responsible for the drop
in mortality rates among mothers and their babies—
doctors today safely deliver by Cesarean babies who
would have otherwise died. That is the medical goal of
C-sections.
High malpractice premiums. Malpractice suits
against obstetricians have increased dramatically over
the last decade. The resulting premium that doctors
have to pay (in some cases more than $100,000 a year)
has made physicians more cautious in theit practice of
medicine. The legal liability associated with difficult
vaginal deliveries in which something could go wrong
may pressure doctors to perform C-sections more
often than is medically necessary. Rarely are doctors
sued for performing a C-section when a vaginal deliver) would have sufficed.
"Once a C-section, always a C-section." Cesareans
may be self-perpetuating. Once a patient has had one
C-section, many doctors will routinely perform a
Cesarean with subsequent deliveries even when a vaginal birth is possible.
PAGE 15
�I AT P G S
E LH A E '
H
H T IS A VBAC A D SHOULD YOU
A
N
CONSIDER HAVING ONE?
w
Vaginal B i r t h Alter Cesarean involves a trial o f
labor which results in either a vaginal birth or another
G-section.
In 1988, ACOG issued guidelines in an attempt to
curtail routine repeat C-sections. The guidelines advise
doctors to give women who have previously given birth
by C-section the opportunity to let labor progress naturally rather than automatically scheduling a C-section
for subsequent births.
In 1990, 20 percent ol women who previously had
a Cesarean were able to give birth vaginally. That's
up from l.H percent in 1988 and less than 4 petcent
in 1980.
factors that make a VBAC attempt possible:
1. Neither the mother nor the baby has any major
medical problems.
2. The health ol the mother and baby can be closely
supervised during labor. The hospital should be equipped to p e r f o r m an emergency Cesarean or provide
other emergency medical treatment if necessary. Note:
The chances of needing an emergencv Cesarean are no
greater for a woman who has already had one Cesarean
than for a woman who previously gave birth vaginally.
:\. T h e incision in the uterus f r o m the previous
Cesarean is horizontal.
Our thanks to thi: following doctors for nmicwing this section: C.
Iruivg Meeker, M.D.. Maine Medical Center, Portland. ME and
Vrunda Patel, M.D.. Princeton Medical (..enter, Princeton. N.J.
W H A T ARE THE A D V A N T A G E S OF A V B A C ?
1. Less risk. A vaginal birth usually results in fewer
medical problems for both the mother and the baby
than Cesarean birth.
2. Shorter recovery. Recovery lime for a vaginal
birth, both in the hospital and at home, is much shorter than that for a Cesarean birth. Because there's no
surgery lo recuperate from, a woman generally feels
better and can resume her everyday activities sooner.
She can also enjoy and care for her baby earlier.
3. M o r e involvement. Many women want to be
actively involved in childbirth and there's no question
that a vaginal delivery allows for greater participation.
Also, although most hospitals allow a support person
to be present during labor and vaginal birth, the same
is not necessarily true Ibr Cesareans, especially if general anesthesia is used.
ARE Y O U A CANDIDATE FOR V B A C ?
There are a number of issues caregivers must consider when deciding if a woman can have a VBAC. Key
Incision made in the abdominal wall for Cesarean birth:
Classical (left) and transverse (right).
WHAT TO ASK YOUR DOCTOR
ABOUT C-SECTIONS
• Are you planning to deliver the baby by
Cesarean? Why? Do I have any other
alternatives?
• My first baby was delivered through a C-section.
Will you let me try a vaginal birth this time?
• If my labor doesn't progress, will you try other
procedures, like medication, before performing a
C-section?
• If the fetal monitor indicates the baby is in distress,
will other methods be used to confirm the monitor's
reading before a C-section is performed?
If y o u r d o c t o r h a s t o l d y o u t h a t a
Cesarean definitely w i l l be necessary,
y o u m a y w a n t to ask some of the
f o l l o w i n g questions:
• Will the type of incision you make adversely
affect my ability to attempt a vaginal delivery
with my next child?
• Will the father be able to hold the baby immediately after the birth?
• Can the baby stay in the room with me after the
birth?
• How much time will I spend in the hospital for
recovery?
• What physical discomfort and limitations can I
expect following the surgery?
I
PAGE 16
�IEALTH PAGES
^Wisconsin's Cesarean Rates:
The Second Lowest in the Nation
1992 Public Citizen Health Research ie«ei or a hospital. L«ei s hospitals handle complicated perinatal
Group study of Cesarean rates in 48 states cases, Level 2 hospitals handle
A
„
i
1
•
ir
\
1
*7 r
^ T » T*
intermediate cases and all other
L. found that in 1990, at 17.5 percent, Wisi
e maternity se.consin had the second lowest state Cesarean rate "designated Level 1
h o s p
vic
t a l s t h a t otf
r
Htgh Risk Pregnancies. If you
in the United States! In fact, the Wisconsin rate are over 35, h v h d a cesarean
ae a
,
,
,
.
,
section, are having a multiple preg-
wasperformed, for a total savings of about $12,600,000 bloodaverage obesity, your doctor may classify.your
26 percent lower than the national pressure or
were
n a n t y
have a disease such as dia
of 23.5 percent. That means 4,200 fewer Cesareans
for Wisconsin consumers.
Wisconsin's VBAC rates are even more encouraging.
VBAC rates in Green Bay, Madison and Milwaukee
averaged 31 percent—55 percent higher than the
national VBAC average of 20 percent.
Clearly, Wisconsin's physicians are leading the way
for the rest of the nation when it comes to restraint in
the use of Cesarean deliven'.
HOSPITAL-SPECIFIC
CESAREAN SECTION RATES
The Cesar ean rates for hospitals
in Wisconsin range from a low of 10
percent to a high of 21 percent
(which is still below the national
average). One reason a hospital
might have a higher Cesarean section rate: If it is set up to serve a
high risk pregnancy population.
Neonatal ICU and Level of Care.
In most areas of the country perinatal care (care for women in the laterstages of pregnancy, during labor
and delivery and during the first
week after delivery) has been
regionalized. Verv high-risk maternity patients are generally referred
to centers with special neonatal intensive care units, which can provide more sophisticated care to sick
infants. These patients may be more
ikely to require a Cesarean delivery, accounting for the hospital's
relatively higher C-section rate.
States designate the perinatal
betes, or are at risk for complications such as high
pregnancy as high risk. This means you will need additional monitoring, including more frequent ultrasounds and other tests. Depending on why your pregnancy has been classified as high risk, you may or may
not be more likely to have a Cesarean delivery. For
example, complications resulting from high blood
pressure might make a C-section necessary, whereas
having had a previous C-section due to failure of labor
to progress may not. Remember,
many high-risk pregnancies proceed absolutely normally, and result
HOW WE COMPILED
in natural deliveries.
THE INFORMATION
The HEALTH PAGES requested the
Cesarean section rate o f every ' PHYSICIAN-SPECIFIC
physician in the three- metropolitan • CESAREAN SECTION RATES
The listing that follows repreareas who performed af least 50
sents the first time in Wisconsin, in
deliveries a year in both 1990 and •
fact, in the United States, that
1991. The state's disclosure laws
physician Cesarean rates are being
require that a;physician be notified
of any information-''requests and -;\ made available to the public.
When reviewing the tables, bear
that he or"she^be given 30 days to^
in mind that a physician's rate may
review all patient discharge data
be higher if he or she regularly sees
before it is released. After we
received the ' inf6rmdtibn;> t h e { high risk pregnancies or is a conHEALTH PAGES sent'two mailings t o ' sultant to family practitioners.
every physician listed that included
Family Practice Consultants. In
the doctor's C:se,ction rate rand
1989, 27 percent of the deliveries
number of tota I deliveries. We
in Wisconsin were performed by
asked the doctors to confirm the
family/general practice physicians.
information and provide us with
Family practitioners actually saw
characteristics about their practices
many more pregnancies but often,
which might affect their rates. The
as the delivery date neared, or durphysicians' comments were incor-:
ing labor, a decision was made to
porated into the listings that follow.
perform a Cesarean, which many
hospitals do not allow family practi!
PAGE 17
�E L H PAGES'
AT
H
tice...and that...higher Cesar ean rates did not result in
bettet neonatal outcome." Instead, the researchers
concluded that "individual physician practice style was
the only apparent determinant of Cesarean rates for
the 1 1 obstetricians studied. Cur rent Cesarean rates
can be substantially reduced without sacrificing fetal
and newbor n safety" {American Journal of Obstetrics and
Gynecology 1990; 162:1593-602).
It is because of the role that an individual physician
practice style may play in Cesarean delivery that the
tioners to perform. In those instances, an obstetrician
who the family practitioner may regularly consult or
one who happens to be on call at the time may be
asked to perform the Cesarean, increasing his or her
Cesarean rate.
The information in the listings does NOT factor out
these additional Cesareans except in a few cases in
which the physicians themselves factored out the number of consultant Cesareans they pet formed and provided us with a separate C-section rate for their own
patients.
HEAI rn RAGES decided to publish physician-specific C-
CESAREAN: THE ROLE OF THE PHYSICIAN
T he debate over why Cesareans are performed is
heating up and studies are underway throughout, the
nation. On the local level, Dr. Herbert Sandmire and
Dr. Rober t DeMott of Ob-Gyn Associates in Green Bayare conducting a multi-year research study, begun in
1986, of busy obstetricians' pr actices at St. Vincent arrd
Bellin Memorial hospitals.
Their findings thus far: The differences in individual physician Cesarean rates cannot be explained by
"patient obstetric r isk factors, socioeconomic status,
service status, or duration of the physician's prac-
Doctor
Board
Certification
GREEN BAY
Bechtel, Richard Jr.
1974
Brockman, Michael
mmm
1990
Cavanaugh, Robert
Hospital
Affiliation
Vaginal
Delivery
Price
(1992)
section rates. After learning about this decision a number of obstetricians and hospital administrators wrote
or called our office applauding this effort. Other s wondered, sometimes not in the Iriendliesi of ways, why we
wer e doing this.
Our answer : The public has a right to know C-section r ates and other inlormation about the health care
professionals whose services they pay for. Some doctots may be mor e likely to per form a Cesarean. Some
women who've already had one Cesarean may prefer
to have another r ather than attempt labor. L'ltimately.
each woman together with her doctor- must choose
what's right for her.
Cesarean
Cesarean
Section Number of Section
Price
Deliveries
Rate
(1992) (1990-91) (1990-91)
Comments/Special Interests
Bellin Mm
e.
$1,486
$1,796
401
High R k
i
s
1985
Bellin M m
e.
1,486
i 1,796i
i
413
High Risk & Infertility
DeMott, Robert
1987
Bellin Mem.. ;.l,486f
Gallagher, John
1982
St. Mary's
Halloin, Thomas
1986
St. Mary's
Mncheloe, Thomas
> .2
.7U--..-vT.-^.n
St. Morys
Mahoney, Thomas
W'im
St. Vincent
Sandmire, Herbert
1961&1978
^2,000
319?;
High Risk& infertility'
High R k
i
s
i-siiring, Frederick
1991
Shaffer, Richard
1979
1,796
434
1,702
'2,084
373
'"••9%
1,600
1,820
132
15%
1967
Sehring, Stephen
1,486
Bellin M m
e.
Sthueckler, Amy
Bellin Mm
e.
St. Vincent
;;1,600^
1,633
270
1,904
PAGE 18
597
High Risk & Infertility
High Risk 8, Infertility
1%
3
�IEALTH PAGES'
Cesarean
Cesarean
Section Number of Section
Deliveries
Rate
Price
(1992) (1990-91) (1990-91) Comments/Special Interests
Board
Certification
Hospital
Affiliation
Vaginal
Delivery
Price
(1992)
Utriejohn
1968
St. Vincent
$1,702
$2,084
270
13%
Vogel, Edword
1972
1,633
1,904
615
14%
1,575
2,000
303
13%
1,383
2,045
295
23%
Doctor
Walbridge, Mary
High Risk
High Risk
Anderson, John
1975
Baker, Robert Jr.
1971
Meriter
1,723
2,182
421
17%
Barnard, Jerald
1991
Meriler
1,566
1,820
239
16%
High Risk Only- Referral Required
Beck, James
1967
1,383
2,045
290
23%
High Risk
Christmann, Robert
1971
1,383
2,045
419
22%
High Risk
Davidson, Susan
1989
St. Mary's
1,383
2,045
242
23%
Perinatologisl-High Risk
Demopoulos, Jean
1986
St. Mary's
1,383
2,045
390
20%
High Risk
Diem, Klaus
1980
Meriter
1,723
2,182
332
20%
High Risk, Infertility & Endoscopic Surgery
Droste, Sabine
1992
Meriter
1,566
1,820
176
22%
High Risk Only - Referral Required
Estrin, Margaret
1985
Meriter
1,490
1,938
286
11%
High Risk
Fok, Joseph
1984
St. Mary's
1,383
2,045
709
26%
High Risk, Infertility & Laparoscopy
Hackforth-Jones, Jenny
1988
Meriter
1,490
1,938
218
13%
High Risk, Infertility & Adolescents
Henderson, Perry
1970
Meriter
1,566
1,820
248
10%
High Risk & Maternal-Fetal Medicine
Henog, Paul
1971
Meriter
1,723
2,182
386
21%
Jackson, C. Robert
1964
Meriter
1,723
2,182
183
19%
Koller, Jr., William
1979
St. Mary's
1,383
2,045
347
22%
High Risk
Kronman, Karen
1987
St. Mary's
1,383
2,045
367
26%
High Risk, Laser Laparoscopy & Menopause
Landauer, Megan
1988
Meriter
1,723
2,182
147
28%
Perinatologist - High Risk
McLeod, Paul
1969
Meriter
1,723
2,182
283
25%
Miller, Kim
1989
Meriter
1,723
2,182
328
20%
Roley, Everett
1966
1,383
2,045
320
36%
1,383
2,045
210
*5
Roley, Kevin
St. Mary's
* 1 The state's information on Dr. Gallagher's practice listed a C-section rate of 22% and 403 deliveries. St. Mary's hospital wrote us that
Dr. Gallagher had performed 282 deliveries with a C-section rate of
23%. When his family practice consultant C-section rate is factored
out, his C-section rate with his own patients is 17%.
' 2 The state's information on Dr. Halloin's practice listed a C-section
rate of 23% and 503 deliveries. St. Mary's hospital wrote us that Dr.
Halloin had performed 313 deliveries with a C-section rate of 22?6.
When his family practice consultant C-section rate is factored out, his
C-section rate with his own patients is 14%.
* 3 The state's information on Dr. Kincheloe's practice listed a C-section rate of 17% and 447 deliveries. St. Mary's hospital wrote us that
Dr. Kincheloe had performed 314 deliveries with a C-section rate of
:
High Risk Patients
High Risk, Family Practice Referral & Infertility . :
15%. When his family practice consultant C-section rate is factored
out, his C-section rate with his own patients is 10%. In addition Dr.
Kincheloe wrote us that his C-section rate was 1 2% (July 1 990-June
1992); after adjusting for consultant C-sections that rate falls to 8-9%.
• 4 St. Mary's Hospital asked us to print the following sentence: "This
percentage figure includes an unknown number of emergency
Cesarean sections performed at the request of family physicians who
deliver at his/her hospital ond does not reflect the Cesarean section
rate on patients followed throughout pregnancy by this obstetrician."
• 5 The state provided the HEALTH PAGES with a 3 1 % C-section rate. Dr.
Roley adds that during the period of July 1, 1991 to June 30, 1992
his primary C-section rate (excluding women who previously had a
Cesarean) was 2 1 % . Dr. Roley is Board Certification Eligible.
PAGE 19
|
�I A T PAGES'
E LH
H
Dodor
Board
Certification
Vaginal
Delivery
Price
(1992)
$1,383
$2,045
716
13%
1,723
Hospital
Affiliation
Cesarean
Cesarean
Section Number of Section
Rate
Price
Deliveries
(1992) (1990-91) (1990-91) Comments/Special Interests
2,182
263
19%
High Risk
Rudot, Karl
1979
Rodman, Sherwin
1980
Shay, Gerald
1977
1,383
2,045
308
23%
High Risk
Torhorst, James
1977
1,383
2,045
261
26%
High Risk
128
19%
MILWAUKEE^fMM
Aiman, Edward
Alexander, A. Charles
Meriter
lllll
ill
1976
1991
Angsten, Beth
St. Joseph's
1988
2,195
533
14%
1,650
1,874
187
*6
2,050
295
13%
239
Alexander, Janice
1,820
1,728
1978&1989 St. Luke's-Racine
14%
Azcueta, Ester
Cervical Dysplasia
High Risk, Infertility & family Practice Consultant
Babbitz, Allen
1976
St. Mary's
1,700
2,000
131
14%
Baccus, Donald
1982
St. Joseph's
1,750
1,980
389
20%
High Risk
Bae, Ik Hak
1973
St. Luke's -Milw
1,800
2,200
199
37%
High Risk & Family Practice Consultant
Bahal, Rajinder
1977
1,600
1,800
131
26%
Barr, Carmela
1985
1,800
2,200
125
25%
Bear, Brian
1991
1,750
1,980
539
13%
1,600
2,000
168
18%
1,800
2,250
321
20%
1,765
2,205
163
17%
Bellis, David
Bhathena, Dhun
1983
Bines, Milton
Bodner, Aaron
1974
1,500
1,700
721
9
%
Borkowf, Harold
1972
1,980
2,310
285
14%
Boyce, Lorenzo
1988
St. Luke's - Racine
1,701
2,122
463
15%
Brennan, John
1957
St. Joseph's
1,630
2,020
597
14%
Brockman, Lenora
1987
St. Luke's-Racine
1,701
2,122
570
14%
Broekhuizen, Fredrik
1981
Sinai Samaritan
1,550
1,650
354
12%
Budarapu, Suseela
1985
1,800
2,000
387
14%
Burch, Kim
1982
Community Mem.
1,769
2,220
360
16%
High Risk
Burstein, Paul
1979
St. Mary's
1,700
2,000
188
17%
High Risk
Castillo, Marcelo
1972
Sinai Samaritan
1,550
1,650
350
12%
Chambers, LaRoyce
1980
West Allis Mem.
1,665
1,975
274
*7
' 6 The state's information on Dr. Alexander's practice listed a C -section rate of 34%. Dr. Alexander wrote us that her C-section rate with
her own patients, excluding referral patients, was 2 1 % .
*
7
T
e
s t a t e
s
High Risk & Maternal-Fetal Specialist
High Risk & Infertility
' information on Dr. Chambers' practice listed a C-secrate of 50%. Dr. Chambers wrote us that his "true C-section rate
around 1 7%" when you factor in his role as a high risk pregnancy
consultant for family practice doctors for the H M O , Family Health
|
^
High Risk, Infertility & Natural Family Planning
i o n
i s
Plan.
PAGE 20
�IEALTH PAGES'
'
Doctor
Clark, Douglas
Claude, John
Board
Certification
1968
Hospital
Affiliation
Vaginal
Delivery
Price
(1992)
Cesarean
Cesarean
Section Number of Section
Rate
Price
Deliveries
(1992) (1990-91) (1990-91) Comments/Special Interests
C m u iy M m $1,769
o m nt e .
$2,220
258
1%
0
1,650
2,000
154
3%
2
1,800
2,060
350
1%
9
cnmwc
1962 & 1978 O o o o o
Hg Risk& Infertility
ih
Coulter, Renee
1986
Craft, Samuel
1985
St. Luke's-Milw
1,800
2,250
364
1%
4
E d s o y & Minimally Invasive Surgery
n oc p
Daleiden, James
1975
Wueh Mm
a ks a e .
1,800
2,250
238
1%
6
H h Rs
i ik
g
Darling, Raymon
1986
490
9
%
Decker, Mark
1991
St. Joseph's
1,675
2,440
369
•8
Diulio, Lynn Knitter
1980
Em r o M m
l bo k e .
1,728
2,050
290
1%
7
Dolan, James
1979
W s Allis M m
et
e .
1,750
2,050
226
15%*'
Dvoracek, Francine
1988
1,900
2,100
137
1%
6
1,900
2,100
259
8
%
1,680
1,970
309
1%
8
1,650
2,200
554
15%*'0
1,680
1,890
399
1%
2
1,785
2,336
449
1%
2
1,800
2,000
259
1%
9
352
8
%
Earle, Sandra H.
St. Mary's
Eiche, Jocelyn
1989
Fait, Gary
1990
. Finlayson, William
1962
Vox, Brian
1986
Clmi
ou ba
Fritz, Robert
St. Luke's-Racine
1965
Garay, Fema
Gilman D.O., Daniel
1991
Gilman D.O., Michael
1987
Gondi, Jyothi
1984
Graciosa, Elena
1986
Gryniewicz, Michael
1973
St. Joseph
1,680
Gustin, Alan
1980
Oo o o o
cnmwc
Handrich, Thomas
Sinai Samaritan
Hg Risk, Infertility & L p r s o y
ih
a ao c p
Heitman, Timothy
1989
Hofbauer, Thomas
James, Janine
1986
Sinai Samaritan
360
1%
1
1,864
267
1,654
1,864
179
4%
1
1%
7
1,970
251
•il
1,650
2,000
244
2%
3
1,800
2,060
327
1%
9
2,200
286
2%
4
1,600
1,900
286
1%
3
2,220
231
1%
0
2,270
2,841
280
1%
3
ft
1%
8
1,769
1966
St. Lukes-Milw
1,950
1,800
Hayes, James
1,600
280
1970 & 1978 C l m i
ou ba
Hg Risk, Infertility, L p r s o y & H seo c p
ih
a ao c p
ytr so y
H h Rs
i ik
g
1,654
St. Michael's
High R k
i
s
' 8 The state's information on Dr. Decker's practice listed a C-section
rate of 23%. Dr. Decker wrote us that in 1990-91 he received high
risk referrals from 1 1 family practice doctors who do not perform Csections. In addition, his primary C-section rate was 8% in 1991 and
. 5% in the first half of 1992. He also stated that he is "a strong propo| nent of vaginal birth after C-section (VBAC), twin deliveries vaginally
• and breech deliveries vaginally."
V
• 9 Dr. Dolan provided the following information: Primary C-section
rate of 1 2% and a VBAC rate of 43%.
Infertility & Obstetric C r
ae
High Risk
High Risk
High Risk & Infertility
Hg Risk
ih
High Risk, Maternal-Fetal Specialist & P d Gynec.
e
* 1 0 Dr. Fait provided the following information: His C-section rate
with his own patients was 10%; the 15% number includes C-sections
on consults.
,,,
.
_ _
. . ,
T
^
Z ^ ™
" 2"
>'
:
P™ '
. / r
° .
^ Dr. Gryn.ew.cz wrote us that h.s practice
!!?
°"
g » ° y practitioners for high nsk pregnancies.
Consequently, with his own patients his total C-section rate was only
18.6%.
T L
1
1
S
e
£
h e
5
0
G r
J
PAGE 21
n i e w l <
z
s
: ,
c e
l , s t e d
L
C
r a t e
c l u d e s
c
2
s u l t i n
6
0
f
m i l
a
C
�I A T PAGES'
E LH
H
Doctor
Board
Certification
Hospital
AHiliotion
Vaginal
Delivery
Price
(1992)
Cesarean
Cesarean
u br
Section N m e of Section
Rate
Price
Deliveries
(1992) (1990-91) (1990-91)
191
1989
Community Mem. 51,675
Klieger, Jack
1954
52,012
442
15%
1,850
515
16%
27%
1987
Kaminski, Henry
26%
157
Jirak, George
Comments/Special Interests
1,600
Kuhlmann, Randall
Kuhn, Michael Jr.
1966
St. Joseph's
1,700
2,000
302
*12
LaBranche, Janice
1989
St. Luke's-Racine
1,701
2,122
494
9
%
Waukesha Mem.
1,850
2,419
207
*13
1,650
2,025
145
12%
1,680
1,970
304
18%
1,785
2,336
499
16%
1,650
2,025
183
21%
1,687
1,947
552
13%
1,550
1,900
274
9
%
1,800
2,060
263
15%
1,720
2,150
149
25%
342
High Risk, Infertility & Laser Surgery
19%
Lalich, Roger
Lamping, Barbara
Lawrence, Rebecca
1991
LeCloux, David
1977
Lee, Glenda
1990
Linn, James
1986
St. Luke's-Racine
St. Mary's
Lontok, Emilio
Lucca, Paul
1979&1989
Columbia
Macak, James
Majewski, Michael
1985
Burlington Mem.
1,700
Maker, George
1982
Burlington Mem.
1,696
2,179
287
17%
Mathews, Richard
1969
1,687
1,947
353
1,440
1,800
239
1,750
1,980
600
18%
Waukesha Mem.
1,850
2,419
473
*14
Sinai Samaritan
1,400
1,680
1064
20%
1,675
2,012
257
19%
1,695
2,050
348
15%
1,800
2,250
386
16%
1,785
2,336
283
14%
155
Hg Risk, Infertility & M n p u e
ih
eoas
19%
Metoff, Joanne
Hg Risk & Family Practice Consultant
ih
16%
Melnyczendo, Walter
Hg Risk, Pelviscopy & Vaginal Surgery
ih
22%
Meyer, Matthew
1977
Millan, Alfredo
Miller, Dennis
1991
Miller, Donald Jr
1983
Mondloch, Victoria
1991
Musson, Jeffrey
1983
St. Luke's-Racine
St. Luke's-Racine
Myers, Robert
Nash, David
Nohl, James
1982
St. Mary's
1,700
2,000
161
1,769
2,220
228
19%
Hg Risk, Infertility & Mmm l Invasive Surgery
ih
i i a
Hg Risk & M l a d Female Infertility
ih
ae n
11%
Waukesha Mem.
Hg Risk
ih
• 1 2 The state's information on Dr. Kuhn's practice listed a C-section
rate of 26%. Dr. Kuhn wrote us that his C-section rate was 20%.
• 1 3 The state's information on Dr. Lalich's practice listed a C-section
rate of 23%. Dr. Lalich wrote us that his practice includes consulting
to a large number of family practitioners for high risk pregnancies.
Consequently, with his own patients his total C-section rate is only
Hg Risk
ih
14.5% and his primary C-section rate is 11%.
,. . ,
, . r
,•
^ »„
<
i- . J r1 4 The state s intormation on Dr. Meyer s practice listed a C-section
rate of 19%. Dr. Meyer wrote us that his practice includes consulting
to a large number of family practitioners for high risk pregnancies.
Consequently, with his own patients his total C-section rate is only
14.5% and his primary C-section rate is 1 1 % .
P A G I L 22
T
L
L
�IEALTH PAGES'
O'Reilly, Julie
1989
Pogedas, Anthony
1970&1978 St. Luke's-Milw
Parcon, Jazmin
1974
Parker, Edward
1970
W s Allis Mem.
et
Parker, Wayman
Patillo, Roland
1991
Poremski, Tod
Riendl, Anne
22%
1,800
2,200
147
33%
2,000
317
11%
1,750
2,050
273
1%
9
1,600
382
107
1968
Pircon, Richard Adam
234
1970
Pelland, Philip
$2,200
1,700
Hospital
Affiliation
Cesarean
Cesarean
u br
Section N m e of Section
Rate
Price Deliveries
(1992) (1990-91) (1990-91)
1,400
Board
Certification
Doctor
Vaginal
Delivery
Price
(1992)
$1,800
'
Comments/Special Interests
High R k & Consultant for St. L k Family Practice
i
s
ue
High Risk, Infertility & L p r s o y
a ao c p
21%
1,650
2,050
212
1%
6
2,500
2,500
325
34%
1982
1,680
1,970
394
22%
1983
1,965
2,450
228
1%
8
1,830
2,200
235
32%
St. Joseph's
Rogers, John
Maternal-Fetal Specialist & High R k
i
s
Shroeder, Thomas
1967
Oo o o o
cnmwc
1,650
2,000
254
19%
Shafi, Mohammad
1975
Sinai Samaritan
1,580
1,942
926
•16
Hg R k
ih i
s
Sirin, Kerim
1974
St. Francis
1,600
2,000
369
1%
8
Hg R k
ih i
s
•tadler, James II
1980
1,680
2,020
550
1%
7
Stewart, William
1970
1,680
1,970
376
1%
7
Sturino, Kathy
1989
1,728
2,050
252
1%
6
Urlakis, Kenneth
1967
1,800
2,300
264
14%
Vitamvas, Gerald
1980
1,800
2,060
246
1%
3
Vondrak, Ben Frank
1968
1,775
2,275 .
