Strikes: strategy and tactics for managers. The threat of a strike is a powerful weapon in the union's arsenal. Management, caught off-guard when a strike hits, can be faced with insurmountable problems regarding maintenance of business operations and may be put in a position of capitulating to labor's demands. To avert these problems and to be able to effectively cope with the impact of a walkout, management must have a plan of action well in advance of the strike. In the following article, the authors provide a detailed strategy for strike preparation and discuss the issues management must address in dealing with a potential strike.


Alternative selection procedures and the Uniform Guidelines: improving the quality of employer investigations.


Court acceptance of Uniform Guidelines provisions: the bottom line and the search for alternatives.


Bargaining for concessions: what information must the employer provide? Employers faced with the current bleak economic situation increasingly are demanding concessions from the unions representing their employees. Unions faced with such demands are fighting back by requesting confidential information from their employers concerning the need for concessions. In recent years, the scope of the information to which a union may be entitled has been expanded greatly. This article examines recent decisions and suggests some alternatives for avoiding disclosure of information to the union.


The legality of employee attitude surveys in union environments. Employee attitude surveys are becoming an increasingly popular tool for employers. A host of legal implications, such as the circumstances under which they can be used, what they can ask, and whether or not they are a subject of mandatory bargaining, arise when surveys are conducted by companies that have an incumbent union or by companies that are involved in union-organizing campaigns. The following article describes the survey process, outlines some of the inherent advantages and pitfalls, and examines the legal questions raised when surveys are used by nonunion employers, by employers with incumbent unions, and by employers who are involved in union-organizing-campaigns. It concludes with recommendations for employers that undertake attitude surveys.


New EM research institute hopes to coordinate lab, clinical data speedily.


Who's responsible for 'abuse'?

Who's responsible for 'abuse'?


CT scanner-sharing setups are working well in three locations.


Wooing ambulance crews one way to keep business.


Death and dying: support systems.

Death and dying: support systems.


Working with the family and environment.


Attitudes and aging: US/USSR contrasted.


Nutrition and the older individual.

Nutrition and the older individual.


Biomedical aspects of aging and their relation to geriatric care.


Pharmacology of aging.

Pharmacology of aging.


Gerontological nursing.

Gerontological nursing.


St. John Hospital's restaurant: the Courtyard.


The coming of the mega-hospital.

The coming of the mega-hospital.


A decade in hospitals.

A decade in hospitals.


A decade in nursing homes.

A decade in nursing homes.


How to turn a humble public service ad into a moneymaker.


Computer, other services can be business-donated.


Taming the cost of health care.

Taming the cost of health care.


Inaugural of the Health Policy Forum and Proceedings of the Health Policy Forum on Foreign Medical Graduates in New York City, June 1-2, 1978.


National policy toward the foreign medical graduate: the legislative history, the policy and how it will work.


Transitional and long-range implications of reduction in house staff in New York City hospitals.


The number and specialty distribution of foreign medical graduate house staff in New York City teaching hospitals.


The foreign medical graduate and graduate training in New York City hospitals.


Proceedings of the Health Policy Forum on Hospital Closures in New York City, October 26-27, 1978.


Hospital closure: the federal government perspective.


Patient drug information from the health professionals.


Hospital closures: the New York City experience.


Viewpoints on hospital closure.

Viewpoints on hospital closure.


State concerns and role in hospital closure.


Formularies: conceptual and experimental factors related to product selection.


Hospital closure: the Congressional perspective.


Indications, process and implications of hospital closure.


Drug information service to community pharmacists: a survey of providers.


Times of challenge and opportunity.

Times of challenge and opportunity.


Facing the uninsured: a new admitting dilemma.


Diasonics' winning ways to look inside you.


Importance of a uniform licensing examination.


Selector system design for the Iowa drug information service microfilm file.


Admitting joins team to help in discharge planning.


Admitting psychiatric patients: gear procedures to their needs.


Admitting managers write their own professional standards and ethics.


Hospitalized travelers get help from ministering programs.


Physicians' sources of information about teratogenic effects of drugs.


Admitters market their hospitals to physicians' staffs.


Infection control for admitters.

Infection control for admitters.


Career ladder program may improve turnover rate.


New plain language forms mean patients give informed consent.


Use care, tact and planning to admit paralyzed patients.


Routine admitting methods not grist for patient lawsuits.


An interview with Linda Lemon. Director of security at Maryview Hospital.


Security staffing: making the most of your options.


Improved communications can overcome QA obstacles.


Home IV cancer chemotherapy benefits patients and hospital.


Inpatient physical therapy programs must meet criteria.


Unemployed receive free care in volunteer-staffed program.


Child guidance center offers predivorce counseling.


Pastoral education program serves clergy in the "Arklatex".


Systems, commerce, and the caring tradition.


Participation in Social Security: a social justice perspective.


Lay-religious collaboration from three perspectives.


Survey examines dying patients' image of God.


Orientation programs prepare volunteers for patient contact.


Expanded bereavement program focuses on children's needs.


Preserving hospice values crucial with influx of Medicare dollars.


Private, nonprofit hospitals have right to manage physician appointments.


Are Catholic hospitals morally responsible for surgical practices in associated office buildings?


Credible witnesses, documentation necessary to support neglect charges.


Choose vendors who can help deliver patient care competitively.


The importance of educational materials in product and supplier selection.


Guarantees and warranties.

Guarantees and warranties.


What is the sales representative's role in a multihospital system?


Ethics in business: problem identification and potential solutions.


Evaluation of product samples.

Evaluation of product samples.


Packaging can make a good product better.


Determining product quality.

Determining product quality.


Effective warehousing and distribution practices.


Your hospital brochure can sell your facilities. The time to use it is now!


DC District Court permanently enjoins HHS regulation.


Quarterly tax report. Unrelated business income, Social Security amendments of 1983, tax procedure, and IRS regulations.


Recreation program is more than just play.


Communication. Say what you mean!

Communication. Say what you mean! The following suggestions are offered to improve your communication with coworkers and patients: 1. Don't use jargon when it isn't necessary. 2. Use feedback when seeking the meaning to a secondary message. 3. Key your messages to the level of understanding the receiver possesses. 4. Always realize your abstracting. 5. Do not always interpret message literally. Yes, in the beginning was the word. But when we interpret all words literally, we miss much of what is really being said. Ultimate meaning and awareness can only take place if we allow our intuition to come into focus. Sometimes it's best to literally "lose your mind" and "come to your senses."


Hospital fills a radiotherapy void through sharing.


Infection control. A patient on isolation.


Day centres--alternatives for action.

Day centres--alternatives for action.


Risk management fights back--the hospital's response to the malpractice explosion. The development of hospital Risk Management prevention programs will lead to improved patient care and reduce the number and cost of future medical malpractice actions. An effective Risk Management Program must gear itself toward improving patient care through identifying and reducing hospital risks. This, in turn, will tend to reduce mortality and morbidity, and, in time, reduce the number of claims filed against the hospital, as well as decreasing the liability in each case. The ultimate goal of a successful Risk Management Program is to both improve patient care, and to reduce the cost of medical malpractice for the institution.


Geriatrics--a future challenge.

Geriatrics--a future challenge.


Overcoming PR problems.

Overcoming PR problems.


Another view of clinical engineering in a health care environment.


Stress management training for hospital supervisory personnel. The overall goal of Stress Management Training is the re-orientation of people's typical stress reaction habits into new, more rational and assertive patterns of problem-solving. Participants gain new insights into what stress is and how it affects them. They learn skills which reduce stress to nondamaging levels. They learn to use their minds to productively solve problems and to manage their personal and professional lives to a better end.


IV infusion devices--make the right choice.


An oasis in times of need.

An oasis in times of need.


Housley outlines clear path to product standardization.


How to improve communication in central service.


Management tools for the modern day health administrator. Part 2. Organizational tools.


Performance measurement to become more important.


"Listening' underscored as a communications tool.


Avoiding disappointment in MBO programs.


Telephone processing is "key' to special orders.


Seminar tests purchasing law I.Q.

Seminar tests purchasing law I.Q.


Group purchasing: a blessing, a curse, or somewhere in between?


Strategic career management--a missing link in management by objectives.


Evesham Day Hospital.

Evesham Day Hospital.


Innovative alarms help monitor patients in bed.


Q: Must a hospital permit nonMD health practitioners to render services in the hospital?


Credentialing and quality of care.

Credentialing and quality of care.


MDs and hospitals: conflict or partnership. Hospitals and their medical staffs face separate and significant economic pressures. In working out their respective responses to these pressures, both will have to work hard to avert a collision of economic interests that could damage our health care system.


Pharmaceutical sales representatives.

Pharmaceutical sales representatives.


Role of the chairman in the P&T committee. The chairman of a P&T Committee has the power to set goals and priorities simply by the way he prepares for and disposes of committee business. A major goal of every P&T Committee is education, and it is the responsibility of the Committee chairman to create an educational atmosphere for the conduct of committee business so that ultimately good patient care will be accomplished.


