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* AND WELFARE

. Health Services. and Mental Health Administration
— Division of Regional Medical Programs —

National Advisory. Council on
Regional Medical Programs

Minutes of the Meeting
February 2-3, 1971

Parklawn Building
Conference Room G/H

 
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DEPARTMENT OF HEALTH, EDUCATION AND WELFARE
PUBLIC HEALTH SERVICE

National Advisory Council on Regional Medical Programs

Minutes of the Twenty-second Meeting 1/ 2/
February 2-3, 1971

The. National Advisory Council on Regional Medical Programs convened
for its twenty-second meeting at $:30 a.m., Tuesday, February 2, 1971,
in Conference Room G/H of the Parklawn Building, Rockville, Maryland.
Dr. Harold Margulies, Acting Director, Regional Medical Programs
Service, presided over the meeting.

The Council members present were:

Dr. Michael J. Brennan (2/2 only) Dr. William R. Hunt

Dr. Bland W. Cannon Dr. Alexander M. ‘McPhedran
Dr. Edwin L. Crosby Dr. Clark H. Millikan

Dr. Michael E. DeBakey (2/3 only) Dr. Alton Ochsner

Dr. Bruce W.. Everist Mrs. Florence R. Wyckoff

Mr. Harold H. Hines, Jr. (2/3 only) Dr. Marc J. Musser (2/2: only)

A listing of RMP staff members, and others attending is appended.

CALL TO ORDER AND OPENING REMARKS

 

The meeting was called to order at 8:45 a.m. on February 2 by
Dr. Harold Margulies.

INTRODUCTION OF. NEW COUNCIL MEMBERS AND EX OFFICIO MEMBER FROM THE
VETERANS ADMINISTRATION

 

Dr. Margulies introduced Dr. Herbert B. Pahl, the new Acting Deputy -
Director for Regional Medical Programs Service. Dr. Pahl will have
responsibility for work with the Council. It is hoped that future
Council meetings can be held in smaller more convenient quarters with |
staff services planned to help the members make optimum use of their.
sessions. Dr. Margulies welcomed Dr. Alton Ochsner as a new Council
member, and Dr. Marc J. Musser, the new Ex Officio member from the '
Veterans Administratiou. - Another new member, Mr. tlarold H. Hines, Srey
was introduced the following day on February 3. /

 

Proceedings of meetings are restricted unless cleared by the Office of |

the Administrator, HSMHA. The restriction relates to all material submitter
for discussion at the meetings, the supplemental material, and all. other
official documents,- including the agenda.

For the record, it is noted that members absent themselves from the oy
meeting when the Council is discussing applications: (a) from their
respective. institutions, or. (b) in whiten a conflict of interest might

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IV.

VI.

ANNOUNCEMENTS

Dr. Margulies made general announcements, and called attention to
the statement on, "Conflict of Interest," in the information folder.
He reported that Mr. Curtis Treen has resigned from the Council and
that ‘we are working on the appointment of new. Council members to
increase the membership to twenty, not including the Ex Officio
member from the Veterans Administration, in accordance with Public
Law 91-515.

CONFIRMATION OF FUTURE MEETING DATES

 

The Council reaffirmed the following dates for future meetings:

May 11-12, 1971 November 9-10, 1971
August 3-4, 1971 February 8-9, 1972

CONSIDERATION OF MINUTES OF THE NOVEMBER 9-10, 1970, MEETING

With the addition of Dr. Hunt to the list of Council members présent,
the Council unanimously recommended approval of the Minutes of the
November 9-10, 1970, meeting as written.

Dr. Brennan, Chairman of a Council subcommittee on automated multi-
phasic screening, announced that the subcommittee had met the day
before for six hours and that they are developing a working conference |
to be held in April 1971. The members of the subcommittee are:

Dr. Michael J. Brennan, Chairman; Dr. Alexander M. :McPhedran,

Dr. Clark H. Millikan, and Dr. John E. Kralewski of the Review
Committee. The working conference in April will be held in Detroit
and will report its findings to the Council at the May meeting. —

‘LEGISLATION, APPROPRIATIONS - RMPS BUDGET

A. Termination of RMP Support for Projects

At the November 1970 meeting, Council discussed project renewal and
termination of RMP funding for those that seek such support beyond
the dates at which they originally proposed to terminate or become
self-sustaining.

At this meeting Mr. Roland Peterson, Assistant Director for Planning
and Evaluation, presented salient findings from experience in six

regions with 90 projects that became operational three or more years’

ago. In most of these projects, three or more years of RMP support ae
was requested initially. Thirty percent of the group tn BOCTOR OF 3.
support on schedule. In some regions this happened with 60-702 of

_the projects. On the other hand, many individual projects expanded |

their budgets. In some instances projects seemed to disappear from
-3-

RMP listings, but the activities continued to receive RMP support
through the budgets of core or other project activities. RMP support
tended to persist longer for medical school than for community projects. |
This kind of analysis will continue to be reported. Additional regions
will be included as they reach appropriate ages.

B. Overview of Adaptation to Requirements of New Legislation

The ongoing process of adaptation to the "program review' and triennial
cycle must be integrated with adjustment to features added to the .
legislative base by P.L. 91-515. . Regulations and guidelines are being
re-examined for this purpose. It is hoped that the formal regulations
can be kept simple and straight-forward. Publication of guidelines _
should take a form that will facilitate both their development by

-Council and their application to RMP operations. New: legislation

features of particular interest include:

1. Review of RMP plans by CHP "b" agencies that have plans in ce
being: RMPS is hopeful of broadening the RMP-CHP working relation-.
ships beyond the letter of the law, to improve the combined effect. :
of the agencies' planning on health services.

2. .DHEW recommendations for changes in the scope of the program:
Modification of the disease~categorical targeting of the legislation
might be one such proposal that RMPS and Council should examine. 9
Council may wish to express its opinions on any. proposals concerning.
the scope of RMP or CHP legislation that go to the Secretary.

3. Annual report on RMP effectiveness: The first report, already
prepared by RMPS, was essentially a status, or baseline report.
Council may wish to contribute to these reports regularly. The:
schedule for such reports suggests that Council's input should be
presented in the fall of the year.

