Historical Perspective

SPAHQ - Our Historical Perspective

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.