Clinical pharmacist impact on parenteral cephalosporin prescribing. A study was undertaken to evaluate clinical pharmacist influence on parenteral cephalosporin prescribing patterns. Two intervention methods were evaluated: (1) publication of pharmacy newsletter for physicians containing specific recommendations and emphasizing the primary use of cefazolin, and (2) personal interaction between the clinical pharmacy staff and physicians promoting the recommendations outlined in the newsletter. These two methods were compared with each other as well as with an initial time span during which no influencing efforts were made. The effect of the pharmacy newsletter as a sole means of influencing physician prescribing of parenteral cephalosporins was minimal. The effect of pharmacist-physician interaction, either as a sole means of in conjunction with a pharmacy newsletter, resulted in an increased use of cefazolin. An annual cost savings of up to $11,265.88 was projected. The results indicate that physicians can be influenced in their prescribing of parenteral cephalosporins, leading to significant cost savings.


Determinants of disenrollment: implications for HMO managers.


A new way to interest students in hospital related careers and a plentiful source of "that extra pair of hands".


Patient satisfaction with a family practice clinic: comparison of a questionnaire and an interview survey.


A comparison of responses to adolescent-oriented and traditional contraceptive programs. Compares characteristics of teenage patients attracted to a traditional family planning clinic and an adolescent oriented clinic, and studies the success of each in promoting contraceptive use.  Data were collected from 2 clinics operating in the same physical site in an urban hospital.  The traditional family planning clinic (Day Clinic) serves both teenage and older women.  The Young Adult Clinic (YAC) serves only patients 21 or younger and operates 2 evenings a week.  The 2 clinics have an overlapping staff and medical services are identical in each, except that patients of the YAC are offered counseling, and admission to the clinic is simplified.  The data from each clinic covers 2 years.  Results show that the most important difference between the clinics is that the YAC attracts 3 1/2 times as many teens as the Day Clinic.  Different background characteristics of the patients account for differences in contraceptive method utilization, revisit patterns, and pregnancy rates within the 2 clinics, rather than clinic differences.  YAC patients are likely to be younger, and less likely to have been pregnant before.  Thus, the YAC offers more of an opportunity for primary prevention of pregnancy.  The authors concluded that the major benefit of offering an adolescent only evening clinic lies in its ability to attract young women who might not otherwise receive services.


Characteristics of outpatient room utilization.


Patient care delivery in nursing homes: legal issues for owners and administrators. American Health Association.


The interdependence of employee loyalty and increased productivity: you can't have one without the other.


Using management trends to impact on cost efficiency and quality assurance.


Taking charge of the future. Continuing case retirement centers: an expansion opportunity.


Taking charge of the future. Adapting today's facility to meet tomorrow's needs.


Cost effective quality food service.

Cost effective quality food service.


Managing your image.

Managing your image.


Reimbursement oriented budget systems.

Reimbursement oriented budget systems.


Materials management: a success story at Sunny Acres.


Quality circles: fad or management trend?


What does ACPE expect of ministry?

What does ACPE expect of ministry?


A comparative evaluation of changes in basic clinical pastoral education students in different types of clinical settings as measured by the adjective check list and the experience scale.


The new politics of national health insurance.


National health insurance: an implementation perspective.


How national health insurance will change health planning.


A wellness model for national health insurance.


Putting your best foot forward . . . TV exposure for management.


The electronic office: how to make it user friendly.


More companies shifting cost of medical care to employees.


Have you got what it takes to get to the top?


Psychiatry: the lost horizon: the erosion of human rights.


Anaesthesiologist and the law.

Anaesthesiologist and the law.


Medical instrumentation at Mount Sinai.

Medical instrumentation at Mount Sinai.


Bubble memory at Miami Heart Institute.

Bubble memory at Miami Heart Institute.


Annual buyers guide surveys. Electrodes.


Annual buyers guide surveys. Biofeedback.


Annual buyers guide surveys. Patient monitors.


Annual buyers guide surveys. Stimulators/defibrillators.


Is hospital or supplier of x-ray machine liable for accident injury?


New medical device standards: how should hospitals respond?


Instrumentation magnetic tape-recording: an overview.


Ultrasonics for medical diagnostics. Part 7--Quality assurance (2).


EEG data recording.

EEG data recording.


NMR imaging: an overview.

NMR imaging: an overview.


Respect for life--theological aspects.

Respect for life--theological aspects.


Appointment booking at Oldchurch Hospital, Romford.


The work of the community physician in England.


Monitoring and trends--the moving average.


Information needs for the assessment of clinical performance in general practice.


Körner proposals: the new facility returns.


The patient information system.

The patient information system.


A district information service.

A district information service.


The new 'informed patient'. Prescribers' pens are target of ads for the public.


HHS auditor wants required second opinions.


Four hospital pay systems held up as national models.


Feds finalizing payment cuts for dialysis.


Measuring work.

Measuring work.


Time: how to make a little a lot.

Time: how to make a little a lot.


How doctors can help hospitals adjust to the technology pullback.


Quality of worklife--1. A sense of belonging.


Ways to be more assertive.

Ways to be more assertive.


Second annual guide to copiers.

Second annual guide to copiers.


Panel charges U.S. shirks duty to make "adequate' health care accessible to all.


Personnel. Every manager's responsibility.


A quality atmosphere. Quality circles demand a supportive business philosophy.


Tracking motivation. Surveys help gauge employee needs.


Physician recruitment: a five-step plan.


Board responsibility for patient care: a prototype reporting system.


Firing without shooting yourself in the foot.


Better safe than sorry. Federal antitrust laws have a major impact.


High-powered performance. Interview by Kelly F. Guncheon.


The urgent care craze.

The urgent care craze.


The best defense is a good offense.

The best defense is a good offense.


HHS auditing chief tough on DME fraud.

HHS auditing chief tough on DME fraud.


Hospital gift catalog is a 'capital' idea.


The purposing of high-performing systems. Vaill maintains that clarifying an organization's purposes is a prominent feature of all high-performing systems (HPSs). He defines HPSs as human systems that are doing dramatically better than other systems as measured by one or more criteria. Ten years' research on such systems is summarized in eight broad categories: (1) clarity of purposes, (2) member motivation, (3) teamwork, (4) leadership, (5) technology and innovation, (6) boundedness from the environment, (7) relationship to the environment, and (8) the unique ways in which the system "jells." HPSs are treated as unusually fertile settings for understanding how leaders of human systems engage in what is called "purposing"--a continuous stream of actions that has the effect of inducing clarity, consensus, and commitment regarding the organization's basic purposes. The article explores the personal qualities that enable HPS leaders to define and maintain a clear sense of purpose among all systems members. Three major characteristics are ascribed to such leaders: (1) the willingness to invest large amounts of time in the system, both in the sense of hour-to-hour and day-to-day time and in the sense of year-to-year and even decade-to-decade time; (2) the ability to develop and express deep feeling about the system, its purposes, the people in it, its history, and its future; and (3) the ability to focus on the issues and variables in the system that really make a difference in its performance. This is the Time-Feeling-Focus theory of HPS leadership.


Cost cutting. A route to hidden profits.


From skyhooks to walking sticks: on the road to nonrational decision making. The amount of information that should be processed to reach a rational solution is so vast that it overwhelms our limited memory and analytic capacity. To grapple at all with real problems, we must shrink them to mind size. As Nobel Laureate Herbert Simon has suggested, we must learn to "satisfice." Using examples and a case history of managerial succession, Agnew and Brown demonstrate the importance of nonrational factors in decision making. "Skyhooks," their first major concept, are composed of an individual's strong beliefs and biases that appear almost as acts of faith without any obvious foundation. They help the exceptional executive operate on a limited set of alternatives. But while skyhooks give direction, they do not provide the means to reach a destination. Simpler conceptual models, or "walking sticks," are necessary to cover the rocky trails. Agnew and Brown offer four walking sticks that can be applied to managerial succession problems. The first walking stick considers executive decision making in three parts--nonrational, semirational, and rational--and covers the conditions in which each component comes into play. The second helps examine human resources as fixed or fluid and as assets or liabilities to develop a schema for manpower accounting in executive succession. Playing vs. talking a good executive game is the topic for walking stick three. The concern here is to distinguish the real players--who can manage systems--from the mere talkers, who can manage only fragments of systems. The fourth walking stick draws on the law of resource gravitation and crystallization, a law with implications for trainers: You can't fashion management training to fit all comers; instead, you must tailor it to what the trainees already are and know.


Quality of work life: perspectives and directions. The values that quality of work life (QWL) has brought to the workplace are in danger of being lost, say authors Nadler and Lawler; to avert this danger, they debunk several "definitions" of the concept that miss the point, give it a precise definition, and spell out ways to use it successfully. They delineate six factors that they believe separate more successful from less successful QWL efforts. The first success factor is a perception of need--that is, in successful efforts organization members actually perceive a problem. Second, the problem is salient to the organization. Third, a structure for participation is created. Fourth, rewards are provided both for the processes and for the outcomes of QWL activities. Fifth, multiple levels of management are involved. And, finally, QWL involves all organization members in a way that avoids "we-they" rivalries. With these factors in mind, the authors conclude that three major components of QWL efforts must be managed well if they are to succeed: (1) development of projects at different levels; (2) changes in management systems and structure; and (3) changes in senior management behavior--that is, if the QWL effort is to be credible to organization members, there must be some specific, tangible QWL activity in which senior managers participate.


EEO: watch your next step.

EEO: watch your next step.


The controller's role in management.