C. Budgetary Outlook.

Plans for the fiscal year 1972 budget will have a considerable impact

on the final apportionment of-funds for the remainder of fiscal year
1971. . At present the outlook is for level funding of RMP grants at.

$70 million for each of the two years. ‘This would be accomplished by °

reserving a large part of the 1971 appropriation to be carried over for |
obligation in 1972. This presents two kinds of problems. First, because: .”
it requires a major reduction in current commitments to Regional. Medical. _

Programs for both years, the planning and persuasive aspects: of the

Regional Medical Programs becomes more important, with less emphasis. on.
their capabilities to support projects.+ Secondly, it presents a very.
low appropriation base for the 1973 budget, so that maintaining the same ~

 
~&-

$70 million level through that fiscal year will require a significant
appropriation increase. The 1973 budget presentation is.essentially
a technical problem that must be solved by RMPS within the DHEW
structure. The adjustment of RMP awards to the proposed reduction
would affect everyone and requires Council's attention. One possible
route would be to find the necessary reduction by cutting awards to.
thé less effective regions, and retaining levels closer to.existing
commitments in the more effective regions. This and alternative
policies will be the subjects of intensive study over the next few
weeks.

D. Progress in Administrative Adjustment to Legislation, the Triennial
Cycle and National Emphasis on Frogramnng

Council's policy statements are being examined: for possible review and
updating. Review criteria have been updated, but are subject to modifi-,
cation and refinement as necessary. Council's participation will be
sought as plans and drafts become available.

When completed, these materials will be given not only to Council and
staff, but also to the Regional Medical Programs as well, as aids to
program development.

Meanwhile the RMPS- ris ‘developing a comprehensive review system integrated :
with a new Management Information System. The objectives of these dem
velopments are to effect economies in time, integrate RMP activities with |
the total HSMHA program surveillance, and improve RMP performance. These —
developments are intended to potentiate the formation and implementation |
of our human judgments. ; are

1. The current status of the RMPS Management. Information System was
presented by Mr. Frank Ichniowski, Acting Chief, Office of Systems
Management, RMPS. During his presentation he highlighted some of
the most recent accomplishments of the MIS team and then proceeded

- to tie.in these current activities with the MIS implementation plans.
_In line with these plans, he announced a planned reorganization of |

‘the Office of <ivstems Management to better reflect the demands .of the
Management Infurmation System and to more optimally utilize available ,
personnel. This reorganization provides for separate branch activities
within OSM dealing with: MIS Design and Analysis, Programming, and MIs
Data Base Control.

It was pointed out that at least five major sources will be providing |
inputs to the MIS. These inputs include the Anniversary Review :
Application, the. Regional Reporting System, Site Visits, and other ..
reports on contact, RMPS Staff and the Regional Office. Certain other oe
efforts currently underway by the MIS team were identified, namely:
Devel opment of an MIS liaison team, use of MIS consultant, and: MIS. Mes

eacmnfatis
le fs intended that these extra curricular activities will
strengthen and more accurately guide the plan being developed.

Mr. Ichniowski then linked these various ongoing activities to

a- series of proposed outputs which could reflect the needs and
demands of the system users. This output plan categorized outputs
as emanating from combinations of four major groupings: Financial
Information, Regional Characteristics, Performance Records and
Control, and Historical Records.

Ultimately, the MIS will provide usage, via remote teletype or
video display units, to RMPS, Review Committee, National Advisory

Council, HSMHA, the Regional Office and the Regions themselves.

2. ‘he Review Cycle and its Tools. Mr. Ken Baum presented a

_description of the purposes, phases and tools of the proposed

triennial cycle of review and surveillance.
a. Council Discussion

.-- On efficiency of operation: Development of such systems
always risks over-elaboration of the Management Information
System; the manualizing of procedures, ritualization of site :
visits and of application reviews can result in ever-increasing:

demands on staff and advisors' time.

.-. Danger of over-simplifying a complex multi-disciplinary

operation like the management of RMP; observance of rigid pro-

cedural specifications may conceal real problems and forestall
application of important professional judgments.

.»«. Council-staff responsibilities: Need full understanding of
Council's responsibility for program and financial judgments.
In some research programs councils have: concerned themselves

with content, left funding to staff discretion. Some councils, |

control initial funding and commitments; others concern them-
selves with other funding decisions. Staff discretion in
approving program changes without Council. review also needs’
definition. :

-.. Regional Medical Program development and progress: Council
needs to observe conformance with guides, quality of project

designs and operations, not only to maintain program direction,

but also to evaluate its own guidelines and policies.

 
Developments jin regions do not always present -themselves on
fixed anniver... y or triennial dates; sometimes it is highly
desirable to review and activate new departures as soon as
their virtues become apparent.

Cross communication between regions could be impeded at
considerable loss in effectiveness if concepts had to await
fixed dates of Council review.

Council's job is primarily policy determination, but both ~
cyclical and interim reviews of operating and proposed changes
contribute to fmicil's judgments. Perhaps Council and staff
action respon: iiities could be enumerated, with staff pre-
senting a list of its actions for discussion at each Council
meeting. . ,

 

The position of. the Regional Advisory Group needs very clear
specification in documentation of the review process and the
assignment of responsibilities.

b. Staff Response

..+ Efficiency of operation: Staff projections for the modes

of operation in the management information and review procedures
now envisione-: indicate that the new approach will save. time. on
routine basi zyrocesses and leave more time available for sub-
stantive taeks.

... Over-simplification: The general aim of the plan is to
emphasize human professional judgments at all points of. decision.

... Council-staff responsibilities: Council's responsibilities —
for grant decisions are fixed by law; the purpose of this pro-
cedural development is to give Council a choice of ways in which
its responsibilities can be carried out efficiently.

Staff will prepare a list of Council-staff responsibilities and
Council cnet . for next meeting.

eee Repional“nedical Program development and progress: Cross-
communication between regions occurs naturally through direct
region-to~region exchange and through region-staff-region routes.
Staff plans to bring Council a report on cross-communication at
the next meeting.

... Council action: Staff was requested to circulate for-con-. |
sideration at-*::: next meeting a description of the proposed
review process and. the types of judgments that would be reserved.
to the Council.

 
Vit.