242
,52%
Waeltz, John Lee
1989
1,650
2,200
253
9
%
Worth, Robert
1974
1,800
2,250
232
11%
Washington, Janie Marie
1989
Sinai-Samaritan
1,995
2,250
269
1%
5
Wetzler, Robert
1972
St. Francis
1,800
2,000
134
; 19%
St. Luke's-Racine
1,785
2,336
402
1%
3
St. Joseph's
2,500
2,500
426
.34%
1,687
1,947
265
14%
136
;. 2
%
Wilczynski, Joseph
Worthington, Dennis
1977
Yellick, Clyde
>~ii*:
W u e h Mem.
aksa
1968
i ,
Hg Risk, Infertility & L p r s o y
ih
a ao c p
Maternal-Fetal Specialist & Hg Rs
i h ik
r
,'wv !N-3':r--v. .'=i-- •'•''.^^.•'SiA-i
f
FAMILY PRACTITIONERS
Lewan, Richard
Ranola, Pedro
Stevens, Robert
AVERAGE CHARGE 4>
1983
Waukesha Mem.
19778,1984 Sinai Samaritan
1987
St. Vincent
1/461 '
1,250
N/A
573
0
%
1,285
N/A
114
Family-Oriented Health C r
ae
0
%
i i i l l ^0591
*1S Dr. Parker provided the following information: Primary C-section rate
of 10% and a VBAC rate of 44%.
* 1 6 The state's information on Dr. Shafi's practice listed a C-section rate of
•.'..•sr. '-CV-
21%. Dr. Shafi wrote us that for the period of July I, 1991-June 30, 1992,
his primary C-section rate was 7% and his repeat C-section rate was 8%,
for a total C-section rate of 15%.
PACE 23
�H
I A T PAGES"
E LH
OSPITAL
M T R I Y SERVICES
A E NT
H
Women have many options today when it comes to
where and how to birth theit babies. So, hospitals have
begun competing with one another for maternity
patients. This has resulted in modernized delivery
facilities as well as a greater variety of services from
which women can choose. Improvements have come
on many fronts, including the number of times a
woman is shuffled from room to room during labor,
delivery and recovery; the decor in labor and delivery
rooms; the llexibility afforded fathers in terms of visiting hours (all the hospitals surveyed allow fathers to
visit anytime); the ability to have the newborn spend
time after delivery with his or her parents; and the
authorization of midwives to deliver babies.
HOSPITAL C L A S S E S
A valuable education resource
All hospitals offer classes to help new mothers and
their lamiiies pr epare for the proper' care of their new
ar r ival. Most of the hospitals listed offer valuable
classes in;
• Baby Care
•Breastfeeding
• Infant Nutrition
•Infant CPR
•Sibling Preparation
In addition, some hospitals also offer special classes
for single parents (St. Vincent, St. Mary's-Madison),
adoptive parents (St. Mary's-Madison, Menomonee
Falls) and grandparents (Bellin, St. Mary's-Madison).
Meriter, Columbia and St. l-'rancis hospitals have sup-
CIRCUMCISION
DECISION
Should you circumcise
a newborn son?
Hospital
Type ol
Class
Offered
Bellin Memorial Hospital
Lamaze
$28
St. Mary's Hospital Medical Center
Lamaze
40
St. Vincent Hospital
Lamaze
40
St. Mary's Hospital Medical Center - Madison
Lamaze
60
Meriter Hospital
Lamaze
Burlington-Memorial Hospital
Columbia Hospital
Menomonee Falls-Community Memorial
Average
Class Size
(Couples)
Number of
Meetings
Cost
Combination
1
0
1
7
40
IE
CA
1
2
40
Combination
1
5
35
60
Milwaukee County Medical Complex Hospital
Oconomowac-Memorial Hospital
Combination
35
St. Francis Hospital
Lomaze
35
St. Luke's Medical Center • Milwaukee
Lamaze
1
0
40
St. Luke's Memorial-Racine
Other
St. Mary's Hospital
Other
1
2
1
5
50
St. Michael
Other
1
2
40
Sinai Samaritan Medical Center
IE
CA
1
0
45
Waukesha Memorial Hospital
Lamaze
West Allis Memorial Hospital
Other
30
2
0
Circumcision is the surgical remova
of the foreskin from the penis. Although for many people the procedure
is an important religious ritual, it is not
without risk and is usually not considered medically necessary. Consequently, the circumcision debate goes on:
PRO. Some studies have shown
that circumcised males have a lower
risk of urinary-tract infections than
uncircumcised males because their
penises collect fewer bacteria and are
easier to clean.
CON. Critics of the procedure
argue that it is unnecessary— that
proper hygiene can be taught, and that
the benefits of circumcision don't outweigh the risks associated wilh any surgical procedure.
Discuss the risks and benefits of circumcision with your doctor and your
family. If you decide to have your son
circumcised, tell your doctor soon after
the baby is born. That way, if you
choose, the procedure can be done in
the hospital. You will have to sign i
permission slip, and pay an additiotu
fee (see chart on p. 27).
20
Many hospitals offer "refresher" classes for the second time around. A speciaf teenage cW/dbirffi class is available at St. Vincent's Hospifof.
PAGE 24
9
�IEALTH PAGES'
|port groups for new mothers. St. Luke's offers a special four-hour class on VBAC for $20 and an Infant
CPR class in Spanish. St. Michael's will arrange for
interpretation of some of its classes.
GETTING THE MOST OUT OF
YOUR HOSPITAL STAY
Bonding, Anyone? Bonding time is the period immediately
following the birth (after the baby has undergone preliminaiy tests) when mother and father can cuddle and
caress their newborn without any intmsions. All of the
hospitals listed set aside a minimum of 60 minutes for
bonding. Many allow for a longer bonding period.
Colling All Coaches, All the hospitals listed allow the presence of at least one coach during delivery. In fact, many
hospitals allow more than one loved one to help you
through childbirth. Check with your hospital to see if
prior arrangements are necessary.
Bring the Cameras — Better Yet, the Video Recorder. All the
should be prepared to invest much time and money,
knowing that the chances of success are low. How FVF
works: The woman is given a combination of hormonal drugs—usually Clomid and Pergonal—to stimulate
the ovaries to produce eggs. The eggs are usually
retrieved through the vagina and then fertilized with
sperm from the woman's partner or a donor. The fertilized eggs are then transfered into the uterus, and if
they implant, a pregnancy ensues.
Labor/Delivery/Recovery Room (LDR): The newest trend
in hospital maternity facilities, this all-in-one birthing
room can accommodate high-, low- and normal-risk
pregnancies. Since women who give birth in these
rooms are not moved from labor to delivery room
once the birth is imminent, LDRs make for a more settling and less disruptive birth experience.
Labor/Delivery/Recovery/Postpartum Room (LDRP): Like
the LDR this type of room is becoming increasingly
popular in hospitals nationwide. Here, patients not
only labor, deliver and recover in one room, but also
remain there until they are discharged.
hospitals listed allow you to record the birth on your
own equipment.
•
pecial Roomate. After the birth, many mothers opt to
have the baby stay with them at all times. This is called
rooming-m. Having the baby in the same room makes it
easier for a new mother to breastfeed and to respond
directly to her baby's needs. (All the hospitals listed
allow rooming-in). The down side: A woman whose
baby rooms with her may forfeit a large chunk of much
needed sleep and rest time.
TERMS IN THE TABLE
Here are definitions for some of the terms that
appear in the table on the following page.
Genetic Counseling: Genetic counseling can help a couple determine their chances of having a child with an
inherited genetic disorder and make informed choices
based on what they find out. A complete history of the
couple's family health is taken and the couple must fill
out a form listing diseases that may have occurred in
their families or that are common to people of their
ethnic backgrounds. This is done to find out whether
any specific type of prenatal testing should be offered.
Lab tests may also be performed at the first counseling
session. The risks of having a child with a genetic disorder, which often are lower than the couple may have
eared, are explained and the couple's concerns are
iscussed.
IVF: In vitro fertilization, or IVF, brings a man's
sperm and a woman's egg together outside the
woman's body. To achieve in vitro pregnancy, couples
PAGE 25
HOSPITAL & LAB AFP PRICES
Alpha-Fetoprotein screening is a blood test usually performed between the 15th and 18lh week of pregnancy.
MILWAUKEE
Trinity Memorial
$41
St. Joseph's Hospital
58
St. Francis Hospital
85
Northwest General
36
Milwaukee County Medical 28
St. Mary's Hospital
47
West Allis Memorial
36
Lakeview Hospital
30
Waukesha Memorial
43
St. Luke's Medical Center 57
Elmbrook Memorial
61
Columbia
69
Froedtert Hospital
51
St. Mary's-Ozaukee
61
Community Memorial
45
St. Michael's Hospital
54
COMMERCIAL LABS
Bayshore
50
Damon
113
Medical Science
Metpath
Rce
oh
Smithkline
General Medical
M L Health Services
M
GREEN BAY
Bellin Hospital
St. Mary's Hospital
St. Vincent
MADISON
Meriter-General Med
St. Mary's Hospital
University of WI
$38
76
62
92
47
53
61
58
50
40
34
43
�E L H PAGES"
AT
H
Neonatal
ICU
Genetic
Counseling
In Vitro
Fertilization
LDR/LDRP
Rooms
Labor
Rooms
Delivery
Rooms
Private
Rooms
SemiPrivate
Rooms
Siblings
Other
Bellin Memorial
Hospital
N
o
N
o
N
o
6 (LDR)
1
0
15
0
Unlimited
2PM -4PM
6PM -8PM
St. Mary's Hospital
Medical Center - Green Bay
N
o
N
o
N
o
12 (LDRP)
0
0
12
0
Unlimited
11AM8PM
St. Vincent
Hospital
Yes(3)
Yes
No
8 (LDR)
0
0
14
7
11AM8M
P
11AM8PM
St. Mary's Hospital
Medical Center - Madison
Yes(3)
Yes
No
9 (LDR)
0
2
11
11
Unlimited
Meriter
Hospital
Yes(3)
Yes
N
o
26 (LDRP)
0
0
8
10
Unlimited
Unlimited
N
o
No
No
4 (LDR)
1
0
8
0
11AM-
2PM -3:30PM
Yes(2)
Yes
Yes
5 (LDR)
0
2
4
8
Unlimited
Unlimited
Burlington
Memorial Hospital
Columbia
Hospital
Menomonee FallsCommunity Memorial
Visiting Hours
Noon8PM
8P
M
7PM
- 8PM
2:30PM-4PM
7PM
-8P
M
N
o
N
o
No
3 (LDR)
4 (LDRP)
0
0
8
0
Yes(3)
Yes
Yes
4 (LDR)
0
3
6
9
No
No
No
4 (LDR)
0
0
6
3
Unlimited
St. Francis
Hospital
Yes(2)
Yes
No
4 (LDR)
2
3
27
0
Unlimited
2:30 -3:30PM
7PM - 8PM
St. Luke's Medical
Center-Milwaukee
Yes(2)
Yes
Yes
16 (LDRP)
0
1
0
0
Unlimited
Unlimited
St. Luke's
Memorial-Racine
Yes(2)
N
o
N
o
4 (LDR)
6
6
11
9
11AM8M
P
11AM-
St. Mary's
Hospital-Milwaukee
Yes(3)
St. Michael
Hospital
No (2)
No
Sinai Samaritan
Medical Center
Yes(3)
Yes
Milwaukee County
Medical Complex Hospital
OconomowacMemorial Hospital
Unlimited
2:30PM -4PM 2:30PM -4PM
6:30PM -8 P 6:30PM -8 P
M
M
2PM
7PM
- 4PM
- 8PM
8 PM
8 (LDR)
0
2
21
2
Unlimited
2PM - 3PM
7-8PM
No
5 (LDR)
1
2
15
0
10AM10PM-
2PM-8PM
Yes
12 (LDR)
24 (LDRP)
0
4
4
0
Flexible
11AM8PM
Waukesha
Memorial Hospital
Yes(2.5)
Yes
Yes
26(LDRP)
0
0
0
0
Unlimited
llAMB:30PM
West Allis
Memorial Hospital
Yes(2)
Yes
No
8 (LDR)
0
3
24
0
9:30 AM-
11AM-
9:30 PM
8PM
I'AGli 2(1
�IEALTH PAGES'
C-SECTION & VBAC HOSPITAL RATES & PRICES
' (1991 figures ^ 4 0 0 patient minimum
. -; :
Vaginal
Childbirth
Price*
Cesarean
Section
Price'
40
$1,400
$3,485
15
38
1,378
3,493
13
36
1,543
. -
3,297
Total
Deliveries
Cesarean
Section
Rate
VA
BC
Rate
(1990)
GREEN BAY
;3,978 ':
,-;12%^v
Bellin Memorial
1,397
10
St. Mary's
736
St. Vincent
,845
MADISON
6,074'^
Meriter
3,045
16
38
1,763
5,120
St. Mary's
3,029
15
31
1,604
3,415
592
14
47
1,589
4,131
1,031
18
32
2,457
5,075
Elmbrook Memorial-Brookfield
835
17
19
2,307
4,284
Menomonie Falls-Community Memorial
985
35
1,981
3,724
Milwaukee County Medical
751
43
2,816
7,694
1,761
4,106
^25;247;v"|
MILWAUKEE
Burlington-Memorial
Columbia
nr.''.''-.'IA :*
...V
16
Oconomowoc-Memoria!
21
St. Francis
1,593
18
16
2,138
3,879
St. Joseph's
3,789
19
20
2,392
5,182
St. Luke's-Milwaukee
1,021
19
44
1,966
5,664
St. Luke's-Racine
2,289
14
44
2,200
3,997
St. Mary's-Milwaukee
2,641
12
38
1,967
4,407
St. Michael
1,056
13
41
2,284
5,046
Sinai Samaritan
4,698
13
28
2,409
5,625
Waukesha Memorial
1,638
15
35
1,862
4,217
West Allis Memorial
1,840
18
27
TOTAL/AVEWGE,: :
^
^
• " 35,322 K •
1,740
t ;
1,978:/^
3,616
:
^r- 4;473'^— 3
The C-section rates f o r
Green Bay, Madison
a n d M i l w a u k e e fall
w e l l b e l o w the
national a v e r a g e ,
w h i l e their VBAC rates
are w e l l a b o v e it.
National C-Section Rate
f National VBAC Rate
ft = City's C-Section Rate
= City's V A Rate
BC
Greenbay
Madison
Milwauke
'This does not include the fee for the baby (healthy, with no complications) which ranges from $500-$800.
PAG F. 27
�E
HALTH PAGES
MEN'S HEALTH
Prostate Alert
A s a man a^es, his prostate, the cluster of glands
/
1
o
% responsible
%
,
i
f o r the
,
o
p r o d u c t i o n Of Semen,
AI^U
i ^u-
m e n
<
sllch i l s t h o s e w l 1 0 h l w e
h a d
bladder or kidney damage, repealed urinary tract infections or
episodes of acute urinarv reten-
A. ^ gradually grows larger. Although this en- *
.
.
lavement is a natural part of the aging process and majority of men, the discomfort,
nn) l c q i m e
.
.
.
.
.
s m
g e l y
lol
t h e
a n ( :
'"'sk l recovery period associated
generally harmless, sometimes important for every
ous problem. That's why it is it can indicate a seri- with surgery must be weighed
against its probable benelits.
man over 40 to learn about his prostate—what's normal,
into surgery simply because your symptoms are annoyThere is usually no need to rush
what's not, how to detect a problem and how to treat it.
ing. Indeed, one alternative to surgery is "watchful
Here's what you need to know now in order to prevent
waiting:" Living with the symptoms to see if they stabitrouble later.
lize over time and become less bothersome on theit
own. If this is not the case and symptoms worsen,
surgery is still an option. It is important to remember,
HOW COMMON ARE PROSTATE PROBLEMS?
though, that the risks of surgery increase as a patient
Fairly common. Around the age of 50 about half of
ages and possibly develops other medical problems.
all men develop prostate problems resulting from the
way the prostate grows. Common complaints:
Surgery: The most common surgical treatment for
• A need to urinate frequently, especially at night
BPH is transurethral resection of the prostate, or TURP, in
• Difficulty starting urination or holding it back
which the doctor trims away excess prostate tissue
• Inability to urinate
using a tiny instrument inserted through the penis. A
• Weak or interrupted urine flow
post-surgerv hospital stay of two to three days is com• Pain or burning din ing urination
monly required.
If you are experiencing any of these symptoms, see
The success rate of TURP is high—about 85 peryour physician without delay. Chances are you simply
cent—with only 15 percent of men needing a repeat
have an enlarged prostate, or benign prostatic hypertrophy
(BPH).
In BPH, as the prostate grows larger, it pushes
HOW PROSTATE ENLARGEMENT
against the urethra and bladder, blocking the normal
INHIBITS URINATION
flow of urine. This condition occurs in 10 million
American men. In fact, more than half of men in the
Normal Prostate
Enlarged Prostate
United States between the ages of 60 and 70 and as
.
Ureter
many as 90 percent of men between the ages of 70 and
Vas deferens
( f r o m testicles) \
||j'
90 exhibit symptoms of BPH. Although the condition is
^kidney)
not life threatening, it can result in urinary tract infection and blood in the urine, and should be taken seriSeminal
^Vesicle
ously. Treatment may be required to relieve symptoms.
Sometimes, though, the symptoms listed above signal a more serious problem such as cancer. Only your
doctor can tell for sure.
o m
WHAT ARE THE MOST COMMON TREATMENT
OPTIONS FOR AN ENLARGED PROSTATE?
In most instances, symptoms resulting f r o m
prostate enlargement develop slowly. Although some
•s
PAGE 28
�H
EALTH PAGES-
TURP within 8 years. An estimated 400,000 TURPs
are performed each year, making TURP the second
most common procedure paid for by Medicare,
topped only by cataract lens replacement.
But the surgery is not without side effects. After
undergoing TURP many men experience retrograde
ejaculation, in which semen travels back into the bladder
rather than out through the penis. This is not medically harmful, but it does render the man infertille and
the sensation may take some getting used to. About 4
to 8 percent of patients become permanently impotent.
Drug Therapy: Men with moderate symptoms may be
prescribed the new drug Proscar, approved by the
Federal Drug Administration (FDA) in June 1992.
This drug actually shrinks the prostate by blocking
production of the male hormone that stimulates
prostate growth. According to researchers, about 70
percent of men who took the drug experienced symptomatic relief. Some of Proscars drawbacks: It takes
effect slowly (it must be taken for one to three months
before improvement occurs), it is expensive, it
obscures prostate cancer test results, and symptoms
generally recur once a man stops taking the drug.
INTERACTIVE V I D E O S G E T PATIENTS M O R E
I N V O L V E D IN TREATMENT D E C I S I O N S
In 1992, The Foundation for Informed Medical
Decision Making, a nonprofit medical education
and research foundation based in Hanover, New
Hampshire introduced an interactive video program
designed to help patients choose a treatment for
benign prostate disease. Combining state-of-the-art
technology with scientific data, the interactive video
offers viewers detailed descriptions of the risks and
benefits of treatment options ranging from monitoring symptoms to surgery.
"It brings patients into the equation and makes
them equal partners with their doctors in the decision making process," says John E. Wennberg,
M.D., a professor of community and family medicine at Dartmouth Medical Center and the creator
D O E S A N E N L A R G E D PROSTATE INCREASE
A M A N ' S RISK O F PROSTATE C A N C E R ?
of the project. "We're beginning to democratize
the doctor-patient relationship."
Patients sit in a designated room where they r
view the video alone or with their spouses. The pro--:
gram begins with a basic overview of benign
Although researchers are still trying to determine
whether BPH increases the risk of prostate cancer, so
far there is no evidence of increased risk.
H O W C O M M O N IS PROSTATE C A N C E R ?
prostate disease, which includes frank comments
from patients who have taken various courses of ,
action. For instance, a man who underwent surgery
to relieve painful urinary blockages tells viewers •
;;
how happy he is with the results. On the flipside/a ; •
patient who rejected surgery in favor of "watchful;-.^
waiting" talks about how satisfied he is with his;
decision—even though it means he has to get ah
aisle seat whenever he goes to the movie theater!.
Prostate cancer has become the most common cancer in American men, second only to lung cancel as a
cause of cancer deaths. Each year more than 130,000
men are diagnosed with cancer of the prostate; M,OOO
will die of it (see cancer chart on p. 31).
Autopsy studies of men in their fifties showed that
one third had microscopic prostate cancers. By the
time men reach their eighties, 75 percent have some
cancerous prostate cells. Still, most cases of prostate
cancer are "silent," and grow very slowly. Consequently, it is said that more men die with prostate cancer than from it.
After the overview, patients use q touchscreen .to x
W H O GETS PROSTATE C A N C E R A N D W H Y ?
tailor information to their individual needs and interests, and fill out questionnaires that are.then put
into the computer in order to get a personalized
t ' ';;
model of their risk factors and treatment options.
Similar interactive programs now exist for
.patients suffering from low back pain, high blood •
pressure and early stage breast cancer.
fhe causes of prostate cancer are not known. But
studies show that prostate cancer occurs mainly in men
over 55; the average age of patients at the time of
diagnosis is 70.
The disease is more common in black men than in
their white counterparts. In fact, black men in the
United States have the highest rate of prostate cancer
in the world.
Although doctors cannot explain why one person
gets prostate cancer and another does not, one area
PAGE 29
�E L H PAGES'
AT
H
that scientists are currently studying is diet. Some evidence suggests that a diet high in fat (including regular consumption ol whole milk and whole milk products like ice cream and certain cheeses) increases the
risk of prostate cancer. In fact, in 1991, the FDA proposed that labels on certain low-fat foods be allowed to
state that diets high in fat are associated with an
increased risk of breast, colon and prostate cancer.
ARLY DETECTION IS T E BEST DEFENSE
H
AGAINST P O T T C N E
R SAE A CR
E
prostate cancer cases (resulting in false negatives) and
signals cancer in up to 40 percent of patients who are
cancer free (resulting in false positives).
Ultrasound rectal probe. This test uses sound waves
sent out by a probe that is inserted into the rectum to
form a computerized picture of the prostate called a
sonogram. Ultrasound can detect cancers that may
have been missed in the other two exams, but it is not
regularly recommended f o i ' screening purposes
because of its expense and high rate of false positives.
Your best bet f o r early detection? Having both the PSA
test and the rectal exam. One study found that the two
tests combined found . O to 55 perceni more prostate
H
cancers than either test alone. Although a doctor cannot diagnose prostate cancer using just these tests, he
or she will take their results inlo account when deciding whether to run further tests.
Since the causes of prostate cancer are not known,
it is not yet possible to know how it can be prevented.
Consequently, medical attention has focused on early
d e t e c t i o n . T h e e a r l i e r the cancel is f o u n d , the
greater the chances o f treatment success. Here is an
HOW IS PROSTATE CANCER DIAGNOSED?
explanation of the various detection methods curII your doctor suspects prostate cancer, lie or she will
rently available.
probably refer you to a urologist, a doctor who specialDigital rectal examination. Both the American Cancer
izes in diseases of the urinary tract and male reproducSociety and the National Cancer Institute recommend
tive system, for a biopsy. Peiiorming a biopsy is the only
that all men age 40 and older have an annual digital
way to make a definite diagnosis. How it works: tlie docrectal examination. In this exam, the physician inserts
tor removes a small amount of prostate tissue, usually
a gloved, lubricated finger into the rectum and feels
with a needle, and sends it
the prostate gland for hard
to a lab, where it is examl u m p y areas (the proceHOSPITAL & LAB PSA PRICES*
ined u n d e r a microscope
dure usually takes less than
for cancerous cells. Often, a
one minute). The problem
MILWAUKEE
Smithkline
$ 89
biopsy can be performed in
with this method of detecTrinity Memorial
$ 55 General Medical
62
a urologist's office, eliminatt i o n is that r u m o r s may
St. Joseph's Hospital
135 M L Health Services
M
98
ing the need for a hospital
lurk in areas a doctor can't
St. Francis Hospital
82
visit.
reach. Additionally, many
54 GREEN BAY
Northwest General
If prostate cancer is contumors in the early stage of
Milwaukee C u t Medical 59 Bellin Hospital
o ny
77
firmed, the next step is to
the disease are missed
St. Mary's Hospital
65 St. Mary's Hospital
65
determine the stage o f the
because thev are too small
W s Allis Memorial
et
42 St. Vincent
62
disease—whether the canto be felt by hand. By the
Lakeview Hospital
45
cer has spread beyond the
time a t u m o r can be felt,
p r o s t a t e . T h i s is accomW u e h Memorial
aksa
44 MADISON
the cancer may a l r e a d y
plished by p e r f o r m i n g adSt. Luke's Medical C ne 36 Meriter-General M d
etr
have spread to other parts
e
62
d i t i o n a l i m a g i n g tests,
of the body, m a k i n g sucElmbrook Memorial
118 St. Mary's Hospital
51
which can include a bone
cessful treatment much less
Columbia
84 University ofWI
55
scan, cat scan or magnetic
likely.
Froedtert Hospital
48
resonance imaging (MRI).
PSA. There is now a simSt. Mary's-Ozaukee
92
Doctors generally recple b l o o d test that meaC m u iy Memorial
o m nt
52
ommend therap\ based on
sures levels o f PSA,
St. Michael's Hospital
98
the stage o f the disease.
prostate-specific antigen,
P R E T I F R N E j.2
E C N; FE E C f
D
They also take into account
in the blood. High levels of
COMMERCIAL LABS
the patient's age and medthis antigen can indicate
Bayshore
52 Medicare's approved payment for
ical historv, tlie probable
B P H or cancer o l the
Dmn
a o
103 PSAs in 1992 was $31.91
risks and benelits of treaiprostate. Although studies
Medical S i n e
ce c
58 Patients without Medicare were ment, the patient's ability
have shown the PSA test to
charged an average of $75
to comply with treatment
be the single most accurate
Metpath
75
and the preferences o f the
detection m e t h o d , it still
'Prices indude blood drawing f
se
Rce
oh
67
patient.
misses up to one t h i r d o f
ill
i!^
I'AGE H
O
�H
-
E L H PAGES
AT
IAT ARE THE COMMON TREATMENT
OPTIONS FOR PROSTATE CANCER THAT HAS
NOT SPREAD BEYOND THE PROSTATE?
Early prostate cancer that is confined to the gland
itself is more than 90 percent curable with surgical
removal of the diseased prostate—radical prostatectomy.
The surgery used to render most men impotent and
many men incontinent, but improvements in surgical
techniques over the last few years have reduced the
impotency rate to 40 petcent. Significant incontinence
now only occurs in about 5 pet cent of cases.
