MBN DEPARTMENT OF HEALTH, EDUCATION AND WELFARE f Health Services and Mental Health Administration Regional Medical Programs Service ‘f fd ‘National Advisory Council on Regional Medical Programs Minutes of the Meeting August 3-4, 1971 Parklawn Building : @ : oe , _ Conference Room G/H Bohs all s ™ DEPARTMENT OF HEALTH, EDUCATION AND WELFARE PUBLIC HEALTH SERVICE National Advisory Council on Regional Medical Programs Minutes of the Twenty-fourth Meeting 1/ 2/ August 3-4, 1971 The National Advisory Council on Regional Medical Programs convened for its twenty-fourth meeting at 8:30 a.m., Tuesday, August 3, 1971 in Conference Room G-H of the Parklawn Puilding, Rockville, Maryland. Dr. Harold Margulies, Director, Regional Medical Programs Service presided over the meeting. ae . The Council Members present were: Dr, Bland W. Cannon - . Mr. Sewall O. Milliken Dr. Michael E. DeBakey- . Dr. Alton Ochsner Dr. Bruce W. Everist Dr. Russell B. Roth Dr. William R. Hunt Dr. George E.Schreiner Dr. Anthony L. Komaroff Mrs. Florence R. Wyckoff Dr. Alexander M. McPhedran Dr. Benjamin W. Watkins Dr. John P. Merrill Mr. Edward Friedlander for Dr. Clark H. Millikan Dr. Musser A listing of RMP staff members, and others attending is appended. I. CALL TO ORDER AND OPENING REMARKS The meeting was called to order at 8:30 a.m. on August 3 by Dr. Harold Margulies. II. INTRODUCTION OF NEW ‘COUNCIL MEMBERS, COMMISSIONED OFFICERS, AND STAFF Dr. Margulies introduced the following new members of the Council — who were attending their first meeting: Dr. Anthony L. Komaroff , Dr. John P. Merrill,-Mr. Sewell 0. Milliken, and Dr. Benjamin W. Watkins. Dr. Margulies noted that two new members of the Council, Mrs. Audrey M. Mars and Mr. C. Robert Ogden were unable to be present. . 1/Proceedings of meetings are restricted unless cleared by the Office ° ~ of the Administrator, HSMHA. The restriction relates to all material — ae submitted for discussion at the meetings, the supplemental material, » and all other official documents, including the agenda. 2/For the recard, it ds vetoed that morhors ahsent thosselves from the respective institutions, or (b) in which a conflict of interest might ie occur. This procedure does not, of course, apply to en bloc actions--. ene . meee ean AR anntdinantaan te undar indiavaicial diecnecaian. Til. IV. 2 The following new Commissioned Officers and new RMPS staff members were then introduced: "Commissioned Officers Elvin, E. ‘Adams, M.D. Martin A. Greenfield, M.D. James I, Cleeman, M.D. Kenneth E. Joslyn, M.D. Paul E. Cohart, M.D. Michael A. Newman, M.D. Jeffrey B. Crandal, M.D. Daniel Nemzer Alan Kaplan, N.D. New ‘Staff Members Charles Barnes Mrs. Glinter Johnson Richard Clanton Mrs. Nancy McGuire Mrs. Shirley Fairley Roger Miller John Farrell, M.D. Spero Moutsatsos . Robert. Handy, Ph.D. ' Jeffrey A. Passer Calvin Jackson . Roland Williams ANNOUNCEMENTS Dr. Margulies made general announcements, and called attention to the statement on “conflicts of interest" in the information folder. CONFIRMATION OF FUTURE MEETING DATES The Council reaffirmed the following dates for future meetings: November 9-10, 1971 February 8-9, 1972 Council then set the following subsequent meeting dates: May 9-10, 1972 August 15-16, 1972 CONSIDERATION OF MINUTES OF THE MAY 11-12, 197, MEETING The Council considered and “approved the minutes of the May 11-12, 1971 meeting with the following changes: . 1. South Carolina Project #43, "A Regional Program for the Improved Therapeutic Management of Hypertension for South Carolina." | The record should show that the renal disease panel recommended — disapproval and that the Council concurred. . 2. The addition to the minutes of a resolution concerning funds placed in reserve which was adopted in Executive Session at the VI. 3 Council Meeting of February 3, 1971 with a-request that it be transmitted to the Secretary. The full text of the resolution and the copies of the appropriate erensmittad memorandum are appended as Attachment A. REPORT BY DR. MARGULTES Meeting with the Secretary Dr. Margulies, several Council members, Coordinators, and others interested in Regional Medical Programs, met with the Secretary on May 24th. The meeting had the effect of correcting some prior misconceptions about RMP. The meeting served to identify all the strengths which characterized Regional Medical Programs. During the meeting, strong support was elicited from the Secretary's professional staff, and the Secretary himself indicated that in the future RMP will be a key element in devel- oping mechanisms such as HMO's through which the Department . will carry out new initiatives. Hearing and Appropriations Both the Senate and