A PUBLICATION OF News in NYCHSRO/MEDREVIEW VOLUME 10, NO. 1 JANUARY - JUNE 2007 REVIEW www.medreview.us NYCHSRO/MedReview Celebrates Helen Mutchler’s 25th Anniversary

ednesday May 9, 2007 began party included Dr. Bruce Schechner with as any other ordinary day with whom Helen worked with at her first profes- W NYCHSRO/MedRe v i e w ’s sional job and Phil Schuh who worked with President/CEO Joseph Stamm and his Helen during the early NYCHSRO days. Executive Vice President Helen Mutchler Noted public officials were also on hand attending a number of scheduled meetings to personally present proclamations to with potential new clients. Helen. They included Borough Upon their return Helen was greeted by President Scott Stringer, who proclaimed more than 150 staff members, friends, May 9, 2007 as Helen Mutchler Day, clients, board members and public officials Assemblyman Dov Hikind, Councilman who gathered to honor Helen in a surprise , Chairman of the Council’s celebration for her 25 years of outstanding Finance Committee and Councilman Bill de services for the organization. Helen has Blasio. served the organization with honor and dis- Other proclamations and letters of tinction as Chief Financial Officer and Vice acknowledgement were received from President for Human Resources and more Governor Elliot Spitzer, Mayor Michael recently as Executive Vice President where Bloomberg, NY State Senate Speaker Inside This Issue... she continues with her previous responsibili- Joseph Bruno, NY State Assembly Speaker ties while working directly with the CEO on Sheldon Silver, NY City Comptroller William e NYCHSRO/MedReview Celebrates organizational policy making, oversight and Thompson, United States Congressman marketing. and Philippine Consul Mutchler’s 25th Anniversary Joining the celebration were Helen’s hus- General Cecilia Rebong, among others. e Healthcare Headline Summaries band, Andy and their younger daughter Alexa. Other participants at the surprise CONTINUED ON PAGE 8 e Joseph Stamm Honored by Beitar Foundation & COJO of Flatbush TributeTribute toto HelenHelen e Legislative & Healthcare Rounds e NYCHSRO/MedReview Mourns the Passing of Dr. Scheidt e Anthony Weiner & Denny Farrell Visit MedReview e Nurses Day 2007 e Joe Ivey Bufford- Newly Elected President of the Academy of Medicine e In Tribute to Dr. Bernard Lander e MedReview & AliCare Join Forces e Critical Issues in New York’s Healthcare Delivery System e News in Review Profile: Dr. Anthony Mustalish Heart Attack Death Rates – Health & Human Confirmation of new Commissioner of Health a 30-year veteran of NY County District Services (HHS) – In June 2007, the HHS mod- for the State of New York – March 2007 – Attorney Robert Morgenthau’s office, and ified its Hospital Compare Quality tool (see This week the New York State Senate con- has served as Executive Assistant District www.hospitalcompare.hhs.gov) to reflect firmed Richard Daines, M.D., as Attorney in the New York County District assessments of individual hospitals’ death Commissioner of the State Department of Attorney’s office since 1998. In that post, rates in relation to heart attack. As of data Health (DOH). Dr. Daines was formerly she led major projects, including the develop- updated through September 13, 2006, the President and Chief Executive Officer of St. ment of protocols for DNA testing and the U.S. national average death rate within 30 Luke’s-Roosevelt Hospital Center in New York creation of a Child Advocacy Center. Ms. days from heart attack was found to be 16%. City. Prior to becoming President, Dr. Daines Hamann was also formerly Deputy Chief of Out of 4,477 hospitals in the United served as Senior Vice President for the Trial Division in charge of the Criminal States, only 17 were found to have a better Professional Affairs and as Medical Director Court from 1994 to 1998, Director of rate and 7 were found to have worse rates. at St. Luke’s. He also served in a series of Training from 1991 to 1994 and Deputy Of the 188 hospitals surveyed in New York, clinical and administrative positions at St. Bureau Chief of the Career Criminal Bureau 2 were found to be better than the U.S. Barnabas Hospital in the Bronx, including from 1968 to 1991. National Rate and 1 was found to be worse. Director of Critical Care, Director of Medical New York State’s Office of the Medicaid Education, Medical Director and Vice Inspector General (OMIG) consolidates staff Medicare vs. FDA – Conflict on Stents for President for Professional Affairs, and Senior and other Medicaid fraud detection, preven- Neck Arteries – May 2, 2007 (NYT) – The Vice President for Professional Affairs. Dr. tion and recovery functions into a single more Food and Drug Administration (FDA) endors- Daines received a Bachelor of History efficient and accountable office, reorganiz- es carotid stents in patients showing no symp- degree from Utah State University in 1974 ing and streamlining the state’s process of toms of blockages if a diagnostic image and served as a missionary in Bolivia from detecting and combating Medicaid fraud, shows a carotid restriction of 80 percent or 1970 to 1972. waste and abuse and maximizing the recov- for high-surgical-risk patients with symptoms ery of improper Medicaid payments. of blockage – like a previous stroke or other Medication Errors – March 7, 2007 (NYT) – brain impairment and diagnosed blockage A study performed by the United States 1199 Leader in New Position – NYP – of 50% or more. Pharmacopeia and the University of the January 30, 2007 - New York hospital-work- In a surprise announcement, Medicare Health Sciences in Bethesda, Md., in con- ers union chief Dennis Rivera – one of the dropped its announced plan to follow the junction with two nurse associations conclud- city’s most powerful labor leaders, FDA’s lead and expand coverage of these ed that young children are the most likely vic- announced his resignation and intent to head carotid stents and determined instead that it tims of surgery-related medication mistakes a new national health-care union. Mr. Rivera will not pay for any carotid stent in any and