TALKING TO YOUR DOCTOR
Radiation therapy is another treatment option. It is
not as effective as surgery but it is recommended for
older patients who may be poor surgical risks because
of their age and/or the coexistence of other complicating illnesses.
WHAT ARE THE TREATMENT OPTIONS WHEN
CANCER HAS SPREAD BEYOND THE PROSTATE?
Neither surgery nor radiation are effective once the
cancer has spread to the lymph nodes and/or bones.
Hormone therapy that counters the stimulation of
testosterone or surgical castration is commonly recommended to curb the cancer's growth and prolong life,
but there is no known cure.
SHOULD I GET A SECOND OPINION?
Decisions about prostate cancer treatment are complex, and sometimes it's helpful to have the advice of
more than one doctor. In fact, if your doctor recommends surgery, many insurance companies require
that you obtain a second opinion before they will pay
for the full costs incurred. If the second opinion contradicts the first, you may need a third opinion. A
short delay in starting treatment will not reduce the
chances of treatment success.
Patients generally want to learn all they can
about their condition and treatment choices so they
can take a more active part in decisions about their
medical care. Since treatment for prostate cancer
sometimes affects sexual activity and bodily functions, such as urination, it is especially important to
weigh the risks and benefits of different treatments.
Although written material is a good start, it cannot take the place of discussion with your doctor.
Your physician is best qualified to answer questions
about the extent of the cancer, how it can be treated, how successful the treatment is expected to be
and how much it is likely to cost. It is helpful to
make a list of questions before you see your doctor:
Our thanks to David W. McDermotl, M.D., F.A.C.S., Anne
Arundel Medical Center, Annapolis, MD for reviewing this
article.
ESTIMATED CANCER INCIDENCE
AND DEATHS - BY SITE, 1992
Here are some questions you may want to ask:
:
• What are my treatment choices?
.
• What are the expected benefits of each treat- "• , '
ment?
• What are the risks and possible side effects of
each treatment?
• How will the treatment affect my sex life?
• If I have pain, how will the treatment help me? •
• Will I need to change my normal activities? For
how long?
• How often will I need to have follow-up exams?
:
Taking notes can make it easier to remember
what the doctor says. Some patients find it also helps
to have a family member or friend along to take part
in the discussion, to take notes or just to listen.'
There's a lot to leam about prostate cancer and
its treatment. Don't feel like you need to understand
everything the first time you hear it. You will have
many opportunities to ask your doctor to explain
things that are not clear. Use them.
PAGE 31
INCIDENCE
DEATHS
Melanoma of the skin
17,000
4,100
Oral
20,600
5,175
Lung
. 102,000
93,000
h '.Breast
1,000
300
Pancreas
13,900
12,000
Stomach
. 15,000 •
» 8,000 •
Colon & rectum
79,000
28,000
Prostate
132,000
34,000
Urinary
54,700
, 12,700
Leukemia & lymphomas
49,500
25,500
All other
80,300
51,325
All sites
.565,000
275,000
�UEALTH PAGES
-37—
Board
Certification
Doctor
Accepts
Medicare
Assignment
1
Primary
Hospital
Affiliation
Needle
Biopsy
Ultrasound
Biopsy
2
*•• ' - *
•^ •
'
Transurethral
Resection
Radical
Prostatectomy
Special Interests
l
;
:,--- i > ' ';•'<:.••.;•.''.
GREEN BAY
Kennedy, Timothy
1991
Ys
e
Marlett, Myron Max
1978
Schiebler, John Charles
St. Vincent
$2,000
$3,500
200
2,000
200
200
2,000
200
200
2,000
3500
Bellin
149
226
1,803
3,381
149
226
1,803
3,381
2,300
4,410
S200
Ys
e
200
1974
Ys
e
Sonneland, Arthur Malcom III
1985
Ys
e
Troup Charles W.
1974
Ys
e
Ys
e
MADISON
, -wi
3,500
St. Vincent
....
3,500
$200
Windsor, Richard
.* '• .-•.'•'..''.„'-.
v
- i
v
.' j - .
Pediatric Otology & Stones
Urinary Incontinence
^
Bruskewitz, Reginald C
1981
Ys
e
University
230
Graf, Richard Andrew
1967
N
o
Meriter
214
151
2,461
4,280
Greenberg, Earl Barry
1971
N
o
Si. Mory's
265
196
2,232
3,786
Kuglitsch, Michael Ervin
1987
N
o
Meriter
214
151
2,461
4,280
Licklider, Gary Melvin
1979
N
o
St. Mory's
265
196
2,232
3,786
Mahler, John Herbert
1975
N
o
Meriter
214
151
2,461
4,280
Malek, Gholam H.
1973
N
o
Meriter
214
151
2,461
4,280
Messing, Edward M
1980
Ys
e
University
230
2,300
4,410
Moon, Timothy David
1985
Ys
e
University
230
2,300
4,410
Smith, Franklin Leo
1989
Ys
e
University
230
2,300
4,410
Uehling, David T
1967
Ys
e
University
230
2,300
4,410
Waters, Raul F
1970
N
o
St. Maiy's
265
196
2,232
3,786
Wegenke, John D.
1978
N
o
Meriter
214
151
2,461
4,280
MILWAUKEE
^;
••Sr.-/"'.'<. •'
Prostate, Bladder Tumors & Stones
Lithotripsy & Prostate Ultrasound
•.(-'•: i . f'v;
Andres, Francis 1.
1969
N
o
W s Allis Mem. 143
et
280
1,958
3,500
Annesley, William H., Jr.
1984
N
o
143
280
1,958
3,500
'sgun, Frank Phillip
1986
N
o
191
273
1,908
3,338
rtourne, Charles W.
1971
N
o
200
2,100
3,400
Bourne, Richard B.
1968
N
o
175
92
1,742
3,132
Dixon, Christopher
1992
N
o
Froedtert Mem.
191
273
1,908
3,338
Ferber, Thomas
1985
Ys
e
Waukesha Mem. 165
95
1,834
N/A
Fine, Stuart W.
1971
N
o
196
2,100
3,675
St. Luke's
PAGE 'i'Jt
273
Cancer of Genitourinary System
BH
P
Prostate & Vasectomy Reversal
�H
I A T PAGES'
E LH
Board
Certification
Accepts
Medicare
Assignment'
Flanagan, W. Patrick, Jr.
1990
Yes
Harkavy, Raymond
1963
Hein, Richard C
Doctor
Primary
Hospital
Affiliation
Needle Ultrasound
Biopsy
Biopsy
2
Transurethral
Resection
Radical
Prostatectomy
Waukesha Mem. $165
$95
$1,834
N/A
N/A
1,624
N/A
1977
Ys
e
Waukesha Mem. 165
95
1,834
N/A
Herrman, Richard A.
1976
Ys
e
426*
426*
2,160
N/A
Hodgson, Norman B.
1961
N
o
175
92
1,742
3,132
Jacobsohn, Harold A.
1976
Ys
e
121
Kearns, John Westhofen
1958
N
o
Lawson, Russell K.
1972
Lepor, Herbert
i
$2,384
Ys
e
Special Interests
I
1,621
150
N/A
1,690
3,350
N
o
Froedtert Mem. 191
273
1,908
3,338
Urologit Oncology
1987
N
o
Froedtert Mem. 191
273
1,908
3,338
Prostatectomy & B H
P
MacGillis, Alexander J.
1968
N
o
143
280
1,958
3,500
Manuel, Emmanuel S.
1981
Ys
e
250*
250*
1,485
2,342
Otto, Samuel J.
1983
N
o
St. Luke's
273
196
2,100
3,675
Pollard, Randle E.
1961
Ys
e
Sinai/Samaritan
Pope, John Francis
1990
N
o
143
280
1,958
3,500
Rasmussen, Robert James
1967
Ys
e
184
204
2,076
N/A
1958
Ys
e
Sinai/Samaritan 273
196
2,100
3,675
Slocum, Peter
1990
N
o
150
N/A
1,690
3,350
Usow, Barry H.
1976
N
o
273
196
2,100
3,675
1
Walsh, John Patrick
1978
N
o
175
92
1,742
3,132
A
Weisenthal, Charles Leonard
1964
Ys
e
327*
327*
1,825
N/A
'Silbar, John David
^WRAGE^CHARGElfSi
Columbia
Columbia
St. Joseph's
'mm
:%030 :
U s of December 1992
^Note: Some of the lower priced ultrasound exams may indicate a separate radiologist charge.
* Needle and ultrasound biopsies are billed at this combined price.
PACE 33
:
Prostate Disease & Impotence
BPH, Prostate Ultrasound & Biopsy
mmmam
�I A T PAGES"
E LH
H
Transurethral Resection (TURP)
Number
Average
of Patients
Charge
Bellin Memorial
89
$3,256
St. Mary's
38
3,383
St. Vincent
55
Meriter
St. Mary's
Radical Prostatectomy
Number
Average
of Patients
Charge
MADISON
V
'
'''''
19
$8,279
3,643
17
8,491
84
3,868
31
9,572
84
2,579
21
6,592
23
13,416
27
14,978
:
'
University ofWI
MILWAUKEE U^^M^l
A"['J-h
Burlington-Memorial
20
4,469
Columbia
67
3,506
Elmbrook Memorial-Brookfield
60
3,319
Froedtert Memorial
27
6,385
Lakeview
24
2,965
Menomonie Falls-Community Memorial
83
2,406
Oconomowoc-Memorial
18
3,501
St. Francis
38
3,636
11
7,504
St. Joseph's
107
3,713
17
7,928
St. Luke's-Milwaukee
77
3,694
24
9,338
St. Mary's-Milwaukee
79
3,630
St. Mary's-Ozaukee
11
3,555
St. Michael
47
4,201
Sinai Samaritan
33
5,532
Trinity
21
3,114
Waukesha Memorial
71
3,877
West Allis Memorial
107
3,701
19
8,408
Milwaukee County Medical
Northwest General
St. Luke's-Racine
^ ^3,724 ; V;
r
I'AGK :vi
;
;
-
8,921
{
�I AT P GS
E LH A E
WOMEN'S HEALTH
Breast Cancer:
What'ibu Need to Know
B
reast cancer is the most common type of
J
1
a s ea,l
as
>' i
,,,ssihk
vi
h
,om M
:- \ ; P '
treatment, the outlook tor cure is
cancer amons; American women. Experts good. According to the National
, *"
. . .
Cancer Institute (NCI), the five. . i ] rate ior w m n
o e
elopi estimate that a woman in this country
stands a she lives to age percent) chance of dev- " .
°
"' P
assumingone in nine (11 r85.
/
beyond the breast is 90 percent.
In fact, each year in the United States, more than
ing breast cancer at some point in her life, when the cancer has spread to
175,000 women are diagnosed with breast cancer—
yeai
sul v va
h o s c t l , m
r s
have
t
s
read
1
v
that's equivalent to a woman learning she has breast
cancer every three minutes. An estimated 46,000
women will die of the disease in 1992 alone, according
to the American Cancer Society (ACS).
nearby lymph nodes under the
arm, the rate decreases to 71 percent, dropping drastically to 18 percent once the cancer has spread to the liver, lungs or brain.
REAST CANCER DETECTION PLAN:
A E I A C N E SOCIETY GUIDELINES
M RC N A C R
B
WHO'S AT RISK?
Medical science has yet to fully understand what
[1] MAMMOGRAPHY
factors predispose a woman to breast cancer. But as a
Beginning at age 40, a woman should have a mamwoman ages, her risk increases. Other possible risk
mogram every 1 to 2 years, annually after age 50.
factors include:
What is a mammogram? A mammogram is an x-ray
• Having a mother or sister who has had breast
of the breast. It can reveal tumors too small to be felt
cancel, especially if the cancer occurred before
by hand and can show other changes in the breast that
menopause
may suggest cancer. When high-quality equipment is
• Early menstruation (before age 12)
used and the x-rays are read by well-trained radiologists, 85 to 90 percent of cancers are detectable. Of the
• Late menopause (55 or older)
10 to 15 percent ol cases that don't
• Never being pregnant or a first
show up on mammograms, most occur
pregnancy after age 80
in younger women with dense, fibrous
It is important to note that all of
Breast Cancer
breast tissue in which lesions are diffithese factors combined account for only
Risk by Age
cult to spot.
25 percent of all breast cancers—a full
Ae
g
Rs
ik
75 percent of women who develop
How a mammogram works: The breast
breast cancel have none of these risk
is placed between two plates and some
by age 30
1 in 2,525
factors.
pressure is applied to ensure a clear picby age 40
1 in 217
ture. Women may experience varying
by age 50
lin 50
WHAT IS THE BEST DEFENSE
degrees of discomfort during breast
by age 60
lin 24
GAINST BREAST CANCER?
compression. Usually, two x-rays artby age 70
lin 14
EARLY DETECTION!! To ensure
taken of each breast, one f rom the top
by age 80
Tin 10
the widest range of treatment options,
and one from the side. Although some
by age 85
lin 9
it is important to detect breast cancer
women are concerned about the risk of
PAGE 35
�E
HALTH PAGES'
cancel' posed by radiation exposure during mammography, the actual risk is ven small.
A CONSUMER'S GUIDE
TO MAMMOGRAPHY
Two important issues to consider when choosing a mammography facility are quality and cost.
[2] P H Y S I C A L B R E A S T E X A M
All women should have breast examinations as part
of their routine checkups. Women 40 and older should
have them annually.
Periodic breast examination by a health prolessional is an important step in early detection. During the
exam, the doctor leels the breast and underarm with
his or her lingers, checking lor lumps. This is called
palpation.
O n e sign of a facility's quality: A m e r i c a n College of
Radiology (ACR) accreditation. Facilities accredited by ACR
have had their equipment, personnel and procedures evaluated and approved by the college. Their doctors and other staff
members are specially trained to perform and read breast xrays. And their equipment and procedures are designed to
provide high-quality mammograms with the lowest possible
amount of radiation exposure.
However, since accreditation is voluntary, it is possible for
a facility to be of high quality and not be accredited by ACR.
[3] B R E A S T S E L F - E X A M I N A T I O N (BSE)
Beginning at age 25, women should do monthly
breast self-examinations.
Women's breasts come in many sizes and shapes.
Age, the m o n t h l y m e n s t r u a l cycle, p r e g n a n c y ,
menopause and taking birth control pills or othet hormones can all result in breast changes. It is important
to learn what is normal fbr you. This can be accomplished with regular BSE. The exam is easy to do, and
as the name states, you do it yourself—making it a
good way to take charge of your health.
BSE should be done once a month after menses.
(See page H9 Ibr step-by-step instructions on how to do
BSE.) Being familiar with the usual appearance and
feel of your breasts on a monthly basis will make i l easier to notice any changes from month to month. I f you
discover anything unusual, such as a lump, discharge
from the nipples, or dimpling or puckering of the skin,
see your doctor at once. Although many women have
irregular ot "lumpy" breasts, and many doctors believe
that nearly all women will have some benign breast
changes (changes in a woman's breasts that are not cancerous) after age 30, any change is best diagnosed by
your doctor.
If you are considering a facility that is not ACR accredited, you
should ask the f o l l o w i n g questions to help you evaluate
whether the facility is a good one.
/. Is the x-ray equipment specifically designed for mammography? These are called dedicated mammography machines
and provide higher quality breast x-rays than a machine that
also takes x-rays of the bones and other parts of the body.
2. Are your x-ray technologist a n d radiologist trained in
mammography? Technologists perform the exam and must be
trained to position the breast correctly to get a good pic'
1
Radiologists are medical doctors who interpret the rest
the mammogram; they should have taken special course,
mammography and be board certified (which indicates th
they have been properly trained and have passed the neces^
sary oral and written tests).
3. Does the radiologist read at least 10 mammograms a
week? Radiologists who read fewer than that number may be
i
less skilled at identifying the signs of a cancerous tumor.
4. Is the mammography
machine calibrated
(tested for cor-
rect measurements and radiation doses) at least once a year?
Feel free to call and ask these questions before you make
an appointment. A qualified facility should be able to answer
your questions easily. If the facility's representative is reluctant
to answer your questions, look for another facility.
HOW IS BREAST CANCER DIAGNOSED?
A biopsy is the only surefire way to know whether a
breast lump or suspicious area seen on a niammogram
is, in fact, cancer. In a biopsy, the doctor surgically
removes all or pan of the lump and sends it to a laboratoiy for analysis.
The good news: Four out of five breast lumps are
not cancerous. Often the lump is a fluid-filled cyst,
which can most likely be drained by fine needle aspiration. I f the lump is a benign tumor, i l often can be surgically removed w i t h no f u r t h e r p r o b l e m s . Some
lumps may just need to be monitored regularly for
changes.
II the biopsy shows that the lump is cancer, othet
l a b o r a t o r y tests may be p e r f o r m e d l o d e t e r m i n e
whether the cancer has spread from the breast to other
parts of the body.
\'AC\i 'Mi
DOLLARS AND SENSE
The cost of a mammogram ranges from $ 4 9 to $ 1 8 9 . In
the last several years, many insurance companies have begun
to pay for routine screening mammograms as well as for diagnostic mammograms to evaluate a specific lump. Medicare
reimburses up to $55 for one mammogram every other year.
When comparing mammogram prices, keep in mind thai a
higher priced mammogram can be easily justified if a facility
provides additional services such as a physical breast exam
and instruction in breast self-examination.
i
�Results
Accepts
Breast Self-Exam MomniO' UltraAR
C
Accreditation Exam Instruction graphy sound Medicare Given To Wolk-lns
Price
Given By Given By
Price Assignment' Dr/Patient Welcome
Status
Center
Evening &
Weekend
Hours
Accepts
Self
Referral
•• i f ' V :
Beaumont Clinic
Approved
Dr
Dr
$107
$244
No
Dr
N
o
No
N
o
Bellin Memorial Hospital
Pending
None
None
97
132
§
Dr
No
Yes
No
St. Mary's Hospital
Pending
None
Video
99
160
§
Dr
Ys
e
N
o
N
o
St. Vincent Hospital
Approved
None
Video
99
160
§
Or
No
No
No
'-•*•'.'V' "
..-••v.;.-;... •'
y..'.
N
o
University of Wisconsin
150
123
N
o
Both
No
Yes
Yes
Nurse
Nurse
178
282
Yes
Both
No
No
Yes
None
None
189
192
§
Dr
No
N
o
N
o
Approved
St Mary's Hospital
Nurse/Video
No
Meriter Hospital
None
Approved
Dean Medical Center
Nurse
Nurse/Video 50/140*
247
Yes
Both
No
No
Yes
Approved
Dr/Tech
wm
Tech
120
63
Yes
Both
N
o
Evng
Yes
None
None
124
272
Yes
Both
No
Evng
Yes
120
153
Yes
150
252
§
Yes
Yes
Yes
122
N/A
:
r MILWAUKEE V ^ S * V - ;
Breast Diagnostic Clinic
Memorial Hospital of Burlington Pending
Coleman Soref Center
Approved
lumbia Hospital
Approved
Tech
Tech
^pbrook Internal Medicine
Approved
Plbrook Memorial Hospital
Approved
Tech
Tech/Video
138
222
§
Dr
No
Yes
No
Fine-Lando Clinic
Approved
Dr
Video
110
121
Yes
Both
N
o
Wkend
No
Kurten Medical Group
Approved
Dr
Dr/Video
85
171
Yes
Dr
No
Wkend
No ,
Menomonee Falls, Comm Mem
Pending
Tech
Video
55/137*
182
Yes
Both
N
o
Evng
Yes
Milw County Medical Complex
Approved
Tech
TechAideo
121
170
Yes
Dr
No
No
Yes,
Milwaukee Medical Clinic
Approved
Dr
Video
145
108
N
o
Dr
N
o
Yes
No
Moreland Medical Center
Approved
100 .
188
No
Newtowne Medical Group
Approved
Tech
TechAideo
120
153
Yes
Dr
Yes
No
Yes
Oconomowoc Memorial
Approved
Nurse
NurseAideo 65/145*
251
§
Both
No
No
Yes
Racine Medical Clinic
Approved
74
168
Yes
St Francis Hospital
Approved
159
174
§
Dr
No
Evng
No
St. Luke's Medical Center-Milw
Approved
158
215
Yes
Dr
No
Evng
Yes
St. Luke's - Racine
Approved
Tech
83
162
Yes
Both
No
Wkend
Yes
St. Mary's Hospital - Milw
Approved
Nures
278
Yes
Both
N
o
Yes
Yes
St. Mary's Med Center - Racine
Approved
94
159
Yes
St. Michael Hospital
Approved
Nurse
Video
112
171
§
Dr
No
Yes
Yes
Sinai Samaritan Medical Center
Approved
Tech
Video
49/169*
220
Yes
Both
Yes
No
Yes
nity Memorial Hospital
Pending
Nurse
NurseAideo 75/161*
225
Yes
Both
N
o
No
Yes
^^gkesha Memorial Hospital
Approved
None
Video
108
232
§
Dr
No
Yes
Yes
^ H t Allis Memorial Hospital
Approved
Tech
Tech
184
246
Yes
Dr
Yes
Yes
Tech
None
DrAech VideoAech
Video
NurseAideo 70/151*
nts with sCTptoim j ^
1
As of December 1992
PAGE 37
,
;
�E L H PAGES'
AT
H
WHAT ARE THE TREATMENT OPTIONS
FOR BREAST CANCER?
Treatment for breast cancel depends on tbe type of
cancel and bow far it has spread, as well as on a
woman's age, menopausal status and general health.
T h e doctor will develop a treatment plan to Fit a
man's individual needs.
Mefore starting treatment, a woman might want a
second doctor to review her diagnosis and treatment
plan. A short delay in beginning treatment will not
reduce the chances of treatment success. There are a
number of ways to find a doctor for a second opinion:
TALKING TO YOUR DOCTOR
Concerns about what the future holds—
as well as worries about tests, treatments,
1
hospitalization and medical bills—are common. Talking with doctors and nurses may
help to calm those fears and ease confusion. Asking questions about her condition
and treatment choices can also help a
woman take an active part in decisions
about her medical care. Here are some
examples of questions to ask the doctor:
•
What are my treatment choices?
•
What are the benefits of each treatment?
•
What are the risks and side effects of
each treatment?
•
How will I look after treatment?
•
Will I need to change my normal activities? For how long?
•
Can I keep working during treatment?
•
How often will I need to have checkups?
•
What's the cure rate/prognosis?
Patients often find it helpful to keep a
written list of questions to ask the doctor.
Taking notes during visits can help patients
remember what was said. Some people
find it beneficial to have friends or family
members accompany them on these visits.
Never be afraid to ask the doctor to
explain something that is not clear.
• Call the local medical society or nearby hospitals.
Refer to page 40 for a listing of focal oncologists and
breast cancer surgeons.
• Ask friends tor recommendations.
Methods of Treatment
T h e t r e a t m e n t o p t i o n s f o r breast cancer are
surgery, radiation therapy, chemotherapy and hormone therapy. The doctor may recommend just one
method or a combination, depending on the patient's
needs. In some cases, the patient may be referred to
other doctors for dillerenl therapies.
S U R G E R Y : This is the most common treatment
for breast cancer. There are several different types of
surgery:
• Radical mastectomy removes the breast, chest
muscles, all o f the lymph nodes under the arm and
some additional fat and skin. This operation was the
standard treatment for many years. It is still used on
occasion, but for most patients, less extensive surgery
has been shown to be just as effective.
• M o d i f i e d r a d i c a l mastectomy removes the
breast, the lymph nodes under the arm and the lining over the chest muscles (leaving the muscles in
tact). This is the most common surgical treatment
for breast cancer.
• Lumpectomy removes just the breast lump and
usually the lymph nodes under the arm. About two
to three weeks after surgery, patients begin radiation
therapy, which generally consists o f a live-day-a-week
regimen f o r six weeks. Lumpectomy is a c o m m o n
treatment choice for women who are diagnosed with
early stage breast cancer. Research has shown that
when c o m b i n e d with r a d i a t i o n , lumpectomy is as
effective as mastectomy in treating early stage breast
cancer.
A D J U V A N T T H E R A P Y : A doctor may advise a
woman with early stage breast cancer to supplement
surgery and/or radiation with chemotherapy or hormone therapy. Called adjuvant therapy, this additional
regimen can help prevent cancer f r o m recurring by
killing cancer cells that may slill be lingering in the
body undetected.
Chemotherapy uses drugs to kill cancer cells. These
drugs may be taken orally or injected into a muscle or
vein. Chemotherapy is administered in cycles—a treatment period followed by a rest period, then another
series o f treatments, and so on. Although it depends
upon the type o f drugs used, chemotherapy generally
does not require a hospital stay.
Hormone therapy keeps cancer cells from getting the
hormones they need to grow. Drugs may be administered to alter the way the hormones work or surgery
may be p e r f o r m e d to remove organs (such as the
ovaries) that manufacture the ofFending hormones.
I'AGE 38
�IEALTH PAGES'
R E S O U R C E S F O R BREAST C A N C E R
PATIENTS A N D THEIR FAMILIES
General information about breast cancer is widely available. Some helpful
resources are listed below. You may also
want to see what your local library has to
offer and contact support groups in your
community.
Health professionals and patients alike
have learned the value of mutual support
among cancer patients. When someone
who has a serious illness feels frightened
or depressed, it often helps to talk about
those feelings with a person who has
been through a similar experience. A
patient's family members and loved ones
can also benefit from this type of support.
• CANCER INFORMATION SERVICE
(1-800-4-CANCER) is a National Cancer
Institute nationwide telephone service set
up to answer questions from the public.
Many informative booklets on all aspects
of breast cancer are available free of
charge.
• AMERICAN CANCER SOCIETY (ACS)
is a nonprofit organization that offers a
variety of services. The group's Reach to
Recovery program is specially designed
for breast cancer patients. Trained volunteers, all of whom have had breast cancer themselves, visit patients and provide
emotional support before and after treatment. Contact your local chapter for
more information.
Green Bay: 1600 Shawano Avenue
414-496-9250
Madison: 1 Point Place 608-833-4555
Milwaukee: 11401 Watertown Plk Rd.
1-800-227-2345
• ENCORE, sponsored by the YWCA,
is a national breast cancer surgery recovery program that incorporates exercise
and group discussions. With her doctor's
permission, a woman may sign up for the
program beginning the third week after
surgery. Contact your local chapter for
more information.
Green Bay: 414-432-5581
Madison: 608-257-1436
Waukesa: 414-547-1872
• NATIONAL ALLIANCE OF
BREAST CANCER ORGANIZATIONS
(NABCO) provides breast cancer
patients with information to help them
make decisions about treatment. For information write to NABCO at 1180 Avenue
of the Americas, New York, N.Y. 10036
or call 212-719-0154.
• Y-ME (800-221 -2141) is a toll-free
hotline staffed by women with breast cancer. In addition to providing information,
Y-ME can direct callers who want to volunteer time or money to a breast cancer
organization.
BREAST SELF-EXAMINATION
Breast self-examination should be done once a month so you become familiar with the usual appearance and feel of your breasts. Familiarity makes it easier to notice any changes in the breast from one month to another. Early discovery of a change from what is "normal" is the main idea behind BSE. The outlook is much better if you detect cancer in an early stage.
If you menstruate, the best time to do BSE is 2 or 3 days after your period
ends, when your breasts are least likely to be tender or swollen. If you no
longer menstruate, pick a day, such as the first day of the month, to remind
yourself it is time to do BSE.
Here is one way to do BSE:
Stand before a
mirror. Inspect
both breasts for
anything unusual
such as any discharge from the
nipples or puckering, dimpling, or
scaling of the
skin.