The controller's role in management. A controller has two apparently contradictory responsibilities: (1) the management service responsibility of ensuring that specialist knowledge and expertise get proper consideration when business decisions and actions are taken, and (2) the custodial and monitoring responsibility of ensuring the accuracy of financial reporting and the integrity of internal control. The apparent contradiction is that the first responsibility requires active involvement in management while the second calls for a sense of independence from affiliated management. Sathe stresses that "strong" controllers overcome this dilemma by developing certain interpersonal skills. Such "strong" controllers thus have access to sensitive information and deliberations in progress--an access that permits them to take before-the-fact actions that stop ill-conceived, ill-advised, or illegal decisions before they are taken. A controller who is not actively involved in decision making is not privy to such information and can exert only after-the-fact or reactive control. However, the costs of operating with a strong controller must be weighed against the potential benefits and compared with the benefits of alternate approaches.


The evolution of Japanese management: lessons for U.S. managers. To find the key to the success of Japanese economic performance since World War II, Marsland and Beer explore five main "environmental" factors used by Japanese firms to build a successful human resources management approach: Japanese social values, the structure of private enterprise, the structure of labor markets, the historic development of the Japanese employment system, and the structure of Japanese management. This discussion shows that post-war Japanese management, faced with rapid change, introduced new concepts and techniques that reinforced and maintained certain social values and traditions that fit well with human resources management objectives. This skillful blend of new ideas with traditional values enabled the Japanese to achieve superior economic performance.


Learning from the Japanese: management in a resource-scarce world. The principal value of studying the Japanese managerial system, according to Zussman, lies not in the prospect of copying it or of finding secrets for success, but in our ability to identify the relationship between the material resource position of an economy and the managerial systems that will be most effective in it. Zussman briefly discusses the historical development of the Japanese response to their resource-poor homeland and the principles they identified for success through the utilization of human resources--the one resource they had in abundance. He also cites the United States's historical response to its resource position as a source of our present economic difficulties. He contends that the structural changes required to cure our economic woes include eliminating the "entitlement" culture, developing better processes for employee selection, utilizing nonmonetary rewards, and adopting different criteria for selection and promotion of managers.


New perspectives on hospital governance. A report of the 1981 National Forum on Hospital and Health Affairs. Department of Health Administration of Duke University.


The impact of collective action on hospitals. A report of the 1976 National Forum on Hospital and Health Affairs. Department of Health Administration of Duke University.


EEO: where we stand now.

EEO: where we stand now.


A decade of implementation: the multiple hospital management concept revisited. A report of the 1975 National Forum on Hospital and Health Affairs. Department of Health Administration of Duke University.


Private sector coalitions: a fourth party in health care.


Contract management and its implications.


A trustee's perspective on trusteeship.

A trustee's perspective on trusteeship.


The future directions of multiple unit management.


Physician collective action: in quest of Pharos.


The political realities of capital formation and capital allocation.


The physician's perspective on coalitions.


The changing environment of hospital governance.


A fourth party in health care: background.


The management perspective on coalitions.


Collective actions by professional employees.


The small hospital under multiple unit management.


Current examples of active coalitions.

Current examples of active coalitions.


Hospital governance and the community: a reexamination.


Collective action by organized labor.

Collective action by organized labor.


The evolution of multiple hospital management.


The politics of collective action.

The politics of collective action.


The interest of business and industry in health care.


Hospital governance and government: perspectives and challenges.


The economics of collective action.

The economics of collective action.


The investor owned approach.

The investor owned approach.


Coalitions and competition.

Coalitions and competition.


Physicians and hospital governance: a changing dynamic.


Patient care and collective action.

Patient care and collective action.


The consortium approach.

The consortium approach.


The regulation of collective action.

The regulation of collective action.


Other perspectives on private sector activities.


Proper board-management relationships.

Proper board-management relationships.


Navy regionalization: an object lesson.

Navy regionalization: an object lesson.


Collective responses to collective actions.


Private foundations' role in coalitions.


Health care coalitions.

Health care coalitions.


Board relationships with other boards.

Board relationships with other boards.


The administrator and the future of collective actions.


Business methods for containing medical costs.


Changes in Church-operated systems.

Changes in Church-operated systems.


Hospital leaders as community leaders.

Hospital leaders as community leaders.


Hospital governance and the future.

Hospital governance and the future.


Future implications: private sector coalitions.


Wisconsin officials told of some abuses in health sales.


Base projections on the 1980 Census report.


Physician & community input is key for success.


The osteopathic difference.

The osteopathic difference.


Focus on management effectiveness. Personal letters increase possible collection results.


The Social Security option--a controversial choice.


The experimental effects of "autonomy" on performance and self-reports of satisfaction. Though the job characteristics model proposed by Hackman and his associates has provided the impetus for a large number of correlational studies, few of any studies have involved the systematic manipulation of one or more of the five-core dimensions (job properties) while noting the performance outcomes. In this study, the autonomy dimension was experimentally varied (four levels) in a laboratory setting. Four groups of undergraduate students performed a job comprised of three tasks under varying degrees of autonomy while measures of performance, "perceptions" of task properties, and other self-reports were obtained. It was found, contrary to our hypothesis, that variations in autonomy produced a negative effect on quantity of performance and no effect on quality of performance, though subjects in the more autonomous conditions reported a higher level of autonomy. Reservations regarding the strategy of drawing causal inferences from correlational analyses are discussed.


Task interdependence and job design: test of a theory. This paper develops the concept of task interdependence and integrates it in the Hackman and Oldham (1976) theory of job design. Two dimensions of initiated task interdependence and received task interdependence are developed as multidimensional concepts, each being made up of the elements of scope, resources, and criticality. A distinction is made between the two psychological states of experienced responsibility for one's own work and personal outcomes, and experienced responsibility for others' (dependents') work and personal outcomes for whom one initiates task interdependence. Autonomy is hypothesized to be related only to experienced responsibility for one's own work outcomes while initiated task interdependence is related to experienced responsibility for others' work outcomes. Initiated interdependence is also hypothesized to be positively related to the affective positive work and personal outcomes, while received task interdependence is negatively related to these variables. New subscales for the measurements of these constructs are developed and reliability and validity coefficients are reported. The substantive results give support to the motivating potential of initiated task interdependence. However, the results do not support the hypotheses associated with received task interdependence.


The nature of importance perceptions: a test of a cognitive model. This study empirically examines an alternative conceptual approach to the nature of importance perceptions. Current interpretations of importance evaluations--demand, need, and value-based approaches--have been primarily connotative and continue to remain bereft of convincing logical or empirical support. Borrowing from social-psychological theories of cognitive structure, the study tests the usefulness of a conceptualization of importance perceptions which presents the construct as a function of cognitive centrality, dependence, criticalness, and temporary salience of factors and outcomes in the individual cognitive space. The model is examined over a wide range of factors with findings indicating that significant proportions of variance in importance rating/rankings may be thus explained. Implications for management theory and practices are discussed.


Video medicus: cable TV tunes in to health care.


Too many doctors?

Too many doctors?


Radiation monitoring in the clinical laboratory--update.


Affordable quality: a matter of attitude.


The Navajo Indian Hospital is making it on its own.


Special issue on health care. Preface.

Special issue on health care. Preface.


Quality control and therapeutic drug monitoring. Dramatic improvements have been achieved in a relatively short time in the performance of therapeutic drug testing. The primary reasons for these advances have been the introduction of drug-specific immunoassays and, concomitantly, the availability of standards prepared in a biological matrix. For some drugs which are tested by other methods, such as the tricyclic antidepressants, interlaboratory variability is still excessively high. It is possible that this variability could be reduced through the proper preparation of serum-based standards. Manufacturers who provide quality control products could greatly assist the analyst by providing weighed-in target values for the drugs which have been added.


Simulation of a health insurance market with adverse selection. A health insurance market is examined in which individuals with a history of high utilization of health care services tend to select fee-for-service (FFS) insurance when offered a choice between FFS and health maintenance organizations (HMOs). In addition, HMOs are assumed to practice community rating of employee groups. Based on these observations and health plan enrollment and premium data from Minneapolis-St. Paul, a deterministic simulation model is constructed to predict equilibrium market shares and premiums for HMO and FFS insurers within a firm. Despite the fact that favorable selection enhances their ability to compete with FFS insurers, the model predicts that HMOs maximize profits at less than 100% market share, and at a lower share than they could conceivably capture. That is, HMOs would not find it to their advantage to drive FFS insurers from the market even if they could. In all cases, however, the profit-maximizing HMO premium is greater than the experience-rated premium and, thus, the average health insurance premium per employee in firms offering both HMOs and FFS insurance is predicted to be greater than in firms offering one experience-rated plan. The model may be used to simulate the effects of varying the employer's method of contributing to health insurance premiums. Several contribution methods are compared. Employers who offer FFS and HMO insurance and pay the full cost of the lowest-cost plan are predicted to have lower average total premiums (employer plus employee contributions) than employers who pay any level percent of the cost of each plan.


Application of multi-attribute utility theory to measure social preferences for health states. A four-attribute health state classification system designed to uniquely categorize the health status of all individuals two years of age and over is presented. A social preference function defined over the health state classification system is required. Standard multi-attribute utility theory is investigated for the task, problems are identified and modifications to the standard method are proposed. The modified methods is field tested in a survey research project involving 112 home interviews. Results are presented and discussed in detail for both the social preference function and the performance of the modified method. A recommended social preference function is presented, complete with a range of uncertainty. The modified method is found to be applicable to the task--no insurmountable difficulties are encountered. Recommendations are presented, based on our experience, for other investigators who may be interested in reapplying the method in other studies.