poor communications as the patient will become chairman of the million-member patient who has not shown symptoms of moves from the operating room to the recov- Service Employees International Union blockage and, for symptomatic patients, only ery room is the most likely culprit. In analyz- Health Care. His current union, the if the blockage is 70% or greater. Medicare ing almost 11,000 medication mistakes 300,000-member 1199 SEIU United cited amongst its reasons for the reversal (1) made on patients undergoing surgery, the Healthcare Workers East will be the largest strong opposition from several medical survey identified that most of the errors local in the national union. Rivera is backing groups representing specialists who perform involved painkillers and antibiotics. Typical 1199 Secretary-Treasurer, George Gresham the neck surgery [called endarterectomy] and dangerous mistakes were as follows: to succeed him. Rivera’s departure will send (2) various clinical trials that raised doubts Failure to administer antibiotics before ripples through New York political and about the safety of carotid stenting. surgery, Failure to note allergies, Errors in set- health-care circles, where he wields tremen- ting pumps that dispense blood thinners and dous clout. Rivera presided over 1199 for The Dangers of Optional Caesarean Surgery painkillers, Overdoing of infants, Poor pen- 20 years. – March 27, 2007 (NYT) – According to a manship’, Careless listening or bad arith- study published in the March 2007 issue of metic (converting pounds to kilograms) caus- Cancer Deaths On the Decline – NYT – Obstetrics and Gynecology, Caesarean sec- ing patients to get doses 10 or even 50 times January 18, 2007 – The number of cancer tions performed without a medical reason higher than they should have. deaths in the United States has dropped for result in longer hospital stays, higher costs The survey reinforced the recommenda- the second year in a row, reported the and more than twice as many rehospitaliza- tions that hospitals install computerized sys- American Cancer Society. It credited most of tions as vaginal deliveries. These hospital tems for prescribing drugs with alarms built in the decrease to smoking cessation and stays were 7% longer and cost 76 % more to sound if toxic combinations are ordered for improved detection and treatment of colorec- than normal deliveries. Mothers who have a patient. tal, breast and prostate cancers. However, optional Caesarian sections were 2.3 times cancer is still the second leading cause of more likely to return to the hospital, usually The New Medicaid Inspector General – death in the United States, after heart dis- because of wound complications or major February 2007 – Gov. Eliot Spitzer ease. Lung cancer is still the leading cause systemic infections. The study reviewed announced the appointment of Ms. Krisitine of cancer mortality with 160,390 deaths 3,334 Caesareans done without a medical Hamann to serve as New York State’s expected in 2007. reason over a five year period. Medicaid Inspector General. Ms. Hamann is Joseph Stamm Honored By Beitar Foundation and COJO of Flatbush n Thursday, March 15, 2007 the City tremendous amount of pride in its anticipat- of Beitar, Israel and the Beitar ed completion. Foundation honored MedReview’s The Mayor of Beitar, Yitzchak Pindrus OPresident/C.E.O., Joseph Stamm at a Gala has been friends with Mr. Stamm for a Benefit Tribute, at the Broad Street Ball number of years and he requested that Joe Room in the Wall Street section of New accept the honor. The presentation to Joe York City. The event celebrated the Beitar’s at the dinner was made by Assemblyman 18th anniversary since its establishment as Dov Hikind who is a close personal friend a hallmark of Jewish pride and tenacity. At of Mr. Stamm and a long-time supporter of the dinner, Mr. Stamm was presented with Beitar. The dinner also featured a message the HaTov U’ Meitiv Man of the Year from Senator Norm Coleman of Minnesota Award in commemoration of his activities who is a strong supporter of Israel in the in support of the Beitar community through- United States Senate. The event culminat- out its history. ed with the presentation to Mr. Stamm of The city of Beitar has experienced con- the “Key to the City of Beitar” by Senator tinuous growth in leaps and bounds. One Coleman and Mayor Pindras. vital addition to Beitar is the new Sprung Joe Stamm was also honored by the Emergency Medical Center, which will Council of Jewish Organizations (COJO) of serve the entire region. The proceeds of the Flatbush at their 28th Annual Community Beitar tribute dinner were designated to the Legislative Breakfast held on March 11, completion of the Medical Center which 2007. The event was attended by an over- will open in the Fall of 2007. The impetus flow crowd who came to support COJO for building the center was to expedite and pay tribute to the honorees. Co-hon- medical assistance – up until now people orees included U.S. Congresswoman Yvette with medical emergencies have traveled to D. Clarke, the New York State Senate Jerusalem, which although is only 15 min- Minority Leader, Malcolm A. Smith and utes away, can be an arduous trip during New York State Assemblyman Vito J. a medical emergency. Now, the city of Lopez. Beitar will be equipped to help those in Every prominent politician in dire need – women in labor, injured chil- was in attendance at the Breakfast. dren, or people wounded in these unfortu- Speakers included Council nately violent times in Israel. Speaker, Christine Quinn and New York The city of Beitar has played an impor- City Police Commissioner, Raymond W. tant role in Joe Stamm’s life as he has visit- Kelly. Mr. Stamm’s Community Service ed this vibrant, new metropolis on several Award was presented by U.S. occasions, and considers it a “home away Congressman Charles Rangel who is a from home”. He played a prominent role major supporter of Jewish causes in the in the planning and creation of this new Congress and an old friend of Joe’s and emergency medical center and takes a the organization.