1
The next two steps are designed to
emphasize any change in the shape or
contour of your breasts. As you do
them, you should be able to feel your
chest muscles tighten.
2
Watching
closely in the
mirror, clasp
your hands behind
your head and press
your hands forward.
3
Next, press
your hands
firmly on your
hips and bow
slightly toward
your mirror as
you pull your
shoulders and
elbows forward.
Some women do the next part of
the exam in the shower
because fingers glide over
soapy skin, making it
easy to concentrate on
the texture underneath.
PAGE :i9
Raise your left
arm. Use three
or four fingers
of your right hand
to explore your
left breast
firmly, carefully and thoroughly.
Beginning at
the outer edge, press the flat part of
yourfingersin small circles, moving
the circles slowly around the breast.
Gradually work toward the nipple. Be
sure to cover the entire breast. Pay
special attention to the area between
the breast and the underarm,
including the underarm itself. Feel
for any unusual lump or mass
under the skin.
4
Gently squeeze
the nipple and
look for a discharge. (If you have
any discharge during the month—
whether or not it is
during BSE—see
your doctor.) Repeat steps 4 and 5 on
your right breast.
Steps 4 and 5 should be repeated
lying down. Liefiaton your back
with your left arm over your head
and a pillow or folded towel under
your left shoulder. This position flattens the breast and makes it easier to
examine. Use the same cir^ .^^k cular motion described
earlier. Repeat the exam
on your right breast.
"
s
�I
E
HALTH PAGES'
Doctor
Accepts
New
Established
Medicare'
Patient
Patient
Board
Certification Assignment Office Visit Office Visit
GREEN BAY
Hospital
Affiliation
Special Interests
•= * ( v i ; <.
'
Bayer, Gerald
1979
N
o
Blank, Jules
1985
N
o
Koch, Paul
1977
N
o
45
St. Vincent
McGovern, James
1983
N
o
45
St. Vincent
MADISON
545
5135
95
;
',}..
St. Vincent
Pain Control & Adult Hematology/Oncology
.
;
;
'^vSf.y:, V;W'>:'::^'''•^^• -^>^.•^•^^'.^:: '••v•^;.;'i
Carbone, Paul
1979
Ys
e
138
11
0
Univ of WI
Diggs, Charles
1977
N
o
135
97
St. Mary's
Ershler, William
1981
Yes
138
101
Univ of WI
Kohler, Peter
1985
N
o
141
107
Meriter
Longo, Walter
1987
Ys
e
138
101
Univ of WI
Prendergast, Edward
1981
N
o
135
97
St. Mory's
Robins, Henry
1981
Yes
138
101
Univ of WI
Breast Cancer, Systemic Hyperthermia & Lymphoma
Anderson, Tom
1977
N
o
159
115
Bomzer, Charles
1985
N
o
100
53
Borden, Ernest
1975
Yes
159
115
Chitambar, Christopher
1983
N
o
159
115
Milw County
Leukemia, Lymphoma
Divgi, Apt
1983
N
o
73
St. Luke's-Milw
Dubner, Howard
1977
Yes
160
50
Geimer, Nicholas
1975
Yes
160
50
Columbia
54
Sinai Samaritan
Trinity
Breast Cancer, Clinical Trials & Prevention
Aging & Cancer
Bone Marrow Transplant
MILWAUKEE • ' • ^
Hurwitz, Lawrence
Yes
Kallas, Gerald
1973
N
o
155
85
Oesterling, Kurt
1983
Yes
160
50
Ritch, Paul
1979
N
o
159
115
Yes
105
69
Schuetz, Michael
' As of December 1992
PAGE 40
Columbia
Breast Cancer & Hematologic Malignancies
�H
I A T PAGES'
E LH
ONCOLOGISTS
New
Established
Accepts
Patient
Patient
Board
Medicare
Certification Assignment' Office Visit Office Visit
Doctor
Taylor, Robert
Vukelich, Majorie
Weissman, David
92
160
50
N
o
1985
151
159
115
•-• ' V •. • •. • •^
:, . . n ^ . s ' - ' r
AVERAGE PRICE
VRADIATIONjprllC< OLOGIST
Special Interests
Sinai Samaritan
$85
Yes
1987
$155
No
1983
u
:
:':•- *
No
Singson, Juonito
Hospital
Affiliation
illlllil
1-
lllll
Cooley, Gregory
No
178
N
o
178
St. Luke's-Milw Breast Cancer & Bone Marrow Transplant
mm
i
•V
^
^
^
1
t
.••VT '. »:'^: ;?;: ;;r?'' .>'?)..j-
.
- : "-.:>•;(•''::/•-..-^v,;-•<
,
;
^
^
^
^
^
^
69
Schlise, Sally
:
69
Yes
1980
Stitt, Judith
Univ of WI
Yes
Steeves, Richard
Univ of WI
Bruckman, James
1977
No
178
69
Richards, Marcia
1974
N
o
178
69
n y Ir GUI DE" TO LOG AL SU RGEON S
1
response.
Accepts
Board
Medicare Breast
Certification Assignment' Biopsy
Doctor
1
GREEN BAYMHy
>• -,.'
Lumpectomy
r f>.
Radical
Mastectomy
Hospital
Affiliation
Special Interests
^'•—o''"•'•i
k-' •••.'v". : *:' • 'Z
v
' • • i ; : : •. v. .«&i,:.' «-.-J" * .
u
Anderas, Per
1987
Yes
$424
$1,355
$1,750
Bernacki, Michael
1988
No
500
•1,700
1,900
- St. Vincents
Geocaris, Thomas
1975
Yes
424
1,355
1,750
Bellin Mem.
Laparoscopic Surgery
1980&1990
No
530
1,180
1,920
St. Mary's
Vascular Surgery
N
o
530
1,180
1,920
St. Mary's
Pediatric and Thoracic Surgery
Manke, David
Reckard, Paul
?^bis6N^4t%*v
Vascular & Laparoscopic Surgery, Endoscopy
:
j
1969
No
615
2,153
2,328
St. Mary's
Decock, David
1978
N
o
615
2,153
2,328
St. Mary's
1964
No
714
2,238
2,249
Meriter
1985
No
714
2,238
2,249
Meriter
Vega, Roland
1
1
,
:
t ^ V - ^ ' ^ ' ^ ; ..V:.v^fvis.;.-ite->'-..fh
1
•W'.-l- .'- .....
Bernhardt, Louis
Mackman, Sanford
Laparoscopic & Endoscopic Surgery
As of December 1992
PAGE 41
�EALTH PAGES'
H
Accepts
Board
Medicare Breast LumpCertification Assignment' Biopsy ectomy
Doctor
Radical
Mastectomy
Hospital
Affiliation
Special Interests
Wenger, Ronald
1978
N
o
$615
$2,153
$2,328
St. Mary's
Wolberg, William
1962
Yes
650
2,100
2,300
Univ of WI
Altman, David
1969
Yes
400
1,600
1,600
Sinai Samaritan
Battista, Joseph
1989
Yes
Bowman, John
1972
Yes
463
1,574
1,759
W s Allis
et
Davies, William
1972
N
o
426
1,650
1,700
Waukesha Mem
Ekbom, Gregory
1982 & 1990
N
o
400
1,600
1,600
W s Allis
et
Farrell, David
1985
N
o
500
1,625
2,000
St. Luke's-Milw
Flynn, George
1962
Yes
Fox, Paul
1974
N
o
426
1,650
1,700
Waukesha
Grieshop, Joseph
1972
Yes
463
1,574
1,759
W s Allis
et
Hardacre II, Jerry
1991
Yes
493
1,818
2,122
St. Mary's -Racine
Jan, Mazhar
1974
Yes
440
1,900
1,617
St. Francis
Kelley, William
1974
Ys
e
440
1,760
1,760
St. Joseph's-Milw
Yes
463
1,574
1,759
W s Allis
et
1983 & 1991
Yes
533
1,843
2,084
St. Mary's-Racine
Hand Surgery
1988
Yes
440
1,600
1,760
St. Luke's
Breast Disease
1978 & 1987
No
458
1,590
1,870
Trinity Mem
Pavlovitz, Gwenn
1987
No
Pequet, Archebald
1987
N
o
426
1,650
1,700
Waukesha Mem
Sattler, Marvin
1956
Yes
450
880
1,760
Sinai Samaritan
Schmidt, Robert
1973
No
Schmitt, David
1988
No
335
1,650
1,700
Waukesha Mem
Sleight, Douglas
1976 & 1985
N
o
504
1,725
2,016
Trinity Mem
Stobbe, Knud
1966 & 1981
Yes
450
1,700
St. Francis
1973
Yes
460
1,380
1,840
St. Mary's-Racine
Breast Carcinoma, Colon Carcinoma, Trauma
No
606
1,568
2,398
Menomonee Falls
Minimally Invasive Surgery
Breast Disease
MILWAUKEE . ' . ^
Kispert, John
Malinowski, Rodney
Mikkelson, Wendy
Mittal, Ram
Tiffany II, Joseph
Timm, Mark
Breast, Gallbladder, Stomach, Colon, Thyroid
St. Joseph's
Endocrine, Vascular Surgery
Breast Cancer, Colon Cancer
Vascular Surgery
Colon & Rectal Surgery
Vascular Surgery
General & Vascular Surgery
Laser & Laparoscopic Surgery
Breast Disease, Breast Cancer
Vincent, Dennis
1989
No
400
1,600
1,600
W s Allis
et
Vascular & Laparoscopic Surgery, Angioplasty
Willson, Donald
1977 & 1986
Yes
438
1,553
1,752
Columbia
Laser & Laparoscopic Surgery
1976 & 1986
N
o
400
1,600
1,600
St. Joseph's
Woods, James
:
1
AVER/^E PRICE-
^
*•, f
As of December 1992
PAGE 42
Colonoscopy, Endoscopy, Vascular Surgery
�I
E
HALTH PAGES'
LUMPECTOMY
MASTECTOMY
Nme
u br
of Patients
Average
Charge
» ^
$3,552
110
$1,401
27
3,814
3
1
1,770
39
3,729
55
1,682
Meriter
33
4,011
12
$3,486
212
1,523
St. Mary's
45
3,213
22
2,229
200
1,260
University of WI
63
4,852
30
3,970
Nme
u br
of Patients
Htii«
27
St. Mary's
St. Vincent
Nme
u br
of Patients
Average
Charge
Hospital
Bellin Memorial
Average
Charge
OPEN BIOPSY OF BREAST
(Outpatient)
:MADISON:i% - r ? ^ ^ .|VS
;
••-x::: \;'--:y
MILWAUKEE !
•
Burlington-Memorial
12
5
1
3,104
90
1,421
1,807
1,725
!
80
1,145
1
3,594
424
1,102
340
953
12
1,058
197
1,589
12
1,070
20
1,805
30
2,954
83
13
819
3,881
3,529 ."
.11
1,045
13
:
183
72
25
16 1
,9
55
Menomonie Falls Community
4,880
18
Elmbrook Memorial-Brookfield
4,845
33
| Columbia
986
3,361
382
1,443
3,236
276
1,335
.3,594
.
3,616
Milwaukee County Medical
Northwest General
i
Oconomowoc Memorial
-
. '.v - r.:l
15
St. Francis
49
St. Luke's - Milwaukee
4,141
2
1
•4,338
St. Luke's - Racine
St. Mary's - Milwaukee
18
4,145
St. Mary's - Ozaukee
St. Michael
- 22
Trinity
7,684
1
4
6,487
j
Waukesha Memorial
^AVERAGE CHARGE
4,698
26
Sinai Samaritan
59
3,905
14
;
^ ;3,870 r V .';13 •'
•
1
;
4,924
' ;; :4,387 ' ;: ;
St. Joseph's
|West Allis Memorial
1
v
WIS
l.t-.-.vt'.'/^:.. ,'»«?>'..?.»• ••,.-*-*l\.y;g''.-•<••.•'•%!. ">? ••-i
•Minimum of ten patients necessary for inclusion in chart
PAGE «
'
�H
E L H PAGES
AT
S E N I O R ' S HEALTH
Medicare and
Medigap Made Easy
WHAT TYPES OF MEDIGAP
POLICIES ARE AVAILABLE
UNDER THE NEW RULES?
Every new Medigap policy must
have a core package of benelits that
will pay the co-insurance portion of
Medicare Part A hospital benelits
for the first 150 days in the hospital, and oiler 100 percent coverage of up to 365 additional days over the
course of the insured's life. Without supplemental
insurance. Medicare patients with prolonged hospital
stays are responsible for $163 per day lor the 61st
through the 90th day in the hospital, $326 a day for
days 91 through 150 and lull costs after that. The basic
Medigap policy also pays the 20 percent of doctors'
bills not covered by Medicare, as well as the cost oi the
first three pints of blood drawn for tests per year.
^ew rules are now in effect nationwide
that will make it easier for older consumers to comparison-shop for insurance
policies to supplement their Medicare benefits.
N
Medicare, tlie government's healthcare program for
older Americans, is div ided into two parts:
Medicare Part A - which covers hospital costs - is
available free to anyone 65 or older who qualifies for
Social Security benefits. Eligible individuals should
contact the Social Security Administration before their
65th birthday to ensure coverage.
Medicare Part B - which covers doctor's lees, laboratory tests, x-rays and other outpatient services charges a premium of .|-<6.60 a month, which can be
deducted from an individuars monthly
Social Security check.
But since Medicare does not cover all
MEDIGAP COVERAGE OPTIONS
health care costs, many people choose to
Here are the 10 different types of plans, labeled A to J, that are availbuy private supplemental insurance,
able under the new standards. The basic package is included in all.
known as Medigap policies, to pay for
deductibles, co-payments and other
A
B C D E F G H 1 J
expenses.
The good news: As of July 30, 1992,
Basic
• •
•
•
•
•
•
•
•
•
insurers in virtually all states are required
Skilled Nursing Home
•
•
•
•
•
•
•
•
to offer standardized Medigap policies,
Hospital Deductible
•
•
•
•
•
•
•
•
•
making it easier for consumers to comDoctor Deductible
•
•
•
pare the coverage and premiums of differExcess Doctor Charges
ent insurance companies when shopping
8%
0
10 10 10
0% 0% 0%
for a policv. (Wisconsin has received an
Foreign Travel
•
•
•
•
•
•
•
•
•
exemption from the federal standardizaAt-Home Recovery
•
•
•
•
tion regulations on Medigap, since the
Prescription Drugs
BS
AC
I
B S E T*
AC X .
I
state's regulations are equal to, or more
Preventive Screening
•
stringent than, the national regulations.)
But you still need to ask the right quesN T : The basic package includes payment of the patient's 20% share of coverage for doctoi
OE
tions in order to make careful, informed
vices, $163-per-day contribution to hospital bills for the 61st through 90th day, the patient's c m
o
tion for blood tests and s m coverage or hospital stays beyond 90 days.
o e
coverage choices. Here are some questions you should be asking along with tips
Extended
to make Medigap shopping easier.
PAGE 44
!
�IEAI H PAGES'
More elaborate and expensive Medigap insurance
policies include the basic benefits plus varying degrees
of added coverage. Prices vary by state, insurance company and the age of the insured.
WHAT ADDED BENEFITS ARE AVAILABLE
UNDER THE BROADER MEDIGAP POLICIES?
Additional benefits include coverage of a patient's
hospital bill (currently $676 per illness episode), the
$100 annual deductible on doctors' bills, prescription
drugs and preventive care.
Neither Medicare nor Medigap covers nursing
home expenses. Seniors looking for that kind of protection must purchase a separate long-term care insurance policy.
WHO SHOULD BUY MEDIGAP INSURANCE?
Anyone who needs and can afford private insurance
to meet health care costs that Medicare doesn't cover
and who is not covered by a former employer's healthinsurance plan should consider Medigap.
People with serious health problems who are
approaching 65 should definitely take advantage of the
open enrollment period for Medigap policies. During
this period, which ends six months after an individual
first enrolls in Medicare part B, either at age 65 or
later at retirement, insurance companies cannot deny
coverage to a new policyholder based on his or her
medical history. However, the insurer is permitted to
require a six-month waiting period before covering
medical costs related to a pre-existing condition.
MP
BASIC POLICY B y A g e)
ADDITIONAL PREMIUM OPTIONS
Health
History
Waiting
Period
Years
Selling
Medigap
Ys
e
60 D y
as
5
$629
$724
$800
American
Republic
Ys
e
Nn
oe
12
354
434
489
541
583
Banker's
Life
Yes**
60 D y
as
26
439
536
665
845
Limited
180 Daysf
26
420
564
636
Continental
General+
Ys
e
6 M nh
ots
7
458
498
Medico Life
Insurance
Yes**
Nn
oe
1
0
527
North Amer.
Insurance
Ys
e
90 Daysf
3
Pekin
Ys
e
—
Mutual of
0maha+
N
o
Utmer. Family
ftie Assur.
Blue
Cross
Physicians
Limited
feftutual Ins. Co.
Part A
Deduct
Home
Health
PartB
Deduct
Foreign
Travel
Excess
Charges
$908 $908 $216*
$47*
$84*
$24*
$148*
152*
80
92
5
190*
845
138*
61*
75*
18*
191*
720
720
180
24
72
60
240
533
563
588
234*
40*
90
12*
200*
588
640
693
693
233*
28*
83*
38*
226*
512
569
598
622
647
226*
35
90
20
254*
1
4
631
730
836
934
1,139
207
20
207
23
207
6 Months
26
417§
519§
603§
696§ 696§
278
18
92
1
8
155*
Nn
oe
—
384
413
413
461
244*
61*
88
11
330
+ H s a prescription drug policy option
a
* A e 65
g
65
70
75
80
" Excluding open enrollment
t Waived first 6 months enrolling
Parti
PAGE 45
80+
461
§ Plus $11.97 for Diabetes Coverage
�I A T PAGES'
E LH
H
S H O U L D I SWITCH T O O N E O F THE N E W
POLICIES IF I A L R E A D Y H A V E
MEDIGAP INSURANCE?
HEALTH C A R E C O S T ' S U N H E A L T H Y
SQUEEZE O N OLDER AMERICANS
If you are satisfied with your current policy, there is
no need to switch. Many existing Medigap policies are
quite good and may cover items, such as the cost of a
private hospital room, that newer policies don't.
If you decide to shop for a new policy, consider
what type of coverage you need and can afford, keeping in mind that annual premiums will probably continue to rise. When comparing the prices charged by
different companies, look at the premium for your age
now as well as what it would be in several years.
Remember, you need only one Medigap policy. It is
illegal for insurance agents to sell consumers duplicate
policies or use scare tactics to frighten consumers into
dropping existing policies or purchasing policies they
don't need or can't afford.
In 1 9 9 1 , America's elderly spent more than
twice as much money on health care (almost 10
times in inflation adjusted dollars) as they did in
1 9 6 1 . In that year, out-of-pocket costs averaged
$ 1,589 per elderly family. By 1 9 9 1 , those costs
had reached $3,305 (see table ). That's 17 percent of the average family's after-tax income.
Twelve percent of that amount is paid directly to
health care providers; the remaining 5 percent
goes to insurance companies. And this amount
does not even include the increased taxes that
elderly families must pay to support government
health programs. These ever increasing health care
WHERE C A N I G O FOR MORE I N F O R M A T I O N ?
There are a number of publications that explain the
various policy options. Foi a free, eight-page brochure
describing the new Medigap laws and plans, send a
self-addressed, business-size envelope with 52 cents
postage to United Senior Health Cooperative, 1331 H.
St., Dept N., Washington, D.C. 20005.
To receive a free copy of A Consumer's Guide, to
Medicare Supplement Insurance write to Health
Insurance Association of America, P.O. Box 41455,
Washington, D.C. 20018.
Medicare Supplement insurance Approved Policies
explains the additional requirements for Wisconsin
policies. To get a free copy of this book, write to the
State of Wisconsin, Office of the Commissioner of
Insurance, P.O. Box 7873, Madison, Wis. 53707-7873.
H MEDICARE PATIENT'S
E
HOSPITALIZATION GUIDE
T
In 1983, in order to simplify reimbursement, the
federal government divided over 450 medical procedures into Diagnostic Related Groups or DRGs.
H O W D O E S THE D R G S Y S T E M
AFFECT M Y HOSPITAL S T A Y ?
Under the DRG system, hospitals are paid a fixed
amount per patient based on what Medicare determines
is the average cost lor patients with similar diagnoses.
This amount does not change regardless of how sick you
are or how long you stay in the hospital. As a result, a
hospital can save money by cutting down on the cost of
serving each patient or lose money if it keeps patients
too long or provides them with care that is too intensive.
Since providing high-quality care — and avoiding
PAGE -tfi
costs have over time tightened the squeeze on the
American family and there's no relief in sight,
making the need for health care reform more
urgent than ever.
Elderly family out-of-pocket
health expenditures (1991 dollars)
1961
1991
PER FAMILY OUT-OF-POCKET EXPENDITURES
$1,589
Total
$3,305
Direct out-of-pocket
1,285
2,332
Hospital
228
90
Physicion
316
408
Nursing h m
o e
287
1,194
Other
454
640
Insurance
304
973
Private insurance
304
653
Medicare premium
N
A
320
PERCENT OF AFTER-TAX INCOME
Total
10.6%
Direct out-of-pocket
8.6
Insurance
2.0
Private insurance
2.0
Medicare premium
N
A
17.1%
12.1
5.0
3.3
1.7
�I AT P GS
E LH A E
much you will have to pay depends on whether or not
the doctor accepts assignment.
WHEN THE DOCTOR ACCEPTS
MEDICARE ASSIGNMENT
If there is a "Yes" next to the doctor's name under
the Accepts Medicare Assignment column in our listings, then you pay 20 percent of the doctor's charge
and no more.
complications — is often the best way to get patients
out of the hospital quickly, the DRG system does not
necessarily reduce the quality of cai e patients receive.
Studies have shown that hospitals are not releasing
patients "quicker and sicker" since the DRG system
went into ellect.
HOW MUCH WILL I PAY?
Reimbursement is based on benefit periods. A benefit period starts when you first enter a hospital and
ends when you have been out ol a hospital or skilled
nursing facility for 60 consecutive days. There is no
limit to the number of benefit periods covered under
Medicare .
From Day 1 - Day 60 in each benefit period,
Medicare pays for all covered services except the first
$676 (the insurance deductible). The hospital may
only charge you the deductible for your first admission
in each benefit period.
From Day 61 - Day 90 during each benefit period,
Medicare pays for all covered services except for $163
a day.
What happens on day 91? Medicare includes an
extra 60 hospital days — reserve days— which you can
use if you are hospitalized for more than 90 days.
Once you use a reserve day you never get it back.
Unlike your 90 hospital days in each benefit period,
reserve days are not renewable.
Medicare pays for all covered services except $326 a
day for each reserve day you use. You are responsible
for this amount.
WHEN THE DOCTOR DOES NOT ACCEPT
MEDICARE ASSIGNMENT
If there is a "No" next to the doctor's name under
the Accepts Medicare Assignment column in our listings, you will be responsible for paying not only 20
percent of the doctor's charge, but also the amount
that is above Medicare's highest allowable charge. (See
the table below to help you calculate your out-of -pocket expense.)
CAN I ASK MY DOCTOR TO ACCEPT
ASSIGNMENT?
Absolutely. I f a doctor does not accept Medicare
assignment, it means that he or she has not agreed in
advance to accept Medicare assignment for all
patients. But these doctors may accept assignment for
individual patients and often do if a patient asks.
CAN THE DOCTOR CHARGE ME
ANY PRICE HE OR SHE WANTS?
Until 1990 a doctor could charge whatever he or she
deemed fair. Then, the federal government enacted a
law that imposes limits on what physicians and other
health care professionals can bill for services provided
to Medicare patients. As of January 1, 1993, health
care professionals may not charge more than 15 percent above Medicare's maximum, or allowable rate.
HOW ASSIGNMENT SAVES YOU MONEY
Doctor's fee is:
Medicare's allowable fee is:
Most doctors will treat Medicare patients. However,
doctors can choose whether or not to accept
Medicare's allowable charge schedule. I f a doctor
chooses to always accept what Medicare is willing to
pay, then the doctor is called a Medicare participating
physician. In other words, a Medicare participating
physician agrees to Accept Medicare Assignment. How
PAGE 47
$500
Medicare pays the doctor:
THE MEDICARE PATIENT'S GUIDE
1 TO PHYSICIAN PARTICIPATION
$575
$400 (80% of $500)
WITH Assignment you pay:
$100 (20% of $500)
WITHOUT Assignment you pay: $175 (20% of $500 PLUS
the entire difference b t e n
ew e
Medicare's allowable fee a d the
n
doctor's fee)
Total Savings with Assignment: $75
�E
HALTH PAGES
HEALTH CARE O P T I O N S
House Calls
What You Should Know
About Home Health Services
l
s the saying goes, "There's no place like ]
'
0
0
1
o m e t a r e SL
rvicL
', '.
N m s
p
c,ian
(
« -'
dressings, administer drugs and
home." Although there are i times 1 1
when monitor serious changestomplica,
i - i
tions or patients I'or in health.
the medical resources and round-the,
.g
clock attention of a hospital or rehabilitation hospital patients and thei. lam.T h e y als() (t
1
_
ldl ll<:uK
dischai
cd
lies how to perlorm skilled nurs-
facility are needed to provide maximum care for ing procedures s they c n eveno
a
,
,
i
surroundings ol a person's own home and the loving
presence of family members can help to speed recoveiy or ease the transition at the end of a person's life.
Many acute care services are now available at home
for people discharged from the hospital. Home health
providers are helping the chronically ill, aged and disabled regain and retain their independence. It is
important to note that home care is not just for the
elderly. It can be a major help for people of all ages,
including children and families. In fact, one out of
every four people currently receiving home care is
under age 65.
i
-itually perform these procedures.
groups: registered nurses, or RNs; and licensed practical
nurses, or LPNs. RNs, who hold a four-year college
nursing degree or BSN (Bachelor of Science in
Nursing), are trained to make independent judgments
about a patient's condition and care, and can perlorm
basic patient examinations. LPNs undergo much
shorter training that focuses on mastering routine
nursing tasks.
Therapists make up another part of the spectrum of
home health care providers. Their role: To restore,
maintain or enhance the abilities of those under their
care. There are several different types of therapy.
Physical therapy focuses on enhancing physical movement. Speech therapy works on communication problems. Occupational therapy helps people overcome
problems of daily living at home or at work.
• Basic home care refers to the kinds of services
provided tf) patients who otherwise might be unable
to remain at home because of a disabling health condition. Continued health supervision with an emphasis on health promotion enables these patients lo
maintain both a stable state ol health and relative
independence.
Homemaker and h.ome healih aide sewices are the least
expensive home care sen ice. Many of I lie recipients of
such care have a chronic illness or disability.
Homemakers, or companions, are responsible for a
wide variety of tasks that keep the home clean and
safe, and generally contribute to a person's well-being.
These include basic housekeeping (tidying rooms, vacr
a patient, there are other times when the ramuiar
WHAT SERVICES ARE AVAILABLE?
Home care sen ices can range from fairly sophisticated high tech care (similar to what a patient would
get in a hospital) to help with the activities of daily living such as housecleaning and meal preparation. Each
person's home care program must be tailored to match
his or her needs with appropriate services. A variety of
home care workers could be involved in an individual's
plan for home care services. The two main types of
home care:
• Rehabilitative home care is provided to people who
are convalescing from an illness or are in a rehabilitation
program. Many of these patients have been recently discharged from a hospital. The rehabilitative health care
team may include a physician, nurse, nutritionist, homemaker, home health aide and various therapists.