the House have reported out marked increases in funds for Fiscal Year 1972. The House would add $30 million, and the Senate $70 million to the amount requested. In. addition to this, $10 million supplementary appropriation for FY 1971 increases the amount held in reserve for FY 1972, The marked increases plus the larger reserve indicate that greater amounts may possibly be available for grants in FY 1972. During recent Senate appropriation hearings, the Chairman expressed his determination that budget procedures would not’ block expenditure of all monies appropriated. In response to questions concerning the possible use of Section 910, it was pointed out that Section 910 has not been implemented in the past because of restricted availability of funds. Use of this authority might have been misunderstood as a signal that additional funds were available. If additional funds become available, however, RMPS will consider using the Section 910) authority. First consideration would be given to allocation of aoe additional funds to strong RMP's that have been hurt by cuts in ‘the past. Area Health Education Centers The Congress is considering two proposals relating to Area Health Education Centers. The Administration's Bill which has passed ‘Br. piidiixen. . 4 the House would place Arca Health Education Centers in NIH. The other would place AHEC's in RMPS. The Senate and House Bills are still in conference and it is still] not certain whether Arca Health Education Centers will go to NIH or RMPS. The House Bill which makes NIH responsible, requires that any Arca Health Education Center be developed in cooperation with a Regional Medical Program, so in any event, RMP will have extensive involvement. In view of this RMPS has developed a very close working relationship with the Bureau of Health Manpower. The two organizations have been working well together, have a good understanding of what needs to be done, and will be able to cooperate effectively. Veteran's Administration has also exhibited a high level of interest in Area Health Education Centers. The VA in’ cooper- ation with RMP and NIH has mounted a series of site visits to. examine the potentialities for establishing Area Health Education Centers which would include an investment and involvement on the part of the VA. These visits have been conducted in areas having inadequate medical services, where good working relation- ships. are already established with Regional Medical Programs. The VA has made it quite clear that RMP relationships would | be very desirable, if not essential in all cases. Dr. Margulies asked Mr. Friedlander to comment on the VA's interest in AHEC's. Mr. Friedlander indicated that only those’ communities would be funded through VA where activities have a direct relationship to improved quality of care. VA funding would provide initial support which an Area Health Education Center would be expected to pick up once legislation has passed . and funds have been appropriated. Equal Employment Opportunity Progress Report The Regional Medical Programs Service has developed a very strong Equal Employment Opportunity program. The Service has an EEO Council made up of RMPS employees which meets weekly. RMPS has established definite goals and targets for employment of | us minorities and women by-January 1972. RMPS expects similar EEO _ efforts to be undertaken by grantees and affiliates. Report on Orientation Sessions - August 2, 1971 An orientation session for new Council members was held on August 2, 1971. The staff discussed the general purposes, organizational structure and history of Regional Medical Programs. The kinds of matters that come before the Council were also discussed? = The session was. att Ch Ln pepe Phy To Ute yest { ii go Llb we BT dial aog 6a 2K ended by Mrs. Wyckoff, | ee HMO's - Progress Report Regional Medical Programs throughout the country have developed an intense interest in Health Maintenance Organizations. RMP has been assigned two specific responsibilities in relation to HMO's. These are (1) to set up guidelines for monitoring the quality of care and (2) to describe for monitoring or for guide- Jine purposes what is meant by "health maintenance.'' These assignments are an outgrowth of increased awareness of the need for a more satisfactory method of determining whether or not quality of care being provided and paid for with Federal or non-Federal funds is indeed adequate. Many units of the Federal government have been dealing with these and other issues relating to quality of care. RMPS is. consequently working with other HSMHA units, NIH and Social Security to gain the benefit of their experience. : In addition, RMP is setting up