LEFT: LEON ROTH DINNER CHAIRMAN, BEITAR MAYOR YITZCHAK PINDRUS, DOV HIKIND AND ANNE STAMM, BEITAR MAYOR YITZCHAK PINDRUS, ANNE STAMM, JOE STAMM AND US SENATOR NORM COLEMAN. JOE STAMM ADDRESS AT THE DINNER. STAMM FAMILY. BOTTOM L-R:US CONGRESSMAN CHARLES RANGEL WITH JOE STAMM, JOE STAMM WITH BROOKLYN BOROUGH PRESIDENT MARTY MARKOWITZ, ASSEMBLYWOMAN RHODA JACOBS WITH JOE STAMM for Planning George Bopp) attended the State of the State address. Legislative & Prior to the address, MedReview conversed with several prominent figures including New York City’s Mayor . Mr. Stamm continued his meeting-packed schedule with dia- Health Care Decision logue with the newly elected New York State Comptroller, Thomas DiNapoli and the newly elected Councilman from Brooklyn, Dr. Maker Rounds Eugene Mathieu. Other key political figures with whom the MedReview staff met he year 2007 began where 2006 left off in terms of included New York City Comptroller William Thompson and three MedReview reaching out to politicians and other key figures in key members of the New York City Council David Weprin, Bill de the health delivery process in its ongoing quest to keep them Blasio and Melinda Katz. T MedReview’s President/CEO Joe Stamm and Executive VP Helen informed of both MedReview and its clients’ healthcare concerns. On New Years Eve, MedReview’s C.E.O. Joseph Stamm and his Mutchler were also honored to have been invited to meet with wife, Anne were invited guests of Lieutenant Governor Elect David Baltimore City Mayor Sheila Dixon to discuss progressive health- Patterson at a New Years Eve celebration. This was followed up by care cost containment initiatives occurring in Maryland. This initial their attendance at the New Years Day swearing in ceremonies for meeting has led to a follow up meeting with Baltimore City’s newly elected Governor, Elliot Spitzer, Lt. Governor David Patterson dynamic Health Commissioner Dr. Josh Sharfstein and key mem- and Attorney General . Mr. and Mrs. Stamm also bers of the Maryland Health Services Cost Review Commission participated in private receptions held by each of these newly elect- staff. In May 2007 Anne and Joe Stamm had the opportunity to visit ed officials. with Beitar’s Mayor Yitzchok Pindrus to follow up on the progress Two days later key MedReview’s administrative executive staff on the 24/7 Medical Center Complex. (President/CEO Joe Stamm, Executive VP Helen Mutchler and VP