Skilled Nursivg is the most common rehabilitative
PAGF. 4H
Nurses are divided into two
�IEALTH PAGES'
uuming, making and changing the bed, preparing and
serving meals, shopping for food) and personal care
(helping patients to wash and dress).
Home health aides perform three general services:
(1) personal care (2) basic nursing (3) incidental homemaking. An aide cannot provide skilled nursing care.
For example, although an aide can take and record
your temperature, pulse and respiration rate, and
make sure you follow simple medical recommendations such as gettting more exercise, he or she generally can nol administer drug injections.
IS HOME CARE FOR YOU?
The first step in determining whether home care is
appropriate foi you is to discuss the issue with your
physician. Make sure your doctor knows you are willing to work with him or her to reach a decision on
home care. You can also evaluate options with a hospital discharge planner, whose job it is to discuss local
home care sen ices with you.
If home care is deemed appropriate, your home
care agency w i l l conduct an assessment.. T h i s is a
detailed evaluation of your situation that confirms the
need for sen ices ordered and identifies any other beneficial sen'ices. The assessment is usually made by an
RN either in the hospital or at home. The agency then
tailors a home care plan to your needs and reviews it
with you. Before finalizing the plan, the agency advises
your doctor of its assessment and presents the plan for
your doctor's approval. The plan outlines key details,
including treatment goals, the specific services and
level of care that will be provided, and any medical
equipment and supplies that may be needed.
HOW DO I PAY FOR HOME CARE?
Some agencies are certified by Medicare to piovide
sen'ices to Medicare patients. T o find out whether you
or someone you love qualifies for home health sen ices
under Medicare, talk to the hospital discharge planner
or your doctor, or call the agency directly. For those
patients who are not covered by Medicare, most home
health agencies accept reimbursement f r o m private
insurance companies or from the patient directly.
T o be eligible for Medicare paid visits, a patient
must first qualify for skilled care, such as that provided
by a RN. Medicare does not cover home health care
services limited to assistance with bathing, dressing
and/or feeding. I f a Medicare patient qualifies for service under the Medicare guidelines, Medicare is billed
directly; a bill is usually not sent to the patient. In
some instances, t h o u g h — f o r e x a m p l e , when the
patient is not homebound—Medicare will pay 80 percent of the cost, leaving the patient responsible for the
remaining 20 percent.
COMPANION: YeS
HOME HEALTH SERVICES
LIVE-INS: YeS
TRANSPORTATION: Y e s
PRIVATE DUTY SERVICES
HOSPITAL: $30-40/hour
PAYMENT: Medicare/Medicaid
fii
• All Saints Community Homecare and
Hospice. Racine
• Camillus C R S Home Health.
AE
HOSPICE CARE: Yes
Wauwatosa
PAYMENT: Medicare/Medicaid
CONTACT: Debra Ostroski
OWNKRSHII': St. Luke's affiliate
YEARS IN liUSINF.SS: 7
• ANEW Health Care Services.
NURSING SERVICES
RN: $75/visit
CONTACT: Sharon Pfeifer
OWNERSHIP: St. Camillus Campus
YEARS IN BUSINESS: 7
CONTACT: Sally Sprenger
OWNERSHIP: Local private
u>N: $75/visit
HOMI- HHA ITH AIDHS: Yes
THERAPISTS
PHYSICAL: $75/visit siTK I I $75/visit
OCC UI' AT IO N A L: $ 7 5/v i s i t.
OTHER HOME SERVICES
COMPANION: YeS
PRIVATE DUTY SERVICES
HOSPITAL: YeS
Wauwatosa
NURSING SERVICES
RN: $70/visit
HOME HEALTH AIDES: Y e s
YEARS IN 111 SINTNS 10
NURSING SERVICES
RN $80/visit
:
I.PN:
Yes
THERAPISTS
PHYSICAL: $75/visit SPEECH: $75/visit
OCCUPATIONAL: $75/visit
HOME HEALTH AIDES: YeS
THERAPISTS
PHYSICAL: $90/visit SPEECH $90/visit
OCCUPATIONAL: $90/visit
OTHER HOME SERVICES
PAGE 49
OTHER HOME SERVICES
COMPANION $10/110111'
TRANSPORTATION: Yes
PRIVATE DUTY SERVICES
HOSPITAL: Yes
�I A T PAGES"
E LH
THERAPISTS
NURSING HOMI-.: Y e s
PAYMENT: Medicare/Medicaid
• Horizon Home Care and Health
Staffing. M i l w a u k e e
CONTACT: M a n ' A n n
Wolkomir
OWNERSHIP: C o l u m b i a H o s p i t a l
alliliate
PHYSICAL: Y e s
H O M E H E A L T H AIDES: $51/visit
SPEECH: Y e s
OCCUPATIONAL. Y e s
THERAPISTS
PHYSICAL: $ 8 6 / v i s i t SPEECH: $86/visit
COMPANION: YeS
oc:c:u p.-vnoNAL: $90/v i si t
LIVE-INS: YeS
HOSPICE CARE: Yes
• Seton Health Care Services.
PAYMENT: Medicare/Medicaid
Brooklield
NURSING SERVICES
I.PN: $26/ll0UI'
CONTACT: M i c h a e l Conway
OWNERSHIP Local p r i v a t e
THERAPISTS
YEARS IN BUSINESS: 19
< H( i PA I K IN AL $ 8 5 / l i o u r
OTHER HOME SERVICES
HOSPITAL: $ 1 6 - 2 6 / l i o u r
NURSINO HOME: $ 1 6 - 2 6 / b o u r
RN: $ 4 0 / h o i i r
LPN: $ 3 0 / l i o u r
HOME HEALTH AIDES: $ 16-19/hoiir
PHYSICAL S80 visil SPEECH: S8() visit
OCCUPATIONAL: $8()/visil
OTHER HOME SERVICES
PRIVATE DUTY SERVICES
PAYMENT: Medicare/Medicaid
HOSPITAL: $ 1 6 - 4 0 / h o u r
NURSING HOME: $ 1 6 - 4 0 / h o u r
• Interim Healthcare. Madison
PAYMENT: Medicare/Medicaid
CONTACT: D a v i d U t t e r
YEARS IN BUSINESS: 10
NURSING SERVICES
LPN: S30/hour
THERAPISTS
PHYSICAL $ 9 5 / v i s i t SPEECH: $95/visit
HOSPICE CARE: Yes
PAYMENT: Medicare/Medicaid
• VNA of Greater Waukesha.
Waukesha
CONTACT Elizabeth J e n s e n
OWNERSHIP: Waukesha H o s p i t a l
affiliate
YEARS IN BUSINESS: 4 5
OWNERSHIP: L o c a l p r i v a t e
• St. Francis Home Health.
Milwaukee
YEARS IN BUSINESS- 15
CONTACT: L o r i P a p r o c k i
RN: $ 3 2 - 3 5 / h o u r
OWNERSHIP: St. Francis H o s p i t a l
LPN: $25-2H/hour
HOME Hi- \ l 1 11 AIDES: $ 1 4 - 1 6 / l i o u r
O T H E R H O M E SERVICES
COMPANION: $ 13- 1 5 / h o u r
PRIVATE DUTY SERVICES
affiliate
YEARS IN BUSINESS: 6
N U R S I N G SERVICES
RN: $85-9()/visit
HOME HEALTH AIDES: $ 2 0 - 2 2 / h o u r
NURSINC HOME: $ 1 3 - 1 5 / l i o u r
THERAPISTS
lJ
THERAPISTS
PHYSICAL $ 8 4 / v i s i t SPEECH !$84/visii
O T H E R H O M E SERVICES
COMPANION: $ 1 2 / h o u r
HOSPICE CARE: Yes
PHYSICAL $85-90/visit .sPEE(:;H:$85-9()Aisit
OCCUPATIONAL $85-90/visit
^ J'>f rsor' Hor"' erlth f^re
LPN: $75/visit
H O M E H E A L T H AIDES: $ 2 3 / h o u r
OCCU PA I 10N AL: $ 8 4 / v i si t
HOSITI AL: $ 1 3- 1 iVllOUr
PAYMENT: Medicare/Medicaid
NURSING SERVICES
RN: $75/visit
N U R S I N G SERVICES
l o
Colla
occ.up.vnoNAL: $95/visit
COMPANION: $ 1 l / l l O U l '
HOSPICE CARE: Yes
1
OWNERSHIP D a u g h t e r s o f C h a r i t y
H O M E H E A L T H Aini-S: $ 2 7 / h o u r
THERAPISTS
PRIVATE DUTY SERVICES
CONTACT: M a r )
RN: $90/visit
NURSING SERVICES
COMPANION: $ 1 1 - 1 3 / l i o u r
LIVE-INS: .|168/clay
Milwaukee
affiliate
HOME HEALTH AIDES: $ 1 7-24/llOUr
rHYSiCAL.:.f85/hoiir si'KK.c:n:$85/liour
LPN: $88/visit
O T H E R H O M E SERVICES
• Midwest Medical Homecare.
YEARS IN BUSINESS: 2
RN: $43/llOUr
RN: $88/visit
PAYMENT: Medicare/Medicaid
Madison
PAYMENT: Medicare/Medicaid
• We Care Services. Madison
CONTACT': C a r o l y n J o h n s o n
( . O N I AC i B i l l H a m i l t o n
OWNERSHIP: L o c a l p r i v a t e
• St. Vincent Hospital Home Health
Care. G r e e n Bay
OWNERSHIP: Local p r i v a t e
YEARS IN BUSINESS: 3
CONTACT: Joan L i n d e m
N U R S I N G SERVICES
RN: $ 2 9 / h o u r
LPN: s 2 4 / l i o i i r
HOME HEAITH AIDES: $ 1 9 / l l O U r
O T H E R H O M E SERVICES
OWNERSHIP: St. V i n c e n t H o s p i t a l
YEA RS IN BUSINESS: 8
COMPANION: $ 1 2 . 5 0 / h o u r
YEARS IN BUSINESS: 8
PAYMENT: Medicare/Medicaid
N U R S I N G SERVICES
PAGE 50
�I AT PGS
ELH A E
CHILDREN'S HEALTH
"four Child's
Tonsils - In or Out?
N
^Ot
Very l o n f f affO, i f a C h i l d h a d a COUple
J
0
0
1
O f SOre t h r O a t S , a t r i p t O t h e h o s p i t a l WaS
in order, and his or her tonsils and adenoids would be surgically removed in a tonsillec0
/
tonsillitis, see you. pediatrician. He
or she will examine your child s
throat and probably take a throat
culture. If tonsillitis is diagnosed,
your doctor will probably prescribe
a 10-day supply of an antibiotic,
,
.„
,
which will usually clear up the
tomy and adenoidectomy. But thanks to new
information about the role of tonsils and the
availability of improved antibiotics to treat tonsil infec-
WHEN IS A TONSILLECTOMY
tions, tonsillectomies have become far less common.
AND ADENOIDECTOMY
CALLED FOR?
iWHAT ARE TONSILS AND ADENOIDS?
The tonsils are a pair of small almond-shaped structures on either side of the throat just behind and
above the tongue. Tonsils act as a defense against
infections that invade the body through the nose and
mouth. They are part of the lymphatic system of the
body, a protective system whose cells attack and literally devour bacteria. Adenoids are tissue located at the
back of the nose, above the tonsils. They, too, help
protect against respiratory-tract infections.
symptoms in a few days,
Tonsils and adenoids are generally removed when
they become so enlarged that they obstruct breathing, distort speech, or cause swallowing difficulties
that result in weight loss and poor nutrition. Doctors
may also recommend surgery for chronic, severe or
stubborn tonsillitis that doesn't clear up. The operation is usually performed when a child is six or seven.
WHAT EXACTLY IS A TONSILLECTOMY
AND ADENOIDECTOMY?
Tonsillectomy and adenoidectomy is a surgical procedure requiring general anesthesia, in which the tonWHAT IS TONSILLITIS?
sils and adenoids are cut away and the cut area is left
Tonsillitis is an infection of the tonsils that children
to heal naturally. It is a simple operation but like all
often come down with between
surgery, it involves a small
the ages of three and six.
amount of risk. The procedure
LOCATION OF THE TONSILS
When infected, tonsils become
can be performed either in a
greatly enlarged, almost meethospital, which requires a stay of
ing in the middle of the throat.
a day or two, or in an outpatient
They turn fiery red and may
surgical room, with rehabilitahave white spots on them.
tion occurring at home.
Occasionall), the adenoids
Vou can expect your child's
swell too, lending a nasal qualithroat to be very sore for several
ty to the child's voice. Since the
days after the operation. Soft
symptoms of tonsillitis are simfoods, including custards, soups,
ilar to those of the flu—severe
and especially ice cream, can
re throat and a fever—it may
help soothe the pain. You can
le d i f f i c u l t to distinguish
tell your child that he or she can
etween the two. If the sympe
look forward to playing as usual
toms last more than 48 hours
and going back to school within
Tonsil
•Trachea
or your child has a history of
a week after the operation.
PAGE 51
�E LH P G S
AT A E "
H
THE TRUTH
ABOUT TONSILS
>
YOUR GUIDE T< ENT SPECIALISTS
irriaitiompr^
^ndorsemenho^^
Doctor
Board
Certification
Tonsillectomy & Tonsillectomy &
Adenoidectomy Adenoidectomy
Over Age 12
Under Age 12
GREEN BAY
W
hen it comes to tonsillectomies, it's hard
to figure out where
the myths end and the facts
begin. Don't try to talk your
doctor into removing your
child's tonsils on the basis of
any of these misconceptions:
Primary
Hospital
Affiliation
.• .••, :
- . '
S3
55
Dodds, Brian
1990
S3
55
Mills, John M
1967
456
Schmidt, Frederic
1989
456
Titulaer, Richard
1975
535
Vander, Woude
1972
456
456
Wineinger, David
1969
456
456
Anderson Jr., Ashley
1982
600
600
Meriter
Donovan, Timothy J
1970
716
662
St. Mary's
Finch, William Wesley
1978
600
600
Meriter
Ford, Charles N
1971
660
610
University of W
I
Scott, John Kimball
1959
600
600
Meriter
Stanley, Robert John
1988
716
662
St. Mary's
456
• "Tonsils are
useless."
Not true. Medical scientists continue to report new evidence
that shows tonsils are a valuable part of the body's defense
mechanism against invading
germs and viruses.
Sl. Vincents
456
535
MADISON
•••'"•^
;
}
;y:.::\ -'': .
MILWAUKEE
Barton, James Robert
1980
525
525
St. Luke's-Milw
Belson, Thomas Patrick
1971
400
400
W ueh
aksa
Condon, Kenneth Gerard
1988
515
588
W ueh
aksa
Dankle, Steven Kle
1987
525
525
St. Luke's-Milw
Darling, William Anthony
1976
400
400
W ueh
aksa
Durkin, Gretchen Elizabeth
1988
510
530
St. Mary's-Milw
Friedman, Jerry Eli
1966
491
536
Children's
Grunke, Richard John
1983
475
475
Mnmne
eo oe
Janowak, Michael Charles
1978
420
420
Oo o o o
cnmwc
Kidder, Thomas
1973
511
Kleiner, Harvey
1977
491
535
Children's
Martinelli, Dean Louis
1976
428
478
Oo o o o
cnmwc
Park, John Raymond
1973
420
420
Elmbrook
Wermuth, Douglas John
1989
450
450
Columbia
i^VERAGrCHARGE^'y » J
i
Froedtert
1
. r - ; 521
.-I.''-.
• '-.
• " M y c h i l d is a l w a y s
s i c k . " Chances are your child
is going through a normal
stage or growth, irrespective of
the condition of his or her tonsils. Before a child can build up
his or her own antibodies to
fight off disease agents, he or
she must be exposed to them.
So, a certain number of mild
respiratory diseases are to be
expected during a child's early
years.
.V
I'AGli 52
• "He'll be healthier w i t h
t h e m o u t . " It's a myth that a
tonsillectomy and adenoidectomy makes a child less susceptible to colds, sore throats and
other respiratory diseases. Nor
does the operation relieve an
allergy such as asthma.
• " T h e y ' r e s w o l l e n . " What
you perceive as swelling may
je the tonsils' normal size.
Tonsils are very small at birth,
then enlarge gradually, reaching maximum size at age six or
seven. Thereafter, they usually
shrink to walnut size. Adenoids
grow between the ages of three
and five and then shrink, eventually disappearing altogether
during puberty. Unless a medical problem is diagnosed,
enlargement alone is no basis
for surgery.
�E
HALTH PAGES'
Inpatient Procedure
Average
Number
Charge
of Patients
GREEN BAY
Procedure Performed on Outpatient Basis
Average
Number
of Patients
Charge
:
•••
y '.
-.
•'T'
Bellin Memorial
St. Mary's
76
$1,725
63
$1,584
St. Vincent
39
1,547
249
1,325
;
:
.:A'.-v: .,..;\ ^-^
MADISON
Meriter
145
1,911
St. Mary's
65
1,338
University of WI
27
2,724
MILWAUKEE
:
,
•/-,^'^'''.^>^^|^.'?f/'.l-^•y,,'
l
J
52
1,831
174
1,818
35
1,543
Lakeview
48
1,119
Menomonie Falls-Community Memorial
89
867
31
1,210
47
974
40
2,163
Burlington-Memorial
Children's Hosp of WI
4,241
157
Columbia
Elmbrook Memorial-Brookfield
Froedtert Memorial
Milwaukee County Medical
Northwest General
Oconomowoc-Memorial
69
2,154
St. Francis
St. Joseph's
42
1,535
St. Luke's-Milwaukee
St. Luke's-Racine
St. Mary's-Milwaukee
41
1,876
St. Mary's-Ozaukee
St. Michael
Sinai Samaritan
Ti
Trinity
Waukesha Memorial
109
2,302
|yw^aiARG^fl l f l f f i l l
PAGE :>3
1,857
47
West Allis Memorial
32
1,422
�E
HALTH PAGES
WELLNESS
ISSUES
Weighty Matters
Still, that doesn't mean you
shouldn't reduce your calorie intake
if you need to. Some medical conditions, like an elevated cholesterol
level, hypertension and adult-onset
diabetes are exacerbated by being
ovenveight. Losing 10 to 15 percent
of your starting weight (at your doctor's recommendation) will often
significantly reduce your health risk,
even if you are still considerably
above your weight goal. Remember,
even if your expectations aren't met, your weight loss
program may still be considered "successful."
It's important to have reasonable expectations for any
diet program. If you expect that losing weight will solve
all your problems, like finding that special partner or
getting a new job, you're setting yoursell up for trouble.
Chances are you'll just get frustrated and go back to your
old eating and exercise habits if your problems aren't
solved.
uperstars' Diet Secrets! Shed Pounds the Rich
and Famous Way!" shouts the headline. Your
hand reaches out. How did Liz... Forget it.
There are no tricks, no secrets, no miracles.
Losing weight is hard work. The people who succeed are the ones who see through the hokum
and false promises.
S
In the 1980s, obesity went from being seen as a purely cosmetic problem to being designated a health risk.
As a result, the past decade has been a boom period foi
ihe weight-loss industry. A host of companies rushed in
offering miracle "cures" for the new disease. Even
Oprah Winfrey got swept up in the hoopla—boasting to
television viewers about her 67-pound weight loss
thanks to one of these programs.
Since then a number of research studies have questioned the success claims of diet programs. A
National Institute of Health conference on diet,
for example, concluded that there was often "no
HOW MUCH SHOULD I WEIGH?
data with which to answer questions about voluntary weight loss and control methods." The limited
of every woman can look like Cindy Crawford. Nor should she
data there was suggested that many people who
try to. Your body type and the weight that is biologically approcomplete commercial diets can expect to regain
priate for you are determined primarily by genetics. Any adjustone-third of their lost weight after one year, twoments—up or down—are somewhat limited by your biological heritage.
thirds or more after three years and 90 to 95 perConsequently, more and more physicians and researchers are recomcent in three to five years.
mending that people aim for their "natural weight" rather than a goal or
ideal weight. In general, natural weight is achieved when a person eats
Around the same time, the Federal Trade
normally (about 1,800 calories a day for a woman and 2,200 calories a
Commission (FTC) began investigating the diet
day for a man) and exercises regularly—the equivalent of a brisk oneindustry's claims of success. As a result of this
hour walk each day.
investigation, which did not find research to support the claims, the FTC is thinking of recomIf you are interested in losing weight it is important to understand that
mending that center-based diet programs be
diet is only one part of the equation. Although there are a number of
required to keep accurate statistics about the
weight loss programs that have proved to be very successful, with people
number of people who enroll, the length of their
shedding many pounds in a short time, the problem is keeping the weight
participation, the rate of weight loss and the
off. Studies have shown that the people most likely to maintain the' amount of time that weight loss is maintained.
weight loss are nof those who are the best dieters, but those who sup
ment their diet program with an exercise routine and continue to exerc
These research findings along with Oprah's
regularly after reaching their goal weight. Experts say that establish!
gradual return to her former weight have had
new eating and exercising habits is the real key to long-term weigh
their effect. Many weight loss programs have
maintenance—and the only hope for breaking the yo-yo diet syndrome.
gone out of business; others have seen their
demand plummet by 50 percent or more.
Ni
1
J
PAGE 54
�I A T PAGES
E LH
H
$19/15 min. follow-ups
• Point System Diet, West Allis
one mtegrat
•ram that
OWNERSHIP: West Allis Memorial
INSTRUCTORS: Dieticians
BEHAVIOR CLASSES (AVG. SIZE): 7 - 8
AVERAGE TIME: 90 m i l l .
PROGRAM LENGTH: ClaSSCS plus
individual counseling-program
length open to individual needs
COST/WEEK: $25
• Behavioral Weight Management
Services. Milwaukee
nutrition classes and 12 weeks of
behavior modification classes
Racine
CONTACT: Julie Dickert
COST/WEEK: $25
CONTACT: Lynn Fischer, R.N.
• Think Light-Lowfat Living Plan,
OWNERSHIP: St. Luke's Hospital
OWNERSHIP: St. Luke's Medical
LIQUID DIET: LightSource
AVERAGE COST/WEEK: $ 2 3 - 4 6
INSTRUCTORS: Dieticians
PREPARED MEALS: Back to Basics
Center
AVERAGE TIME: 120 m i l l .
BEHAVIOR CLASSES (AVC. SIZE): 18
INSTRUCTORS: Dieticians,
AVERAGE COST/MEAL: $3.75
Psychologists & Nurses
BEHAVIOR CLASSES (AVG. SIZE):
AVERAGE T I M E : 90
8-10
PROGRAM LENGTH: 1 0 - 2 5 + Weeks
COS I WEEK
PROGRAM LENGTH: 10 weeks
MAINTENANCE CLASS: 12 weeks (Free)
COST/WEEK: $ 1 2 . 5 0
EXERCISE CLASS: Low impact
min.
MAINTENANCE CLASS: S u p p o r t G r o u p
aerobics ($20/four weeks)
$27
LIQUID DIET: Optif'ast
• Diet Center, Milwaukee
AVERAGE COST/WEEK: $60
(Free)
CONTACT: Karolyn Anderson
• Weight Management Program.
Menomonee Falls
and
group meetings ($32-411)
CONTACT: Shawn Seurce
INSTRUCTORS: Nutritionists
MAINTENANCE CLASS: Individual
OWNERSHIP: Franchise
OWNERSHIP: Community Memorial
Hospital
EXERCISE CLASS: W e i g h t ($30)
PROGRAM LENGTH: Individual
INSTRUCTORS: Dieticians
counseling
• Bellin Health Connection. Green Bay
PROGRAM LENGTH: N u t r i t i o n Class/8
wks/$60; Adult Weight
Control/10 wks/$65; Children
Weight Control/10wks/$100
EXERCISE CLASS: Fitness center
BEHAVIOR CLASSES (AVG. SIZE): 7
AVERACE TIME: 90
• Embody, Madison
OWNERSHIP: Bellin Memorial
and
aerobic classes ($210/year)
OWNERSHIP: Meriter Hospital
PROGRAM LENGTH: 6 weeks
INSTRUCTORS: Exercise Physiologists,
COSTAVEEK: $70 total fee
Dieticians
MAINTENANCE CLASS: 6 Weeks ($35)
BEHAVIOR CLASSES (AVG. SIZE):
AVERACETIME: 30
12-15
min.
PROGRAM LENGTH: 1 2 weeks o f
behavior and exercise classes
• Burlington Weight Control Center
CONTACT: Jan
COST/WEEK: $23
Burlington
INSTRUCTORS: Nutritionists
• Nutrition and Weight Control Clinic.
INSTRUCTORS: Previous Weight
Watchers' members
AVER.AGF.TIME: 60
min.
PROGRAM LENGTH: Weekly meetings
Milwaukee
CONTACT: Jan
• Weight Watchers
AV ERAGE CI ASS SIZE- 30-40
Caflisch
OWNERSHIP: Memorial Hospital of
min
Howard
until goal is reached
OWNERSHIP: St. Michael Hospital
COST/WEEK: S 1 I
AVERAGE TIME: 60-90 m i l l .
INSTRUCTORS: Dieticians
MAINTENANCE CLASS: Meetings (free
PROGRAM LENGTH: Individual
PROGRAM LENGTH: Individual
BEHAVIOR CLASSES (AVG. SIZE): 6
if at goal weight, otherwise $11)
counseling plus 6 weeks of
instruction; $76 first meeting,
PAGE 55
�I AT P G S
E LH A E "
H
Guidelines for
Doctors and Patients
octors receive no shortage of advice when c n e e an expen panel oi omo vns
side phvsicians and researchers to
it comes to treating patients. But now a do so. Fo. example, in constructnew authoritative voice is distinguishing \ f ^
s"'^ " o
O below, the appointed panel criticalitself from the crowd, representing the opinions 'y examined 11,000 scientific
1 1 1 1
1 1 - 1
1
sources of information to cleteiot experts backed by the Federal Government, Before the guidelines were released, pain
mine the state-of-the-art in they
management.
n
l h
, l l i n cont,
o1
1
1
1
fhe Agency for Health Care Policy and Research,
established by Congress in 1988, has been charged
with finding out what the nation gets for the billions of
dollars it spends annually on health care as well as
what can be done to improve the quality of care provided. What investigators found was a tremendous
variation across the country, even within a single community, in how doctors treat dillerent illnesses, sometimes to the patient's detriment.
As a result, in March 1992, the agency began issuing guidelines that outline the best ways for doctors,
nurses and other healthcare providers to treat certain
conditions that affect large numbers of Americans.
The agency itself does not develop the guidelines; it
were tested in hospitals and clinics across the nation to
ensure their clarity and applicability.
When the pain control guidelines were made public. Dr. Louis Sullivan, then Health and Human
Services Secretary, said that they mark "the beginning
of a peaceful revolution in American medical care."
The HiiAL'i it PACKS believes that in order for the revolution to be successful, il is essential that you, the reader, learn about these guidelines. Coiisequently, as a
regular feature, we will publish a summary of government findings. Among the areas we hope to cover in
future issues: prostate enlargement, impairment from
cataracts and lower back problems.
PAIN CONTROL AFTER SURGERY: A PATIENT'S GUIDE
Adapted from a booklet by the Agency for Health Care Policy and Research ,
an agency of the U.S. Public Health Service. The complete guide is availuble free by calling (800) 358-9295.
W h a t is pain?
Pain is your body's way of sending a warning message
to your brain. Your spinal cord and nerves (there are
thousands of receptor nerve cells in and beneath your
skin) provide the pathway for messages to and from
your brain and other parts of your body. Pain medicine
blocks or reduces the ellect of these messages.
W h a t role does pain control after surgery play?