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REMARKS BY DR. VERNON E. WILSON, ADMINISTRATOR, HEALTH SERVICES AND
MENTAL HEALTH ADMINISTRATION

A. Appointment of Director: Dr. Harold Margulies has been confirmed.
as Director, RMPS; only the paper work remains to be completed.

B. Recommendations of the Willard Task Force: Completion of the task
force report is expected soon. Unfortunately a draft could not be
developed in time for this session.

C. Health Maintenance Organization: The Health Maintenance Organization:
(HMO) concept is a broad flexible one that has strong HEW support. The ©
term now refers to organizations providing comprehensive health care to.
enrolled populations and financed by capitation. Prepayment and carefully.
defined packages of services to represent comprehensive care are important. |
elements in current considerations. . nbs

 

HEW is very active in implementing the concept and in stimulating the
formation of HMO's.

Late in November the Secretary appointed the following four task forces
to examine important aspects of HEW posture toward the concept:

Policy

Relationships with non-HEW agencies
Financing

Technical Assistance

The Administrator, HSMHA, heads the technical assistance group. However,
heads and members of the groups were selected, not to represent their ns
constituent agencies, but to explore concepts of the Department's in-
volvement. Ultimate assignments for implementation of HEW policies and) —
responsibilities for HMO's are by no means obvious and certainly are not.
decided. oo

There is a high probability that HSMHA as the Department's technical rhs
agent in health care delivery will have an {mportant role in technical |
assistance for HMO propagation.

CHP agencies undoubtedly will have review and. comment responsibilities —
concerning proposed HMO activation. RMP as a channel for provider
expression will be fully involved.

It seems clear that HEW will actively support promotion of HMO activation. .
The Department will offer technical assistance and the planning and.
coordinating capabilities of its field arms and associated agencies. B
There is no plan to replace existing forms of health care with the HMO; ~~
the objective is to open access to health care as broadly as possible and

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are not fiow availdbie.

  
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Funding of HEW activiti-. “stu as yet unresolved. $2.25 million may be
available from NCHSRD 1971 appropriation; some amount might be taken
from reserved RMP funds; other amounts may yet be found elsewhere.
Technical assistance funuing might well become a HSMHA responsibility.
Whatever is decided for fiscal year 1971 activities will affect planning

- for 1972 appropriations for other programs as well as for the HSMHA total.

D. Questions and Answers:

 

Q.

A.

What are the charecteriststs of a desirable HMO?
It has taken fros “September to January to arrive.at. the following
list of characteristics:

An organized system of contractually related health care facili~
ties; an organized multi-disciplinary group of health care pro- |
fessionals; an enrolled group of clients; a sound insurance plan.

No rigid prescriptions have been adopted for accommodation to
the insurance plan or for minimum enrollments.

What is the Department's view on coverage of enrollment?

Broad. If acce*3: vu health care is to be extended through the
HMO device, som: groups will require assistance. SSA-.and SRS
are looking at“this. A Family Health Insurance Plan might be a
vehicle for extending coverage. ,

  
 

Looking beyond the problems of initiation and establishment, what
will provide long-term support?

A soundly planned HMO should be supported by the revenues from.
its operations.

Will Federal contributions on behalf of Federal beneficiaries

be uniform?
. Ye Tne

It seems logic: .o believe that Federal. HMO's will expect

uniform or at jeast minimum packages of individual or family

care, but will “regionalize" the prices. of the standardized

packages.

Could a large employer set up a "house" HMO?

Some are already studying the idea... Tt’ seems likely that three .
ata Soon. Labor organizations also are interested.

 

 
@ VIII.

Q. Is legislation expected?

A. “Proposals on financing loans and insurance are being considered.
Nothing new is needed for program administration.

Q. What rate of progress does the HEW visualize - how many HMO
projects might be established in a year?

-A. Many questions must be investigated in order to organize an
HMO, establish the necessary contractual relationships, specify
and price service packages, and work out enrollment principles.
About fifty groups are known to be interested.

Q. What is the outlook for action in the field of quality of medical
care? |

A. Models for operations in this field are needed. SSA, SRS, and
HSMHA are studying the possibilities. Agency responsibilities
are not yet clear. The RMP as a provider organization might
logically be a vehicle for administration, but lacks credibility |
because performance has been uneven. This is one of the multi- |
program topics on which Council may expect to be asked for
advice, in line with last meeting's discussion.

STATUS REPORT ON GUIDELINES, CONTRACTS AND PLANS FOR THE FUTURE
A. Heart Disease, Cancer and Stroke Guidelines

Dr. Margaret Sloan reported on the status of the heart disease, cancer
and stroke guidelines. Preparation of the guidelines has been going
forward under three contracts. These have enabled multidisciplinary
groups of health professionals representing all the professional
organizations interested in a particular disease area to obtain the
consensus of experts. Agreement has been reached on the criteria
which would have to be met by medical institutions. in the country

in regard to personnel, organization, and facilities if they were

to be capable of providing the highest quality of care for patients
with heart disease, cancer, or stroke. j

In the original concept, these groups were expected to develop criteria
for a list or lists of 10-20 outstanding centers in the country as
required by Section 907 of PL 89-239. As the work progressed, it was
redirected to the present focus on quality care in all types of medical
installations which will be more broadly useful.

The Cancer Guidelines, prepared under a contract with the American
College of Surgeons, are about to be published by the College at their
own expense. The final document will still not be entirely satisfactory.
to the Council, but should prove useful in setting a goal. for development
of resources for the trestment of cancer patients.

 
~ 10 -

The Heart Disease Guidelines, being prepared by the Inter-Society
Commission on Heart Disease Resources under a contract with the

' American Heart Association, are being published in preliminary form

as a series of reports in the Journal Circulation. These deal
separately with each major form of cardiovascular disease excluding
stroke, and cover the areas of prevention, diagnosis, treatment, and
rehabilitation. When the last report has appeared in Circulation,
they will all be reviewed again in the light of comments and criticism
received, revised as necessary, and printed in monograph form by the
G.P.0O. Initial response to these: reports has been most enthusiastic.
RMPS is now working on problems of publicity, distribution, and gaining
the attention of physicians, hospital personnel,. and health planners
to their contents. Implementation will be stimulated by the RMPs

and the affiliates of the AHA. ;

The Stroke Guidelines are being developed by the Joint Committee
for Stroke Facilities under a contract with the American Neurological
Association but have not yet reached the publication stage.

