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GEOGRAPHIC LOCATION OF OSTEOPATHIC HOSPITALS

APPENDIX A

[AOHA active member; AOHA associate member]

Hospital

Mesa General Hospital..
N.H.E. Community Hospital.
Phoenix General Hospital..
Tuscon General Hospital..

Eisenhower Hospital, Osteopathic.

Rocky Mountain Hospital..

Valley View Hospital & Medical Center.

Grand Junction Osteopathic Hospital.
Memorial Hospital..

Longmont United Hospital.
Riverside Hospital..

Las Olas General Hospital.

West Broward Hospital.

Daytona Beach General Hospital.

Community Hospital of South Broward.

Jacksonville General Hospital..
Sun Coast Hospital...

Northwest Hospital..

Westchester General Hospital.
Osteopathic General Hospital.
Orlando General Hospital.

Ormond Beach Osteopathic Hospital

Metropolitan General Hospital.
Doctors General Hospital.

St. Petersburg Osteopathic Hospital.

Good Samaritan Hospital of Tampa..
Tampa Osteopathic Hospital.

Community Hospital of the Palm Beaches.

Powder Springs Hospital..

Doctors Hospital..

Chicago Osteopathic Hospital.

Ottawa General Hospital.

Wirth Osteopathic Hospital..

South Bend Osteopathic Hospital..

Davenport Osteopathic Hospital.
Des Moines General Hospital..

Manning General Hospital.
Gordon Memorial Hospital.

Gleason Community Osteopathic Hospital..

Wellington Hospital & Clinic.

Osteopathic Hospital of Wichita.

James A. Taylor Osteopathic Hospital.

Osteopathic Hospital of Maine.

Waterville Osteopathic Hospital.

Huntington General Hospital.

Lakeview General Hospital.

Bay Osteopathic Hospital.

Belding Community Hospital.
Unity Hospital.

Carson City Hospital.
Clare Osteopathic Hospital.

Art Centre Hospital Osteopathic.
Detroit Osteopathic Hospital..
Martin Place Hospital-West.
Northwest General Hospital..
Zieger Osteopathic Hospital.
Botsford General Hospital..
Flint General Hospital.
Flint Osteopathic Hospital.
Garden City Osteopathic Hospital.

Grand Rapids Osteopathic Hospital.
Jackson Osteopathic Hospital.

Lansing General Hospital.

Martin Place Hospital-East.

Harrison Community Hospital.

Mount Clemens General Hospital.

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Pontiac Osteopathic Hospital.

Muskegon General Hospital..

Butler Memorial Hospital...

Memorial Hospital of Manistee County.

Muskegon Heights, Mich.

Onekama, Mich.

Pontiac, Mich.

Saginaw Osteopathic Hospital.

Saginaw, Mich.

Sheridan Community Hospital.

Sheridan, Mich.

Mecosta Memorial Hospital.

Stanwood, Mich.

Traverse City Osteopathic Hospital.

Traverse City, Mich..

Riverside Osteopathic Hospital.

Trenton, Mich.

Bi-County Community Hospital.

Warren, Mich.

Cameron Community Hospital.

Cameron, Mo.

South Barry County Memorial Hospital. Chaffee General Hospital...

Cassville, Mo.

Chaffee, Mo..

17,304

1, 174

85,279

91, 849

684

272

8,048

24, 127 179, 260

3,960 1, 910 2, 763

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Belen, N. Mex.

Roswell, N. Mex.
Brooklyn, N.Y

LeRoy Hospital (division of the Osteopathic Hospital & Clinic of New New York City, N.Y..

Albuquerque General Hospital..

University Heights Hospital.

Belen General Hospital.

Memorial Osteopathic Hospital.

Interboro General Hospital..

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(1) 58,537 45, 108 243, 751 243, 751 4,823

33,908

7, 893, 956 7,893, 956

(1) 17, 508 21,922

Brentwood Hospital..

Doctors Hospital..

Green Cross General Hospital.
Grandview Hospital...

East Liverpool Osteopathic Hospital.

Selby General Hospital..

Doctors Hospital of Stark County.

Northeastern Ohio General Hospital.
Wayne General Hospital..

Richmond Heights General Hospital.

Sandusky Memorial Osteopathic Hospital.

Parkview Hospital..

Community Hospital of Warren.

Warren General Hospital..

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18, 163

Cincinnait, Ohio.

452, 524

Cleveland, Ohio.

750, 903

Columbus, Ohio.