Pain control can help you enjoy greater comfort
while you heal, get well faster (with less pain you'll be
able to do necessary breathing exercises, get your
strength back, even leave the hospital sooner) and
improve results (people whose pain is well-controlled
seem to do better after surgery and may avoid some
problems, such as pneumonia and blood clots).
W h a t a r e the options?
Severe pain after surgery is no longer something
you "just have to put up with." Both drug and nondrug ireatnients before and after suigen can successfull) help prevent or relieve pain. The most common
methods of pain control: pain medication before
surgery; general anesthesia, spinal anesthesia (nerve
block) or an epidural (in which medication is administered through a small tube in your back), during
I'AGK. 51,
�-
IEALTH PAGES
surgery; pain medication in pill, shot or suppositoiy
lorm or through a tube in your vein or back, massages,
hot or cold packs, relaxation exercises, positive thinking and nerve stimulation (TENS) after surgery.
Many people combine two or more pain control
methods. Since the amount or type of pain you feel
may not be the same as what others feel—even those
who've had the same operation—you and your caregivers will need to work together to choose the pain
control methods that are right for you. If you're worried about getting "hooked" on pain medication, don't
be. Studies show that this is rare unless you have a
drug abuse problem to start with.
After Surgery
5. Take (or ask for) pain relief drugs when pain
first begins. Additionally, ii you know the pain will
worsen when you start walking or doing breathing
exercises, take pain medication first. It's harder to ease
pain once it has taken hold.
THE SEVEN STEP
PAIN CONTROL PROGRAM
7. Tell your caregiver about any pain that won't go
away. Don't worn' about being a bother. Pain can be a
sign of problems with your operation and your caregiver will want to know about it. Also, if the pain control plan isn't working, your caregiver will want to
change it.
These guidelines for things you can do before and
after surgery can help you help yourself keep pain
under control.
6. Help your caregiver "measure" your pain. He
or she may ask you to rate your pain on a scale of 1 to
10 or to choose a word from a list that best describes
the pain. Reporting your pain as a number helps your
caregiver know how well the treatment is working and
whether to make any changes. You may also set a
number as a pain control goal.
Before Surgery
1. Ask your caregiver what to expect. Getting
answers to questions such as "Will there be much pain
after surgery?" "Where will it occur?" "How long is it
likely to last?" will help you prepare for surgery and
put you in control. Write down your questions before
you meet with your caregiver.
2. Discuss pain control options with your caregiver. Talk about methods that have or haven't worked
well for you in the past, mention any concerns you
may have about pain medication, ask about treatment
side effects and alert your caregiver to medication
allergies as well as medicines you are taking for other
health problems to avoid negative drug interactions.
3. Talk about the schedule for pain medicines in
the hospital. Instead of waiting until pain breaks
through to take medication, getting pain pills or shots
at .set times can help keep pain under control.
Additionally, patient controlled analgesia (PGA) may
be available at your hospital. With PGA you are in control, pressing a button to inject medicine through an
intravenous (IV) tube in your vein when you begin to
feel pain. Whichever method you choose, keep your
caregiver abreast of how well it's wot king.
4. Work with your caregiver to create a pain control plan. Use the form (opposite) to begin planning
or pain control with your caregiver—he or she needs
your help to design the plan that's best fbr you. Refier
to the form after your operation and keep it as a
record in case you need surgery in the future.
PAGE 57
PAIN CONTROL PLAN
Pain Control Plan For:
Before surgery, I will take
N m of medicine:
ae
Instructions for use:
After surgery, I will take
N m of medicine:
ae
in the hospital
The medicine will be given to me:
as a pill
as a shot
through a vein
through a tube in my back
I will receive the medicine:
at regularly scheduled times
every
hours for
days
around the clock
when I call the nurse
I will also use these non-drug pain control methods in the hospital and at
home (list methods):
At home, I will take
N m of medicine: _
ae
Instructions for use:
�I A T PAGES'
E LH
H
Physicians' File
OB/GYN
G E N BAY
RE
Bechtel, Richard Jr.
MKDICAI. SCHOOI..: Duke
Univ, I9(i6
INTKRNSHIl'S: Blodgett
Memorial Hosp, Grand
Rapids, 1967
KI s i n i A c i r s Duke Univ,
1971
Kl'L.LOWSHll'S: Duke Univ,
1969
COVERAGE GROUP: OB-GYN
Associates of Green Bay
SERVICES: Circumcisions,
Ultrasound, Venipuncture
HOURS: Weekend
CREDIT CARDS: MC & Visa
Cavanaugh, Robert
MEDICAL SCHOOL: SIU
School Medicine
INTERNSHIPS: SIU School
Medicine
RESIDENCIES: SIU School
Medicine
COVERAGE GROUP: OB-GYN
.Associates of Green Bay
SERVICES: Circumcisions,
Ultrasound, Venipuncture
HOURS: Weekends
CREDIT CARDS: MC &: Visa
DeMott, Robert
MEDICAL SCHOOL: Univ ol'
Wisconsin, 1981
INTERNSHIPS: Univ of
Pittsburgh, 1982
RESIDENCIES Univ o f
Pittsburgh, 1985
COVERAGE GROUP: OB-GYN
.Associates o f Green Bay
SERVICES: Circumcisions,
Ulirasound, Venipuncture
HOURS: Weekends
CREDIT CARDS: MC & Visa
Mahoney, Thomas
MEDICAL SCHOOL- Univ o f
South Dakota, 1985
INTERNSHIPS: McLennan
Hospital
RESIDENCIES: St. Joseph's
Hosp, Milwaukee
COVERAGE GROUP: Webster
Clinic
SERVICES: Circumcisions,
Ultrasound, Venipuncture
Sandmire, Herbert
MEDICAL SCHOOL: Univ of
Wisconsin, 1953
INTERNSHIPS: Beaumont
Army Hospital, 1954
RESIDENCIES: Univ of Iowa
Hosp, Iowa City, 1958
COVERAGE GROUP: OB-GYN
Associates of Green Bay
O TO R A
W
ED
THE PHYSICIAN LISTINGS
H
SERVICES: Circuincisions.
Ultrasound, Venipuncture
HOURS: Weekends
CREDIT CARDS: MC & Visa
Schueckler, Amy
MEDICAI. SCHOOL: SUNY at
Bullalo, 1984
INTERNSHIPS: Sisters of
Charity Hosp
RESIDENCIES: SUNY at
Bullalo
COVERAGE GROUP: Pole)' &•
Utrie
SERVICES: Circumcisions.
Ultrasound, Venipuncture
Sehring, Frederick
MEDICAL SCHOOL: Med Coll
W I , 1956
SERVICES: Ultrasound,
Venipuncture
Sehring, Stephen
MEDICAL SCHOOL: Med Coll
o f W I , 1985
INTERNSHIPS: Emory Univ
A l i i I Hosp
RESIDENCIES: Emory Univ
AHil Hosp
COVERAGE GROUP: Frederick
Sehring
SERVICES: Circumcisions.
Ultrasound, Venipuncture
Shaffer, Richard
INTER N sHI PS: \V i scon si n
Hosp, 1973
RESIDENCIES: Wisconsin
Hosp, 1976
Utrie, John
MEDICAL SCHOOL: Marquette
Univ. 1959
INTERNSHIPS: Miller Hosp,
St. Paul, 1960
RESIDENCIES: Aflil Hospital,
Minn, 1966
MADISON
Anderson, John
MEDICAL SCHOOL: Univ o f
Nebraska, 1967
INTERNSHIPS: Madison Gen
Hosp, 1968
R ES ID E N c I ES: N e b r a s k a
Hosp, 1973
COVERAGE GROUP: Roley,
Roley & Torhorst
SERVICES: Ultrasound.
Venipuncture
CREDIT CARDS: MC & Visa
Baker, Robert Jr.
MEDICAL SCHOOL: Univ o f
Minnesota, 1962
INTERNSHIPS: Santa Clara
Hosp, San |ose, 196:5
RESIDENCIES: Univ o l ' W l ,
m a n y years ago, he o r she s h o u l d s t i l l be u p to d a t e
on current medical procedures t h r o u g h w o r k i n g w i t h
peers, k e e p i n g u p w i t h the j o u r n a l s a n d a t t e n d i n g
conferences.
Medical School: A doctor's t r a i n i n g requires a p r e m e d i c a l
u n d e r g r a d u a l e e d u c a t i o n a n d f o u r years o f m e d i c a l
school. T h e year i n w h i c h his o r her medical degree was
g r a n t e d can tell you how o l d the d o c t o r is a n d how l o n g
ago his o r her t r a i n i n g was c o m p l e t e d .
Internship: A n i n t e r n s h i p is a one o r two year p e r i o d o f
hospital t r a i n i n g f o l l o w i n g graduation f r o m medical
school. D u r i n g this t r a i n i n g p e r i o d , physicians are
called i n t e r n s .
Y o u m a v p r e f e r a d o c t o r w h o has j u s t l e a r n e d
a b o u t the latest m e d i c a l b r e a k t h r o u g h s a n d techniques, o r y o u may p r e f e r a d o c t o r w h o has h a d years
o f p r a c t i c a l e x p e r i e n c e a n d has seen f i r s t h a n d a vast
r a n g e o f m e d i c a l p r o b l e m s . O f course, w h i l e a p h y s i cian's f o r m a l m e d i c a l t r a i n i n g may have t a k e n place
Residency/Specialty: A residency is a p o s t - i n t e r n s h i p hosp i t a l t r a i n i n g p e r i o d o f two to six years at the e n d o f
w h i c h a d o c t o r b e c o m e s a specialist. A specialist is a
d o c t o r w h o concentrates o n c e r t a i n b o d y systems, spec i f i c age g r o u p s o r c e r t a i n t e c h n i q u e s d e v e l o p e d to
PAGE: 58
�IEALTH PAGES'
1969
' COVERAGE GROUP:
Physicians Plus
SERVICES: Uhrasuund,
Venipuncture
CREDIT CARDS: MC & Visa
Beck, James
MEDICAL SCHOOL: Univ of
Wisconsin, 1963
INTERNSHIPS: Madison
General Hosp, 1963
RESIDENCIES: St. Joseph's
Hosp, Milwaukee, 1967
COVERAGE GROUP: Dean
Medical
Fok, Joseph
Medical
SERVICES: Ultrasound,
Venipuncture
Diem, Klaus
MEDICAL SCHOOL: Baylor
Coll of Med, 1974
INTERNSHIPS: Univ of W I ,
1975
RESIDENCIES: Univ o f W I ,
1978
COVERAGE GROUP:
Physicians Plus
SERVICES: Circumcisions,
Ultrasound, Venipuncture
HOURS: Weekend
CREDIT CARDS: MC & Visa
Christmann, Robert
Droste, Sabine
MEDICAL SCHOOL: NY Med,
MEDICAL SCHOOL: Univ of
South Dakota, 1984
INTERNSHIPS: Univ of W l
RESIDENCIES: Univ o f WI
FELLOWSHIPS: MaternalFetal Med, Univ o f WA
COVERAGE GROUP: Univ OBGYN .Associates
SERVICES: Midwives,
Ultrasound, Venipuncture
CREDIT CARDS: MC & Visa
1965
INTERNSHIPS: Albany Med
Center Hosp, 1966
RESIDENCIES: Albany Med
Center Hosp, 1969
Davidson, Susan
MEDICAL SCHOOL: Albert
Einstein Coll of Med,
1982
RESIDENCIES: Albert Einstein
K
College of Medicine, 1986
ELLOVVSHIPS: Maternal-
Fetal Med, Univ of W l ,
1988
COVERAGE GROUP: Dean
Medical
SERVICES: Circumcisions,
Ultrasound
Demopoulos, Jean
MEDICAL SCHOOL: Univ o f
W I , 1980
INTERNSHIPS: Univ o f W l
RESIDENCIES: Univ of WI
COVERAGE GROUP: Dean
Estrin, Margaret
MEDICAL SCHOOL: Univ of
Kansas, 1979
INTERNSHIPS: Univ of W l ,
1980
RESIDENCIES: Univ o f W I ,
MEDICAL SCHOOL: Univ of
W I , 1978
INTERNSHIPS: Univ o f W I ,
1979
RESIDENCIES: Univ o f W I ,
1982
COVERAGE GROUP: Dean
Medical
SERVICES: Ultrasound,
Venipuncture
HOURS: Evening & Weekend
COVERAGE GROUP:
Hackforth-Jones & Stoft'el
(all female)
SERVICES: Ultrasound,
Venipuncture
HOURS. Weekends
diagnose or treat specific types o f disorders. As a resid e n t , a d o c t o r gets f u l l - t i m e e x p e r i e n c e i n a h o s p i t a l
c a r i n g f o r p a t i e n t s u n d e r the s u p e r v i s i o n o f e x p e r i enced t e a c h i n g specialists.
r
1969
COVERAGE GROUP:
Physicians Plus
SERVICES: Ultrasound,
Venipuncture
CREDIT CARDS: MC & Visa
Jackson, C. Robert
MEDICAL SCiHOOL: Jefferson,
1956
Hackforth-Jones, Jenny
INTERNSHIPS: St. Mary's
MEDICAL SCHOOL: Univ of
Michigan, 1982
INTERNSHIPS: Univ of WI
RESIDENCIES: Univ o f WI
COVERAGE GROUP: Estrin &
StofTel (all female)
SERVICES: Ultrasound,
Venipuncture
HOURS: Weekends
Hosp, Duluth, 1957
RESIDENCIES: Univ o f W I ,
1961
COVERAGE GROUP:
Physicians Plus
SERVICES: Ultrasound,
Venipuncture
CREDIT CARDS: MC & Visa
Henderson, Perry
MEDICAL SCHOOL: Western
Reserve Univ, 1958
INTERNSHIPS: Cleveland
Metropolitan General
Hosp, 1959
RESIDENCIES: Cleveland
Metropolitan General
Hosp, 1965
FELLOWSHIPS: Univ WA,
1968
1983
INTERNSHIPS: Johns
Hopkins Hosp, 1965
RESIDENCIES: Univ o f W I,
COVERAGE GROUP: Univ
OB/GYN Associates
SERVICES: Midwives.
Circumcisions,
Ultrasound, Venipuncture
CREDIT CARDS: MC & Visa
Herzog, Paul
MEDICAL SCHOOL: State Univ
Syracuse, 1964
Koller, J r . , William
MEDICAL SCHOOL: Ohio Stale
Univ, 1970
RESIDENCIES: Univ of Wl
Hosp
COVERAGE GROUP: Dean
Medical
SERVICES: Ultrasound,
Venipuncture
HOURS: Evening &
Weekends
Kronman, Karen
MEDICAL SCHOOL: Mavo Med
School, 1979
INTERNSHIPS: Univ of
Colorado
RESIDENCIES: Univ of ' W I
COVERAGE GROUP: Dean
Medical
SERVICES: Ultrasound,
Venipuncture
Services Available in the Doctor's Office : If ultrasound and
b l o o d - d r a w i n g services are p r o v i d e d i n a doctor's o f f i c e ,
it may save y o u a t r i p to the lab.
Evening/Weekend Hours: S o m e d o c t o r s have w e e k e n d o r
F e l l o w s h i p / S u b s p e c i a l t y : A f e l l o w s h i p is a p e r i o d o f
e v e n i n g h o u r s to a c c o m m o d a t e p a t i e n t s ' w o r k sched-
one o r m o r e years o f a d d i t i o n a l t r a i n i n g i n a m o r e spe-
ules. C a l l the d o c t o r ' s o f f i c e f o r m o r e i n f o r m a t i o n .
cific sub-area of a specialty u n d e r t a k e n by some p h y s i cians f o l l o w i n g t h e i r residencies. U p o n c o m p l e t i o n o f
the f e l l o w s h i p the p h y s i c i a n
in
is g r a n t e d sub-specialist
l a n d i n g . For e x a m p l e , o n c o l o g y is a sub-specialty o f
t e r n a l m e d i c i n e a n d p e d i a t r i c s u r g e r y is a sub-specialty o f surgery.
Certified Nurse-Midwife: T h e s e p r a c t i t i o n e r s are r e g i s t e r e d
nurses w i t h a bachelor's degree i n n u r s i n g a n d a master's or o t h e r advanced degree i n
maternal-child
h e a l t h . M i d w i v e s are g e n e r a l l y chosen by w o m e n
want constant attention
process—labof, d e l i v e r y a n d recovery.
PAGE 59
who
t h r o u g h o u t the entire b i r t h
�E L H PAGES"
AT
H
Miller, Kim
MF.DICAI..SCHOOL: Univ ol
WI, 1983
RLSIDENCIKS: Univ of
Pittsburg, 1987
COVERAGE GROUP:
Physicians Plus
SERVICES: Ultrasound.
Venipuncture
CREDIT CARHS: MC & Visa
Roley, Everett
MEDICAL SCHOOL: Creighton
Univ, 1956
INTERNSHII'S: USN Hosp,
Chelsea, Mass, 1957
RESIDENCIES: Univ of'VVI,
1963
SERVICES: Ultrasound,
Venipuncture
CREDIT CARDS: MC & Visa
Borkowf, Harold
MILWAUKEE
Aiman, Edward
MEDICAL SCHOOL: Marquette
Univ, 1969
INTERNSHIPS: Kansas, 1970
RESIDENCIES: Med Coll W I ,
1974
Alexander, A. Charles
MEDICAL SCHOOL
Northwestern Univ
INTERNSHIPS: Northwestern
Univ
SERVICES: Circumcisions,
Ultrasound
CREDIT CARDS: MC
Azcueta, Ester
MEDICAL SCHOOL: Univ of
the East, Phillipines
Roley, Kevin
MEDICAL SCHOOL: Creighton
Univ, 1986
INTERNSHIPS: Univ o f WI
Aflil Hosp
RESIDENCIES: Univ of WI
A f i i l Hosp
COVERAGE GROUP: Anderson
Roley, Torhorst
SERVICES: Circumcisions,
Ultrasound, Venipuncture
CREDIT CARDS: MC & Visa
Rudot, Karl
Castillo, Marcelo
MEDICAL SCHOOL- Marquette
Univ, 1946
INTERNSHIPS: St. Joseph's
Hosp., Milwaukee, 1947
RESIDENCIES: St. Joseph's
Hosp., Milwaukee, 1953
COVERAGE GROUP: Finlayson
SERVICES: Circumcisions,
Venipuncture
HOURS: Evenings &
Weekends
MEDICAL SCHOOL: Univ
Philippines, 1952
INTERNSHIPS: Univ
Philippines
RESIDENCIES: Univ
Philippines, 1958
Brockman, Lenora
MEDICAL SCHOOL: Univ SK,
Canada, 1980
Baccus, Donald
HOURS: Evenings and
Bae, Ik Hak
MEDICAL SCHOOL: Univ of
Illinois. 1974
INTERNSHIPS: Univ of
Illinois Hosp, 1977
COVERAGE GROUP:
Physicians Plus
SERVICES: Ultrasound,
Venipuncture
CREDIT CARDS: MC 8c Visa
Brennan, John
MEDICAL SCHOOL: Univ of
WI, 1964
INTERNSHIPS: Evanston
Hosp, 1969
RESIDENCIES: Univ of WI,
1974
COVERAGE GROUP: Burstein,
Nash
SERVICES: Circumcisions,
Ultrasound, Venipuncture
CREDIT CARDS: MC & Visa
MEDICAL SCHOOL: Univ o f
Michigan, 1976
INTERNSHIPS: St. Joseph's
Hosp, Milwaukee, 1977
RESIDENCIES: St. Joseph's
Hosp, Milwaukee, 1980
SERVICES: Circumcisions,
Ultrasound
HOURS: Evening
Rudman, Sherwin
RESIDENCIES: Univ o f WI,
1976
COVERAGE GROUP: Babbitz,
Nash
SERVICES: Circumcisions,
UItrasound, Venipimcture
CREDIT CARDS: MC & Visa
Babbitz, Allen
MEDICAL SCHOOL: Univ of
WI, 1983
INTERNSHIPS: Med Coll
Virginia, 1974
RESIDENCIES: Med Coll
Virginia, 1977
COVERAGE GROUP: Dean
Medical
SERVICES: Ultrasound,
Venipuncture
Weekends
INTERNSHIPS: Univ of W I ,
MEDICAL SCHOOL:
Witwaiersrand
(Johannesburg), 1959
INTERNSHIPS: Queen
Victoria Maternity Hosp,
1961
RESIDENCIES: Johns Hopkins
Hosp, 1968
RESIDENCIES: Hennepin Co.
Med,
Minneapolis, 1981
Broekhuizen, Fredrik
MEDICAL SCHOOL: Univ of
Utrecht, Netherlands,
1972
INTERNSHIPS: Univ o f Wl
RESIDENCIES: Univ o f WI
COVERAGE GROUP: Univ o f
WI Physicians
SERVICES: Midwives,
Circumcisions.
Ultrasound, Venipuncture
Budarapu, Suseela
MEDICAL SCHOOL: Andhra
(India), 1946
RESIDENCIES: Mt. Sinai Med
Center, Milwaukee, 1982
MEDICAL SCHOOL:
Kyungpook Univ (Taegu,
Korea), 1963
INTERNSHIPS: Detroit
General Hosp, 1966
RESIDENCIES: Detroit
General Hosp, 1970
SERVICES: Circumcisions.
Ultrasound, Venipuncture
HOURS: Evenings
Barr, Carmela
MEDICAL SCHOOL: Univ of
Illinois, 1979
INTERNSHIPS. Med Coll W I Milwaukee Co Hosp, 1980
RESIDENCIES: Med Coll W l Milwaukee C u H o s p , 1983
Burch, Kim
MEDICAI. SCHOOL: Med Coll
WI, 1976
INTERNSHIPS: Med Coll W l ,
1977
RESIDENCIES: Med Coll W I ,
1980
1973
Chambers, LaRoyce
MEDICAL SCHOOL: Univ of
Michigan, 1970
INTERNSHIPS: Chicago
Wesley Memorial Hosp
RESIDENCIES: Northwestern
Univ
COVERAGE GROUP: OB/GYN
Medical Services
SERVICES: Circumcisions,
Ultrasound, Venipuncture
Clark, Douglas
MEDICAL.SCHOOL: Ohio State
Univ, 1961
INTERNSHIPS: Milwaukee
County Hosp, 1962
RESIDENCIES: Ohio State
Univ, 1965
FELLOWSHIPS: Ohio State
Univ, 1966
COVERAGE GROUP: Medical
Associates
SERVICES: Circumcisions,
Ultrasound, Venipuncture
HOURS: Evenings &
Weekends
CREDIT CARDS: MC, Visa, &
Amex
Claude, John
MEDICAL SCHOOL: Marquette
Univ, 1953
INTERNSHIPS: St. Joseph's
Hosp, Milwaukee, 1954
RESIDENCIES: Milwaukee
COVERAGE GROUP: Medical
Associates
SERVICES: Circumcisions,
Ultrasound,
Venipuncture
HOURS: Evenings 8c
Weekends
CREDIT CARDS: MC, Visa &
Amex
Countv Gen Hosp, 1959
COVERAGE GROUP:
Wilkinson Medical Clinic
SERVICES: Circumcisions,
Ultrasound,
Venipuncture
HOURS: Weekends 8c
Evenings
CREDIT CARDS: MC & Visa
Burstein, P. D.
Coulter, Renee
MEDICAL SCHOOL: Univ o f
Michigan, 1972
MEDICAL SCHOOL: Med Coll
W I , 1979
PAGE 60
�HIEALTH PAGES'
NTERNSHIPS: M e d C o l l W I ,
1980
RESIDENCIES: M e d C o l l W l ,
1984
COVERAGE GROUP:
Milwaukee Medical Clinic
SERVICES: U l t r a s o u n d ,
Venipuncture
HOURS: W e e k e n d
CREDIT CARDS: M C & Visa
Craft, Samuel
I N T E R N S H I P S : St. J o s e p h ' s
Hosp, Milwaukee
RESIDENCIES: St. Joseph's
Hosp, Milwaukee
SERVICES: C i r c u m c i s i o n s ,
Ultrasound, Venipuncture
Earle, Sandra H.
M E D I C A L S C H O O L : Rush M e d
C o l l , 1983
RESIDENCIES: Cook County
Hosp, Chicago
MEDICAL SCHOOL: M e d C o l l
Wise, 1976
INTERNSHIPS: M e d C o l l
Wise, M i l w a u k e e , 19761977
RESIDENCIES: M t . Sinai
H o s p , M i l w a u k e e , 19801983
COVERAGE GROUP:
COVERAGE GROUP: D r .
o f W I , 1984
I N T E R N S H I P S : W a y n e State
Affiliated Hospitals
RESIDENCIES: W a y n e State
Affiliated Hospitals
SERVICES: U l t r a s o u n d ,
Venipuncture
HOURS: E v e n i n g s &
Weekends
CREDIT CARDS: M C 8c Visa
Heitman
Daleiden, James
MEDICAL SCHOOL: U n i v of
Minnesota, 1969
INTERNSHIPS: St. J o s e p h ' s
Hosp, Milwaukee, 1970
RESIDENCIES: St. Joseph's
t
H o s p , M i l w a u k e e , 1973
.COVERAGE GROUP:
Moreland OB/GYN
RVICES: C i r c u m c i s i o n s ,
Ultrasound, Venipuncture
HOURS: E v e n i n g
CREDIT CARDS: M C & Visa
Decker, Mark
MEDICAL SCHOOL: U n i v o f
N o r t h Dakota, 1984
INTERNSHIPS: M t Sinai M e d
Center
RESIDENCIES: U n i v o f WT
SERVICES: M i d w i v e s ,
Circumcisions,
Ultrasound, Venipuncture
HOURS: E v e n i n g s
CREDIT CARDS: M C & Visa
Diulio, Lynn Knitter
MEDICAL SCHOOL: M e d C o l l
o f W I , 1974
INTERNSHIPS: St. J o s e p h ' s
Hosp, Milw
RESIDENCIES: St. Joseph's
Hosp, Milw
COVERAGE GROUP:
Womencare
SERVICES: C i r c u m c i s i o n s ,
Ultrasound, Venipuncture
HOURS: E v e n i n g s
EDIT CARDS: M C & Visa
IK
Ian, James
MEDICAL SCHOOL: U n i v o f
I r e l a n d , Galway, 1973
Lakeside
OB/GYN
SERVICES: C i r c u m c i s i o n s ,
Ultrasound, Venipuncture
HOURS: E v e n i n g
Fait, Gary
MEDICAL SCHOOL: M e d C o l l
MEDICAL SCHOOI : M e h a r r v
M e d C o l l , 1953
INTERNSHIPS: M e h a r r y M e d
C o l l , 1954
RESIDENCIES: M e h a r r y M e d
C o l l , 1957
Fox, Brian
MEDICAL SCHOOL: W a y n e
U n i v , 1979
INTERNSHIPS: B l o d g e t t & St.
Maiy's Hosp, Grand
Rapids, 1980
RESIDENCIES: B l o d g e t t & St.
Mary's Hosp, G r a n d
R a p i d s , 1983
C O V E R A G E GROUP: R a c i n e
Medical Clinic
SERVICES: C i r c u m c i s i o n s ,
Ultrasound, Venipuncture
CREDIT CARDS: M C & Visa
MEDICAL SCHOOL: U n i v o f
O s t e o p a t h i c M e d , Des
Moines, 1980
INTERNSHIPS: Riverside
Osteopathic Hosp,
Trenton, M I
RESIDENCIES: R i v e r s i d e
Osteopathic Hosp,
Trenton, M I
COVERAGE GROUP: U n i v o f
Wisconsin
Circumcisions,
Ultrasound, Venipuncture
CREDIT CARDS: M C 8c Visa
Gilman, Michael D.O.