There was agreement that the Guidelines would be of value only as

long as they are kept up-to-date and, therefore, that a mechanism
should be established for periodic updating and revision. In the

case. of the Heart Disease Guidelines and in an attempt to preserve
continuity in the effort, it was proposed that a new contract be
negotiated with the AHA to continue the ICHD for one more year during
which that organization would carry out an evaluation of the acceptance
and applicability of the Guidelines. At the end of that period, it was
anticipated that the AHA and the American College of Cardiology would
jointly assume responsibility for revision and maintaining the currency
of the Guidelines.

A similar arrangement will eventually be considered for the Stroke
Guidelines. :

In the case of the Cancer Guidelines, which are organized according
to the specialty groups involved in diagnosis and treatment, the
Council considered the possibility of a different approach which
might be mounted to consider all the resources of personnel, —
organization, and facilities needed to deal with each major type

of cancer. The Board of Regents of the American College of Surgeons”
was considering the establishment of a Task Force which might .under-
take the development of cancer guidelines dealing more specifically
with the major types of cancer.

Dr. Brennan proposed that RMPS negotiate a contract to develop a
model for the comprehensive, multidisciplinary treatment of cancer
patients on a regional basis using a systems analysis approach.

The concept proposed involved:

period of years. 4dhead;

 
IX.

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2. Measuring the cancer control resources and capability of the
reglon to provide the quality of control envisioned in the Guide-
Lines; ,

3. ‘Determining the improvements needed to make the region's
cancer capabilities equal to its requirements; and

4. Programming steps the providers of health care could take to
achieve this goal.

Dr. Brennan indicated that Detroit might be an appropriate locality in
which to develop the proposed model.

Dr. Margulies agreed that RMPS would review the pilot model ‘proposed
‘and report on the plan at its next meeting.

The Council expressed approval of the guideline contracts as a mode

of obtaining expert opinion and consensus of the medical profession

in the complicated fields of preventive and clinical medicine. Since
the Guidelines were prepared by the profession for the profession, it
was felt that they would be far better received than any Federal guide-.
lines or standards. It was suggested that the Heart Disease Guidelines |

be considered a model which could be used by. HEW for other target disease.

areas.

The Council was warned that such guidelines would not always. be accepted
without dissent and could provoke controversy. For example, the National
Heart and Lung Institute had expressed the opinion that the dietary.
recommendations in the report on the Prevention of Atherosclerosis,
reviewed at the preceding meeting of this Council, were premature. |.

STATUS REPORT ON RMP AND CHP CONTRACTS

"Information Support System (ISS) for Management Control and Evaluation."

‘Mr. Peterson reported on progress made on the contract, HSM 110-RMP- 62(1),.

This contract is to assist the administrators of Regional Medical Programs |

in solving problems ‘in management control and program evaluation by..
providing them with certain types of information which are not usually
available. The system is designed to develop information for Program
Coordinators on the character and extent of the interaction of the RMP :
with the various segments of the medical community, as well as with its,
level of involvement with various types of medical problems. Information |

collected through the analysis of documents as grant applications, news-

papers, and newsletters will form the basis of individual reports to each |
Regional Medical Program, and.a summary report -to the Regional Medical |
Programs Service.
XI.

XIT.

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The contract to study, "Comprehensive Health Planning," made with

the Organization for Social and Technological Innovation, Inc. (OSTI),
and Arthur D. Little, Inc., to assess the character and progress of
Comprehensive Health Planning is now getting underway.

COUNCIL POLICY ON LONG TERM TRAINING AND TRAINING IN SPECIALTY AREAS

Council continues to receive inquires about specialized long-term
training as an RMP activity. Individual inquiries sometimes relate
to support of professional pre-doctoral training and sometime to
post-doctoral or post-residency training. At the present meeting,
requests urging RMP support of post-resident training in nephrology.
for physicians and of training for occupational, physical and speech
therapists were received from the Southeastern Coordinators.

Council took note of the need for trained personnel in these and
other categories and urged the Regional Medical Programs to take
steps to identify the needs and stimulate action, such as listing
existing vacancies and publicizing them. :

Council also noted that RMP funds are insufficient to finance a
significant contribution to solve this problem.

ACTION: Council reaffirmed the position taken at its last two

meetings and did not make an exception for the requests presented

at this. meeting.

COUNCIL POLICY ON PUBLIC SERVICE PROGRAMS (BROADCASTS) OF RMPs

Council was asked to consider enunciation of .a policy governing
content of broadcast or other public service utterances of Regional
Medical Programs. One incident was reported to illustrate the need
for a stated policy.

Council noted that a Regional Medical Program, through an unguarded
issuance can embroil itself in counter productive controversy. It

was noted, also, that such incidents have been few in number, and

local in effect. There is some danger of exaggerating the significance
of such events by making a formal pronouncement of what, in general,

is a matter of common sense.

ACTION: The Acting Director, RMPS, was asked to discuss the specific

circumstances with the coordinator of the region in which it occurred.

HYPERTENSION RESOLUTION

 

A representative of the National Heart and Lung Institute presented
zesoTurions of the Councits of pat Institute andthe Nartonet

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mended ‘by ail three was a "program of ‘community projects “for appli-
cation of drugs to control of hypertension. VA studies utilizing

cone
XIII.

- 13-

_ experimental placebo groups have shown such dramatic effects with
both severe and moderate hypertensives that. medical ethics dictated

discontinuance of the placebo control groups. The NHLI has prepared
request for proposals for clinical trials in the general population.

All three of the advisory bodies mentioned above have commended this
need and effort to the attention of the Regional Medical Programs,
in. hope that they will find ways to initiate and assist in such trials.

ACTION: Council requested RMPS to alert all Regional Medical. Programs
to these opportunities and to distribute the NHLI requests for .pro-_
posals as well as reports of the VA experience to all regions.

REPORT OF THE AD HOC REVIEW COMMITTEE ON KIDNEY DISEASE.

At the request of Dr. Harold Margulies, this Ad Hoc Committee was.
convened on January 27-28, 1971, to review the applications submitted
to RMPS related to renal disease projects. It was the unanimous
opinion of the committee that there is a need to define the mechanism.
of evaluation of these projects. .