539, 677

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Allentown Osteopathic Hospital..

Delaware Valley Hospital...

Clarion Osteopathic Community Hospital.

Doctors Osteopathic Hospital..

Erie Osteopathic Hospital..

Bristol, Pa.
Clarion, Pa.
Erie, Pa

do.

Shenango Valley Osteopathic Hospital.

Bashline Hospital..

Community General Osteopathic Hospital..

Lancaster Osteopathic Hospital..

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12,085

6, 095

129, 231

129, 231

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Hospital of Philadelphia College of Osteopathic Medicine-Frederic Philadelphia, Pa.
H. Barth Pavillion.

28,572 38, 169 1,614 1,948, 609

GEOGRAPHIC LOCATION OF OSTEOPATHIC HOSPITALS-Continued

APPENDIX A-Continued

[AOHA active member; AOHA associate member)

Hospital

Metropolitan Hospital..
Parkview Hospital.
Tri-County Hospital.

Troy Community Hospital..
Memorial Osteopathic Hospital.

Cranston General Hospital Osteopathic..
Community Memorial Hospital.
Northwest General Hospital..
Chesemore Clinic & Hospital.
Southwest Osteopathic Hospital.
Fannin County Hospital...
Comanche Community Hospital.
Commerce Medical & Surgical Center.
Corpus Christi Osteopathic Hospital.
Dallas Osteopathic Hospital..
East Town Osteopathic Hospital..
Oak Cliff Community Hospital..
Stevens Park Osteopathic Hospital..
Denton Osteopathic Hospital..
Concho County Hospital..
Campbell & 5th Street Hospital.
Tigua General Hospital..
Doctors Community Hospital.

Fort Worth Osteopathic Hospital.

White Settlement Hospital.

Grand Prairie Community Hospital.
Groom Memorial Hospital..

Doctors Hospital..

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Sunnyside General Hospital..

New Valley Osteopathic Hospital.

Marshall Community Hospital.

Frank E. Pick Memorial Hospital.

Weirton Osteopathic Hospital.

Wellsburg Eye & Ear Clinic..

Lakeview Hospital.

Northwest General Hospital..

New Berlin Memorial Hospital.

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503, 831

530, 831

Sunnyside, Wash.

6, 751

Yakima, Wash.

45,588

Moundsville, W. Va.

13, 560

South Charleston, W. Va.

16, 333

Weirton, W. Va.

27, 131

Wellsburg, W. Va..

46,000

Milwaukee, Wis.

717, 099

717, 099 29,937

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New Berlin, Wis.
River Falls, Wis.

STATEMENT OF SISTER MARY KIERNAN HARNEY

7,238

Sister HARNEY. I am Sister Mary Kiernan Harney, chairman of the board of trustees of the Catholic Hospital Association.

We also have a written statement which we would like to have made a part of the record.

Mr. ROSTENKOWSKI. Without objection, Sister, your entire statement will be included in the record.

Sister HARNEY. We do represent nearly 900 hospitals which include specialty as well as general hospitals. Our hospitals serve all areas of the country and 184 of these are the only hospitals serving the

community in which they are located. My personal perspective is that of a former hospital administrator, a nurse involved in direct patient care, a nurse-educator. I currently serve as a board member of four hospitals ranging in size from 75 beds to 450 beds.

I do not wish to repeat points that have already been very adequately made but only to stress a couple of points from that particular perspective. Certainly the nursing intensive factor is a valid factor. Older patients do require greater care and more time-consuming care. Physical disability, disorientation, declining strength, and inability to ask for what they need all complicate the problem. Many times the diagnosis of the older patient-often an orthopedic diagnosis or a stroke resulting in paralysis-requires the presence of two people to perform many procedures. Reality orientation requires constant effort and planned programs. It even takes longer to express concern and compassion when vision and hearing problems complicate the simplest of procedures.

Mr. Bromberg made the point very clearly regarding the regulations which require hospitals to enforce rules on physicians when we have no effective way of imposing a sanction on the physician. That has been an increasingly frustrating factor in hospital administration during recent years.

Regarding utilization review, I would like to make a plea that we build on the strengths that already exist in the health care delivery system in this country. Great strides have been made in the review of quality patient care through the organized medical staffs of many of our hospitals. Many governing boards have seen clearly their responsibility to call the medical staff to accountability on this point. At the governing board meetings of many of them the presentation of the results of medical audit has as prominent a place on the agenda as do the results of the fiscal audit.