Some aspects of TEFRA.

Some aspects of TEFRA.


A quality systems approach to laboratory assessment.


Nurse recruiting: Part 1.

Nurse recruiting: Part 1.


Training megatrends.

Training megatrends.


Creating a direct mail recruitment program.


Conducting an employee attitude survey.

Conducting an employee attitude survey.


Conditional rate derivation in the presence of intervening variables using a Markov chain. When conducting inferential and epidemiologic studies, researchers are often interested in the distribution of time until the occurrence of some specified event, a form of incidence calculation. Furthermore, this interest often extends to the effects of intervening factors on this distribution. In this paper we impose the assumption that the phenomena being investigated are governed by a stationary Markov chain and review how one may estimate the above distribution. We then introduce and relate two different methods of investigating the effects of intervening factors. In particular, we show how an investigator may evaluate the effect of potential intervention programs. Finally, we demonstrate the proposed methodology using data from a population study. In an effort to determine whether a prespecified response occurs more frequently among those persons who exhibit a certain risk, biological and epidemiological investigations often assess the relationship between risk factors (e.g., personal or demographic variables) and response factors (e.g., development of disease).  Researchers frequently will investigate more than the initial risk and response; they will consider intervening variables.  2 ways of incorporating intervening variables--as either subsequent or antecedent factors--are investigated in this discussion.  Noting that traditional epidemiological approaches to both methods of intervening variable analysis frequently exert an unreasonable large data demand, it is shown how a Markov chain (MC) may be used to significantly reduce the data requirements.  It is assumed that the underlying process is a stationary (time homogeneous) MC.  Formal analytic definitions of both types (antecedent and subsequent) of intervening variable analyses are presented, and a relationship is derived between them.  It is shown how researchers may conduct both analyses, as well as the ordinary (nonintervening variable) analysis, using functions of the MC transition matrix.  All analyses demand only sufficient data either to estimate the transition matrix or to modify an existing matrix; none requires the subgroup specific data required by traditional epidemiologic approaches (e.g., direct incidence measures).  To illustrate these concepts, a numerical example is presented using a MC from a study of induced abortion.  The MC was submitted to formal goodness of fit tests to verify the Markov property (Shachtman et al.).  Alternatively, depending on the application the researcher may prefer to employ structural assumption validation, accept the model as a reasonable approximation to the empirical process under study, or "internally" validate the property by examining functions of the transition matrix and seeing if these functions replicate equivalent empirical distribution functions derived directly from the underlying data.  Possibly the most important aspect of this approach is that by developing stochastic models, e.g., Markov chain models, and using these conditional rates, researchers may perform intervening variable analyses as parameterizations of the model used in the nonintervening variable analysis.  This permits them to circumvent the estimation of independent distributions for each of the subgroups defined by the intervening variables, offering the potential for a large reduction in data requirements.


An iterative estimation and validation procedure for specification of semi-Markov models with application to hospital patient flow. This article presents a methodology to identify and specify a continuous time semi-Markov model of population flow within a network of service facilities. An iterative procedure of state space definition, population disaggregation, and parameter estimation leads to the specification of a model which satisfies the underlying semi-Markov assumptions. We also present a test of the impact of occupancy upon realizations of population flows. The procedure is applied to data describing the movement of obstetric patients in a large university teaching hospital. We use the model to predict length-of-stay distributions. Finally, we compare these results with those that would have been obtained without the procedure, and show the modified model to be superior.


Political action committees burgeoning: need reform?


Who is poor? Who is truly needy?

Who is poor? Who is truly needy?


After the welfare state.

After the welfare state.


Estimating need and demand for prehospital care. Models estimating demand and need for emergency transportation services are developed. These models can provide reliable estimates which can be used for planning purposes, by complementing and/or substituting for historical data. The model estimating demand requires only four independent variables: population in the area, employment in the area, and two indicators of socioeconomic status which can be obtained from census data. The model can be used to estimate demand according to 4 operational categories and 11 clinical categories. The parameters of the model are calibrated with 1979 data from 82 ambulance services covering over 200 minor civil divisions in Southwestern Pennsylvania. This model was tested with data from another 55 minor civil divisions, also in Southwestern Pennsylvania, and it provided good estimates to total demand. The model to estimate need evolves from the demand model. It enables planners to estimate unmet need occurring in the region. The effect of emergency transportation service (ETS) provider characteristics on demand was also investigated. Statistical tests show that, for purposes of forecasting demand, when the sociodemographic factors are taken into account, provider characteristics are not significant.


Are volunteers worth the effort?

Are volunteers worth the effort?


Alcoholism: recovery in the workplace. Part 2.


Physical abuse of the elderly.

Physical abuse of the elderly. Physical abuse of the elderly is more common than appreciated. Physical abuse includes physical or sexual assault or depriving a person of life necessities. It occurs most often within the family system. Victims of abuse are usually elderly women who are dependent on caretakers. Abuse should be suspected when an elderly person presents at an emergency room or medical office in a battered or abused condition. Psychological issues surrounding abuse can be frustrating and complex. Casting the spotlight of publicity on physical abuse is helpful.


The new federalism.

The new federalism.


The states and children.

The states and children.


Abuse of the elderly through fraud & deception. Hard economic times combined with a longer life-span for the nation's elderly have resulted in substantial increases in abuse of the elderly through fraud and deception. Physical infirmities and reduced mental capacity make the elderly easy prey for unscrupulous individuals who view advancing age as an invitation to their own financial prosperity. Popular fraudulent practices and devices include "bait and switch" tactics, the "pigeon drop," and the "ponzy" scheme. The unwarranted transfer of an elderly person's property to a trusted friend or family member to "reduce taxes" or "avoid probate" may represent potential abuse, which can have devastating financial consequences in later years. Very often these abuses have national and international effects as distant family members summon financial and psychological support in the aftermath of the victim's anguish over such tragedies. This article identifies some of the areas of potential abuse and addresses available means of preventing their occurrence through timely legal advice and counsel.


A low-cost evaluation of alcoholism treatment in a private psychiatric hospital program. The authors designed a low-cost evaluation study to examine outcome on an alcoholism specialty unit of a private psychiatric hospital as well as to look at the effects of several post-treatment therapies. Using conservative criteria for good outcome, and accounting for the expected poorer outcome of non-respondents, they found that the program achieved a 58 percent success rate. Use of Alcoholics Anonymous and a covert sensitization exercise developed especially for the program were associated with better outcome in terms of drinking behavior post-hospitalization. It should not be difficult to conduct a similar study in other treatment settings with a low research budget.


Editorial: caring for the elderly.

Editorial: caring for the elderly.


Treating the aged: how the public system affects the private system. The elderly are an increasingly numerous group within the population. They have a high incidence of treatable psychiatric conditions, yet are psychiatrically underserved. This article reviews the experiences of the Douglas Gardens Community Mental Health Center of Miami Beach in treating older individuals living in the community. Over 12 percent of these patients needed psychiatric hospitalization in 1982 in private community facilities. Information about these patients and comparative data from a typical inpatient facility are described. A new trend seems to be emerging which will move the public sector further away from the treatment of the elderly. An opportunity for the private sector is, therefore, developing.


An organizational model of a psychiatric hospital program for the elderly. This article is a summary describing the program planning and initial experience of a new unit for geriatric psychiatry in a private psychiatric hospital. Elderly psychiatric patients, predominantly with diagnoses of depression, alcohol dependency, and dementia, but also other psychiatric illnesses, demonstrate more self-centeredness and less group awareness than do younger patients. Staff members often experience frustration, sadness, and anger in response to working with them. Major problems unique to a geriatric psychiatric unit include the paucity of adequate resources for post-discharge care and the necessity to plan an excellent medical support system.


Electroconvulsive therapy in the elderly: an experiential report. In this anecdotal account, the author finds electroconvulsive therapy to be a safe and effective treatment in depressed elderly patients, particularly those with histories of recurrent depressive episodes who fail to respond to good medication management. He reports that the use of ECT at Brawner Psychiatric Institute resulted in shorter hospitalization, decreased morbidity, and more cost-effective care in this patient population.


Trends in physician negotiations.

Trends in physician negotiations.


The public's view as input for medical manpower planning.


The impact of smoking on health, productivity, and earnings: a new collective bargaining frontier.


The value of time and the use of medical care.


An economic perspective on hospices.

An economic perspective on hospices.


Antitrust scrutiny of the health professions: developing a framework for assessing private restraints.


Quality control of ambulatory care: a task for health departments.


Community medicine in the United Kingdom. Medical education and an emerging specialty within the reorganized National Health Service.


Social medicine. The advance of organized health services in America.


The management of health care technology in nine countries. Introduction.


The management of medical technology in the United Kingdom.


Policy for medical technology in France.


Technology assessment and diffusion in the health care sector in West Germany.


Medical technology in the health care system of the Netherlands.


Controlling medical technology in Sweden.


The management of health care technology in nine countries. Summary and analysis.


The management of medical technology in Canada.


Australian health care systems and medical technology.


Piedmont Medical: professional, but not institutional.


Medical technology in Japan.

Medical technology in Japan.


Six steps to contemporary career development.


The implications of telephone deregulation.