It is clear that there is a significant gap between the existence
of proven life-saving techniques in kidney disease control and their
application on a broad scale. :

In reviewing the submitted proposals on renal disease, it became
obvious that there was inadequate screening at the local level. This
is a result of the lack of an established advisory group in renal
disease in most areas and the difficulty in finding local expertise:
not involved with the submitted projects.

This Committee recognizes the need for the development of kidney
disease projects at the local. level, based upon the unique needs of
a given region. However, based upon our present review experience,
we would recommend that these projects undergo more intensive peer
review and applicants be encouraged to submit the. proposal to a panel
of reviewers in the field. These reviewers could be from within or
outside of the region. Lccal_Regional Medical Programs intending to
submit proposals could receive aid in'the preparation and technical
review of their project from the Kidney Disease Control Program. It
would, therefore, be possible for a region to submit a realistic.
proposal which best suits its particular area and has undergone
extensive review.

In view of the fact that the total amount of funds. and manpower which
will be available for kidney disease projects will not fulfill the

total national needs for these projects, we believe that the existence

 
XIV.

= 14 -

of a categorical review body at the Federal level may have distinct
advantages. A Kidney Disease Review Committee would be capable of
examining all projects in this area and determining a priority
assignment based upon a proper national distribution of facilities
with emphasis on sharing of facilities and the promotion of inter-
regional cooperation. In collaboration with the Kidney Disease
Control Program, the Committee would therefore be capable of providing
an overall perspective which would be geared to avoiding wasteful

~ duplication of effort and expense in this area and stimulating activity

where needs exist.

Ultimately, we are confident that advances in the state of the art

and in the development of new funding mechanisms will evolve to the
point where there will be no advantage to the consideration of kidney
disease projects separately. A non-categorical approach to evaluation
of these projects will be more appropriate at that time. For the ~
present, however, we feel that the establishment of a categorical

peer review group, which is capable of comparing the numerous kidney
disease projects submitted by the various Regional Medical Programs,
would be an effective way of ensuring the development of kidney disease
activities that embody local needs as well as a broader national or :
inter-regional overview. ‘

RECOMMENDATIONS FOR ACTION - REVIEW OF APPLICATIONS 1/

 

ALABAMA REGIONAL MEDICAL PROGRAM — RM 00028 2/71

Total direct cost levels for continuation. New, renewal, and develop-
mental activities for the next three years are as follows:

03 - $1,765,557 04 - $1,654,245 05 ~ $1,373,606

‘Request for developmental funding is approved as requested. Council

did not believe another site visit was needed to appraise’ the capacity
of the Region to utilize this type of funding.

This Council action. differs from Review Committee in that approval
for developmental component and additional funds for this purpose
are recommended. This Council action also reflects consideration
‘of the policy issues raised by the Continuing Education and Training
Branch regarding Project #37 ~ Taking the Lid Off the LPN and —
Project #4R - Health Manpower in Junior Colleges.

Council believes the Region's priorities should be the determining
factor concerning these education activities since present policy
does: not. preclude their funding.

 

 }OS8 Otherwise upecified rerer

+e
Hrthaaie

to a 12-wonti period.

The designation 01, 02, etc. relates to the first, second, etc., budget ae
ARKANSAS REGIONAL MEDICAL PROGRAM - RM 00052 2/71 (Supplement)
Additional funding is recommended at a minimum of $111,925, $113,734,
$122,884 with the maximum to be determined by staff after receiving
- technical site visit team's recommendations regarding funding for
Project. #37 - Comprehensive Program for Kidney Disease Control.
CALIFORNIA REGIONAL MEDICAL PROGRAM - RM 00019 2/71 & 11/70 (Supplement) _

Approval of developmental component funding for California RMP.

Approval of increasing level of funding for current 03 year by $407,768
of which $200,000 is for developmental funding.

Approval of future funding for California RMP for both core; projects
and developmental funding at following levels: ‘

04 - $8,363,994 05 - $8,363,994 06 - $8,363,994

Subject to following conditions: 1) overall RMPS funding restrictions;
and 2) satisfactory program priorities to be included in May 1971

application.
@ 4 Delegation to California RAG decisions regarding allocation for all
: projects included in both November 1970 and February 1971 applications :

except for Project #65 ~ Comprehensive Renal Detection, Diagnosis
and Treatment Program (Area VIII) and #74, Blood.Banking (Area V).

This action differs from Review Committee recommendations in the
number of years of funding recommended. Council concurred with
site visit team that this Region needed guidance from Council
regarding overall level of funding to be anticipated before sub-
mitting application for three-year funding of operational projects ,

- in May 1971.

COLORADO/WYOMING REGIONAL MEDICAL PROGRAM ~ RM 00040 2/71 (Supplement):
No additional funding is recommended.
Developmental funding is disapproved.

Region may rebudget available funds into Project #22 and Project #24
if the RAG determines that they: a) respond to a recognized need. for
local regionalization and improvement; and b) demonstrate integration
into the Region's health care system in a way that will permit dis-
engagement of RMP funding within a short time.

Because of Council policy regarding use of RMP funds for basic education,

© Project #23 is ineligible.

Phu d es
hap io

and staff interpretation of policy regarding Project #23.

 
~ 16 -

CONNECTICUT RECLONAL MEDICAL PROGRAM ~- RM 00008 2/71 (Supplement)

Additional funding at a reduced amount of $70,496 is recommended
for the current 03 year.

This Council action is the same as recommended by the Review Committee.
FLORIDA REGIONAL MEDICAL PROGRAM - RM 00024 2/71

Additional funding at @is°*%d level of $200,000 ~ 03 year; $160,000 -
04 year; $145,000 - 05 year is recommended.

Action on Project #38, The Florida Statewide System of Patiénts With
End Stage Kidney Disease, was deferred to provide time for advice,
revision and resubmission as recommended by the Ad Hoc Panel on
Renal Disease.

 

This Council action concurs with the combined recommendations of the
Review Committee, and Ad Hoc Panel on Renal Disease and staff with
regard to renewal of Project #15.

GREATER DELAWARE VALLEY 2°°70NAL MEDICAL PROGRAM ~ RM 00026. 2/71

No additional funding is+:ecommended for activities presented in this
application.