some meetings with coordinators and other individuals who are concerned with measuring and monitoring the quality of care. We will also be calling on members of the Council to contribute their thinking and special skills in relation to quality of care issues. , Present Status of Section 907 Section 907 of the Act requires that the Secretary annually publish a list of hospitals which possess the most advanced scientific techniques for dealing with heart disease, cancer, stroke, kidney and related diseases. Recent Congressional interest in Section 907 makes it highly undesirable not to proceed immediately with the preparation of the required list and RMP intends to do so. The list will not attempt to be all- inclusive or to include all institutions where limited services are provided, but rather to List those institutions which demonstrate really superior and advanced performance. The list will be carefully selective and will be designed around criteria which have been derived from contracts to set up guidelines for cancer, | heart disease and stroke, and some other information which has already been assembled in the Kidney Disease Program to identify institutions which would appropriately be included. The list will be compiled on the basis of a voluntary response a to a survey of hospitals throughout the country. The list would | identify those hospitals having characteristics associated wo with special quality. There would be no sense of. accreditation _ or regulation, nor would a sense of approval or disapproval be involved. The list will constitute a selection derived from oo TE opera Teé pievee ere Fade kg KER fe aot hes a3 veut . acer gaa BR core O74 Tine con the cetera 6 Secretary's decision, presumably be available to physicians and to the public in general and would provide information about where certain levels of medical care are available. There has been some question in the past as to whether the - creation of such lists is a feasible endeavor, which has.been . -..- one of the reasons for failing to proceed wore rapidly with this activity. = General discussion followed, but no action was taken, VIT. REMARKS BY MR. BENNY BOB HALL, DEPUTY ADMINISTRATOR, HEALTH SERVICES AND MENTAL HEALTH ADMINISTRATION : Mr. Hall, representing Dr. Wilson who was unable to attend greeted the Council and read a prepared statement concerning the creation — of a better health care system through the application of technolo- gical development to the health field. The discussion which followed Sndicated that the Council and the health field generally have long been aware of the potentialities of computer technology and fallout from the Aerospace program in the provision of health care. A a number of Council members, however, strongly indicated that sub- © ‘ stantial additional funds would be needed to turn the interest into practical results. Mr. Hall also discussed impending changes in the organization of the HSMHA Administrator's Office and indicated the likelihood that in the near future a number of programs would be grouped under four . | Deputy Administrators rather than reporting directly to Dr. Wilson... “VIII. SPECIAL REPORTS A. RMPS Reorganization Dr. Pahl briefly outlined the current status of reorganization within the Regional Medical Programs Service. The reorganization is currently underway and it will probably be early September before all branches are able to get together and interact appropriately. The reorganization will restructure the way in which RMPS inter- acts with the individual Regional Medical Programs. Four operational branches have been established on a geographical | basis. These, together with the Grants Management and Grants Review Branches constitute the new Division of Operations headed __ cue by Mr. Robert Chambliss. Four Operations Branches have been set 6 up on a geographic basis. Teams of professional and supporting . ff 4 a 7 ye Vay : ata y vs each of these, and additional: Aenean ancy va a £ 7 individuals in other divisions and offices, such as Planning and Evaluation and Professional and Technical Development have been identified to serve as joint appointees with the Operations Branches. = . | Review Criteria Dr. Pahl and Mr. Peterson discussed the new RMPS review criteria and rating system. The review criteria and rating system were developed by staff and employed for the first time by the RMPS Review Committee as its July 1971 meeting. The criteria were derived from the RMPS "Mission Statement.'' Each criterion was weighted, and a 1 through 5 scoring system was employed for each. Reviewers were asked to circle the score for any criterion about which they were uncertain. In addition, the rating