Brainstorming: guidelines for generating ideas.


Designing an effective stress-management training program.


Executive turnover: results of a survey.


How to teach how to learn.

How to teach how to learn.


But will they use training on the job?

But will they use training on the job?


Interchange/a problem-solving forum: role as a hospital trustee.


Is your hospital a candidate for a merger or acquisition? Decisions to buy or sell a hospital or to merge with another facility raise concerns for any institution, be it the buyer, the seller, or the proposed partner in the merger. To help trustees assess their options, this article presents profiles of the common characteristics shared by institutions that have been acquired and by those that have acquired other institutions.


A modest proposal for defining the government's role in health care. An industry leader and hospital trustee calls for the establishment of a national commission on health care including representatives from government, health care, private business, and labor. The commission's agenda includes an examination of a national health policy and its implications for state governments and the private sector.


Credit assistance to small hospitals.

Credit assistance to small hospitals.


On the difference between service and servitude. The environment calls for new relations between boards and administration. In this article, the author suggests a model where the board acts as the legislative branch of government and the CEO acts as the executive branch. Implicit in the model is the assumption that the CEO is a full partner of the board rather than its servant.


As I see it: biomedical ethics.

As I see it: biomedical ethics.


Organizing efforts targeted at Beverly.

Organizing efforts targeted at Beverly.


Menu planning in the nursing home.

Menu planning in the nursing home.


Getting your story on cable TV.

Getting your story on cable TV.


A citizen's affairs.

A citizen's affairs.


The coming of age of group purchasing.

The coming of age of group purchasing.


How about a volunteer telethon?

How about a volunteer telethon?


How to tell your story with videotape.

How to tell your story with videotape.


How to train volunteers to 'sell' your organization.


Volunteering in America, 1981-82.

Volunteering in America, 1981-82.


What you should know about the legal definition of 'volunteer'.


The making of a VOP (Voluntary Orientation Portfolio).


Volunteering in times of challenge and change.


Americans volunteer 1981. A Gallup survey on volunteering.


American renewal: the citizen's role.

American renewal: the citizen's role.


Surviving the '80s: an alternative approach.


Stimulating neighborhood involvement.

Stimulating neighborhood involvement.


Fund raising: how to ask for money.

Fund raising: how to ask for money.


Resources for a new beginning: the private sector.


Dollar value of volunteer time.

Dollar value of volunteer time.


The I CAN volunteer development program.


Improving patient care--goal of NYC hospital visitors.


Physician and pharmacy student expectations of pharmacy practice. This study was initiated to examine the attitudes of some of the future health care providers, family practice residents, toward various ambulatory pharmacy services. Pharmacy students were then asked to predict what the resident attitudes would be and the results were compared. This project addressed the following questions: (i) What are the expectations of family practice residents of what today's pharmacists should be doing? and (ii) How accurately can pharmacy students judge what the responses of the residents will be? The survey results indicated that the family practice residents' perceptions of certain pharmacist behaviors rated significantly higher than how the pharmacy students thought they would respond. Such behaviors included: (i) maintain and review patient profiles; (ii) counsel patients; (iii) take medication/allergy histories; (iv) provide therapeutic information to physicians; and (v) stock a wide variety of generic drugs. Most of these behaviors reflect direct involvement of the pharmacist in disseminating information to the patient and/or physician. Other expanded roles of the pharmacist such as triage, refill determination, reimbursement for consultation services, and chronic care management were given low priority.


A pharmacy student searches for psychological predictors of patient compliance. Pharmacists are becoming more involved in patient counseling and dosage regimen design in an attempt to improve patient compliance. A study was designed and implemented by an undergraduate pharmacy student in an attempt to gain experience in research methodology and to enhance individual clinical involvement. Forty patients, randomly selected at a community pharmacy and a family practice clinic, were administered a Myers-Briggs Type Indicator exam to assess the patient's degree of systematic preference. Refill dates for each patient's hypertensive medications were examined for six months in order to infer compliance. Results of the psychological exam did not accurately predict patient compliance or noncompliance. The student working with only minimal faculty guidance was able to design, implement, analyze, and describe the study. Colleges of pharmacy are encouraged to implement similar clinical research training projects for undergraduate students.


Development and utility in externship of a questionnaire on attitudes toward professional roles of the pharmacist. A sixty-six item questionnaire was developed to measure students' attitudes toward pharmacy as a profession, professional principles, and their preparation for the profession. It was administered to three consecutive year graduating classes (1978, 1979 and 1980) both pre- and postexternship so that changes in attitudes during the eight week experience program might be examined. Factor analysis was used to select items which could be combined to form scales (factors). The questionnaire yielded stable responses. The responses of the three classes to the scales were positive both before and after externship in regard to students' adherence to professional values. Mean responses on the scales showed some change during the 1980 externship; the most significant being that students felt better prepared for the profession after their externship.


Study on medical education financing due.


Are you killing bacteria?

Are you killing bacteria?


Australia's health system: condition: unstable; prognosis: needs intensive care. This paper is a discussion of the problems inherent in the development of a health policy in the political arena. Politicians should work towards a consensus health policy, in consultation with health professionals, hospital administrators, health insurance organisations, health care consumers and others. Any consensus health policy must address the issue of health care financing, define the responsibilities of Federal, State and local governments, provide for the special health care needs of disadvantaged groups, and ease the necessary transition from the current emphasis on acute care, to a system which gives high priority to preventive care, health education, individual and community responsibility for health maintenance, and appropriate levels of care.


AoA (Administration on Aging) report includes national statistics on long-term care complaints.


Meeting the mental health needs of the elderly: issues and action steps.


Consumers and health.

Consumers and health.


Health policies in Australia 1970-1979: politics, rhetoric and substance. Since the early 1970s there have been almost yearly reorganisations of the Australian health care system. These reorganisations provide an interesting case study for those who wish to distinguish the rhetoric and the reality of health planning in this country. This paper reviews the changes in the Australian health care system in the decade 1970-80. It examines the impact of these changes on the cost of health care, the use of medical services and the health of the population. Finally, the paper contrasts the available data with successive politically inspired attempts to mislead the community about the true basis and consequences of these changes.


Politics in health.

Politics in health. In the past, public discussion of health in the Australian media has almost entirely centred around the cost of health insurance. Hospitals have regarded the media as an unwelcome intrusion and now with changes in the emphasis of their roles in society, they are anxious to obtain good media publicity. Reaching out, rather than closing shop has involved appointing public relations officers and selling the hospital to society. But it is only one way of developing a positive image. The media is vulnerable as ever to a "good story". The prescription is simple . . . a good dose of the facts, dressed up with drama and bottled up as news and carefully handed over to the report of choice.


Health politics and the aged.

Health politics and the aged. Politicians seeking office respond to sectional interests. Dr Last's paper discusses how our federal system allows division of responsibility and authority between Commonwealth, State and Local Governments, with none accepting responsibility for the system as a whole. Repeated Committees of Enquiry have recommended remedial action but no government has yet made a major commitment. Dr Last discusses how institutions may become the advocates whereby recommendations are implemented and health care services developed.


Aging organization focuses on disaster response.


Panel urges MDs to promote self-care.

Panel urges MDs to promote self-care.


Politics in health--the American experience. By examining various trends of the hospital industry in the context of the American political and social system. Mr O'Leary comments on the expanding role of government in planning, financing and regulating health services in the US. As government has taken on a more powerful central role in American Health care, the hospital industry has become more active in the legislative and political arena. By activating physicians, boards, employees and the patient community to become more involved in the political process, hospitals have been able to have a stronger hand in shaping decisions which will affect the future health care delivery system in the States.


Can you manage stress?

Can you manage stress?


Hospital associations & the political process. Development of the concept of an association and its responsibilities to its members; examination of the diversity of influences (political and otherwise) within the Australian health system; the problem of dealing with short-term Ministers and untrained Oppositions; handling the nonissues and sorting out the real issues from a hospital association's point of view; defining then finding the persons to influence who will be staying around!


Political platforms, pressure groups and the defence of health care in the 1980s. With 14 major changes in health care financing since 1970, it is surely time to consider some basic principles and health policies that ought to be immutable--at least for longer than 10 months at a time. The paper reviews the federal health policies of the three major parties--and asks whether the various health sector interest groups can afford to leave consensus to the parliamentary system.


Rural health issues.

Rural health issues. Two related issues dominate any discussion on rural health--the provision and maintenance of rural health services, and the continuing political battle to retain and improve these services. This battle is exacerbated by the importance that country communities attach to the provision of a doctor, a hospital, aged persons' accommodation, etc. This importance reflects the need for these services in isolated areas--the status this gives the community and the employment these services provide. The community's elected representatives have to determine how to evaluate the competing claims by communities for hospitals or other facilities. The local politician becomes the focus for the community's hopes and fears.


The establishment, progress and success of the Northern Territory's Aboriginal Health Worker training scheme. The Northern Territory Health Service has been training Aboriginal Health Workers to perform primary health care since the late 1960s. They are now an integral part of the health team and are helping to shape one of the great success stories currently taking place in the health field in the Northern Territory. A 13-minute film based on recent activities of Health Workers at Millingimbi in Northern Arnhem Land will be shown. In this and other Aboriginal communities, responsibility for primary health care has been transferred to Aboriginal Health Workers with professional staff being withdrawn, and acting in a resource role when required.