CLOCKWISE: NY GOVERNER ELLIOT SPITZER AT INAUGURATION, HELEN MUTCHLER WITH COUNCILWOMAN MELINDA KATZ, THE STAMMS WITH BEITAR’S MAYOR PINDRUS JOE STAMM WITH STATE COMPTROLLER THOMAS DINAPOLI, HELEN MUTCHLER WITH ASSEMBLYWOMAN NETTIE MAYERSON, JOSEPH STAMM WITH DOV HIKIND AND COUNCILMAN DR. EUGENE MATHIEU, NYC MAYOR BLOOMBERG WITH MEDREVIEW STAFF. NYCHSRO/MedReview Mourns the Passing of Dr. Stephen Scheidt

YCHSRO/MedReview was deeply American College of Cardiology and as Chapel in New saddened by the loss of beloved Vice President of the American Heart York City. An over- NBoard Member, Dr. Stephen Association. He had extensive experience flow crowd was Scheidt. Dr. Scheidt passed away in June, in Peer Review and held administrative treated to countless succumbing to an illness that he bravely positions at Cornell Medical Center, includ- anecdotes about fought off for the past several months. ing Associate Dean for Student Affairs and Dr. Scheidt from his Dr. Scheidt was a member of the Board Assistant Dean for Continuing Medical wife, children and of Directors of NYCHSRO/MedReview Education. In addition to his cardiology colleagues. Each since 1980 had served as the Chairman of practice, Dr. Scheidt served as co-director speaker demon- the Board from 1981-1986. He will of the Salzburg-Cornell seminars, a pro- strated how Dr. always be remembered for his sharp gram that brings the latest advances in U.S. Scheidt managed to be an important part insight and his ever-present sense of humor. and western medical science to physicians of their lives and made every moment spent Dr. Scheidt had the unique ability to diffuse in Central and Eastern Europe and the for- with him a cherished experience that left the tensest discussions with a joke, making mer Soviet Union. Dr. Scheidt was particu- them with a smile on their faces. his point clear without offending anyone. larly proud of this program and enjoyed He will be greatly missed by the Board Dr. Scheidt was an internationally recog- serving as an unofficial tour guide for those of Directors and the entire staff of NYCH- nized cardiologist, having served as accompanying him. SRO/MedReview. President of the New York Cardiological A moving memorial service was held for Society, as the New York Governor of the Dr. Scheidt at the Riverside Memorial U.S. Congressman Anthony Weiner and New York Democratic Leader Assemblyman Denny Farrell Visit NYCHSRO/MedReview