Region has option to rebudget available funds into new Project #27 ~
Director of Medical Education - as well as for previously approved
Projects #6, #8, #10, #14, and #15.

 

RMPS funding is precluded for the training of lay personnel proposed
in Project #28, First Care Cardiopulmonary Resuscitation Training
Program (December 1969 Council).

Projects #25, Regional Dialysis Training Project ~ Crozer~Chester
Medical Center and #26 “= ::monstration and Evaluation of a Dialysis
Training Program —- Thom.~ Jefferson University.are disapproved.
Council agrees with Review Committee and Ad Hoc ‘Panel on Renal
Disease that two dialysis training projects in same area raise
serious questions about cooperative planning and review procedures
in the Region.

 

 

 

This Council action differs from Review Committee recommendations
in respect to funding res-rmended.

 
-~ 17 -

HAWATI. REGIONAL MEDICAL PROGRAM - RM 00001 2/71 (Supplement)
Additional funds are recommended for three years:
03 - $366,300 04 - $285,182 05 - $285,119

Request for one year developmental funding is approved.

. Because of Council policy, Project #23, Mobile Coronary Care, is

not recowmended for support.
This Council action concurs with Review Committee recommendations.
INDIANA REGIONAL MEDICAL PROGRAM — RM 00043 2/71 (Supplement)

Additional funding of $150,000 for one year is recommended for this
Region. : .

Request for developmental funding is disapproved.
This Council action coincides with Review Committee recommendations.
ILLINOTS -REGLONAL MEDICAL PROGRAM -— RM 00061 2/71

Increase in support for one year only to a total level of $2 million is
recommended for the Illinois RMP. : a

Developmental funding request is disapproved at this time.
This Council action coincides with Review Committee recommendations.
INTERMOUNTAIN REGIONAL MEDICAL PROGRAM — RM 00015 2/71

Additional funding of $225,000 recommended for this Region for one
year. : Co eas

Request for developmental funding is approved as requested.

Region may rebudget funds into any projects included in this application |
or for continued cooperative planning for Project #29, Physician's oe
Assistants Training, (11/70 application). However, Council would like =~
to advise Region that decision to continue funding of Project #16R ~—
Endocrine Program - would raise doubts about Regional priorities.

This Council action coincides with Review Committee recommendations. —
© ,

-~ 18 -

LOUISIANA REGIONAL MEDICAL PROGRAM — RM 00033 2/71
Additional funding of $400,000 for one year is recommended.
Request for developmental funding is disapproved.

Region may rebudget available funds into supplemental, core, planning
and feasibility studies or projects included in this application.

Project #9, The Metropolitan Organ Bank, is approved with advice to
Region about the budget and the educational program plans, as noted by
the Ad Hoc Panel on Renal Disease.

 

This Council action coincides with recommendations of the Review
-Committee and incorporates the advice of the Ad Hoc Panel on Renal
Disease.

MARYLAND REGIONAL MEDICAL PROGRAM - RM 00044 2/71

 

No additional funding is recommended for activities proposed in this
application.

The request for developmental funding is disapproved.

Project #33, A Comprehensive Regional Approach to Education and
Therapy for Chronic Renal Failure, is disapproved as recommended by
the Ad Hoc Panel on Renal Disease. ,

Advice to Region should convey Council's specific desire that in-
formation about program concerns should not be interpreted as
criticism of the new coordinator, rather as hope that he can mobilize

_ MRMP. resources for coordinated action.

This Council action coincides with recommendations of both Review
Committee and Ad Hoc Panel on Renal Disease.

METROPOLITAN WASHINGTON REGIONAL MEDICAL PROGRAM - RM 00031 2/71

Total direct cost funding for three-year levels are recommended for
continuation, new or renewal activities as follows: 04 - $1,658,351;
05 - $1,359,906; 06 - $1,116,353.

Request for developmental funding is disapproved.

Additional funding for continuation of Project #12, Mobile Coronary
Care Unit, is not recommended, but Region may rebudget funds for Lea
completing two full years of activity, as originally proposed, provided —

evaluation ts completed
@ -»-

METROPOLITAN RMP CONT.

 

All kidney disease projects are disapproved.

- Project #16 ~ Mobile Dialysis Center, Project #47 - A Regional
Nephrology Program, and Project #31 - Capitol Hemodialysis Training
are disapproved as recommended by the site visit team and the Ad
Hoc Panel on Renal Disease. Region should be advised of Council's
interest in further review only of a comprehensive proposal for renal
disease, rather than project-by-project proposals.

Region may rebudget funds into projects included in this application
4f RAG determines that they are of high priority and within RMPS policy...
Project #17, National Career Council, Project #23, Inhalation. Therapy be
Training, and Project #43, Cervical Cancer Detection raise policy . |

issues. One year funding only is recommended for Project #2R.

This Council action differs from Review Committee recommendations only
in level of funding recommended for each of three years, coincides with

recommendations of Ad Hoc Panel on Renal Disease and incorporates advice |
from the December 7-8, 1970 site visit team. Pk

© , MICHIGAN REGIONAL MEDICAL PROGRAM - RM 00053 2/71 (Supplement)

Additional three-year funding at a reduced level is recommended for two
new projects as follows:

01 - $368,073 02 - $366,098 a 03 - $388,274
This Council action coincides with Review Committee recommendations.
NEW JERSEY REGIONAL MEDICAL PROGRAM - RM 00042 2/71

Total direct cost levels for continuation, new and renewal activities
recommended for the next three years as follows: ’ .

01 - $2,989,501 aan 02 - $1,454,750 03 - $1,276, 466

The second and third year levels do not reflect core support which
was not requested at this time.

Request for developmental funding is approved as requested.

Request for one additional year of support for Project #3R, Regional
Training Center for Cardiac Nursing, is approved. ee

 

a This Council action coincides with Review Committee and incorporates
© x advice and recommendations from December 1970 site. visit team.

   
- 20 -

NEW MEXICO REGIONAL i#EDICAL PROGRAM - RM 00034 2/71 (Supplement)
Additional funding iss. commended as requested for Project #16, Heart,
Sound, and Murmur Screening Program for New Mexico School Children,

as follows:

03 - $45,188 04 - $55,558 05 - $57,069

This Council action coincides with Review Committee recommendations.