Economic issues in health policy.

Economic issues in health policy. This paper is a brief review of the economic implications of recent health policy decisions in Australia. Health expenditure as an aspect of social policy is considered, and the relationship between health expenditure and other public sector expenditure is examined with particular reference to social security and education. Economic considerations in achieving policy objectives, and the resource implications of alternative methods of financing are reviewed. Finally, some economic issues relating to possible future options for Australia are discussed.


Commission's guidelines affecting health policy.


Politics and the medical profession.

Politics and the medical profession. For most of this century--particularly in the '40s, '50s and '60s--the emphasis among politicians and social planners has been on the provision of more and better health services. However, in the '70s a dramatic change of emphasis occurred and today most discussion of health care policy seems to relate to cost containment. Inevitably this has led to conflict. Aspects of conflict relating to the provision of health care will be discussed.


Hospital politics--old and new.

Hospital politics--old and new.


Choosing a computer: consultant's advice.


Political activity in health care.

Political activity in health care.


How to keep the politics out of a new health building.


Consistency and consensus in Labor's health policy. An examination of the consistent themes in Labor's health policies since 1970, particularly Medibank & the Hayden Health plan. Contrast this with the consistency of goals in Liberal health policy which have returned Australia to the 1970 starting point and the tortuous contradictory path pursued by Federal Liberal Government between 1976 and 1981. Illustrates the pursuit of consensus by Labor in the accommodations inherent in the Labor health plan with private fee-for-service medicine, private hospitals and the private health funds. Contrast this with the inflexible Liberal determination to return to the status quo ante-Medibank. Finally contrast the present Australian polarisation with the degree of consensus achieved in Canada around the Medicare programme.


Serving customers and taxpayers.

Serving customers and taxpayers. The welfare interests of the disadvantaged and chronically ill are not incompatible with the interests the taxpayers have for an efficient health care system. Efficiency in health care means meeting the needs of the customer at the lowest possible cost to both customers and taxpayers. Experience, not ideology, informs us that the incentives for efficiency are stronger in competitive private enterprise than they are in public sector monopolies. Our task is to try to harness these forces wherever we can, if not by private sector provision then by the design of alternative incentive mechanisms for the public sector.


Building the manager's workbench.

Building the manager's workbench.


Teleconferencing--business or show biz?

Teleconferencing--business or show biz?


Health: a medical concern.

Health: a medical concern.


Walls.

Walls.


Health forums: a new perspective on holism.


Meeting the unique spiritual needs of the aging.


The role of the philanthropic, church-related retirement community in the 80's.


Association logo symbolizes ministries of members.


How to measure your leadership potential.


Women and absenteeism: health or economics?


50 or more color prints an hour. In hospital photography, rush assignments are normal and cost-effectiveness a must.


Making it through the holidaze: post-holiday distractions.


The need for public involvement in medicine. Part 2: Political factors, consumer activism and approaches to change.


What you need to know about your hospital's competitive position. Part 2: Census data, consumer surveys and competitor information.


Job descriptions: making subordinates accountable.


Women and the use of health services.

Women and the use of health services.


Time allocation, market work, and changes in female health.


Solving the staffing problem in hospitals.


Motivating the underachiever.

Motivating the underachiever.


Learning to level with employees.

Learning to level with employees.


Surgery for medical costs.

Surgery for medical costs.


Turning illness into a way of life.

Turning illness into a way of life.


Debate on the boundary of life. Medical miracles and the patient's right to die.


Stress: can we cope?

Stress: can we cope?


Showdown on smoking.

Showdown on smoking.


Privacy Act of 1974; report of new routine uses--Health Care Financing Administration. Notification of new routine uses. In accordance with 5 U.S.C. 552a(e)(11), we are proposing to add new routine uses applicable to the following notices of Systems of Records; (1) 09-70-0501, Carrier Medicare Claims Records, HHS/HCFA/BPO. (2) 09-70-0502, Health Insurance Master Records, HHS/HCFA/BPO. (3) 09-70-0503, Intermediary Medicare Claims Records, HHS/HCFA/BPO. We have provided background information about the routine uses in the "Supplementary Information" section below. We invite public comments on this proposal.


New war on health costs.

New war on health costs.


Minimum guidelines and requirements for accessible design--Architectural and Transportation Barriers Compliance Board. Final rule. The Architectural and Transportation Barriers Compliance Board hereby revises its "Minimum Guidelines and Requirements for Accessible Design" (guidelines and requirements). These revisions respond to concerns registered by certain Board members and to issues raised in comments submitted during the rulemaking process. The purpose of the revisions is to make the guidelines and requirements more cost effective and consistent with Federal and nationally recognized standards while still providing ready access and use. The guidelines and requirements, as revised, will provide a basis for consistent and improved accessibility standards to be issued under the Architectural Barriers Act by the General Services Administration, the Department of Housing and Urban Development, the Department of Defense, and the United States Postal Service. For clarity, the guidelines and requirements are published in their entirety with the revisions incorporated.


Expanded phase out provisions of intermediate care facilities for the mentally retarded (ICFs/MR) correction plans--Health Care Financing Administration. Final rule. This regulation authorizes Intermediate Care Facilities For the Mentally Retarded (ICFs/MR) to negotiate revisions to their 1977 correction plans for Life Safety Code, living, dining, and therapy area deficiencies under certain circumstances. Under this regulation, HCFA is authorized to approve revised correction plans when facilities have completed at least 25 percent of their original plans and agree to phase out an increased number of beds in previously certified units not already scheduled for phase out under existing correction plans. The timetable for the phase out and the actual number of beds to be phased out will be negotiated with target figures established for each six-month period of the plan. The total time for the plan cannot exceed five years from the effective date of this rule. Facilities are still required to meet the July 18, 1982 deadline for those items in existing plans which include construction or renovation of units that will remain in use after the phase out is completed. The intent of this regulation is to stimulate an overall reduction in the number of certified beds in large residential facilities. We hope that it will forestall further expenditures of capital funds for renovation of existing facilities or construction of new units where an expanded phase out of units is feasible.


Privacy Act of 1974; Report on new system--Health and Human Services Department. Notification of report on new system. Health care program violations. The Department of Health and Human Services (HHS) proposes to establish a new system of records entitled Health Care Program violations, HHS/OS/OIG, under the Privacy Act. Written comments will be received until September 27, 1982.


Unified agenda of regulations--Department of Health and Human Services. Publication of unified agenda of regulations. The President's February 17, 1981, Executive Order (12291) and the Regulatory Flexibility Act of 1980 require the Department to publish an agenda of significant regulations being developed and an indication of those regulatory actions that are being analyzed for their effect on small businesses. The Department published its last agenda on April 30, 1982.


Institutional Radiation Safety Committee--Nuclear Regulatory Commission. Final rule. The Nuclear Regulatory Commission (NRC) is amending its regulations regarding hospitals licensed to use radioactive byproduct material for human applications. Currently, such a license requires that the hospital have a Medical Isotopes Committee to review clinical aspects of the use of radioactive materials within the hospital. The amendment requires instead a Radiation Safety Committee with a simplified membership that will focus on the radiation safety of workers and the general public. The rule change acknowledges the Food and Drug Administration's role in regulating the safety and effectiveness of radioactive drugs with respect to the patient. The membership of the new Radiation Safety Committee will include the hospital management and the nursing staff in decisions affecting radiation safety at the hospital and will be easier for smaller hospitals to recruit.


Minimum funding requirements and minimum funding excise taxes--Internal Revenue Service. Notice of proposed rulemaking. This document contains proposed regulations relating to the minimum funding requirements for employee pension benefit plans, and to excise taxes for failure to meet the minimum funding standards. Changes to the applicable tax law were made by the Employee Retirement Income Security Act of 1974. The regulations would provide the public with guidance needed to comply with that Act and would affect all pension plans subject to the provisions of the Act. The proposed amendments would apply generally for plan years beginning after 1975, but earlier (or later) in the case of some plans as provided for meeting the minimum funding requirements under the Act. The proposed rules pertaining to the frequency of actuarial valuations, and to the time for making contributions, generally would not be effective prior to the publication of final regulations.


Administration on Aging: SCAN data bases; activity notice--Office of Human Development Services, HHS. Announcement of availability of certain data bases for assumption at no cost to the federal government. The Administration on Aging (AoA) announces that applications are now being accepted for assumption, dissemination and utilization of information in the SCAN Information System.


Medicare program; criteria for defining skilled nursing facility under Section 1861(j)(1) of the Social Security Act--Health Care Financing Administration. Notice of HCFA ruling. This notice announces a HCFA ruling that restates HCFA's long-standing interpretation of what constitutes a skilled nursing facility under section 1861(j)(1) of the Social Security Act.


Use of personal sampling devices during inspection--Occupational Safety and Health Administration. Final rule. This document amends 29 CFR 1903.7 to expressly authorize compliance officers to use personal sampling devices and to attach such devices to employees during the conduct of workplace inspections. This amendment is necessitated by conflicting judicial decisions as to whether the present regulation provides sufficient authorization for OSHA to use personal sampling devices.


Treatment of certain hospital services; proposed rulemaking--Internal Revenue Service. Notice of proposed rulemaking. This document contains proposed regulations relating to the treatment of certain hospital services furnished by a tax exempt hospital to other such hospitals. Changes to the applicable tax law were made by the Tax Reform Act of 1978. The proposed regulations would affect those tax exempt hospitals that furnish the services and would provide the furnishing hospitals with the guidance needed to determine their unrelated business taxable income.


