SPAHQ ……..Our Historical
Perspective
Tied to the Changing Times and Needs
of Quality and Utilization Professionals
The Association began meeting informally in 1972. Ruth
Menkin and Meg Carson organized a group that became known
as the Association of Utilization Review Coordinators of
Southeastern Pennsylvania. The first formal meeting was
held September 19, 1973 with 30 people attending. Meg Carson
served as the first President. Meetings were held every
third Wednesday. Topics discussed were the new PDUR process
that became effective in November of 1973 and the new PSRO
areas.
In 1974, the Association had 41 formal members. Bylaws
were established and meetings were held at HAP in an effort
to form a statewide organization. By 1975, all hospitals
had to have a Utilization Review Plan and the Uniform Hospital
Abstract Form was introduced. The Association took its
first stand against more paperwork. Membership grew to
81 members representing 53 hospitals. In 1976, the Association
contacted the PSRO and requested that some of the members
serve as ex officio members on various PSRO committees.
The membership had grown to 90 and there was a balance
of $226.00 in the Treasury.
Between 1977 and 1980, the Association sent a letter to
the President of the National Association requesting information
on liaison between National, State and Local organizations.
The bylaws were changed to allow organizations to join.
The first newsletter was published. The name changed to
The Association of UR/QA Coordinators of Southeastern Pennsylvania.
The organization requested of DVHC that they appoint members
to represent the Association on advisory groups addressing
QA, PSRO, and data collection issues. In 1979, another
name change to Southeastern Association of QA Professionals
followed soon after in keeping with the State and National
Organizations. Our first position paper was presented at
the National Association Conference on Credentialing.
Through the early 80’s, the Association was very
focused on state and federal review guidelines and processes.
In 1980, the Association presented a position paper to
the Montgomery/Bucks PSRO concerning peer review and confidentiality.
DPW instituted a demonstration project of Pre-Discharge
Utilization Review (PDUR) in 30 hospitals. A position paper
was sent in response to this project. In 1981, the Association
sent a position paper to the Philadelphia PSRO concerning
issues related to the use of a standardized UR document.
TEFRA went into effect in 1982, the Association held meetings
with Blue Cross to establish guidelines for SPU and OP
procedures; DVHC held a meeting to discuss the DPW Concurrent
UR Program. The Association was actively involved in the
discussions with DPW in order to improve the process.
In 1983, the Association sent a position paper to DPW on the proposed
limits of MA payment to 75%. Changes in Medicare and Medicaid reimbursement
made UR critical to the financial stability of the hospitals.
1986-1987 saw DRGs going into full swing. Networking groups
were initiated throughout the region. COBRA legislation
was passed requiring a second opinion and KePRO started
a Precertification program. The Association received the
first Proclamation from the City of Philadelphia for UR/QA
week.
In 1988-1989, The Third Scope of Work was initiated for
Medicare. QA was recognized in lights on top of the PECO
building. Our Membership was over 300. In 1990-1991, The
National Practioner Data Bank becomes operational. Job
Descriptions were developed for future office holders.
Letters were sent to Hospital CEOs asking them to recognize
UM/QA week. In 1992-1993, The MA 87 changed to the automated
Place of Service Program for DPW. The Fourth Scope of Work
started.
In 1992, the Association celebrated their 20th Anniversary
and honored Past Presidents. The Association's name was
changed for the fourth time in 1993 to The Southeastern
Pennsylvania Association for Healthcare Quality (SPAHQ).
Networking groups were expanded to incorporate our diverse
interests.
1994 to 1999 saw a huge growth in managed care enrollment.
Denials grabbed everyone’s attention. The most active
subgroup in the Association was the UM Special Interest
Group. A bill was passed requiring extended maternity stays
for women and newborns to 2 days; the State began a mandatory
Health Choices program in Southeastern Pa moving all Medicaid
eligibles into managed care plans. The Long-Term Care group
held their first meeting. The Association participated
in grass roots efforts to pass House Bill 2797, Health
Plan Accountability Act which became law on January 1,
1999 as Act 68. Members of the Association testified in
Harrisburg. Changes in roles and work responsibilities
also affected Association membership. The Association celebrated
its 25th Anniversary with a reception and thank you to
its members held at City Hall in downtown Philadelphia.
In current years, the Association is financially sound.
We are still involved with state and national organizations
in order to affect change. SPAHQ members hold vital positions
in their organizations that effect the quality of health
care services delivered to our members/patients/consumers.
Through our commitment we continue to monitor, analyze,
and coordinate all aspects of health care services.
Today, the Association provides an opportunity for education
and networking for its members across various disciplines
such as utilization, quality, case management, risk management
and from various organizations such as payer, provider,
acute care and long term care. Together we can be here
to support each other and fulfill our mission into the
future.
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