ongressman Anthony Weiner visit- In addition, Assemblyman Herman concern to clients. ed the MedReview office and met "Denny" Farrell Jr., a member of the New The Assemblyman acknowledged that C with senior staff and members of York State Assembly for over 30 years the group had raised several serious the organization's Board of Directors as and the Chair of the State Assembly Ways issues and he committed to investigate well as several MedReview clients and and Means Committee visited NYCH- those problems and schedule a follow-up guests. The Congressman is an SRO/MedReview on January 18, 2007 meeting with staff to share his findings. announced candidate for Mayor of New for a lunch meeting with senior staff and The organization has always been able to York in the next Mayoral election. members of the organization's Board of rely on Assemblyman Farrell to be con- Congressman Weiner has made sever- Directors. cerned and responsive to health care al visits to MedReview in the past few Assemblyman Farrell spoke about vari- issues affecting New York and appreciat- years and he regularly updates the staff ous initiatives in the health care arena ed his participation in this function. on healthcare issues from a federal per- with which he has been actively involved. The lunch program is a regular feature spective. He promised to work with He then participated in a lively question at NYCHSRO/MedReview and other MedReview to address the concerns of ris- and answer session where prominent guests are expected in the com- ing healthcare costs in New York and NYCHSRO/MedReview staff had the ing months. around the country. opportunity to focus on specific issues of

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1. ASSEMBLYMAN DENNY FARRELL WITH CEO JOE STAMM AND EXECUTIVE VP HELEN MUTCHLER , 2. CONGRESSMAN ANTHONY WEINER WITH MEDREVIEW STAFF AND BOARD MEMBERS 3. ASSEMBLYMAN DENNY FARRELL 4. CONGRESSMAN ANTHONY WEINER 3 4 WITH JOE STAMM AND HELEN MUTCHLER Nurses’ Day Celebration 2007

urses and other professional review staff are critical compo- everyone from support staff, the professional review staff and the nents to NYCHSRO/MedReview’s daily review activities. senior staff all work together to provide NYCHSRO/MedReview N The organization has a long-standing tradition of hosting a clients with the high quality work that has become expected. breakfast in the office to pay tribute to the professional review staff Although logistics and scheduling difficulties make it impossible that uses the NYCHSRO/MedReview office as its home base. All to include the professional review staff in field offices, Mr. Stamm staff members in the main office were invited to partake in a deli- gave special recognition to them and noted that they are also cious breakfast in the Executive Boardroom. deserving of our thanks for the outstanding work they do and the Joe Stamm once again thanked the staff for their hard work and manner in which they represent NYCHSRO/MedReview to patients dedication in helping the organization maintain its level of excel- and to clients. As usual, everyone enjoyed a break from the nor- lence. He noted that the organization can only run smoothly when mal office activities to celebrate with the review staff. Jo Ivey Bufford, M.D. – Newly Elected President of the New York Academy of Medicine

oseph B. Stamm, MedReview’s President and Chief Executive Dr. Bufford thanked Officer, joined 200 other healthcare professionals at The New Academy members for JYork Academy of Medicine in February 2007 to celebrate the their support and shared beginning of Jo Ivey Bufford’s tenure as President of the prestigious four themes for the center for urban health policy and action. Academy that represent As testimonial to the caliber of the new president, the following goals towards which she eight leaders offered tribute and well wishes to Dr. Bufford: Ed will work during her Koch, former ; Thomas Frieden, M.D., tenure: (1) Engaging the M.P.H. – Commissioner of the New York City Department of Health Academy’s Fellows and and Mental Hygeine; Stanley Brezenoff, President and CEO, attracting more of New Continuum Health Partners; Claire Fagin, PhD, R.N., FAAN, Dean York’s top healthcare JOE STAMM WITH JO IVEY BUFFORD, MD Emritas of the Univeristy of Pennsylvania’s School of Nursing; June professionals for Osborn, M.D., President of the Josiah Macy Jr. Foundation; Kenneth Fellowship; (2) Continuing cutting edge urban health research; (3) Raske, President of the Greater New York Hospital Association; Building the library’s collection of historical and current academic Karen Davis, PhD, President of the Commonwealth Fund and James texts and (4) Continuing outreach to the community. Tallon Jr., President of the United Hospital Fund. MEDREVIEW JOINS FORCES In Tribute to WITH ALICARE Dr. Bernard Lander