MEDICAL SCHOOL: C o l l e g e o f
Osteo M e d . a n d Surgery,
1979, 1979
INTERNSHIPS: N W General
Hosp, Milwaukee, 1980
RESIDENCIES: U W i s C - M t .
Sinai Hosp, Milwaukee,
1984
Gondi, Jyothi
MEDICAL SCHOOL:
Rangamaya M e d Coll,
I n d i a , 1971
I N T E R N S H I P S : St. J o h n H o s p ,
D e t r o i t , 1977
RESIDENCIES: C o o k C o u n t y
H o s p , C h i c a g o , 1981
SERVICES: C i r c u m c i s i o n s
Graciosa, Elena
Finlayson, William
Gilman, Daniel D.O.
SERVICES: Midwives,
MEDICAL SCHOOL: C e b u Inst
M e d , 1972
INTERNSHIPS: St. J o h n ' s
Epis. H o s p , B r o o k l y n ,
1967
RESIDENCIES: C o o k C o u n t y
H o s p , C h i c a g o , 1981
Gryniewicz, Michael
MEDICAL SCHOOL: M a r q u e t t e
Univ, 1965
INTERNSHIPS: St. J o s e p h ' s
H o s p , M i l w a u k e e , 1966
R E S I D E N C I E S : St. J o s e p h ' s
H o s p , M i l w a u k e e , 1971
SERVICES: C i r c u m c i s i o n s ,
Ultrasound
HOURS: W e e k e n d
Handrich, Thomas
MEDICAL SCHOOL: M e d C o l l
W I , 1964
INTERNSHIPS: Johns
H o p k i n s Hosp, 1965
RESIDENCIES: U n i v o f T e x a s ,
1968
FELLOWSHIPS: J o h n s
H o p k i n s H o s p , 1965
COVERAGE GROUP:
Milwaukee Medical Clinic
SERVICES: C i r c u m c i s i o n s ,
Ultrasound, Venipuncture
HOURS: W e e k e n d
C R E D I T C A R D S : M C 8c V i s a
W I , 1987
COVERAGE GROUP: D r . C r a f t
SERVICES: C i r c u m c i s i o n s ,
Ultrasound, Venipuncture
HOURS: E v e n i n g
CREDIT CARDS: M C & Visa
Hofbauer, Thomas
M E D I C A L SCHOOL: M a r q u e t t e
Univ, 1956
INTERNSHIPS: Milwaukee Co
G e n H o s p , 1957
RESIDENCIES: M i l w a u k e e C o
Gen Hosp, 1962
C O V E R A G E GROUP: M e d i c a l
Associates
SERVICES: U l t r a s o u n d ,
Venipuncture
HOURS: E v e n i n g s &
Weekends
CREDIT CARDS: MC, Visa 8c
Amex
James, Janine
MEDICAL SCHOOL: U n i v o f
Illinois, Chicago, 1979
INTERNSHIPS: M t . S i n a i
Hosp, Chicago, 1980
R E S I D E N C I E S : M t . Sinai
H o s p , C h i c a g o , 1982
FELLOWSHIPS: U n i v of
I l l i n o i s , 1985
SERVICES:
Ultrasound
HOURS: E v e n i n g s
Jirak, George
MEDICAL SCHOOL: U n i v of
W I , 1981
RESIDENCIES: B r o o k e A r m y
M e d , San A n t o n i o , 1 9 8 2
Kaminski, Henry
MEDICAL SCHOOL: U n i v o f
I l l i n o i s , 1983
INTERNSHIPS: M e d Coll o f
WI
RESIDENCIES: M e d C o l l o f W I
COVERAGE GROUP: Falls
Medical Group
SERVICES: C i r c u m c i s i o n s ,
Ultrasound, Venipuncture
HOURS: E v e n i n g
Klieger, Jack
MEDICAL SCHOOL: M a r q u e t t e
U n i v , 1941
INTERNSHIPS: M e d C o l l o f
WI
RESIDENCIES: Milwaukee C o
H o s p , 1946
Heitman, Timothy
MEDICAL SCHOOL: C h i c a g o
M e d School, 1982
RESIDENCIES: M t . S i n a i
Medical Center, Univ o f
PAGE 61
Kuhn, Michael Jr.
M E D I C A L SCHOOL: M a r q u e t t e
Univ, 1958
INTERNSHIPS: St. J o s e p h ' s
�I A T PAGES'
E LH
H
Hosp, Milwaukee
KKSiDi-.NCli'.S: Sl. J o s e p h ' s
Hosp, Milwaukee
SERVICES: C i r c u m c i s i o n s ,
Ulirasound, Venipuncture
CKK.DI'I" CARDS: M C &: Visa
COVERAGE GROUP:
Burlington Clinic
SERVICES: C i r c u m c i s i o n s ,
Ultrasound, Venipunciure
HOURS: W e e k e n d
CREDIT CARDS: M C &: Visa
Lalich, Roger
Meyer, Matthew
M E D I C A I . SCHOOL: O k l a h o m a
Slate U n i v . 1977
INTERNSHIPS: Northwest
Gen, Milwaukee
RESIDENCIES. S t . M a r y ' s H o s p
EELLOWSHIPS: M i c h a e l Reese
MEDICALSCHOOL:
G e o r g e t o w n U n i v , 1971
Hosp, Chicago
SERVICES: U l t r a s o u n d .
Vciiipuncmie
CREDIT CARDS: M C & Visa
Linn, James
MEDICAL SCHOOL: M e d ( .oil
o l ' W l , 1980
INTERNSHIPS: B u l t c i - w o i ' t l l
Hosp, Michigan
RESIDENCIES: l i u t t e n v o r t h
INTERNSHIPS: Georgetown
U n i v , 1972
R ES l D EN CI ES: G e o r g e t o w n
U n i v , 197;.
COVERAGE GROUP: W o m e n ' s
Health Care
SERVICES: C i r c u m c i s i o n s ,
Ultrasound, Venipuncture
HOURS E v e n i n g s &
Weekends
C R E D I I C A R D S : M C & Visa
Millan, Alfredo
MEDICALSCHOOL: Ear
Easlein U n i v . I'hillipines,
1961
INTERNSHII'S: M l . Sinai M e d
H o s p M i c h i g a n , 1984
COVERAGE GROUP:
Northpoint
SERVICES: C i r c u m c i s i o n s .
Ultrasound. Venipuncture
HOURS: E v e n i n g s &
Weekends
C e n t e r . 197:4
R E S I D E N C I E S : M t . Sinai M e d
C e n l e r , 1976
SERVICES: C i r c u m c i s i o n s ,
Ultrasound
Lucca, Paul
Miller, Donald Jr
MEDICALSCHOOL: M e d C o l l
MEDICAL SCHOOI.: Kanzas,
1976
RESIDENCIES: H e n r y Ford
H o s p , D e t r o i t , 1980
COVERAGE GROUP: Racine
Medical Clinic
SERVICES: U l t r a s o u n d ,
Venipuncture
CREDI T CARDS- M C & Visa
o f ' W I , 19(')9
INTERNSHIPS: L A C / U S C
Merl Center. L.A.
RESIDENCIES: M i l w a u k e e
County Gen Hosp
COVERAGE GROUP:
Milwaukee Meilical Clinic
SERVICES: U l i r a s o u n d ,
Venipuncture
HOURS: W e e k e n d s
CREDIT CARDS. M C , Visa, &
Amex
Majewski, Michael
MEDICALSCHOOL:
D a i l m o u t h Medical
S c h o o l , 1978
INTERNSHIPS: M e d C o l l W l
RESIDENCIES: U n i v o f
Colorado
SERVICES:
Venipuncture
HOURS: E v e n i n g & W e e k e n d
Maker, George
MEDICALSCHOOL U n i v o l
V e r m o n t , 1976
INTERNSHIPS: U n i v o C W l .
1977
- I D E M IES U n i v o f ' W I ,
'180
HOURS: E v e n i n g s
CREDIT CARDS. M C &• Visa
Nohl, James
MEDICAL SCHOOL:
Universidad A u i o n o m n de
T a m a u l i p a s , 1982
INTERNSHIPS. W i n l h r o p
Univ Hosp. Mineola. N.Y.
RESIDENCIES: W i n t h r o p U n i v
Hosp, Mineola. N.Y.
SERVICES: C i r c u m c i s i o n s ,
Ultrasound, Venipuncture
HOURS: E v e n i n g
MEDICAL SCHOOL: M i c h i g a n
State U n i v , 1977
INTERNSHIPS:
Ulodgctt/St. Mary's Hosp
RESIDENCIES:
Blodgett/St.Mary's Hosp
COVERAGE GROUP: Racine
Medical Clinic
SERVICES: C i r c u m c i s i o n s ,
Ultrasound, Venipuncture
Nash, David
MEDICALSCHOOL: U n i v of
W l , 1975
RESIDENCIES M l Sinai M e d
Center, Milwaukee
COVERAGE GROUP: Babbit/.
& Burstein
SERVICES: C i r c u m c i s i o n s ,
Ultrasound, Venipuncture
Riendl, Anne
MEDICAL SCHOOI
Med Coll
WI. 1977
EELLOWSHIPS: M t . S i n a i M e d
Center. Milwaukee, I 98 1
Pogedas, Anthony
Shroeder, Thomas
MEDICAL SCHOOL: Indiana
MEDICALSCHOOL: U n i v o f
Iowa, 1959
INTERNSHII'S: St. Joseph's
H o s p , M i l w a u k e e . 1960
RESIDENCIES: St. Joseph's
H o s p , M i l w a u k e e , 1965
U n i v . 196:4
INTERNSHIPS: D e t r o i t
G e n e r a l H o s p , 1964
RESIDENCIES: W a y n e Stale
U n i v , 1968
SERVICES: C i r c u m c i s i o n s ,
Ultrasound, Venipuncture
HOURS: E v e n i n g s
Parker, Edward
M E D I C A L SCHOOL: M a r q u e t t e
U n i v , 1964
INTERNSHIPS: Sl.JosepllS
H o s p . M i l w a u k e e , 1965
RESIDENCIES: St.Josephs
H o s p , M i l w a u k e e , 1968
SERVICES: C i r c u m c i s i o n s ,
Ultrasound, Venipuncture
MEDICALSCHOOL: U n i v o f St.
L o u i s , 1959
INTERNSHIPS: Milwaukee Co
G e n H o s p , 1960
RESIDENCIES: M e d C o l l o f
W l , 1964
EELLOWSHIPS: | o h n s
H o p k i n s U n i v , 1967
Pelland, Philip
MEDICAL SCHOOL: M a r q u e t t e
U n i v . 1959
INTERNSHIPS: M i l w a u k e e C o
G e n H o s p , 1960
RESIDENCIES: Johns H o p k i n s
H o s p , 1965
Pircon, Richard Adam
C R E D I r C A R D S . M C At Visa
MEDICALSCHOOL: L o v o l a
U n i v , 1975
INTERNSHIPS. M i l w a u k e e C o .
G e n H o s p . 1977
RESIDENCIES Milwaukee C o .
G e n H o s p . 1980
SERVICES: U l t r a s o u n d
HOURS: E v e n i n g s
C R E D I T C A R D S . M C A Visa
c
Patillo, Roland
Musson, Jeffrey
Poremski, Tod
MEDICALSCHOOL: Rush M e d
C o l l , 1983
INTERNSHIPS: Rush
I ' i esbyterian-St. L u k e s
Med Center
EELLOWSHIPS. M a t e r n a l Fetal M e d i c i n e
SERVICES: C i r c u m c i s i o n s ,
Ultrasound, Venipunciure
PAGE 62
Shafi, Mohammad
MEDICALSCHOOL. N i s h t a r
M e d C o l l , Pakistan, 196-4
RESIDENCIES: M o u n t Sinai
Hosp, Milwaukee
SERVICES: M i d w i v e s .
Circumcisions, Ultrasound
HOURS: W e e k e n d
Sirin, Kerim
MEDICALSCHOOL: Ankara
Univ, T u r k e y , 1949
INTERNSHIPS: St. B a r n a b a s
H o s p , M i n n e a p o l i s . 1958
RESIDENCIES: C o l u m b i a
Hosp, M t . Sinai H o s p ,
1962
COVERAGE GROUP: G a l l a l .
M c l n y c z e n k o AL- Shaf
SERVICES: C i r c u m c i s i o n s ,
Venipuncture
Stall, Adolf
MEDICALSCHOOL: C h a r l e s
U n i v , P r a g u e . C z e c h , 1957
INTERNSHIPS: C o H o s p
Cheb, Czech. 1958
RESIDENCIES. C h a r l e s U n i v .
C z e c h , 1962
Stewart, William
MEDICAL SCHOOL: M a r q u e t l e
U n i v , 1962
INTERNSHIPS: St. Joseph's
H o s p , 1963
RESIDENCIES St. Joseph's
H o s p , 1968
SERVICES: U l t r a s o u n d
HOURS: E v e n i n g s
�E L H PAGES'
AT
( Sturino, Kathy
MEDICAL SCHOOL: M e d C o l l
o f W I , 198:5
INTERNSHIPS: M t . Sitiai M e d
Centet, Milwaukee
RESIDENCIES: Mt.Sinai M e d
C e n t e r , M i l w a u k e e , 1987
COVERAGE GROUP:
Womencare
SERVICES: C i r c u m c i s i o n s ,
Ultrasound, Venipuncture
HOURS: E v e n i n g s
CREDIT CARDS: M C & Visa
Vitamvas, Gerald
M E D I C A L SCHOOL: N e b r a s k a ,
1975
RESIDENCIES: Nebraska A f l i l
H o s p . 1979
SERVICES: U l t r a s o u n d .
Venipunciure
HOURS: W e e k e n d
CREDIT CARDS: M C & Visa
Worth, Robert
MEDICALSCHOOL: M a r q u e t t e
U n i v , 1968
INTERNSHIPS: St. J o s e p h ' s
H o s p . M i l w a u k e e . 1969
RESIDENCIES: St. J o s e p h ' s
H o s p , M i l w a u k e e , 1972
Washington, Janie Marie
MEDICAL SCHOOL: U n i v o l
W I , 1982
INTERNSHIPS: M t . Sinai M e d
C e n t e r , 1984
RESIDENCIES: M t . Sinai M e d
C e n t e r . 1987
SERVICES: C i r c u m c i s i o n s ,
Ultrasound. Venipuncture
CREDIT CARDS: M C , Visa &
Amex
Wetzler, Robert
M E D I C A L SCHOOL: M a r q u e t t e
U n i v , 1968
I N T E R N S H I P S : St. Joseph's
H o s p , 1969
COVERAGE GROUP: M e d i c a l
C o n s u l t a n t s , SC.
SERVICES: C i r c u m c i s i o n s ,
Ultrasound, Venipuncture
HOURS: E v e n i n g s &
Weekends
CREDIT CARDS: M C
Visa
Worthington, Dennis
MEDICALSCHOOL: U n i v o f
E d i n b u r g h - S c o t l a n d . 1966
INTERNSHIPS: G e n . Rose
M e m l H o s p , Denver , 1967
ESIDENCIES: Q u e e n ' s U n i v ,
K i n g s t o n , C a n a d a , 1971
EELLOWSHIPS: P e r i n a t a l M e d
K i n g s t o n G e n H o s p , 1972
SERVICES: Cir c u m c i s i o n s ,
Ultr a s o u n d , V e n i p u n c t u r e
Yellick, Clyde
MEDICAL SCHOOL: M e d C o l l
WI. 1956
INTERNSHIPS: St. M a r y ' s
H o s p , M i l w a u k e e , 1958
RESIDENCIES: St. M a r y ' s
H o s p , M i l w a u k e e , 1960
SERVICES: U l t r a s o u n d ,
Venipuncture
HOURS: E v e n i n g s a n d
Weekends
FAMILY PRACTITIONERS
Lewan, Richard
MEDICALSCHOOL: U n i v o f
C h i c a g o , 1979
INTERNSHIPS: U n i v o f
Illinois-Rockford
RESIDENCIES: U n i v o f
Illinois-Rockford
SERVICES: C i r c u m c i s i o n s ,
Venipuncture
HOURS: E v e n i n g s
Ranola, Pedro
MEDICAL SCHOOL: U n i v o f
S a n t o T o m a s , 1967
INTERNSHIPS: St. M i c h a e l
H o s p . M i l w a u k e e , 1971
RESIDENCIES: St. M i c h a e l
H o s p , M i l w a u k e e , 1973
Stevens, Robert
MEDICALSCHOOL: M e d C o l l
o l ' W l . 1984
RESIDENCIES: M e d C o l l o f
Wl
SERVICES: Cir c u m c i s i o n s ,
Venipuncture
E T(OTOLARYNGOLOGISTS)
N
GREEN BAY
k . - i - ^ i ^ i ' . Si.... .-'^_- . j j W
Mills, John M
MEDICAL SCHOOL: U n i v o f
I l l i n o i s . 1959
INTERNSHIPS: I . e l t e r m a n
H o s p . San Fr ancisco, 1960
RESIDENCIES: U n i v o f
I l l i n o i s , 1967
TEACHING POSITION:
Assistant Professor, U n i v
ofWI
CREDIT CARDS: M C & Visa
Schmidt, Frederic
MEDICAL SCHOOL: M e d C o l l
o f ' W I , 1983
RESIDENCIES: M e d C o l l o f
WI. 1988
Titulaer, Richard
MEDICALSCHOOL: U n i v o f
W l , 1967
INTERNSHIPS: St Mary's
H o s p , D u l u t h . 1968
RESIDENCIES: M e d C o l l o f
WI, 1975
MEDICALSCHOOL: U n i v o f
M i c h i g a n , 1966
INTERNSHIPS: B l o d g e t t
M e m l Hosp, Grand
R a p i d s , 1967
RESIDENCIES: U n i v o f
1972
Wineinger, David
MEDICALSCHOOL: U n i v o f
Michigan
INTERNSHIPS: I l l i n o i s
Research & E d H o s p ,
1963
RESIDENCIES: U n i v o f
I l l i n o i s , 1967
MADISON
Donovan, Timothy J
MEDICALSCHOOL: U n i v o f
W I , 1964
INTERNSHIPS: W a y n e C o G e n
H o s p , M i c h i g a n , 1965
Finch, William Wesley
MEDICALSCHOOL: U n i v o f
W I , 1973
I N T E R N S H I P S : Kaiser H o s p
O a k l a n d C a l , 1974
RESIDENCIES: U n i v o l ' W l ,
1978
CREDIT CARDS: M C & Visa
PAGE 63
MEDICALSCHOOL: U n i v o f
L o u i s v i l l e , 1965
INTERNSHIPS: H e n r y F o r d
H o s p , D e t r o i t , 1966
RESIDENCIES: H e n r y F o r d
H o s p , D e t r o i t , 1970
TEACHING POSITION: Prof,
Univ of'WI
SERVICES: V e n i p u n c t u r e
CREDIT CARDS: M C
Visa
Scott, John Kimball
MEDICALSCHOOL: O h i o State
U n i v , 1954
IN TERNSHIPS: W h i t e Cross
Hosp
RESIDENCIES: O h i o State
U n i v , 1958
CREDIT CARDS: M C & Visa
Stanley, Robert John
MEDICALSCHOOL: U n i v o f
W I , 1977
RESIDENCIES: G u t h r i e Clinic.
Sayre. PA, 1983
EELTOWSHIPS: Mavo Clinic,
1988
MILWAUKEE
Barton, James Robert
Vander, W u e
od
Michigan,
Ford, Charles N
MEDICAL SCHOOL: West
V i r g i n i a U n i v , 1971
IN TERNSHIPS: R o a n o k e
H o s p , 1972
RESIDENCIES: M e d C o l l o f
WI, 1980
CREDIT CARDS: M C & Visa
Belson, Thomas Patrick
MEDICAL SCHOOL: M a r q u e t t e
U n i v , 1963
I N T E R N S H I P S : Si Francis
H o s p , I l l i n o i s , 1964
RESIDENCIES: V A C e n l e r ,
W o o d , 1970
TEACHING POSITION:
Associate C l i n i c a l
Professor, M e d C o l l o f ' W I
Condon, Kenneth Gerard
MEDICALSCHOOL: U t l i v o f
WI, 1980
INTERNSHII'S: C h a r i l v H o s p .
N e w O r l e a n s , 1981
RESIDENCIES: U n i v o f W I ,
1987
CREDIT CARDS: M C & Visa
Dankle, Steven Kle
MEDICALSCHOOL: U n i v o f
I o w a . 1982
RESIDENCIES: O h i o State
U n i v , 1987
CREDIT CARDS: M C & Visa
�H
E L H PAGES
AT
Darling, William Anthony
Kleiner, Harvey
MF.DICAL SCiHOOL: Med Coll
o l ' W l , 1969
INTERNSHIPS: Sl. Joseph
Hosp, Denver, 1970
MEDICALSCHOOL: Med Coll
of WI, 1972
INTERNSHIPS: Cedars Sinai
Hosp, L.A.
RESIDENCIES: Med Coll of
WT
TEACHING POSITION: Med
Coll o f W I
RESIDENCIES: Med Coll of
W l , 1974
TEACHING POSITION:
Associate Clinical
Professor, Med Coll o f WI
ONCOLOGISTS
GREEN BAY
MEDICAL SCHOOL: Indiana
Univ, 1981
MEDICAL SCHOOL: Univ of
W l , 1974
INTERNSHIPS: Akron Genl
Med Ctr, 1975
RESIDENCIES: Akron Genl
Med Ctr, 1977
FELLOWSHIPS: Univ Hosps,
Cleveland, 1979
MEDICAL SCTIOOL: Loyola
Stritch Med School, 1971
INTERNSHIPS: Milwaukee
WI
RESIDENCIES: Med Coll of
WI
HOURS: Evening
County
RESIDENCIES: Milwaukee
County Institute
TEACHING POSITION: Med
Coll o l ' W l
Friedman, Jerry Eli
Park, John Raymond
MEDICAL SCHOOL: Univ of
Illinois, 1961
INTERNSHIPS: L. A. Co Gen
Hosp, 1962
RESIDENCIES: VA Hosp, III,
1963; III Research & Educ
Hosp, 1966
TEACHING POSITION:
Professor, Med Coll o f W I
MEDICALSCHOOL: George
Washington Univ, 1968
INTERNSHIPS: Cleveland
Metro Hosp, 1969
RESIDENCIES: Univ o f
Minnesota, 1974
TEACHING POSITION: Med
Coll o f W I
CREDIT CARDS: MC & Visa
Grunke, Richard John
Wermuth, Douglas John
MEDICALSCHOOL: Med Coll
o f W I , 1977
INTERNSHIPS: St. Luke's
Hosp, Milw, 1978
RESIDENCIES: Med Coll of
W I , 1982
TEACHING POSITION:
Assistant Clinical
Professor, Med Coll o f W I
SERVICES: Venipuncture
CREDIT CARDS: MC & Visa
MEDICAI. SCHOOL: Med Coll
o f W I , 1984
RESIDENCIES: Duke Univ,
1989
INTERNSHIPS: Med Coll of
Janowak, Michael Charles
MEDICAL SCHOOL: Loyola
Univ, 1972
INTERNSHIPS: Josephs Hosp,
Milw, 1973
RESIDENCIES: Med Coll of
W I , 1977
LEACHING POSITION: Med
Coll of WI
Kidder, Thomas
MEDICALSCHOOL: Med Coll
o f ' W I , 1968
INTERNSHIPS: Columbia
Hosp, Milw, 1969
RESIDENCIES: Med Coll of
WT, 1973
TEACHING POSITION:
Assistant Professor, Med
Coll of WI
Blank, Jules
MEDICALSCHOOL: Loyola
Univ. 1978
INTERNSHIPS: Southern 111
Univ, 1978
RESIDENCIES: Southern III
Univ, 1981
FELLOWSHIPS: Univ of Conn,
Farmington, 1984
MEDICAL SCHOOL: Indiana
Univ, 1968
INTERNSHIPS: Hurley Hosp,
Flint, 1969
RESIDENCIES: SUNY,
Buffalo, 1974
FELLOWSHIPS: Brown Univ,
Kohler, Peter
MEDICAL SCHOOL: George
Washington Univ, 1979
INTERNSHIPS: Univ o f W l .