    

NEW YORK METROPOLITA.. ¢ "ZONAL MEDICAL PROGRAM - RM 00058 2/71 (Supplement)

Additional funding of $200,000 for developmental component,is recommended. —
for one year. . , 4

No additional funding is recommended for new Projects #25, #26, #27, and.
#28; however, Region has option to rebudget available funds into these
activities, provided RAG determines they are of high priority for present
goals and objectives of Kegion. es

This Council action coincides with Review Committee recommendations.

NORTH DAKOTA REGIONAL“, “AL PROGRAM ~ RM 00060 2/71

Additional funding 0f<:430,000 is recommended for one year.

Request for developmental funding is disapproved.

Region may rebudget available funds for increased core or approved

projects in line with its own priority.

aes

This Council action coincides with Review Committee recommendations

_and incorporates advice from the December 1970 site visit team.

NORTHLANDS. REGIONAL MEDICAL PROGRAM - RM 00021 2/71

Approval of level ‘of «1: ‘ing for three years for all activities, including
continuation, new activities and developmental funding as follows:

 

03 - $1,954,400 . 04 - $1,511,600 05 - $1,378,700
Approval of developmental funding as requested for three years.

Region may rebudget available funds into any of activities proposed in’ |
this application, if 21¢-determines they are of high priority for 0
Regional objectives gudcka.iine with RMPS policies. Attention to RMP
policy is particulariy pertinent in regard to Project #20, Diabetes — :
Education Center, and #21 Congenital Heart Disease Registry. Region

Or

 

  

 

 

Project #22, #23, is, aad #iz aud the limited time cecommended for oy
Project #14, as noteii‘vy the Review Committee. ee ged ee
- 21 -

NORTHLANDS RMP CONT.

This Council action coincides with Review Committee recommendations
and incorporates advice from the site visit team,

OREGON REGIONAL MEDICAL PROGRAM - RM 00012 2/71

A total direct cost level of $1,064,291 for the 15-month 04 year
is recommended for this region.

Region may rebudget available 04 year funds into core, continuation
projects, renewal projects and new projects in line with its priorities
and objectives.

Approval for ‘the renewal projects is for one year only with the

exception of Project #4R, Comprehensive Stroke Care with Regional
Education, which is approved for the 05 and 06 years as requested.

05 - $54,444 06 - $56,617

Council takes exception to its general policy regarding phase-out of ere
RMP projects because of Project 4R's outstanding demonstration qualities. | I.

This Council action differs from Review Committee recommendations in

the level of funding recommended for the 04 year, Project #21 was _ , ae

withdrawn by the Region and Council concurred with staff's recommendation
that $91,580 additional funding was needed to support on-going projects. |.

SOUTH DAKOTA REGIONAL MEDICAL PROGRAM ~ RM 00067 2/71
Approval of South Dakota Regional Medical Program as a separate Region. |

Three-year funding for core and one year continued: funding for coronary _
are activities in three South Dakota hospitals is recommended as follows: |

01 - $379,500 . 02 - $313,000 03 - $376,000
This Council action coincides with Review Committee recommendations.

SUSQUEHANNA VALLEY REGIONAL MEDICAL PROGRAM ~ RM 00059 2/71 (SPECIAL

ACTION)

Approval of two years’ additional funding for Project #6R, Coronary
Care Nurses' Training Program, Geisinger Medical.Center and one year. aa
funding for Project #25, Altoona Coronary Care Training, in following

amounts:

01 - $88,425 pe 02 - $31,551
= DD -

SUSQUEIANNA VALIEY_*." CONT.

Deferral of remainder of application for new funding, pending a site
visit to study the program progress, plans for priorities for the
future.

This Council action differs from Review Committee recommendations.
Council considered as a special action the Region's third proposal
for CCU Training at the Altoona Hospital and recommended funding
for one year.

TEXAS REGIONAL MEDI-ct. v ROGRAM —- RM 00007 2/71 (SUPPLEMENT & SPECIAL

ACTION)

Additional funds are recommended as follows: os
03 - $26,900 04 - $26, 500

Region may rebudget available funds into any of the other activities
included in the supplemental application in line with Region's
priorities. Council wishes to advise the Texas RAG that. any RMP

funding for both Project #53, Choriocarcinoma and Related Trophoblastic
Diseases and #50, Control of Hypertension and Chronic Renal Disease,
should be transit» “only to permit project directors time to locate us
other sources of = ing. Council recognizes that long-range support
is necessary to ecomplish the aims of Project #50, but does not: believe
RMP should be the source. :

 
  
 

The previous restriction on expenditure of funds for Project #14R,
Stroke Demonstration Program for Progressive | Patient Care, should be
lifted.

This Council action incorporates recommendations from both Review
Committee and the Ad Hoc Panel on Renal Disease.

VIRGINIA REGIONAL MEDICAL PROGRAM - RM 00049 2/71 (Supplement)

 

‘No additional fur. mig as recommended for the Virginia Regional Medical

Program, _

The request for developmental funding is disapproved.

Council will reconsider request for additional funding, for Project #10,

_Multiphasic Screerving Program, in May when special Council subcommittee

 

reports its recom. :'«tions.

Action on Project #12, Txecurement_ of Cadaver Kidneys for “Transplantation,
is deferred, pending Region": S§ response 2 to ) advice. from Ad Hoe Panel on
Renal Disease.
- 23 -

VIRGINIA RMP CONT.

Region should be advised of Council policy regarding support of new.
mobile units in relation to Project #11.

This Council action incorporates recommendations from Review Committee
and Ad Hoc Panel on Renal Disease.

WASHINGTON-ALASKA REGIONAL MEDICAL PROGRAM — RM 00038 2/71.1 & 2/71.2
Additional funds are recommended as follows:

04 - $289,778 05 ~ $268,129 06 - $30,700
Developmental funding is approved as requested.

Additional funding is recommended for Project #9R ~ Alaska Medical
Library, and #38R ~ Medical Computer Service, as requested.

Additional funding is recommended for the Regional Kidney Program, as
noted by the Ad Hoc Panel on Renal Disease. Region should be advised,
however, that despite the Panel's concerns about specifics of the
Regional Education Program, Region may incorporate continuing education=
on renal disease into overall continuing education program when appro-
priate.

