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Montana Stale Library



L buO



UlVlLi^jTS



3 0864 1004 9693 7

MONT/IHA
COMPUHiHSIVi
HEALTH PLAHHIHG



.IflW 9 1974



Second Class Postage Paid
at Helena, Montana 59601



HiWS



510 Logan Ave. - Helena, Montana 59601 - Phone 449-3121



Volume 5, Number I — November - December, 1973



HJR 18 Implementation —



Legislative Council Studies
Public Health Districting



Among many activities which
were initiated by findings of the
Low-Income Health Task Force
Study conducted in numerous
Montana communities in 1971 was
CHP work to obtain a study of the
Montana pubhc health system.

A scries of meetings following
release of the study between a sub-
committee of the State Personal
Health Services Committee, Mon-
tana State Low-Income Organiza-
tion, Montana United Indian Alli-
ance and other interested groups
culminated in drafting House Joint
Resolution 18, which was subse-
quently passed and signed by Gov-
ernor Judge.

HJR 18 calls for the Montana
Legislative Council, in conjunction
with the SDHES "to conduct a
study to determine an acceptable
minimum level of services to be
provided by county and city-county
health departments, the feasibility
of creating district public health
departments and an economical
means for providing public health
services . . ."

The study design for implemen-
tation of HJR 18, approved by the
Interim Public Health, Welfare and
Safety Committee on June 5, calls
for a multi-step approach. Three
information collecting steps will be
conducted simultaneously over a
three-month period with three syn-
thesis steps which will culminate
in drafting of specific legislation
for the 1975 Legislative Session.

^^CM



A possible outcome of the HJR
18 study could be enabling legisla-
tion for creation of multi-county
public health districts — similar to
hospital districts or solid waste dis-
tricts — which would have the
power to tax themselves and fi-
nance public health projects.

Evaluation of Montana's public
health system by the study group
has been conducted through the
fall of 1973, with the HJR 18 Com-
mittee expected to finish study and
begin drafting legislation by sum-
mer of 1974.



This issue contains the Fiscal
Year 1973 Progress Report Sup-
plement, discussing some high-
lights of the year's CHP activity
as it relates to the Work Pro-
gram adopted last year by the
State CHP Advisory Council.



County Profiles
In Printing

Described as "a basic tool no
planner should be without," the
Montana County Profiles are slated
to become available the first of the
year. The nearly two hundred page
statistical analysis has taken over
three years to complete, at a cost
of '"about $5,000," according to
Health Planner, Edward Mahn.

Mahn said the study of Mon-
tana's population, employment, ed-
ucation, housing and ethnic char-
acteristics is unique in two re-
spects. It is the first correlation of
census data in the state based on
Montana's five health planning
areas and on county divisions.
Mahn said the County Profiles are
also the first publication of Mon-
tana planning data which describes
trends in category areas over the
forty year interval since 1930.

"It's the most objective material
available," said Mahn, and may be
used to compare counties and
multi-county planning area char-
acteristics with state and national
figures. The source of the material
is primarily 1970 census computer
— continued on page 3




930 East Lyndale Avenue



Nixon Signs



Final figures are in for fiscal
1973 federal expenditures with a
CHP budget of $34.8 million, re-
duced $6.9 million from a potential
$41.7 million.

Most HEW cuts were in the
health field, with the Health Ser-
vices and Mental Health Adminis-
tration losing $569.6 million for a
reduced final budget of $1.7 billion.

In a compromise move forced by
an intense Congressional push.
President Nixon has signed the one-
year health programs extension
bill, SB1136. Faced with a 372 to 1
vote in the House and 72 to 19

Morbidify High

Among Indian

Children

Despite recent significant im-
provement, the health of Indian
children falls behind that of other
American children. So says a re-
port by Helen M. Wallace, M.D., of
the University of California School
of Public Health in Berkeley.

Indian infant deaths occur at
nearly three times the national
rate, according to the report, from
the fifth week of life through the
first birthday, a period considered
an index of the baby's care in the
home environment. About 83 per-
cent of Indian children survive their
first fifteen years, compared with
a national average of more than 94
percent.

Dr. Wallace points to a need for
improved health and medical care,
including immunization against
childhood diseases, more accessible
health and medical services, early
identification and treatment of ill-
nesses and more emphasis on
health education for both parents
and children.