Hazardous waste management system--Environmental Protection Agency. Notice of regulatory reform actions; request for comments. In response to Executive Order 12291 and the President's Task Force on Regulatory Relief, the Environmental Protection Agency is reviewing and reassessing the hazardous waste regulations developed under the Resource Conservation and Recovery Act (RCRA). A variety of activities are underway that will simplify procedures and reduce paperwork, modify existing regulations to make them more workable and cost effective, and control new wastes and new processes. The purpose of this notice is to inform the public of these activities and invite comments on the general approaches being taken.


Medicare program: access to books, documents, and records of subcontractors--Health Care Financing Administration. These regulations implement section 952 of the Omnibus Reconciliation Act of 1980 (Pub. L. 96-499), which conditions Medicare reimbursement for the cost of services performed under certain contracts upon compliance with prescribed criteria. If a contract between a provider and a subcontractor covers services valued at or costing $10,000 or more over a 12-month period, Medicare reimbursement cannot be made for the services unless the contract includes a clause allowing the Secretary of Health and Human Services and the Comptroller General access to the contract and to the subcontractor's books, documents, and records necessary to verify the costs of the contract. The clause in the contract must also permit similar access top any subcontract between the subcontractor and a related organization of the subcontractor when the subcontract is worth or costs $10,000 or more over a 12-month period. These regulations specify the criteria and procedures that the Department will use to obtain access to affected books, documents, and records. The purpose of the legislation and these proposed regulations is to permit the Secretary and Comptroller General to make an accurate determination of the reasonable costs under these contracts.


Evaluation of the administrative compliance costs and the impact of the inflation factor for Titles VI and XVI assisted facilities--Health Resources and Services Administration. Rule related notice; request for comments. The purpose of this notice is to solicit comments on an evaluation plan which has been developed to examine the impact of the administrative compliance costs and the inflation factor on health facilities obligated under Titles VI and XVI of the Public Health Service Act to provide a reasonable volume of services to persons unable to pay.


Medicare, Medicaid, and Maternal and Child Health Services Block Grant programs; civil money penalties and assessments for false or improper claims--Department of Health and Human Services. Notice of proposed rulemaking. These proposed regulations are intended to strengthen the Department's ability to protect the health care financing programs against persons and organizations who defraud and abuse those programs. The regulations would specify procedures for implementing the authority provided to the Department by section 2105 of the Omnibus Budget Reconciliation Act of 1981 (Pub. L. 97-35), as amended by section 137(b)(26) of the Tax Equity and Fiscal Responsibility Act of 1982 (Pub. L. 97-248), to impose civil money penalties and assessments administratively for the filing of false or certain other improper claims in the Medicare, Medicaid, or Maternal and Child Health Services Block Grant programs. The statute also permits an individual upon whom the Department imposes a civil money penalty or assessment to be suspended from participation in the Medicare and Medicaid programs. Until enactment of the civil money penalties legislation, the federal government had to rely upon litigation under the False Claims Act or criminal proceedings in order to compel restitution of funds falsely or improperly claimed under HHS health care financing programs.


Health Resources and Services Administration; medical reimbursement rates for fiscal year 1983; inpatient and outpatient medical care.


Pharmaceutical Reimbursement Board; final maximum allowable cost (MAC) determinations for certain drug products--Health Care Financing Administration. Final notice. The Pharmaceutical Reimbursement Board announces the suspension of the maximum allowable cost (MAC) limit on erythromycin stearate, oral tablets, 500 mg, effective November 17, 1982. The limit for this drug product was published in the Federal Register on December 11, 1978 (43 FR 57972) and became effective on January 25, 1979. This suspension of the MAC limit on erythromycin stearate, oral tablets, 500 mg, is based on general price increases by manufacturers that have occurred in the marketplace and the Board's concern that this drug product may no longer be widely and consistently available at the established MAC limit. The Pharmaceutical Reimbursement Board may reinstitute procedures to establish a new MAC limit on this drug product in the future.


Evaluation of the impact and effectiveness of Title XVI uncompensated services assurance--Health Resources and Services Administration. Rule related notice. The purpose of this notice is to solicit comments on an evaluation plan which has been developed to examine the impact and effectiveness of the regulations [42 CFR 124.501 et seq.) governing the provision of uncompensated services by health facilities obligated under Titles VI and XVI of the Public Health Service Act to provide a reasonable volume of services to persons unable to pay.


Exchange visitors program--criteria for evaluating comprehensive plan to reduce reliance on alien physicians--Public Health Service. Interim-final rule with request for comments. These interim final regulations establish the criteria for evaluating the comprehensive plan by programs of graduate medical education or training to reduce reliance on alien physicians under Section 212(j)(2)(A)(ii) of the Immigration and Nationality Act as amended by Pub. L. 97-116.


Cost principles for nonprofit organizations--Office of Management and Budget. Notice. This notice offers interested parties an opportunity to comment on a proposed revision to Circular A-122, "Cost Principles for Nonprofit Organizations." The proposed revision establishes special provisions for costs related to political advocacy. Similar revisions are being simultaneously proposed for civilian and defense contractors through appropriate actions by the Department of Defense, NASA and GSA, the three agencies with authority to issue procurement regulations. The purpose of these proposals is to ensure that federal tax dollars are not used, directly or indirectly, for the support of political advocacy. Over the past 25 years, the volume of federal activity conducted through grantees and contractors has dramatically grown. Sound management of federal grants and contracts has correspondingly gained in importance. The responsibility of the President through OMB to improve the management of the executive branch of government with a view to efficient and economical service, and to fulfill other statutory and constitutional responsibilities, extends to issues of grant and contract management no less than to issues of direct federal activity.


Administrative procedures and sanctions; questions and answers relating to the applicability to the petroleum violation escrow funds of regulations of the energy conservation programs--Department of Energy. Ruling. The Department of Energy (DOE) Office of General Counsel issues the appended Ruling to respond to questions relating to the applicability to the petroleum violation escrow funds of the regulations of the energy conservation programs administered by DOE to which these funds can be distributed under Section 155 of the Further Continuing Appropriations Act, Fiscal Year 1983.


Area health education center programs--Public Health Service. Final regulations. These regulations set forth requirements for cooperative agreements entered into by the Secretary of Health and Human Services with schools of medicine or osteopathy for the planning, development, and operation of area health education center programs. The regulations conform provisions in 42 CFR Part 57, Subpart MM--Area Health Education Center Programs to Nurse Training Amendments of 1979 Pub. L. 96-76), the Federal Grant and Cooperative Agreement Act (Pub. L. 95-224), and the Omnibus Reconciliation Act of 1981 (Pub. L. 97-35). Also in response to public comments to the interim final regulations published in the Federal Register on November 27, 1978, clarification of several provisions were made to the final regulations.


Eligibility of foreign medical schools under the guaranteed student loan program (GSLP)--Department of Education. Final regulations. The Secretary issues regulations for the purpose of determining whether medical schools located outside the United States and Canada are eligible to apply for participation in the Guaranteed Student Loan Program (GSLP). Participation in the GSLP by a foreign medical school means that its students who are citizens or nationals of the United States may apply for loans from eligible lenders under that program. These regulations establish new procedures and criteria that will be used by the Secretary in determining eligibility.


Public mobile radio services; regulatory policies and procedures for the Domestic Public Land Mobile Radio Service--Federal Communications Commission. Final rule. Final policies and procedures concerning objective need showings are being adopted for applications requesting multiple new two-way channels and applications requesting additional channels for an existing system. The policies and procedures we had in the past were vague and did not provide applicants with sufficient information as to what was required in need showings before various types of applications could be granted. Thus, applicants requesting multiple new two-way frequencies or additional two-way channels for an existing system must show that the existing, projected or expected grade of service for the proposed facilities is .25 or greater, this will determine the number of new or additional channels granted.


Medical reimbursements rates for fiscal year 1983; inpatient and outpatient medical care; correction.


Standard-setting requirements for medical and nonmedical facilities where SSI recipients reside--Office of Human Development Services, HHS. Final rule with comment period. This rule amends the standard-setting requirements for medical and nonmedical facilities where SSI recipients reside. (These requirements are known as Keys amendment regulations). This action is necessary because of the passage of the Omnibus Budget Reconciliation Act of 1981 which amended section 1616(e) of the Social Security Act and deleted reference to Title XX thereby removing social services plans as the vehicle for providing public notice of standards for certain facilities.


Regulatory policies and procedures for the Domestic Public Land Mobile Radio Service--Federal Communications Commission. Proposed rule. Policies and procedures concerning objective need showings for applications requesting an additional one-way frequency for one-way signaling stations are being proposed. The present rules do not provide applicants with sufficient information as to what is required in need showings before applications can be granted. Applicants requesting an additional one-way frequency must show that the existing or projected grade of service is .50 before an additional channel is granted. The proposed standards are concurrently being adopted as an interim rule.