MedRe v i e w ’s President, Joseph B. Stamm, joined over a thousand others at the Sheraton New York Hotel at a 36th Anniversary Gala paying tribute to Dr. Bernard Lander, founder and president of Touro College. Dignitaries were present from all over the country ver the past thirty years, MedReview has always had the and the world to celebrate Dr. Lander who founded objective of looking for better ways to serve clients and Touro 36 years ago, at the age of 55, because he O meet their Utilization Management needs. As part of this believed that a new educational institution was need- ongoing objective, in January 2007 MedReview announced that it ed to educate the Jewish and general population. At had formed a strategic alliance with Alicare Medical Management, the event, Dr. Lander, summing up his philosophy, stat- an affiliate company of Amalgamated Life Insurance Company. This ed that, “One should live not only a long life, but a life alliance allows MedReview, at no additional cost to its clients, not of meaning, purpose and creativity. This is the purpose only to continue to offer the high quality precertification and case of Touro.” management services currently provided, but also to significantly Due to Dr. Lander’s efforts, today Touro College has enhance those services. an enrollment of more than 23,000 students in various In addition, the alliance allows MedReview to be more flexible and undergraduate, graduate and professional programs to share clinical and operational systems and staffing resources in at more than 29 campus locations throughout New order to maximize the quality and cost effectiveness of services pro- York, California, Florida and Nevada. Internationally, vided to the members. Touro College has schools in Jerusalem, Berlin and Highlighted below are three "value-added" enhancements from Moscow. which MedReview's clients will benefit as a result of this alliance: The tribute was also highlighted by a tribute to Dr. • 24/7 coverage - Client members will always be able to contact Mark and36 Anna Ruth Hasten, generous contributors to a "live" reviewer 24 hours a day, seven days a week with their Touro College and the presentation of a Torah Scroll to precertification and/or concurrent review authorization requests. Dr. Lander for his decades of dedication to and work • "On-line" status inquiry - MedReview clients will be provided for Touro. with a dedicated internet "HIPAA protected" inquiry capability

CONTINUED ON PAGE 7 CRITICAL ISSUES IN NEW YORK’S HEALTH CARE DELIVERY SYSTEM

n February 2007, MedReview had the to 25% of claims selected for review. sonable and necessary. A opportunity to meet withprominent New Review findings on some common DRGs corresponding impact IYork State Health Department officials to are as follows: of the excessive discuss critical issues facing the New York markups in State Health Care System and proposed 2005/2006 Average solutions. Some of the issues/abuses DRG Nomenclatre Financial addressed were: Impact Rate aHigh Cost One Day Hospital Stays aReadmissions Chronic Obstructive 16.7% aDRG “Upcoding” Pulmonary Disease aInappropriate Emergency Room Simple Pneumonia & 24.1% Utilization Pleurisy charges is experienced aExcessive Markups on Charges/Cost Heart Failure & Shock 12.4% by MedReview clients who Outliers reimburse on a percent of aConcerted Efforts to Reduce or Cellulitis 13.5% charges basis on either an inpatient or out- Weaken the Effectiveness of Managed patient basis. Care Septicemia 24.6% Concerted Efforts to Reduce or Weaken At the State’s request, ongoing meetings C-Section w/cc 14.4% the Effectiveness of Managed Care - are being held to further discuss the issues Several factors in the current health care raised. A summary of the discussion points Vaginal Deliveries w/cc 15.0% environment reflect increased attempts by is as follows: payors and providers to weaken the Inappropriate Emergency Room Precertification/Managed Care process: High Cost One Day Inpatient Stays - Utilization - MedReview experience indi- a“Best guess” decisions – Forcing man- Payments for One day hospital stays are cates that there is widespread misutilization aged care vendors to make decisions escalating. In reviewing payment experi- of the Emergency Room by patients at sev- to comply with timeframes even ence for a group of MedReview clients, it eral levels: though data is not provided was determined that 39 hospitals had an aInappropriate use of the ER in lieu of aElimination of retrospective review – average payment (for all one day stays) of the doctor’s office. Preventing independent auditors from greater than $10,000. Another 463 indi- aHospitals utilizing the ER as a conduit verifying retrospectively whether case vidual one day hospital claims had pay- to often inappropriate Inpatient acute information which was telephonically ments in excess of $25,000 (Total care admissions transmitted can be substantiated by Payments = $19,733,957 – Average Claim aInappropriate Outpatient coding and the medical record. Payment = $ 42,622) payment for the level of ER acuity (lev- aElimination of independent external Readmissions - MedReview’s client data els 1 thru 4) reviewers like MedReview indicates significant incidences of readmis- Excessive Markup on Charges – DRG aElimination of Dispute Resolution sion, particularly within a 15 day period, Cost Outliers - MedReview experience indi- Agents using “binding arbitration” and within the infant and adolescent popu- cates a precipitous rise in DRG cost outlier process to hold patient “harmless”. lations. As a result, significant overpay- activity. The increase is not necessarily aConflict of interest for payors who are ment for fragmented DRG and/or possible driven by the “severity” of the patient’s seeking “most favored nation” con- inappropriate payment for poor quality of medical condition but by increased charge tracts with providers to monitor those care may result. “markups” by hospitals. As a result, all cost same providers’ utilization. DRG “Upcoding” - MedReview experi- outliers must be reviewed to validate that ence reflects DRG “upcoding” occurs in up charges are ordered, documented and rea-