sheets included a place for each reviewer to indicate the basis for his evaluation. The reviewers appeared to feel comfortable with the overall process in which they had engaged. Members of the Review Com- mittee felt that the 17 criteria were comprehensive and that the sub-criteria raised in the form of questions were, in fact, useful in helping them to channel their thoughts. Some modi- fications and improvements were suggested, however. As a result of this initial experience, plans are underway to oe rearrange and clarify a mmber of the criteria and to provide more | adequate information about certain items with a view to increasing - the reviewers confidence in their ratings. ee In general the initial trial indicates that. the criteria and ‘rating system are both workable and satisfactory. Council, Review Committee and Staff Responsibilities for Grants Dr. Margulies-read to the Council the material under VIII, C.. in. the Agenda Book entitled "Review Responsibilities Under the Triennial Review System." It was moved by Dr. Millikan and seconded by Dr. Roth that this statement be formally adopted. — Le The motion was approved unanimously. The full text of the state- hd ment is appended as Attachment B. ca Watts-Willowbrook ‘Dr. Margulies introduced Dr. Alfred M. Haynes, Chairman, Department _ “of Community Medicine and Assistant Dean for Conmunity Health 7 Zagfairs, Charles R. Drew Postgraduate Medical School, Los Angeles, &, California. 8 Dr. Haynes narrated a slide presentation on the Watts-Willow- brook project which involves the concerted efforts of the Martin Luther King, Jr. Memorial Hospital and the new Charles R. Drew Postgraduate Medical School as well as other com- . "munity agencies. These organizations have combined in a concerted effort to establish a health service center in the “Watts area to provide quality care to the residents. The project is organized in such a manner that service to the commmnity is regarded as equally, and perhaps more important, than educational and research activities. . Status of RMPS Regulations Mr, Kenneth Baum summarized the status of efforts to revise RMP policies and Regulations. The HEW General Counsel's Office has advised RMPS to completely rewrite the Program's Regulations to reflect the most recent changes in the Statute as well as new operational procedures. ~ The General Counsel's Office is developing an initial draft of such Regulations in cooperation with RMPS. Considerable progress has also been made in developing a loose leaf policy manual for the use of grantees, affiliates and RMPS staff. Departmental, HSMHA and RMP policies have been assembled for inclusion, however, considerable editorial work still remains to be done. Computer Assisted EKG Analysis Dr. John Farrell and Dr. Kenneth Gimble discussed a draft: report on the subject of computer assisted EKG analysis that was prepared at the request of the Council. © » Technologically fully operational EKG analysis requiring no further reading by a physician has not been achieved. Development of a fully avomated system of that level of sophistication is problematical. Computers have been accurately and reliably used for screening normal and abnormal EKG's with less than. 1 percent error. ~ mo The cost of automated EKG's is estimated at $2 to $4 per cardio- gram exclusive of the cost of rereading by a cardiologist and “assuming a minimum annual volume of input. Basic conclusions reached from the study were: (1) that computer - assisted EKG analysis an effective and reliable screening technique: (2) that definitive diaenosis must be done by a mee oe Sp ogy er n Thia worn OL & Curuicologisi, at icust in tne present state ok Ue arty | it camot replace him. ar OEE TE ne g Ix. EXECULIVE SESSTON ne reenact titel ene 4 During the Executive session there was a discussion of the status of efforts to conso’ ‘date three Ohio RMP's. In view of progress that has been made i: as proposed to permit these Regions to apply in February. It was also proposed that Council and other appropriate staff work with the Interim Committee and the Fiscal Agent. It was moved by Dr. Millikan and seconded by Dr. Komarof£ that the Council go on record as supporting this initial plan including the proviso that RPS begin to work directly with Ohio RMP's on a staff basis. The motion was adopted unanimously. Other items discusset “siaug the Executive Session included (1) the status of the Albany, Rochester and Central New York RMP's3 (2) the status of the Susquehanna Valley RMP, and (3) the possible separation of Delaware from the Greater Delaware Valley RMP. No action was taken on these matters. — REVIEW OF APPLICATIONS A. Hawaii Regional Medical Program