This Council action coincides with recommendations of Review Committee
and the Ad Hoc Panel on Renal Disease.

WESTERN NEW YORK REGIONAL MEDICAL PROGRAM — RM 00013 2/71
Additional funding is recommended for Wester New York as follows:
04 - $359,424 05 - $374,827 . 06 - $113,265
The request for developmental funding is disapproved.

Region has option to rebudget funds into projects included in this
application, but should be advised on Council's concerns about lack

of priorities for the overall program. Funding for Project #21,
Choriocarcinoma and Related Trophoblastic Disease, should be considered:
as transitional and short-term only to provide time to develop other
sources of funding.  Ccuncil cites Project: #1R,. Telephone Lecture —
Network, for special consideration in funding. -

This Council action coincides with Review Committee recommendations. _ “

 
at

——

XV.

-~ 24

WEST VIRGINIA REGIONAL MEDICAL PROGRAM — RM 00045. 2/71
Additional funds are recommended as follows:
02 - $260,000 03 ~ $260,000 © 04 - $260,000

Region may rebudget available funds into any activities included
in this application if RAG determines they are of high priority
and in line with RMPS policy. Attention is called specifically
to Council policy on registries related to Project #12, Cancer
Education and Service. Region should be advised of Council's

 

special interest in Project #8, Medical Self-Audit.
This Council action coincides with Review Committee recommendations.
WISCONSIN REGIONAL MEDICAL PROGRAM - RM 00037 2/71 (Supplement)

Action on this request for developmental funding is deferred pending
Council consideration of Region's triennial application in August 1971.

Council suggests that Region incorporate pians for developmental funding pest
-in Triennial application.

This Council action coincides with Review Committee recommendations.

ADJOURNMENT

The meeting was adjourned at 12:30 p.m. on February 3, 1971.

I hereby certify that, to the best of

my knowledge, the foregoing minutes ee

and attachments are accurate and
complete. ,

  

49 fy Jeane wan tis Y
ah (roll a i i
Harold Margulies, M.Dy

Director
Regional Medical Programs Service

 

April 26, 1971
. . -

- ATTENDANCE AT THE NATIONAL ADVISORY COUNCIL MEETING

FEBRUARY 2-3, 1971

RMPS STAFF

Mr. Ken Baum

Dr. Edward T. Blomquist
Mc. Cleveland Chambliss
Mr. Spencer Colburn
Miss Cecilia Conrath
Mr. Tom Croft

Mr. Herbert Dunning

Mr. Gerald T. Gardell
Mr. Terrance T. Genz ..
Mr. Samuel O. Gilmer, Jr.
Mrs. Eva Handal

Mr. Charles Hilsenroth
Miss Dona Houseal

Mr. Frank Ichniowski
Dr. Philip A. Klieger
Dr. Alan Kaplan

Dr. Marshall J. Keyes
Mr. John M. Korn, Jr.
Dr. Harold Margulies
Mr. Frank Nash

Dr. Herbert B. Pahl

Mr. Ronald L. Peterson

- Mr. Eugene S. Piatek

Mr. Michael J. Posta
Miss Leah Resnick
Mr. Abraham Ringel
Mr. Dale Robertson

Mr. Morton Robins

Mrs. Jacki Rosenthal

Mr. Richard L. Russell

Mrs. Pat. Schoeni

Mr. R.. Shaw

Mrs. Sarah J. Silsbee

Mr. Thomas H.. Simonds ~
Dr. Margaret H. Sloan

Mc. James A. Smith

Mr. Dan Spain

Mr. Lee E. Van Winkle

Mr. David Lovenvirth, RMPS Consultant

RMPS REPRESENTATIVES IN
REGIONAL OFFICES

Mr. William A. McKenna Region I

Mr. T. H. Griffith Region IV...
Mr. Maurice C. Ryan Region Vo.
Mr. C. Ray Maddox Region VIT -.
Mr. Daniel P, Webster Region VItT
Mr. Ronald S. Currie Region IX
Mr. Hugh S. Campbell Region Xo.

OTHERS ATTENDING

Dr. Vernon.E. Wilson, Administrator, HSI
Dr. Margaret H. Edwards, NCI, NIH |
Mrs. Frances H. Howard, NLM, NIH .

Dr. William J. Zukel, NHLI, NIH

 
NATTONAL ADVISORY COUNCIL ON
TS 7 NAL MEDICAL PROGRAMS

BRENNAN, Michael J., M. D. (72) McPHEDRAN, Alexander M., M.D. (73)
President, Michigan Cancer Foundation Emory University Clinic ;
4811 John R Street 1365 Clifton Road, N. E.

Detroit, Michigan 48201 Atlanta, Georgia 30322

CANNON, Bland W., M.D. (73) MILLIKAN;, Clark H., M.D. (72)

910 Madison Avenue Consultant in Neurology

Memphis, Tennessee 38103 Mayo Clinic

Qo Rochester, Minnesota 55902
CROSBY, Edwin L., M.D. (71)

Executive President OCHSNER, Alton, M.D. (73)
American Hospital Association . Ochsner Clinic
Chicago, Illinois 60611 1514 Jefferson Highway

New Orleans, Louisana 70121
DeBAKEY, Michael E., M.D. (72)

President and Chief Executive Officer ROTH, Russell B., M.D. (73)

Baylor College of Medicine 240 West 41st Street

Houston, Texas 77025 Erie, Pennsylvania 16508

EVERIST, Bruce W., M.D. (71) WYCKOFF, Mrs. Florence R. (72)

Chief of Pediatrics wie. 243 Corralitos Road

Green Clinic mes Watsonvalte, California 95076
Ruston, Louisiana 71270 - !
HINES, Mr. Harold H., Jr. (74) - EX OFFICIO MEMBER

Senior Vice President

Marsh & McLennan, Inc. : MUSSER, Marc J., M.D.

231 South LaSalle Street Chief Medical Officer

Chicago, Illinois 60604 Veterans Administration

Washington, D. C. 20420
HUNT, William R., M.D. (71)
Commissioner

County of Allegheny

101 Courthouse

Pittsburgh, Pennsylvania 15." $n

CHALRMAN

Vernon E. Wilson, M.D.
Administrator

Health Services and Mental Health
i> Administration

5600 Fishers Lane

eckville, Maryland 20852