The report indicated as major
contributing factors both poor liv-
ing conditions and a birth rate near-
ly double the national average.
Mental health is also becoming rec-
ognized as a major Indian health
problem with estimates of 20 to
25 percent of the Indian popula-
tion affected in some degree.

PAGE TWO



vote in the Senate, the President
had little choice. He could have
let the bill become law without
signing it. Instead, Mr. Nixon is-
sued a statement warning against
budget-busting bills but saying "so
long as the Congress follows a re-
sponsible course in the passage of
future spending bills, I will cooper-
ate in the spirit of partnership."

The President's move hints at a
coming truce between the White
House and Congress on health
spending. A series of U. S. District
Court decisions appear to have
cracked Administration determina-
tion to impound funds for health
and other domestic spending pro-
grams. The court decisions called
for HEW release of funds for Com-
munity Mental Health Centers,
Neighborhood Youth Corps and
education programs.

The extension bill covered twelve
programs, including CHP, Regional
Medical Program, Hill-Burton,
Community Health Centers, Mater-
nal, Infant, Children and Youth
Centers, and Migrant Health.

Dismantling of many of these
programs, which the Administra-
tion had hoped to eliminate, has al-
ready proceeded at both national
and local levels. HEW Secretary
Weinberger indicated in recent
congressional hearings that HEW
will continue RMP for the year,
but whether many local RMP's can
be brought back to life for a year
is a big question.

Essentially what the one-year
extension offers is an opportunity
to take a thorough look at federal
health programs, and to stimulate
introduction of new health mea-
sures, such as HR 7274, "The Pub-
lic Health Act of 1973."



Surplus
Property
Available

Bargain hunting health facility
administrators should note that the
Office of the Superintendent of
Public Instruction has established
a Surplus Property Section (S.P.S.)
Warehouse to dispose of federal
government property "at consider-
ably less than market price."

S.P.S. Director, William J. Ernst,
warns, however, that eligibility of
educational, public health and civil
defense institutions or organiza-
tions is strictly checked. He said
any Hill-Burton funded facility may
participate.

An HEW Office of Surplus Pro-
perty Utilization memo states: "We
should like to specifically caution
you to insure that the extended
care facilities approval under Medi-
care or Medicaid is for the entire
institution and not just one single
unit of an institution which is de-
voted primarily to domiciliary
care." The memo continues, "Only
non-profit, tax-exempt, approved
extended care facilities can be held
to be eligible . . ."

Ernst said that since stock on
hand varies considerably, no cata-
log is available. Buyers must make
a direct visit to the warehouse,
1320 Bozeman Ave. in Helena and
take delivery.

Interested organizations may ob-
tain Application for Eligibility
forms from the Surplus Property
Director, Office of the Superinten-
dent of Public Instruction, Helena
59601.



Council Member Honored



Miss Mary T. Burke, a member
of State CHP's Advisory Council
and Chief, Area Nursing Branch,
Billings Area Indian Health Service,
has recently been singled out for
recognition by Loyola University
as "an outstanding woman grad-
uate of the School of Nursing."



Miss Burke was also honored by
the Crow Indian Tribe. She was
adopted by the Crows and be-
stowed the name "Bia xia sash,"
the "Noted Lady" in recognition of
her "devotion to the Indian people,
and especially for encouraging
many young Indians to join the
health professions.



NEW FACES
IN CHP

As an outgrowth of the Mon-
tana Indian Cultural Awareness
Conference of last May, Compre-
hensive Health Planning has hired
a new Health Planner. Duane Jean-
otte joined the staff of CHP on
October 1 and is currently familiar-
izing himself with the various or-
ganizations and institution which
deal with Indian-related problems.
A good deal of Duane's time is
presently being spent "just getting
to know people."

Duane comes to CHP from Cuba,
New Mexico, where he was the
Associate Director of the Checker-
board Area Health System, respon-
sible for administering rural health
programs among the Navajo and
Chicano peoples. A native of North
Dakota, Duane is an enrolled mem-
ber of the Turtle Mountain Tribe
of North Dakota. He is a graduate
of Mayville State College, North
Dakota, and holds a Masters De-
gree from the University of Colo-
rado in Health Administration.
Duane is married, has one child
and lives in Helena.