Motion made by Dr. Millikan - Seconded by Dr. Ochsner "Approval of they ::ii application for one year funding at $1,072,000 plus <1: additional $30,000 with the strong recom- mendation that vuney be utilized for support of activities in the Trust region and with the additional advice as specified on page 1 of the Conmittee's report." (Transcript, page 20, line 20) . The motion was unanimously approved. B. Northern New England Regional Medical Program 7 Motion made by Dr. Millikan - Seconded by Dr. Schreiner Approve the recix.. - ‘dations of the Review Committee, including recording the s‘: -items of their critique, with these items to be kept strongly in mind when the triennial application is ultimately reviewed, and with advice that through strong admin- istrative leadership some of the real concepts of RMP should be included in the program. (Transcript, page 26, line. 3) ~The motion was wnanimously approved after .further discussion which suggested “:.°. the Region might profitably examine goals and objectives devé.eped by other RMP's and develop a plan for use of collected data. ~ me 10 Texas Regional Medical Program * Motion made by Dr. Everist - Seconded by Mr. Friedlander " "Approval for two years at a funding level of $1,590,000 including the developmental funding." (Transcript, page 29, line 25) The motion was unanimously approved. Virginia Regional Medical Program Motion made by Dr. DeBakey - Seconded by Dr. Everist . Concurrence with the Comittee's recommendation with the proviso that if the site visit should indicate a need for additional funds, the request will be brought back before the Council, (Transcript, page 36, line 5) The motion was unanimously approved. In subsequent discussion, it was agreed that there would be appropriate representation from staff and the Kidmey Disease Panel on the site visit. Bi-State Regional Medical Program Motion made by Dr. Ochsner - Seconded by Dr. DeBakey Concur with what the Review Committce recommended, that there be an additional year instead of the three years requested, and that this be in the amount of $924,113, and further con- currence with the Committee's disapproval. of the developmental -component and the other funding relative to the project. (Transcript, page 37, line 16) The motion was unanimously approved. Georgia Regional-Medical Program Motion made by Dr. Cannon - Seconded by Dr. Millikan Approval in the amount of $2.9 million for each of the first two years and $1.9 million plus the requested amount for project 39 for the third year, the exact amount to be determined, by staff on the basis of the intent of Council. In addition, the Council concurs in the recommendations of the site visitors with respect to the non-funding of specifically identified | projects with the exception of kidney and the Stephens County yrotect (Transcwi st nner BI Tine 123 _ The motion was: unanimously approved. 1 Albany Regione ~~, odical Prosran Motion made by Mrs. Wyckoff - Seconded by Mr. Friedlander "Approval of the Review Committee's Recommendation that this project be funded for only one year more for $900,000." (Transcript, page 57, line 14) The motion was unanimously approved. Central New Yo. = “/ Londl Medical Program Motion made by Mr. Friedlander - Seconded by Dr. Cannon Approval for one year funding, contingent on a staff follow- up visit six months following the award of this application to evaluate the progress that's been made in meeting the conditions. (Transcript, page 61, line 15) The motion was unanimously approved. Rochester Regional Medical Program Motion made by 2%. Mc Phedran - Seconded by Mr. Milliken Approval of the Review Committee's recommendation of $800,000 and deferral of any action until the next Council,meeting on the kidney project. (Transcript page 63, line 24 and page 68, — line 15) ~ The motion was unanimously approved. Memphis Regional Medical Program* Motion made by Mrs. Wyckoff - Seconded by Mr. Milliken Approval of ti~ lcyiew Committee recommendation for a funding oe level $1,627,000 for each of three years, or a total of $4,950,000 plus approval of suggestions in the blue sheet with deletion — of the reference to Medical Association dues for project 39. (Transcript, page 76, line 7, and page 87, line 20) The motion wa:-umanimously approved. Michigan Regic: “i Medical Program _ Motion made by Dr. Mc Phedran - Seconded by Dr. Komaroff an at a te rego tars Patsy oP eag Tere] _dunding for 2:e fourth, Litt and sixth years for each year, ls 12 including the 1:.:2sted developmental component. (Transcript, _ page 104, line 16 and page 105, line 8) The motion was unanimously approved. Wisconsin Regional Medical Program Motion made by Dr. Roth - Seconded by Dr. Mc Phedran Approval. as recomnended by the Review Committee. (Transcript, page 106, line *- 0%; ‘The motion was unanimously approved. Maine Regional Medical Program Motion made by Dr. Hunt - Seconded by Dr. Komaroff "Accept the requested levels for the three years and bring. the Maine application before the Council again prior to funding the 05 year for Council reconsideration."' (Transcript, page lll, line 14) : : ae 4 Seve The motion was uncrimousiv syoreved, The motion was:*"animously approved. Metropolitan D.C. Regional Medical Program Motion made by Dr. Hunt - Seconded by Dr.. Ochsner - Defer action on the application. Hold a site visit attended by the Ad Hoc Renal Disease Panel, and also include attendance by the Chief of Medicine, the Chief Surgeon and the Chief Nephrologist of each of the applicant institutions. (Transcript, pele page 128, line 7) The motion was-..imously approved. New Mexico Regional Medical Program Motion made by Dr. Schreiner - Seconded by Mrs. Wyckoff Approval for $850,000. for one year as recommended by the Review Committee with:an additional $40,000. The additional funds are not earmarl:.”:;nd may be used for kidney or for other _ purposes at the-uiscretion of the Region. (Transcript, page is, line 12, and page i39,’line 1) © oe Cg Seg 4 @ os P, Tri-State Regional Me.* i Progyam Motion made by Dr. Roth - Seconded by Dr. Cannon “Approval of funding at the rate proposed on page 5 of the revised application." (Transcript, page 140, line 6) The motion was unanimously approved subsequent to some further discussion which indicated that progress on this project might provide some examples that could be used in Metropolitan D.C. © , Q. National Kidnéy Foundation: MOTOS Motion made by Dr. Cannon - Seconded by Dr. Roth Disapproval. (Transcript, page 144, line 17) 7 The motion was unanimously approved. R. California Regional Medical Program** © . Motion made by Dr. xen - Seconded by Dr. Komaroff | "Level funding for tis ‘ee years at $10,043,175 with exact amounts to be determined on the basis of negotiation by staff during that period, and for the sum to include the kidney project." (Transcript, page 16, line 17) The motion was unanimously approved. X. ADJOURNMENT The meeting was adjourned by Dr. Pahl at 1:20 p.m. on August, 1971. I hereby certify that, to the best of my knowledge, the foregoing minutes = and attachments are accurate and complete. Ly lh rate hig a lt Margulies, M.b. J 4,-. Director "Regional Medical Programs: Service 7 o oS “UY. otniCiues was HOU proscht during consideration of this application. ; Mrs. Wyckoff was not present during consideration of this application.» ALAA THON Page April 26, 1971 | coPy Resolution from the National Advisory Council on Regional Medical Programs Service . “Roger O. Egeberg, M.D. Assistant Secretary for Health and Scientific Affairs * Attached is a memo from the National Advisory Council for Regional Medical Programs which expresses their deep concern. It was issued without their having had a detailed chance to look at the report by the group of consultants. “I would hope that we would have a chance to discuss this. in the very >» near future. /s/ Vernon E. Wilson, M.D.. Administrator cc: Herbert B. Pahl, Ph.D. Harold Hargulies, M.D. i . : Page L 6 Lo a oe RESOLUTION ae . SUBJECT: UNAVAILABLLIVY OF THOSE PROGRAM NONTES WHICH WERE APPROPRIATED BY THE CONGRESS FOR FISCAL YEAR 1971 AND mHIcl SUBSEQUENTLY HAVE BEEN PLACED IN RESERVE - REQUESTS RECONSIDERATION. . “SS IcHHIEREAS: «The Regional Medical Programs Service was created and exists. : for the purposes of ¢1)- improving for all citizens access to and utilization of their local health care systems, and (2) _improving the quality and effectiveness of the health services ‘provided within regions, particularly with regard to cancer, stroke and diseases of the heart and kidney, and WHEREAS: ‘the Regional Medical Programs Service during the five years: of jts existence has established viable, local orpanizational networks among the major health care providers, and improved the number and quality of the linkages which now exist: between - _ these providers and the conswners who. comprise the several regions; and . 