MEDREVIEW JOINS FORCES WITH ALICARE

CONTINUED FROM PAGE 6 which will allow them to key in the member ID number and access the current "on-line" status and history of any utilization manage- ment activity in relation to that member. • Reports - In addition to the current MedReview Client Utilization reports that are generated, MedReview will also provide substantial- ly enhanced reporting of utilization management results. Additional reports will include, on a quarterly basis, Admission analysis (Emergency/Urgent/Elective); Length of Stay analysis by type of service (Medical/Surgical/Post Acute/Obstetric/Behavioral Health/Chemical Dependence); Outpatient Analysis by Type of Service (ER, Equipment, Home Care, etc.). The reports will also pro- vide summary information on the Top Ten Diagnoses and Procedures on both an inpatient as well as outpatient basis and the Top Ten Facilities utilized by members during the quarter. MedReview is very excited about this alliance with Alicare Medical Management and the enhancements it provides to its services. News In Review Profile: Dr. Anthony Mustalish

ony Mustalish has been a fixture at NYCHSRO/MedReview for many years. He has served on the Board of Directors for the past fifteen years and currently heads the organization’s Finance T Committee. He has also served as Associate Medical Director for several years and was Acting Medical Director for a period after the death of Dr. Alan Postel. Dr. Mustalish received his M.D. from New York University’s School of Medicine. He also has a Masters in Public Health from Harvard University, is Board Certified in Emergency Medicine and was previously certified in Preventive Medicine. He has been the Attending Surgeon in the Emergency Department at New York Presbyterian Hospital and an Associate Professor of Emergency Medicine in Clinical Surgery and an Associate Professor of Public Health at the Weill Medical College of Cornell University since 1991. Dr. Mustalish also served as a Director of the Rockefeller Group’s Worker Compensation Medical Bureau. Prior to these appointments, he was an Attending Physician and Chief of Emergency Services at Lenox Hill Hospital where, in addition to his clinical practice, he was involved with educational pro- grams and administrative committee work which included Utilization Review and Quality Assurance. He eventually served as Senior Vice President for Hospital Operations/Chief Operating Officer there. Tony began his medical career in the public health arena by spending several years working for the New York City Department of Health where he served as a Deputy Commissioner of Health. Prior to that, he had a distinguished career in the armed forces, serving as a Captain in the United States Army Medical Corp and serving as an orthopedic surgeon in Vietnam. Dr. Mustalish’s wide range of experience has benefited the organization for most of its history and will hopefully continue for many more years.

NYCHSRO/MedReview Celebrates Helen Mutchler’s 25th Anniversary

CONTINUED FROM PAGE 1 Mr. Stamm also presented Helen with a bound book containing over seventy-five letters of appreciation, anecdotal stories and greetings from Helen’s co-workers and friends. NYCHSRO/MedReview’s Chairman, Dr. Norman Medow next presented Helen with a beautiful plaque recognizing her accomplishments and voicing the organization’s appreciation. The gathering was then treated to a video presentation that showed Helen at different stages throughout her career at NYCHSRO/MedReview. Climaxing the evening was a moving address by Helen thanking all for participating, voicing appreciation to the organization, “the place where I grew up” and “looking forward to the challenges of the next twenty-five years.” The evening was a fitting tribute to Helen who has brought a high level of integrity to the organization throughout her career and a sense of warmth, dignity and class which she demonstrates daily in everything she does.

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