As a Health Planner for Com-
prehensive Health Planning, Duane
will be working to provide a more
effective interface between state
institutions and Indian agencies
throughout Montana. The identifi-
cation of particular problems and
needs of off-reservation Indians as
they relate to health services de-
livery will be his primary area of
concentration. He will also be re-
sponsible for assisting in the de-
velopment of the Indian component
of the State Comprehensive Health
Plan, as well as working with the
Health Services Subcommittee of
the State CHP Advisory Council.

The Southwestern Areawide
Health Planning Council has also



Montana Comprehensive Health
Planning News is published bi-month-
ly in January, March, May, July, Sep-
tember, and November by:

Comprehensive Health Planning
Division of Montana Department of

Health and Environmental

Sciences
510 Logan
Helena, Montana 59601



recently hired a Health Planner.
Lyle Monroe, a native Montanan
and 1970 graduate of the College
of Great Falls, will be located in
the Bozeman office, organizing and
planning for the health of Gallatin
County.

Lyle has been working in the
social services field for the past




LYLE MONROE

few years doing community organi-
zation and counseling. He has
served as a Constitutional Conven-
tion delegate from Cascade Coun-
ty District 13 and advocated health,
youth and social concerns as an
elected official.

The pursuit of graduate studies
at Montana State University, his
wife and two children will occupy
Lyle's spare time, though not neces-
sarily in the given order of priority.

State Comprehensive Health
Planning will again have the good
fortune for working with VISTA
Volunteer, Dennis Taylor. In his
second year as a Volunteer, Dennis
will be working closely with the
Personal Health Services Subcom-
mittee of the State Comprehensive
Health Planning Advisory Council
and their work up-dating and im-
plementing the recommendations
of the Low-Income Health Task
Force Report.

A graduate of the University of
Kansas (B.A., 1968) and a Viet Nam
Veteran, Dennis will also spend a
large portion of the forthcoming
year working with Chairperson
Mary Munger and the HJR 18
Study Committee in its study of
public health services in Montana.



County Profiles —

— continued from page 1
print-outs, with additional input
from U. S. Department of Com-
merce and State Department of
Social and Rehabilitation Services
publications.

State CHP staff, with initial as-
sistance from other State agencies,
devised the particular comparisons
used in the analysis. A similar,
though less extensive, analysis of
I960 census data had been pre-
pared earlier by the State CHP
Office.

The County Profiles will be par-
ticularly valuable to city-county
planners, health planners, chambers
of commerce and other state agen-
cies, Mahn said, and will also be
a major objective input in the State
Plan for Health. Several Areawide
CHP groups plan to prepare more
subjective correlation supplements,
according to Mahn, which will de-
tail conclusions which might be
drawn from the Profiles.

An initial printing of five hun-
dred copies is planned. After bulk
distribution to Area CHP Offices,
remaining copies will be distribu-
ted from the State Office on re-
quest.




Old and Cold — One of many turn-of-the
century homes in Helena.

PAGE THREE



Work Begins on Montana State Plan for Health



state CHP staff
Jane Crigler and
have been detailed
Health Plan Team,
have been working
able plan strategy,
the projected date
of the first edition



members, Mary

Dave Turner

to form a State

To date they

out an accept-

July, 1974, is

for completion

of the plan.



While the State Office prepares
a yearly work program which de-
tails the activities planned by the
State CHP Advisory Council and
staff, the Health Plan will be a
considerably more involved docu-
ment for both long and short-term
planning. The purpose of the Plan
will be to outline what the health
scene in Montana should ideally
look like in the future with state-
ments regarding the most appropri-
ate avenues for arriving at these
goals.

One of the most important uses
of the Plan will be to provide a
rational basis for decision making
in health matters. It will be the
document to which decision makers
will refer when faced with options
concerning alternatives such as
what type of legislation is needed
to meet the health manpower re-
quirements of the state or which
of two facilities' proposals would
better benefit an area. The docu-

PLANNING TOOLS
AVAILABLE

Two health data compilations are
available from the AMA headquar-
ters which should provide local
health planning groups with useful
data on physicians' fees and other
health industry costs.