6 WHEREAS: For these disease categories the Regional Medical Programs ee Service was established to be a primary, functional arm of ‘the Department of Health, Education, and Welfare whereby the” - potential benefits which result from the nation's support of the biomedical research enterprise at the National Institutes of Nealth can be realized from practical. applications within communities; therefore be it RESOLVED: ‘That the National Advisory Council for Regional Medical Programs wishes to express to the Administrator, Health Services and Mental Health Administration, and to the Assistant Secretary . for Health and Scientific Affairs its deep concern that the . ae unavailability of those program monies which were appropriated ©: ot _ by the Congress for. fiscal year 1971 and which subsequently have | : ‘been placed in reserve will result in serious curtailment in oe - the momentum of the ovérall program in meeting its objectives - ~ and, therefore, requests reconsideration of this matter in oo terms of the Administrator's expressed national priorities, for , improving the health services and delivery system of the country; | and be it further . oe RESOLVED: ‘That as new systems for the delivery of health services to communities are devised and instituted, the: Council respectfully: submits that the Regional Medical Programs Service is the most. expediont fastrurs: te cecens nrovements,. Pn thre quolity of Cpe pees le ‘ one Prdate ob bin peed ner gin to: be Lhe principal program which interrelates all of. the: providers of health care within Conmun ities; and be it further - : , . AYVVACHMEND A 7 : - Page 3. “ . . . . -2- . RESOLVED: That in support of this request the Council assures. the , Administrator and the Assistant Secretary that specific effort will be made immediately and on a continuing basis to reinforce the liaison and collaborative efforts between the Regional Medical Programs Service and other Health Service and Mental - Health Administration programs as well as all relevant Institutes, and program elermssis of the National Institutes of Health in order that no op, citunity be overlooked for bringing to the regions with the greatest possible speed those medical research . advances which can form the basis for improving access to and ~ “the overall quality of the health care available to the people of these regions. . oe . ie . ur In.so doing the Council announces its intent to establish immediately for the Regional Medical Programs Service a set of sharpened program priorities as determined. in consultation - . with Health Services and Mental Health.Administration, the National Institutes of Health and other leaders in the field , of health. , Tee ; . . . < - . » ® ' con, ‘support: soe _ SALDLAUMDION:E D Page 1 ~ 4t ae “SYSTEM UNDER Under the trienni:<.:eview syster, each Pepional Nedical Program normally will be reviewed by the National. Advisory Council only once each three years. ‘The triennial review serves to recognize the Region as an “accredited” organization and to set a general level of annual support for the three year peried. Thus, the. Council's favorable recommendation constitutes a time limited approval for an PNP as én organization having recognized capabili-~ ties, rather than being approval for a specific set of activities. in addition to recommending the generet level of support, Council actions on individual oymlications mey include advice to the appli- cant Regional Heciin* * xram, or specific conditions for the grant. > S 1 By Prior to review by the Council, each triennial application will be reviewed by assigned KIPS staff, 2a site visit team and the THPS Review Committee. , . Except as specified below, the Director, RMNPS, will make continu- ation awards, including support for new activities, for second and third (02 and 03) year support without further Council action insofar as the preposed activities are consistent with relevant policies. The Council will be provided with a summary of such awards. Specifi-.. cally, the Council's advice will be sought when: 1. Supplenentri», funds are requested in addition Co the general support reitrmended for the year in question. 2. Anew or increased Developmental Component is requested, 3. .The Council, the Director, RMPS, or the Region requests Council review. 4, The appliccnt-has failed in a material respect to meet the requirements of the Program or applicable laws, regulations — ; or formally promulgated pelicies of the Department, HSA ‘ or RMPS. The summary to bee. sided to the Council will include the following information conce:,./u 5 each Regior revieved by staff. for continuation > . -J. The amount previously reccmmended by the Council for funding, and the amount avarded. , 2. A list of sctivities supported during the most recent grant year, ideniiiving those which have been completed and those which have “been supported throug ch a developmental component.. ee. ATTACHMENT B Page 2 - Do “A supncry of the Region's response to any advice specified by the Council or limitations upon or conditions of the award. A summary of any outstancing accompLlishnents. A summary of any outstancing problems. Annual reports from