When medicare came in we layered fiscal audit upon fiscal audit. Hospitals had their own internal auditing system. Most of them were audited by outside auditors. Then came the Blue Cross audit, and then the medicare audit, and we frequently had audits by the State program, such as compensation for crippled children program, et

cetera.

I hope we don't layer medical audit upon medical audit. This would lose the advantages of the current quality control programs in hospitals by saying, "If the Government is going to do it, we will let them do it and we will stop doing it."

Today we have very effective systems operating in many hospitals. I would not like to lose these. Voluntary physicians' hours given freely as members of an organized medical staff and as seen as a professional responsibility for peer review will not be given voluntarily when they are required by a Government-mandated program.

I did a quick calculation on a very conservative basis figuring that ultilization review would require a physician in every hospital for at least a portion of the working day. I used 8,000 hospitals and 5 hours a day and a conservative figure of $30 an hour for the doctor's time and I got $1,200,000 a day for utilization review.

I am not sure that that is the best way to spend our money to improve the quality of care.

Thank you very much.

[The prepared statement follows:]

STATEMENT OF THE CATHOLIC HOSPITAL ASSOCIATION

I am Sister Mary Maurita Sengelaub, RSM, President of the Catholic Hospital Association, 1438 South Grand Boulevard, St. Louis, Missouri, 63104. The Catholic Hospital Association represents nearly 900 member institutions, including long-term, rehabilitation, psychiatric, maternity and pediatric, cancer and 719 personal and associate members. These institutions are owned, operated or sponsored through the auspices of the Roman Catholic Church. I might add that I speak as a former hospital administrator and nurse involved in direct patient care and also as nurse educator.

We support the delineation of the points of concern propounded by the American Hospital Association. We would, however, like to highlight and summarize areas of injustice and inconsistencies as we see them. We can sum up at the outset by saying that it appears that the government is guilty of duplication of effort, contradiction, miscalculation and bureaucratic fiat.

8.5 PERCENT NURSING SALARY COST DIFFERENTIAL

The Congress' clear intent in the Medicare-Medicaid programs wzs that reimbursements should be based on reasonably established costs. Secondly, one category of patients was not to subsidize others.

Because of the commitment of thousands of Sisters, Preists and laity to the compassionate care of the poor, the elderly and the disabled, and the critically ill, we entered into the Social Security Act with the desire to cooperate with government. It is our opinion that the institutional care of the elderly does require additional personnel because of the varying degrees of physical disability, disorientation, declining strength, and, in many cases, almost complete inability to request assistance in carrying out the activities of daily living and attending to personal physical needs. Thus the patient takes longer to eat, to bathe, to walk, and to attend to such bodily functions as proper elimination. Often these patients are affected by paralysis, partial or complete, which requires the attendance of two persons instead of one to effectively minister to them.

Because of declining cellular life in body tissues, these patients are more susceptible for example to upper respiratory diseases, to bed sores and fractures of the limbs. Surgery, when required, because of this general debilitation slows down recovery and thus tends to increase the length of stay. All of these factors contribute to substantially more nursing hours of care per patient as well as general supervision; hence, an increased cost for rendering such care.

Elimination of full reimbursement for the care of those 65 years or older will definitely create the necessity to shift the cost of care of the elderly from the Medicare program to other programs and the private paying patient. This will create a serious community relations problem for our hospitals.

UTILIZATION REVIEW

The UR regulations timetable illustrates an obvious conflict and potential contradictions. The hospital field has received informal assurances that once a conditional PSRO is established all other review mechanisms will be waived. Should not this anomaly be settled before hospitals proceed to gear for the UR program which may prove to be initially inadequate and ultimately unnecessary? Further, the new regulations allow state UR programs to be recognized superior to the federal. Should hospitals in states which have superiority waiver requests before HEW has to duplicate UR reviews of the state and federal? And what is even more astounding is that once waiver requests are announced, some states will continue two review mechanisms with data not transferable between either! Is this not inefficiency which the government purports to want to eliminate! Is this the government's idea of cost containment?

Another concern is the prohibition against anyone having a "financial interest" in the hospital, the definition of which is so broad as to almost preclude anyone having a remote interest in the hospital from participating in a UR review committee.

I simply summarize by saying that it appears that in all the Administration regulations discussed today there is nothing consistent about them save their own inconsistency. How are we in the health care field to deliver needed health services to all of our patients? This is clearly contrary to the intent of the law. I call this shift in intent a gross injustice on the part of the government. This is even graver if the intention of government is to cut federal costs without seeking other ways

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