Produced in yearly editions by
the AMA Center for Health Ser-
vices Research and Development,
the "Red Book," is entitled "Refer-
ence Data on the Profile of Medical
Practice," and its companion vol-
ume, "Blue Book," is entitled "Ref-
erence Data on Socioeconomic Is-
sues of Health."

Individual copies, at $1.35 each
or $2.50 for the set, may be ob-
tained from: American Medical
Association, 535 N. Dearborn
Street, Chicago, IL, 60610.

PAGE FOUR



ment will also provide a rallying
point for organizational efforts to
effect changes in Montana's health
scene.

Both consumers and providers of
health services will be contacted
for their input into the plan. The
Areawide Committee of the State
Advisory Council will review and
comment on all components of the
Plan as they are readied. Final ap-
proval of the Plan will come from
the State Advisory Council.

Health plans prepared by several
other states have provided staff
members with examples of both
good and bad methods and out-
comes. Every effort is being taken

ANA Releases
PSRO Survey

The Montana Medical Associa-
tion Bulletin reports the results of
a survey of the AMA's 51 constitu-
ent rnedicr.l societies on "activities
and attitudes of state medical so-
cieties on PSRO," with 27 state
medical societies favoring estab-
lishment of statewide umbrella
PSRO's.

Sixteen societies plan to support
"an application for designation of
a state-level organization as a
PSRO," six do not plan applica-
tions, and one was undecided.

Montana's physicians have es-
tablished a Foundation for Medical
Care which could assume the func-
tions of a state-level PSRO.

The Bulletin also reported that
a nationwide survey of 96,950 AMA
member doctors showed that "more
than fifty percent" felt that "no
third party authority should be ex-
ercised in utilization review of am-
bulatory services, the establishment
and monitoring of quality care
standards, and physicians' fees.
Nearly half, 48.5 percent, felt that
third party intermediaries should
have partial responsibility for rate
review."

"Third party authorities" could
include insurance companies, con-
sumer health interests, or Uncle
Sam.



with the Montana Plan to produce
a practical, workable document
which accurately reflects citizen
needs and wants and which will
not merely gather dust on a back
shelf.

Military Program
To Provide Health
Professionals

Termination of the military draft
has threatened to leave many rural
Montana communities without
doctors. Several communities pres-
ently served by physicians work-
ing in lieu of military service, may
find the Uniformed Services Health
Professions Revitalization Act of
1972 (PL 92-426) providing some
alternatives by making available
the services of a variety of health
professionals under obligation to
the armed forces for training.

PL 92-426 "provides for estab-
lishment and maintenance of an
Armed Forces Health Professions
Scholarship Program to obtain ade-
quate numbers of commissioned
officers on active duty who are
qualified in various health profes-
sions."

Five thousand scholarships, di-
vided among the various service
branches, will train physicians, os-
teopaths, dentists, veterinarians,
optometrists and Ph.D. level clini-
cal psychologists.

Program participants will be
commissioned officers in reserve
components and required to serve
45 days of active duty during each
year of participation. They will re-
ceive payment for all educational
expenses, excluding room and
board, and receive a stipend of
$400 per month.

A minimum of two years of ac-
tive duty obligation will be incurred
by participants, computed on a
basis of one year of active duty
for each academic year (twelve
months or less of training). Pro-
gram participants may complete
intern or residency training in a
— continued on page 12



PSROs-What Are Theyr



Professional Service Review Or-
ganizations, or PSROs, are causing
a growing furor in the health field,
with no one — either consumer or
provider — completely convinced
that PSROs will be either good or
bad.

One thing is certain, implementa-
tion of PL 92-603 Title XI, which
establishes PSROs, will require
some difficult decisions and involve
providers of health care and the
consumers they serve in a new and
expanding bureaucracy.

Under the 1972 legislation pro-
posed by Sen. Wallace F. Bennett
(R-Utah) , PSROs will have respon-
sibility for:

— Reviewing hospital and other
institutional care and ambulatory
care through provider and pa-
tient care profiles; advance re-
view of elective admission to
facilities, and other extended or
costly treatment; certification of




A small portion of the surplus equipment

available to qualified recipients. (See

story on page 2.)



continuing treatment in an in-
patient facilities; assessment of
utilization and other existing re-
view activities; inspection of
health care facilities; and review
of provider records where per-
tinent.