Exemption of certain research and demonstration projects from regulations for protection of human research subjects--Office of the Secretary, HHS. Final rule. The Department of Health and Human Services (the Department or HHS) is including among the types of research specifically exempt from the application of the regulatory requirements of 45 CFR Part 46 (protection of human research subjects) research and demonstration projects conducted under the Social Security Act and other federal statutory authority and designed to study certain public benefit or service programs, the procedures for obtaining benefits or services under those programs, and possible changes or alternatives to those programs or procedures, including changes in methods or levels of payment. These demonstration and service projects are already subject to procedures which provide for extensive review by high level officials in various program administration offices. Review by an Institutional Review Board (IRB), as required under Part 46, would be duplicative and burdensome to state and local agencies and to other entities participating in demonstration projects. Removal of this unnecessary layer of review will not only reduce the cost of the projects but help to avoid unnecessary delays in project implementation. However, in order to ensure the continued protection of human subjects participating in such research activity, the Department is adding a specific requirement of written, informed consent in any instance, not reviewed by an IRB, in which the Secretary determines that the research activity presents a danger to the physical, mental or emotional well-being of a participant.


Amendment of the Commission's rule pursuant to its unregulatory program--Federal Communications Commission. Final rule. The Federal Communications Commission is amending the Rules concerning the land mobile radio services so as to eliminate those that are now unnecessary or outdated and to bring others into agreement with rules that were amended previously in other rulemaking actions.


Public inspection of exempt organization returns--Internal Revenue Service. Notice of proposed rulemaking. This document contains proposed regulations relating to the public inspection of returns of certain tax exempt organizations. The regulations clarify the rules relating to the disclosure of certain information of exempt organizations. Additionally, the regulations reflect changes made by Pub. L. 96-603 and Pub. L. 95-488.


Loans to state and local development companies--Small Business Administration. Proposed rulemaking. SBA proposes to amend 13 CFR 108.503--4(c) to limit SBA participation with tax-exempt financing under the program authorized by section 503 of the Small Business Investment Act, 15 U.S.C. 697. Under the proposed rule, SBA would participate in the financing of a project which is also financed by tax-exempt obligations provided the repayment of the proceeds of SBA guaranteed financing is not subordinate to the repayment of the tax-exempt financing. This amendment would be in accordance with existing Federal policy which prohibits Federal agencies from directly or indirectly providing a guarantee to tax-exempt obligations.


Sanctions applicable to letter of credit administration--Office of the Secretary, HHS. Proposed rule. We are proposing regulations that would govern the imposition of sanctions against recipient organizations holding letters of credit under programs administered by the Department of Health and Human Services. The regulations would describe the conditions which may prompt the imposition of sanctions and would establish uniform procedures for providing affected recipient organizations: (1) Adequate notice of the grounds upon which proposed sanctions are based, (2) an opportunity to respond to the factual and legal bases of the proposed sanctions, and (3) a reasoned decision that articulates the factual and legal bases of the Department's final decision. We believe that these uniform procedures would be useful both as a sound management tool for the Department and as a guide to grantees and contractors.


Additional protections for children involved as subjects in research--Department of Health and Human Services. Final rule. The Department of Health and Human Services (Department or HHS)( is prescribing additional requirements for protection of children involved as subjects in research. These regulations adopt, with some changes, the recommendations of the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research (National Commission) as were presented in the notice of proposed rulemaking (NPRM) 43 FR 31786 which preceded this final rule. Specifically, these regulations impose certain added responsibilities on Institutional Review Boards (IRBs) depending on the degree of risk involved in the research and the extent that the research is likely to be a benefit to the subject or relate to a subject's illness.


Access charges; MTS and WATS market structure--Federal Communications Commission. Final rule. FCC, pursuant to the Fourth Supplemental Notice of Inquiry and Proposed Rulemaking published on June 21, 1982, at 47 FR 26668, adopts rules for the computation and assessment of end user and carrier's carrier access charges and the creation of an exchange carrier association to prepare access charge tariffs and distribute pooled access charge revenues. The Commission concluded that this action was necessary because existing methods of access compensation produced unlawful discrimination and preferences in interstate rates. These rules were designed to eliminate such unlawful discrimination and preferences.


Top-heavy plans--Internal Revenue Service. Notice of proposed rulemaking.


Accounting for long-term contract--Internal Revenue Service. Notice of proposed rulemaking. This document contains proposed amendments to regulations under sections 446, 451 and 471 of the Internal Revenue Code relating to accounting for long-term contracts. The proposed amendments would conform the regulations to section 229 of the Tax Equity and Fiscal Responsibility Act of 1982 and would affect taxpayers who have long-term contracts whether or not they use a long-term contract method of accounting for such contracts.


Revision of income criteria for eligibility for uncompensated services--Health Resources and Services Administration. Rule-related notice. This notice announces the applicability of the recent revision of the poverty income guidelines to uncompensated services programs administered by health care facilities pursuant to Titles VI and XVI of the Public Health Service Act.


Availability of funds for Community Health Centers (CHCs)--Health Resources and Services Administration. Notice. Under the present Continuing Resolution, Pub. L. 97-377, providing funding for the Department of Health and Human Services, approximately $14 million are available for funding new CHCs and expanding existing CHCs. This notice contains information of interest to prospective applicants for such funding.


Health maintenance organizations; amendments of 1981--Health Resources and Services Administration. Notice of proposed rulemaking. This notice proposes to amend the Public Health Service rules on health maintenance organizations (HMOs) to conform with the 1981 amendments to the HMO statute regarding member protection in the event of insolvency, community rating by class, and primary care within the service area of a non-metropolitan HMO. In addition, this notice proposes: (a) to remove provisions of the rules that are considered unnecessary or burdensome, such as the regulatory specification of contractual provisions, and (b) to increase one of the regulatory limits on copayments to permit HMOs to become more competitive with alternative forms of health insurance.


Miscellaneous amendments to the HHS procurement regulations--Department of Health and Human Services. Proposed rule. The Office of the Secretary, Department of Health and Human Services is proposing to amend its procurement regulations by revising and updating the general provisions for use in fixed price and cost-reimbursement type contracts (HHS-314, -315, -315A, and -316) and related miscellaneous amendments. The revisions will result in the consolidation of all additions, removals and revisions to the general provisions. The effect of the amendment will be the updating of the Department's general provisions.


Bell Operating Co.; furnishing of customer premises equipment, enhanced services and cellular communications services and North American Telecommunications Association--Federal Communications Commission. Proposed rule. The Commission has issued a Notice of Proposed Rulemaking that addresses the questions of whether, following divestiture, Bell Operating Companies' offerings of enhanced services, customer premises equipment or cellular communications services should be subject to structural separation requirements and, if so, whether the degree of separation currently prescribed by Commission Rules should be modified to accommodate the effects of the BOCs' divestiture. The purpose of this proceeding is to determine whether the divestiture's structural separation of AT&T's monopoly activities and competitive activities renders the Commission's structural separation requirements unnecessary or unduly burdensome to the divested operating companies. If so, the Commission's structural separation requirements may be relaxed, eliminated or otherwise modified.


Federal Employees Health Benefits Program; benefits for medically underserved areas--Office of Personnel Management. Final rule. The Office of Personnel Management (OPM) is amending its regulations pertaining to benefits under the Federal Employees Health Benefits (FEHB) Program for individuals in medically underserved areas, these regulations are necessary to implement the FEHB law, as amended, which mandates special consideration for enrollees of certain FEHB plans who receive covered health service in States with critical shortages of primary care physicians.


Health Financing Research and Demonstration grants; availability of funds for grants--Health Care Financing Administration. General notice. This document announces additional priority subject areas for research and demonstration grants for fiscal year 1983, in addition to those included in the Federal Register on September 16, 1982 (47 FR 41090).


Health systems agencies and state health planning and development agencies; certificate of need reviews--Health Resources and Services Administration. Notice regarding adjustment of the expenditure minimum for capital expenditures and the expenditure minimum for annual operating costs. This notice provides necessary information for each State which chooses to adjust the capital expenditure and annual operating cost expenditure minimums that are used to determine whether proposals are subject to review under a State's certificate of need program. The notice also provides guidance to assist a State Health Planning and Development Agency (State Agency) in determining the exact minimum dollar figure it will use and in seeking further information.


Doctors and FTC eye truce that would keep most antitrust powers.


Hospitals' building and buying binge tied to cuts in federal planning aid.


Financing health care: the unfinished agenda.


Prescriptions for Baby Doe.

Prescriptions for Baby Doe.


The Public Health Service--suffering budget cuts in relative obscurity.


Relative responsibility.

Relative responsibility.


Catastrophic health insurance.

Catastrophic health insurance.


Health insurance for the unemployed and uninsured.


'PPO'--three letters that may form one answer to runaway health costs.


Mail-order drugs can cut the cost of prescription plans.


On health issues, this business group is a leader, but is anyone following?


Data base to allow firms to gauge health costs.


EEOC says employer plans must cover older workers.


Employee attitude surveys.

Employee attitude surveys.


Big employers increasing health cost control: study.


O'Connell uses wide variety of risk-funding techniques.


Captive dividends offsetting premium hikes for hospitals.


Sisters establish non-profit agencies to carry out works.


Coalitions continue attack on health costs.


As Congress acts, benefit plans will change.


Changes in law affect malpractice claims.


Exhibitors focus on employee wellness.

Exhibitors focus on employee wellness.


Unisex rates expensive for employers, insurers.


Smoking rule doesn't worry employers in San Francisco.


Older workers' health care rules in limbo.


But 'everybody' is self-funding health benefits.