the Kegional Advisory Group and from IMPS staff. (These will be made available on zat request by the Council.) te Approved + National Advisory Council on Regional Medical Programs August 3, 1971 .. wee : “PaNDANC % LIST APPENDIX | Page Lo National Advisory Louncii on Regional Medical Programs Aug. COUNCIL MEMBERS. Pr. Bland W. Cannon Dr. Michael E. DeBakey Dr. Bruce W. Everist Dr. William R. Hunt Dr. Anthony L. Komaroti.3 Dr. Alexander M4. McPhedran ~ Dr. John P. Merrill Dr. Clark H. Millikan RMPS STAFF Dr. Elvin Adams Mr, Kenneth Raum Mr. Cleveland Chambilss Mr. Richard Clanton Dr. Janes Cleeman Dr. Paul Cohart Mr. Spencer Colburn Dr. Jef££F Crandal Mrs, Shirley Fairley ~~ Dr. John Farrell Mr. Gerald Gardell Mr. Terrence Genz Mr. Samuel] Gilmer Dr. Kenneth Gimbel Dr. Martin Greenfield *: Mrs. Eva Handal Dr. Robert Handy Mrs. Gloria Hicks Dr. Edward Hinman Mr. Calvin Jackson” - Mr. Jaseph Jewell ==” Mrs. Glinter Johnson Mr. Milton Jordan Dr. Kenneth Joslyn Dr. Alan Kaplan Dr. Philip Klieser Mrs. Lorraine Kyttle ; Miss Carol Larson neue. Dr. Marian Leach Dr. Harold Maraulies Dr. Gordon MacLeod Bio © Mr. Sewall. 0. Milliken Dr. Alton Ochsner Dr. Russell 8. Roth Dr. George E. Schreiner Mrs. Florence R. Wyckoff Dr. Benjamin W. Watkins Mr. Edward Friedlander Dr. Harold Marguliés Mr. Reger Miller Miss Marjorie Morrill Mr. Spero Moutsat’sos Miss Mary Murphy Mr. Frank Nash Miss Elsa Nelson Mr. Daniel Nemzer Dr. Michael Newman Dr. Herbert Pahl Mr. Roland Peterson Mr. Eugene Piatek Mr. Michael Posta Mr. Lawrence Pullen Miss Leah Resnick Mr. Morton Robins Mr. Richard Russell Mrs. Jessie Salazar Mr. Luther Says Miss Theresa Schoen Mrs: Patricia Schoeni Mr. Thomas Simonds Mrs. Judy Silsbee Mr. Matthew Spear Mr. Sidney Stein Mr. Jerone Stolov Mr. Willian Torbert Mre Lee Van Winkle Mr. Lyman: Van Nostrand Mrs Margaret Welsh Mr. Richard White Mr. Roland Williams SS RMPS REGIONAL OFFICE REPRESENTATIVES Mr. William Mc Kenna, Region I Mr. Robert Shaw, Region IT Mr. Clyde Couchman, Region III Mr. Theoda Griffith, Region IV OTHER Dr. Margaret Edwards, NCI Mr. Peter Fox, OMB Mr. Howard Hilton, NHSC Mrs. Frances Howard NIM ALCKUNWAA Page 2. — “My. Maurice Ryan, Reaion V Mr. Dale Robertson, Region VI: Mr. Daniel Webster, Region VITIT.:..- Mr. Ronald Currie, Region IX. o Mr. David Lovenvirth, Consultant | Miss Bettye Mobley, HSMHA Mr.. Carl Taylor, OMB a, NATIONAL ADVISORY COUNCIL ON REGIONAL MEDICAL PROGRAMS October 20, 1971 BRENNAN, Michacl J., M.D. (72) President, Michigan Cancer Foundation 4811 John R Street “ST Detroit, Michigan 48201 © ‘ CANNON, Bland W., M.D. (73) 910. Madison Avenue Memphis, Tennessee 38103 CROSBY, Edwin L., M.D. (71) Executive President American Hospital Association Chicago, Illinois 60611 DeBAKEY, Michael E., M.D. (72) President and Chief Executive Officer Baylor College of Medicine Houston, Texas 77025 EVERIST, Bruce W., M.D. (71) Chief of Pediatrics Green Clinic Ruston, Louisiana 71270 HINES, Mr. Harold H., Jr. Senior Vice President Marsh & McLennan, Inc. 231 South LaSalle Chicago, Illinois (74) 60604 HUNT, William R., M.D. (71) Commissioner oe County of Allegheny _ 101 Courthouse ~~ Pittsburgh, Pennsylvania 15219 KOMAROFF, Anthony L., M.D. (72) Beth Israel Hospital Boston, Massachusetts 02215 MARS, Mrs. Audrey M. (71) Mar Land The Plains, Virginia 22171 McPHEDRAN, Alexander M., M.D. (73) Emory University Clinic 1365 Clifton Road, N.E. Atlanta, Georgia 30322 MERRILL, John P., M.D. .(74) Professor of Medicine Harvard Medical School Cambridge, Massachusetts 02115 MILLIKAN, Clark H., M.D. (72) Consultant in Neurology Mayo Clinic Rochester, Minnesota 55902 MILLIKEN, Mr. Sewall 0. (73) Chief, Office of Comprehensive Health Planning Ohio Department of Health 450 East Town Street Columbus, Ohio 43216 OCHSNER, Alton, M.D. Ochsner Clinic 1514 Jefferson Highway New Orleans, Louisiana (73) 70121 OGDEN, Mr. C. Robert (74) President and General Counsel North Coast Life Insurance Company 1120 Paulsen’ Building Spokane, Washington 99201 ROTH, Russell B., M.D. (73) 240 West 41st Street Erie, Pennsylvania 16508 6 . . oo 2 = National Advisory Council on ; . Regional Medical Programs _ SCHREINER, George E., M.D. (74) Director, Division of Nephrology Georgetown University School of Medicine | Washington, D. C. 20007 WATKINS, Benjamin W., D.P.M. (73) “a 470 Lenox Avenue New York, New York 10037 WYCKOFF, Mrs. Florence R. (72) 243 Corralitos Road Watsonville, California 95076 EX OFFICIO MEMBER MUSSER, Mare J., M.D. Chief Medical Officer Veterans Administration Washington, D. C. 20420 @ CHALRMAN a : Vernon E. Wilson, M.D. Administrator Health Services and Mental Health Administration 5600 Fishers Lane Rockville, Maryland 20852 “IBS -CMO at