— Assuring that health services
paid for under Medicare, Medi-
caid and Maternal and Child
Health Programs are medically
necessary, meet professionally
recognized standards, and are
provided at the most economical
sites.

According to Henry Simmons,
M.D., acting director of the Office
of Professional Standards Review
(HEW), January 1, 1974, will be
the deadline for designation of in-
itial PSRO areas. Substantial num-
bers of pSRO areas will be desig-
nated in order to give priority to
local groups without excluding ex-
perienced state organizations from
a role of assistance and guidance.
Factors which will be assessed in
selecting PSRO area designations
reportedly include: ". . . each
should encompass a medical service
area and assume broad, diverse
representation of all medical spec-
ialities; should not be so large so
as to preclude active physician
participation; and take into account
existing boundaries of current local
peer review groups and health
planning areas, as well as the need
for effective coordination with
Medicare/Medicaid fiscal intermed-
iaries."

Newly designated PSROs will be
provisional for no longer than two
years. Section 1154 of Title XI
states that the HEW Secretary may
require "... a PSRO to perform
... as he determines such organ-
ization to be capable of performing.
The number and type of such du-
ties shall, during the trial period,
be progressively increased as the
organization becomes capable of
added responsibility, so that by the
end of the period, such organiza-
tion shall be considered a qualified
organization only if the Secretary
finds it is substancially carrying
out in a satisfactory manner, the
activities and functions required
of PSROs . . ."



The latest clarification from
Washington indicated that there
will be no limitations on the size
of PSROs as was previously repor-
ted. State PSRO organizations,
composed of physicians and osteo-
paths, may have fewer than 300
members or greater than 2,500
members.

Those states having three or
more PSRO organizations will have
State PSRO Councils. The State
Council will be composed of:
". . . one physician from each
PSRO, four physicians (two may
be medical society members; two
may be state hospital association
members) , and four consumers
(appointed by the governor) ." The
State Councils are the only level of
the PSRO which directly involve
consumers.

The legislation also calls for the
establishment of State Advisory
Groups, composed of representa-
tives of health care practioners
(non-M.D.) , hospitals and other
health care facilities, to " . . . ad-
vise and assist PSRO Councils, or
if there is no council, local PSROs."

A National PSRO Council will
also be established to advise the
HEW Secretary; distribute informa-
tion to PSROs and State Councils;
assess and review PSROs and State
Councils; approve significantly dif-
ferent forms of care utilized by
a PSRO; and submit an annual re-
port to the HEW Secretary and the
Congress.

Dr. Simmons says that HEW will
have 200 PSROs and 50 State
Councils established by June 30,
1976, with June 30, 1974 as the
traget date set for review, approval
and funding of the first 25 State
PSRO Councils.

Described as "the biggest thing
in health care delivery since Medi-
care was enacted in 1966," PSROs
will have a great effect in Montana.
Essentially, state and regional
physician's organizations have been
given a big chance to shoulder the
responsibility of quality and cost
control in health care. Montana's
physicians are rising to meet the
challenge. Their success and the
success of physicians nationwide
will decide the future of organized
health delivery.

PAGE FIVE



PROGRESS REPORT



The following is a short Prog-
ress Report showing what Montana
CHP did in Fiscal Year 1973 (July
1, 1972 - July 1, 1973), to accom-
plish the FY '73 Work Program
(what we said we were going to
do). The report is divided into six
sections, corresponding to standing
committees of the State CHP Ad-
visory Council or special areas of
CHP activity, and relates directly
to Work Program objectives. In-
terested readers requiring addition-
al information are encouraged to
contact: State CHP Office, 510
Logan, Helena, MT, 59601, phone
449-3121.

Environment

Environmental problems have
generated concern among Montan-
ans for many years, but only re-
cently have reached prominence in
public news media coverage. FY
'73 was a "big year" for environ-
mental controversy, with statewide
attention focused on plans for
large-scale development of coal re-
sources in the southeastern section
of the state. Coal-related and other
environmental concerns were ex-
pressed often during the '73 Mon-
tana Legislative Session, prompt-
ing much Environmental Commit-
tee and staff legislative activity in
support of compatible legislative
proposals (Environmental Objec-
tive 4).

With completion of a study on
the feasibility of an Environmental
Site Permit System (Env. Obj. 1),
Montana CHP supported several
legislative measures which strong-


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