1980
RESIDENCIES: Univ o f ' W I ,
1982
FELLOWSHIPS: Univ o f WT,
Longo, Walter
Carbone, Paul
MEDICALSCHOOL: Univ o f
Nebraska, 1977
INTERNSHIPS: Mayo Clinic
RESIDENCIES: Mayo Clinic
FELLOWSHIPS: Univ of WT
TEACHING POSITION:
AssocProfessor, Univ o f
WI
SERVICES: Venipuncture
CREDIT CARDS: MC, Visa 8c
Amex
MEDICAL SCHOOL: Albany
Prendergast, Edward
1976
Instructor, Med Coll o f WI
SERVICES: Venipuncture
RESIDENCIES: Univ o f ' W I ,
Madison, 1977
FELLOWSHIPS: Univ o f ' W I ,
Madison, 1980
TEACHING POSITION:
Professor, Univ of WI
SERVICES: Venipuncture
HOURS: Evenings 8c
Weekends
CREDIT CARDS. MCA'isa
1985
Koch, Paul
T E A C H I N G POSITION: Clinical
MEDICAL SCHOOL: State Univ
NY. 1974
INTERNSHIPS: Univ of W I ,
1975
Bayer, Gerald
Martinelli, Dean Louis
Durkin, Gretchen Elizabeth
Ershler, William
MADISON
.^V-.-,
Med Coll, 1956
INTERNSHIPS: USPHS Hosp,
Baltimore, 1957
RESIDENCIES: USPHS Hosp,
San Francisco, 1960;
National Institute of
Health, 1963
TEACHING POSITION:
Professor Human
Oncology, Univ o f WI
SERVICES: Venipuncture
CREDIT CARDS: MCATsa
Diggs, Charles
MEDICALSCHOOL: Johns
Hopkins Univ, 1972
INTERNSHIPS: Johns
Hopkins Hosp, 1973
RESIDENCIES: Johns Hopkins
Hosp, 1974
FELLOWSHIPS: Batimore
Cancer Research Ctr,
1977
SERVICES: Venipuncture
PAGE 64
MEDICALSCHOOL: Univ of
Chicago, 1973
INTERNSHIPS: Univ of W l ,
1974
RESIDENCIES: Univ o f WI,
1976
FELLOWSHIPS: Montefiore
Hosp, N . Y., 1978
Robins, Henry
MEDICAI SCHOOL: Boston
Univ, 1976
INTERNSHIPS: U Wise Hosp,
Madison, 1977
RESIDENCIES: U Wise
Hosp, Madison, 1981
FELLOWSHIPS: U Wise Hosp,
Madison, 1981
TEACHING POSITION:
Professor Human
Oncoloy, Univ ol WT
SERVICES: Venipuncture
CREDIT CARDS: MC/Visa
�IEALTH
PAGES-
MILWAUKEE
Anderson, Tom
MEDICAI. SCHOOL: Stanford
Univ, 1969
INTERNSHIPS: Strong Meml
Hosp, Rochester, 1970
RESIDENCIES: Strong Meml
Hosp, Rochester, 1975
FELLOWSHIPS: NCI/Strong
Meml Hosp, 1974
Bomzer, Charles
MEDICAL SCHOOL:
Northwestern Univ, 1978
INTERNSHIPS: Univ Minn
Hosps, 1979
RESIDENCIES: Univ M i n n
Hosps, 1981
FELLOWSHIPS: Univ o f
Rochester, 1986
Borden, Ernest
MEDICALSCHOOL: Duke
Univ, 1966
INTERNSHIPS: Duke Hosp,
1967
RESIDENCIES: Univ of
Pennsylvania, 1968
EELLOWSHIPS: |ohn Hopkins
Univ, 1973 '
Chitambar, Christopher
RESIDENCIES: Univ o f
Cincinnati, 1972
FELLOWSHIPS: Univ o f W I ,
1974
MADISON
MEDICAL SCHOOL: Univ o f
WI, 1963
INT ERNSHIPS: UCLA, 1964
RESIDENCIES: Milwaukee Co
Genl Hosp, 1969
FELLOWSHIPS: Milwaukee Co
Genl Hosp, 1970
TEACHING POSITION:
Associate Professor, Med
Coll o f WI
SERVICES: Venipuncture
G E N BAY
RE
MEDICALSCHOOL: Marquette
Univ, 1962
INTERNSHIPS: Milwaukee Co
Genl Hosp, 1963
RESIDENCIES: Milwaukee Co
Genl Hosp, 1967
FELLOWSHIPS: Milwaukee Co
Genl Hosp, 1969
SERVICES: Venipuncture
MEDICALSCHOOL: Univ o f
Illinois, 1969
INTERNSHIPS: Univ o f
Cincinnati, 1970
MEDICALSCHOOL:
Northwestern Univ, 1981
INTERNSHIPS: Milwaukee
County Hospital
RESIDENCIES: St Joseph's
Hosp, Milw, 1986
Bernacki, Michael
Univ, 1982
INTERNSHIPS: Univ o f
Illinois
RESIDENCIES: Univ of
Illinois, 1987
SERVICES: Venipuncture
HOURS: Evenings
CREDIT CARDS: Yes
MEDICALSCHOOL: Cornell
Univ, 1977
INT ERNSHIPS: Med Coll W I ,
1978
FELLOWSHIPS: National
Dubner, Howard
Anderas, Per
MEDICAL SCHOOL: Loyola
Oesterling, Kurt
Ritch, Paul
MEDICAL SCHOOL: Univ of
Bombay, 1973
INTERNSHIPS: Bergen Pines
Co Hosp, N.J., 1975
RESIDENCIES: Bronx VA-Mt
Sinai, Milwaukee, 1976
FELLOWSHIPS: Bronx VA-Mt
Sinai, Milwaukee, 1978
TEACHING POSIT ION:
Assistant Professor, Med
Coll o f ' W I
SERVICES: Venipuncture
MEDICALSCHOOL: Univ of
San Diego, 1980
INTERNSHIPS: Univ o f San
Diego, 1981
RESIDENCIES: Univ of San
Diego, 1983
FELLOWSHIPS:Johns
Hopkins Univ, 1985
SURGEONS
Kallas, Gerald
Divgi, Ajit
RESIDENCIES: Med Coll W I ,
1980
FELLOWSHIPS: Univ o f
Rochester, 1982
Geocaris, Thomas
MEDICAL SCHOOL: TuftS
Univ, 1973
INTERNSHIPS: Barnes Hosp,
St Louis, 1974
MEDICAL SCHOOL: Loyola
Univ, 1968
INTERNSHIPS: Chicago
Wesley Meml Hosp, 1969
RESIDENCIES: Univ o f
RESIDENCIES: Anderson
Illinois, 1974
Hosp, Houston, 1977
Taylor, Robert
MEDICALSCHOOL: Yale Univ
INTERNSHIPS: Univ o f
Minnesota Hosp
RESIDENCIES: Univ o f
Minnesota Hosp
FELLOWSHIPS: Univ of
Washington
SERVICES: Venipuncture
INTERNSHIPS: Darmouth
Univ, 1982
RESIDENCIES: Dartmouth
Univ, 1984
Mackman, Sanford
MEDICAL SCHOOL: Univ of
W I , 1959
INTERNSHIPS: Univ of
Minnesota, 1960
RESIDENCIES: Univ of W I ,
1964
Wenger, Ronald
MEDICAL SCHOOL: Case
Western Univ, 1970
INTERNSHIPS: Oregon
Hosps, 1971
RESIDENCIES: Mayo Clinic,
1977
Wolberg, William
MEDICALSCHOOL: Univ o f
WI, 1956
INTERNSHIPS: Ohio State
Univ, 1957
RESIDENCIES: Univ of WI,
1961
TEACHING POSITION: Prof
Surgery and Human
Oncology, Univ of WT
SERVICES: Venipuncture
CREDIT CARDS: MCATsa
MILWAUKEE
Altman, David
MEDICALSCHOOL: Univ o f
WI, 1961
INTERNSHIPS: Mt. Sinai
Hosp, 1962
RESIDENCIES: Marquette
Univ, 1966
TEACHING POSITION: Clinical
Assistant Professor, Med
Coll of W I
SERVICES: Venipuncture
Battista, Joseph
MEDICAL SCHOOL: Univ o f
Cincinnati, 1972
INTERNSHIPS: Hennepin
County Hosp
RESIDENCIES: Iowa
Methodist Med Ctr
FELLOWSHIPS: Univ of
Southern Illinois
SERVICES: Venipuncture
CREDIT CARDS: MCATsa
MEDICAL SCHOOL:
Northwestern Univ, 1983
INTERNSHIPS: Med Coll o f
WI
RESIDENCIES: Med Coll of
WI
SERVICES: Venipuncture
Reckard, Paul
MEDICALSCHOOL: Univ o f
Minnesota, 1981
^
Manke, David
Cancer Institute, 1980
Vukelich, Majorie
CREDIT CARDS: MC/Visa
Weissman, David
Geimer, Nicholas
MEDICALSCHOOL: Punjab
Univ, India, 1977
INTERNSHIPS: Brackenridge
Hosp, Texas, 1978
RESIDENCIES: Brackenridge
Hosp, Texas, 1980
FELLOWSHIPS: Univ of
Colorado, 1983
TEACHING; POSITION:
Associate Professor, Med
Coll of WI
SERVICES: Venipuncture
^
FELLOWSHIPS: Med Coll of
W l , 1987
MEDICALSCHOOL: Univ of
Minnesota, 1984
INTERNSHIPS: Hennepin
County Hosp, 1985
RESIDENCIES: VA Med Ctr,
Des Moines, 1990
SERVICES: Venipuncture
PAGE 65
Bowman, John
MEDICAL SCHOOL: Univ of
Cincinnati, 1966
INTERNSHIPS: Univ o f
Cincinnati, 1967
RESIDENCIES: Marquette
A f l i l , 1971
TEACHING POSI TION:
Associate Professor, Med
Coll o f Wl
�I
E
HALTH PAGES'
SERVICES: V e n i p u n c t u r e
Davies, William
MI-.IIK Al S( l i o o r U n i v o l '
W l , 1965
INTKRNSHIl'S: B o s t o n C i t y
H o s p , 1966
REsliiEMTEs M , i r ( | i i e t l e
A f l i l i a t e c l H o s p s , 197(1
T'K.ACHlNt; I'OSITTON:
Assistant C l i n i c a l
1'rolessoi, Meel C o l l ot W l
RESIDENCIES: I n d i a n a U n i v
SERVICES: V e n i p u n c t u r e
HOURS: W e e k e n d
CREDIT CARDS: M C / V i s a
Assistant C l i n i c a l
Professor. M e d C o l l o f ' W I
Sattler, Marvin
Ml DICAL SCT IOOL K i n g
E d w a r d M e d Sell
( L a h o r e ) , 1963
INTERNSHIPS: C o l u m b u s
H o s p , C h i c a g o , 1965
RESIDENCIES: M t . Sinai
H o s p , M i l w , 1971
MEDICAL SCHOOI.: M a r q u e t t e
U n i v . 1946
INT ERNSHIPS: M t . S i n a i
Hospital
RESIDENCIES: M l . S i n a i
Hospital
TEACHING I'OSITTON:
Associate C l i n i c a l
Professor, M e d C o l l of WT
Koppes, Steven
Schmidt, Robert
M E D I C A L SCHOOL: I n d i a n a
U n i v , 1977
RESIDENCIES: M e d C o l l o f
MEDICAL SCHOOL: C o r n e l l
U n i v , 1966
INTERNSHIPS: U H o s p s o f
Cleve. 1965
RESIDENCIES: U H o s p s o l
Jan, Mazhar
Ekbom, Gregory
Ml.lHI.u.scitool. Univ o f
M i n n e s o t a . 197.'!
IN 11 K \ s l I l l ' s Meel C o l l of
Wl
RHSIDKNCIKS: Meel C o l l o f
WT, 1982
WI
TKACHINC I'OSITK.IN:
Assistant Professor, M e d
Coll o f W I
CRI.DlT C A R D S : M C A ' i s a
Farrell, David
MLDICAL StT IOOL: M e d C o l l
o f W l , 1979
INTERNSHIPS: St. Luke's
Hosp. Milw
RESIDENCIES: St. Luke's
H o s p , M i l w , 1984
Kelley, William
MEDICAL SCHOOL: S l . L o u i s
U n i v . 1967
INTERNSHIPS: U n i v o f
Rochester
RESIDENCIES: St. | o s c p h ' S
H o s p , M i l w a u k e e , 1972
TEACHING I'OSITTON:
Assistant C l i n i c a l
Professor, M e d C o l l of WT
SERVICES: V e n i p u n c t u r e
HOURS
Weekends
C l e v e . 1972
Schmitt, David
MEDICAL SCHOOL. M e d C o l l
o f W l , 1982
RESIDENCIES
Med Coll of
W l , 1987
EELLOWSHIPS M e d C o l l of
W l . 1989
TEACHING POSIT ION:
Assistant Professor, M e d
Coll o f W l
Flynn, George
Kispert, John
MEDICAL SCHOOL: W a v n e
State U n i v , 1984
INTERNSHIPS: M e d C o l l O f
Wl
RESIDENCIES: M e d C o l l O f
WI
EELLOWSHIPS U n i v o f
Kentucky
SERVICES: V e n i p u n c t u r e
MEDICALSCHOOL: O h i o Stale
U n i v , 1969
INTERNSHIPS: U n i v o f
I l l i n o i s , 1970
RESIDENCIES: U l l i v o f
I l l i n o i s , 1975
TEACHING POSITION: M e d
C o l l o f WT
SERVICES: V e n i p u n c t u r e
HOURS: W e e k e n d s
Vincent, Dennis
MEDICALSCHOOL: M e d C o l l
o l ' W l , 1982
INTERNSHIPS: U n i v o f
Kentucky
RESIDENCIES: U n i v of
Kentucky
I EI.I.OWSHII'S: O c h s n e r
Medica] Foundation
T-EACHINC POSIT ION:
Assistant Prolessor, M e d
Coll ol'Wl
CREDIT CARDS: M C A ' i s a
Willson, Donald
MEDICAL SCHOOL: M a r q u e t t e
U n i v , 1969
INT ERNSHIPS: St. Joseph
Hosp, Denver,'1970
RESIDENCIES: M a y o C l i n i c ,
M i n n e s o t a , 1975
T EACHING POSITION:
Assistant C l i n i c a l
Professor, M e d C o l l o f W l
Sleight, Douglas
MEDICAI. SCHOOL: M a r q u e t t e
U n i v , 1956
INTERNSHIPS: M i l w C o H o s p ,
N o n h D a k o t a , 1987
INT ERNSHIPS: M e d C o l l o f
Wl
RESIDENCIES: M e d C o l l o f
WT
SERVICES: V e n i p u n c t u r e
HOURS: E v e n i n g s AL
Weekends
1957
RESIDENCIES: V A C e n t e r
W o o d WT, 1961
Fox, Paul
MEDICAL SCHOOL: Marquette
U n i v , 1968
INTERNSHIPS: U n i v o f
C h i c a g o H o s p i i a l S.C l i n its
RESIDENCIES: M e d C o l l o f
WI
TEACHING POSIT ION:
Assistant C l i n i c a l
Professor, M e d C o l l of'VVI
Grieshop, Joseph
MEDICALSCHOOL M a r q u e t l e
U n i v , 1965
INTERNSHIPS: M i l w C o C e n
H o s p , 1966
RESIDENCIES: M a r q u e t t e
A f l i l , 1970
SERVICES: V e n i p u n c t u r e
Hardacre II, Jerry
MEDICAL SCHOOL: U n i v o f
WI, 1985
INTERNSHIPS: I n d i a n a U n i v
Mikkelson, Wendy
MEDICALSCHOOL: M e d C o l l
W l , 1980
Mittal, Ram
Stobbe, Knud
MEDICAL SCHOOL: U n i v o f
Louisville, 1959
INT ERNSHIPS: N o r t o n M e m l
H o s p , L o u i s v i l l e , 1957
RESIDENCIES: M a v o C l i n i c .
1965
HOURS: E v e n i n g
MEDICAL SCHOOL: M e d C o l l
A m r i t s a r . I n d i a . 1970
INT ERNSHIPS: H u t / e l H o s p ,
D e t r o i t , 1973
RESIDENCIES: S i n a i H o s p .
D e t r o i t A - M i l w . 1977
L
SERVICES: V e n i p u n c i u r e
HOURS: E v e n i n g s &
Weekends
Tiffany II, Joseph
Pequet, Archebald
RESIDENCIES: Alleghenv Gen
MEDICALSCHOOL: U n i v o l
M i c h i g a n . 1981
RESIDENCIES: M i I w a u k e e
Countv Medical Complex,
H o s p , P i n , 1971
EELLOWSHIPS: M a y o C l i n i c ,
M i n n e s o t a , 1968
1986 '
TEACHING I'OSITTON:
MEDICAL SCHOOL:
N o r t h w e s t e r n U n i v , 1965
INTERNSHIPS: C o o k C o
Hosp, Chicago, 1966
Timm, Mark
MEDICAL SCHOOL: U n i v o f
PAGE 66
Woods, James
MEDICALSCHOOL: I n d i a n a
U n i v , 1968
INTERNSHIPS: M e d C o l l o f
W l , 1969
RESIDENCIES: M e d C o l l o f
WI, 1975
TEACHING I'OSITTON:
Associate C l i n i c a l
Professor. M e d C o l l o f W I
CREDIT CARDS: M C A ' i s a
�-
E L H PAGES
AT
UROLOGISTS
RESIDENCIES: Northwestern
Univ, Chicago, 1964
Greenberg, Earl Barry
MEDICAL SCHOOL: Univ of
Miami, 1963
INTERNSHIPS: L.A. County
Waters, Raul F
MEDICAL:SCHOOL: Loyola
MEDICAL SCHOOL: Wayne
Univ, 1961
INTERNSHIPS: Grace Hosp,
Detroit, 1963
RESIDENCIES: Marquette
Univ, 1966
Snitch, 1980
RESIDENCIES: Univ of W I ,
Wegenke, John D.
Hosp, 1964
Kennedy, Timothy
MEDICAL SCHOOL: Ulliv oi
Iowa
INTERNSHII'S: Parkland
Hosp, Univ ol T exas
RESIDENCIES: Parkland
Hospital, 1989
SERVICES: Venipunciure
Marlett, Myron Max
MEDICALSCHOOL: Univ of
Illinois, 1971
INTERNSHIPS: Univ of
Illinois, 1972
RESIDENCIES: Univ of
Illinois, 1976
SERVICES: Venipuncture
RESIDENCIES: US Naval
Hosp USS Repose, 1970
Kuglitsch, Michael Ervin
MEDICALSCHOOL: Ulliv of
1985
WI
CREDIT CARDS: MC & Visa
INTERNSHIPS: San |oaquin
Genl, Stockton, 1972
RESIDENCIES: Ulliv of W I ,
Licklider, Gary Melvin
MEDICALSCHOOL: Univ of
1976
WI, 1971
INT ERNSHIPS: San Francisco
Hosp, 1972
RESIDENCIES: Univ of
California, 1977
Schiebler, John Charles
Hosp, La Crosse, 1970
SERVICES: Venipuncture
nnelond, Arthur Malcom III
MEDICALSCHOOL: Univ of
WI, 1978
INTERNSHIPS: Univ of WT
RESIDENCIES: Univ of W l ,
1983
SERVICES: Venipuncture
Troup Charles W.
MEDICAL SCHOOL:
Northwestern Univ, 1963
INT ERNSHIPS: Wesley Hosp,
Chicago, 1964
RESIDENCIES: Med Coll WT,
1971
SERVICES: Venipuncture
EDISON
v^;:;;;;;;;!
Bruskewitz, Reginald C
MEDICALSCHOOL: Univ of
WI, 1973
INTERNSHIPS: Univ o f W I ,
1974
RLSIDl NCIES: Univ of W l ,
1978
Graf, Richard Andrew
MEDICAL SCTIOOL: Univ o f
WI, 19:16
NTERNSHIPS: Univ of Texas,
1956
ESIDENCIES: Univ of Iowa,
1964
CREDIT CARDS: MC & Visa
ywi^KE^Y^rri
MEDICAL SC HOOL: Marquetle
Univ, 1958
MEDICALSCHOOL: Ulliv of
Minn, 1963
INTERNSHIPS: VA Hosp &
Minn Hosp, 1971
CREDIT CARDS: MC & Visa
RESIDENCIES: St Francis
CREDIT CARDS: MC & Visa
Andres, Francis I.
Mahler, John Herbert
MEDICAL SCHOOL: Cornell
Univ, 1961
1964
SERVICES: Venipuncture
HOURS: Weekend
INTERNSHIPS: St Joseph
Hosp, Milwaukee, 1959
RESIDENCIES: Sl Joseph
Hosp, Milwaukee, 1963
and Med Coll W I , 1966
Malek, Gholam H.
MEDICALSCHOOL: Univ of
Tabriz (Iran), 1961
INTERNSHIPS: Providence
Hosp Wash, 1965
RESIDENCIES: Ulliv W I . 1969
CREDIT CARDS: MC & Visa
Annesley, William H., Jr.
MEDICALSCHOOL: Med Coll
WI, 1977
1978
RESIDENCIES: Med Coll W I ,
1982
Begun, Frank Phillip
MEDICALSCHOOL: Univ of
Michigan, 1979
INT ERNSHIPS: Univ of
Michigan, A f l i l Hosp,
1981
Moon, Timothy David
MEDICALSCHOOL: Univ of
Edinburgh (Scotland),
1972
RESIDENCIES: Queen's Univ,
Canada, 1980
Smith, Franklin Leo
MEDICAL SCHOOL
Northwestern Univ, 1982
RESIDENCIES: Surgery;
Northwestern Univ, 1984:
Urol; Univ of Chicago,
1987
RESIDENCIES: Univ of
Michigan, A f l i l Hosp,
1984
SERVICES: Venipuncture
CREDIT CARDS: Visa & MC
MEDICAL SCHOOL:
Northwestern Univ, 1959
INTERNSHIPS: Cook Co
Hosp, Chicago, 1960
Ferber, Thomas
MEDICALSCHOOL: Ulliv of
W l , 1976
INTERNSHIPS: Univ of'WI
Alhl Hosps, Madison.
1977
RESIDENCIES: Univ of'WI
Aflil Hosps, Madison,
1981
Fine, Stuart W.
MEDICAL SCHOOL: Univ of
Louisville, 1963
INT ERNSHIPS: Mount Sinai,
Milwaukee
RESIDENCIES: Marquette
Univ
Flanagan, W. Patrick, Jr.
MEDICAL SCHOOL: LSU Sell
Med, New Orleans, 1980
INTERNSHIPS: Shands Hosp,
Gainesville, 1981
RESIDENCIES: Ochsner
Foundation Hosp, New
Orleans, 1988
Harkavy, Raymond
MEDICALSCHOOL: Univ of
WT,1953
IN I ERNSHIPS: St. Joseph's
Hosp, Milwaukee, 1954
RESIDENCIES. St. Joseph's
Hosp, Milwaukee, 1957
Bourne, Charles W.
MEDICAL SCHOOL: Ulliv of
Michigan, 1959
INTERNSHIPS: Univ of
Michigan, I960
RESIDENCIES: Univ of
Michigan, 1965
Bourne, Richard B.
MEDICALSCHOOL: Univ of
Uehling, David T
MEDICALSCHOOL: Med Coll
of'WI
RESIDENCIES: Wayne Stale
Univ, Detroit
EELLOWSHIPS: Ulliv of CA San Francisco
T EACHING I'OSITTON:
Assistant Professor. Med
Coll of'VVI
SERVICES: Venipuncture
CREDIT'CARDS: MC & Visa
INTERNSHIPS: Med Coll W I ,
Messing, Edward M
MEDICALSCHOOL: Ulliv of
Tabriz (Iran), 1961
INTERNSHIPS: Providence
Hosp Washington, 1965
RESIDENCIES: Stanford Univ,
1978
Dixon, Christopher
Michigan, 1958
INTERNSHIPS: Univ of
Michigan, 1959
RESIDENCIES: Univ of
Michigan, A f l i l Hosp,
PAGE 67
Hein, Richard C.
MEDICALSCHOOL:
Northwestern Univ. 1986
INTERNSHIPS: Passavani
Meml Hosp., Chicago,
1967
RESIDENCIES: Northwestern
Univ, Chicago, 1974
Herrman, Richard A.
MEDICALSCHOOL: Univ of
WI Med Sch, 1966
INTERNSHIPS: Milwaukee
County Hosp, 1967
�I A T PAGES"
E LH
H
KKsmF.NCiK.S: Med Coll W I ,
1973
Hodgson, Norman B.
MEDICAL SCHOOL: Univ o f
Michigan, 1951
INTERNSHII'S: Univ o f
Michigan, 1952
RESIDENCIES: Univ of
Michigan, 195R
SERVICES: Venipuncture
HOURS: Weekend
Jacobsohn, Harold A.
MEDICALSCHOOL: Med Coll
WI
Kearns, John Westhofen
MEDICALSCHOOL. John
Hopkins Univ, 1947
INTERNSHII'S: St Luke's
Hosp, Chicago, 1948
RESIDENCIES: John Hopkins,
1949; Wesley Meml Hosp,
Chicago, 1951
Lawson, Russell K.
MEDICALSCHOOL: Ulliv of
Oregon, 1963
INTERNSHII'S: L.A. County
Hosp, 1964
RESIDENCIES: Univ of
Oregon, 1968
TEACHING POSITION:
Chairman, Dept of
Urology, Med Coll W l
SERVICES: Venipuncture
HOURS: Evenings & Weekends
Lepor, Herbert
MEDICALSCHOOL: [ohns
Hopkins Univ, 1979
INTERNSHIP.S:Johns
Hopkins Hosp, 1980
RESIDENCIES: Johns Hopkins
Hosp, 1986
TEACHING POSITION:
Professor Med Coll Wise
and Director, Med Coll
Wise Prostate Center
SERVICES: Venipuncture
CREDIT CARDS: MC & Visa
Manuel, Emmanuel S.
Pope, John Francis
MEDICALSCHOOL: Ulliv
Santo Tomas, Manila,
1971
MEDICAL SCHOOL: St.
Georges Univ, Grenada,
1981
RESIDENCIES: Surgery, St
Josephs Hosp, Milw,
1981; Urol, Butterworth
Hosp, Mich, 1986
INT ERNSHIPS: Evangelical
Deaconess Hosp,
Milwaukee, 1973
RESIDENCIES: Surg, Mt. Sinai
Hosp, N.Y., 1976; Urol,
Ll Jewish, N.Y., 1980
Rasmussen, Robert James
Otto, Samuel J.
MEDICALSCHOOL: Univ o f
Wisconsin, 1957
MEDICAL SCHOOL: Ulliv o f
W l , 1971
INT ERNSHIPS: York Hosp,
PA, 1972
RESIDENCIES: Med Coll WT.
1978
RESIDENCIES: Milwaukee
County Hosp, 1962
Silbar, John David
Pollard, Randle E.
MEDICAL. SCHOOL: Meharry,
1951
INTERNSHIPS: Foidham
Hosp, N.Y, 1952
RESIDENCIES: Med Coll W I ,
1958
TEACHING POSITION:
Professor, Med Coll WI
HOURS: Evenings
MEDICAL SCHOOL: Marquette
Univ, 1947
INTERNSHIPS: Albert
Einstein, PA, 1948
RESIDENCIES: A f l i l Hosp,
Univ o f W I , 1954
TEACHING I'OSITTON:
Professor, Med Coll WI
Slocum, Peter
MEDICALSCHOOL: Univ of
WI, 1983
INTERNSHIPS: Rush Presb-St.
Usow, Barry H.
MEDICAL SCiHOOL: Univ o f
Wl
Walsh, John Patrick
MEDICAL SCHOOL: Marquette
Unversity, 1967
INT ERNSHIPS: Chelsea Naval
Hosp Boston, 1968
RESIDENCIES: Medical
County General Hospital,
1976
TEACHING POSITION:
Assistand Clinical
Professor, Med Coll W I
SERVICES: Venipuncture
HOURS: Weekends
Weisenthal, Charles Leonard
MEDICAL SCHOOL: Chicago
Med Sch, 1955
INTERNSHIPS Milwaukee
County Hosp, 1956
RESIDENCIES: VA Hosp, 1960
WHAT'S
SPECIAL REPORTS
Wisconsin Managed Care Options
Heart Disease
WOMEN'S HEALTH
MEN'S HEALTH
SENIORS' HEALTH
Uterine Cancer
Colon Cancer
Nursing Homes
CHILDREN'S HEALTH
MacGillis, Alexander J.
MEDICAL SCHOOL: Med Coll
Wise, 1956
INTERNSHIPS: Univ of Iowa
Hosp
RESIDENCIES: Surgerv, St
Joseph Hosp, 1961;
Rochester Med Ctr, 1965
TEACHING POSITION:
Assistant Clinical
Professor, Med Coll W l
Lukes, Chicago
RESIDENCIES: Rush Presb-St.
Lukes, Chicago
Pediatricians
YY5:.Lrj«s Stop Smoking Programs
GUIDELINES
PLUS: Dental
Lower Back Pain
Care and a Guide to Local Dentists
Health Care Reimbursement Accounts
PAGE 08
�
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
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Health Care Reform
Identifier
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2006-0810-F
Description
An account of the resource
<p>This collection consists of records related to Hillary Rodham Clinton's Health Care Reform Files, 1993-1996. First Lady Hillary Rodham Clinton served as the Chair of the President's Task Force on National Health Care Reform. The files contain reports, memoranda, correspondence, schedules, and news clippings. These materials discuss topics such as the proposed health care plan, the need for health care reform, benefits packages, Medicare, Medicaid, events in support of the Administration's plan, and other health care reform proposals. Furthermore, this material includes draft reports from the White House Health Care Interdepartmental Working Group, formed to advise the Health Care Task Force on the reform plan.</p>
<p>This collection is divided into two seperate segments. Click here for records from:<br /><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=2006-0810-F+Segment+1"><strong>Segment One</strong></a> <br /><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=2006-0810-F+Segment+2"><strong>Segment Two</strong></a></p>
Provenance
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Clinton Presidential Records
Publisher
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William J. Clinton Presidential Library & Museum
Text
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Paper
Dublin Core
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Title
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Quality Briefing Book [4]
Creator
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Health Care Task Force
General Files
Identifier
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2006-0810-F Segment 1
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Box 55
<a href="http://clinton.presidentiallibraries.us/items/show/36144" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/12090749" target="_blank">National Archives Catalog Description</a>
Provenance
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Clinton Presidential Records: White House Staff and Office Files
Publisher
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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.
Preservation-Reproduction-Reference
Date Created
Date of creation of the resource.
5/5/2015
Source
A related resource from which the described resource is derived
42-t-2194630-20060810F-Seg1-055-004-2015
12090749