DEPARTMENT OF WEALTH, EDUCATION AND WELFARE A PUBLIC HEALIN SERVICE OV National Advisory Council on Regional Medical Programs : . . 7 Pe Minutes of the TIwenty~fifth Meeting l/ 2/ . bes "November 9-10, 1971 oo \ - The National Advisory Council on Regional Medical Programs convened for “sits twenty-fifth meeting at 8:30 a.m. on Tuesday, November 9, 1971, in “Conference Room G/H of the Parklawn Building, Reckville, Maryland. Dr. Harold Margulies, Director, Regional Medical Programs Service presided over the meeting. 4. The Council Members present were: ‘Dr, Bland W. Cannon Mr. Sewall 0. Milliken Di. Michael E. DeBakey : Dr. John P. Merrill Dr. Bruce W. Everist o ‘Dr. Alton: Ochsner’ Mr. Harold H. Hines “Dr. Russell B. Roth Dr. Anthony L. Komaroff Dr. George E. Schreiner Dr. Alexander M, McPhedran _ Dr. Benjamin W. Watkins Mrs. Audrey M. Mars Mrs. Florence R. Wyckoff Dr. Clark H. Millikan . Dr. Mare J. Musser Dr. Roth and Dr. Musser were present on: November 9, only. Dr. DeBakey - was present on November 10, only. Dr. Brennan was present beginning on the afternoon of November 9. 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 November 9 by Dr. Harold Margulies. Dr. Margulies called attention to the "Conflict of Interest" statement in the Council books. He then introduced two new Council members, Mrs. Audrey M. Mars and Mr. C. Robert Ogden, who were attending their first Council meeting. Dr. Margulies then introduced _ Dr. Vernon E. Wileon,.Aduinistrator, Health Services and Mental Health ‘Administration. | ~. ~ 7 ? , < 1/Proceedings of meetings are restricted unless cleared by the Office of the Administrator, HSMHA. The restriction relates to all material sub- mitted for discussion at the meetings, the supplemental material, and all other official documents, including the agenda. 2/For the record, it is noted that members absent themselves from the meeting when the Council is. discussing. applications: (a) from their resnective institutions. o7 (b) ta which a conflict of Interest might only when the application 2s under individual discussion. _ . | : : . : ~ aia vor : . chy $e oun haes : JI. REMARKS BY DR. VERNON E. WILSON The new organizational structure for HSMHA has been approved by the Department. Under this arrangement, the 15 HSMHA programs will be grouped under four Deputy Administrators. RMPS will be under the -Deputy Administrator for Development, Mr. Gerald R. Riso. Mr. Riso's ‘4dnmediate Depyty will be Dr. Jack Brown. The Deputy Administrator for Development will be responsible for. . “See “change agent" type programs. In addition to RMPS, other programs ——~-=-~. grouped under the Deputy Administrator for Development: include: (1) Comprehensive Health Planning; (2) the National Center for Health Services Research and Development; (3) the Hill-Burton Hospital Construction Program; and (4) the Health Maintenance Organization Service. ‘Dr. Wilson next turned to the subject of improving the use of advisory groups. About two thousand people provided advice to HSMHA through Councils, Committees or consulting appointments. In order. to- improve the utilization of this resevoir of talent, HSMHA is trying to develop a “skills inventory." Staff is now developing a short questionaire designed to catalogue the skills, interests and availability of ad- visory group members and consultants. I£ HSMHA is able to establish the prospective skills inventory, it: will be able to utilize more , effectively the resevoir of consultative advice available to it, parti- _eularly as new "crash programs'' materialize. Next, Dr. Wilson discussed his participation ina White House study on the applications of technology. The study is under the direction of the Federal Council on Science and Technology, and it involves six different panels. These groups are charged with determining those - €Lelds in which technology can now make the greatest economic contri- butions. Each panel deals with a service area or industry which uses. much labor and little automation. Dr. Wilson, chairs a twelve-man panel on Health Services. The panel consists of outstanding individuals of National stature including, among others, representatives of the American Medical Association, the Veterans Administration, the Departments of Transportation and ’ - Defense, etc. It is expected that each of the personal services ori- _ ented Fields will make its own case for the advantages of technological investments in its particular area. The final report will probably identify those fields in which technological improvements will have the greatest economic impact. It will most likely identify those i fields which can make the best use of investments in technology rather i - than how technology can be applied in each field - health, housing con~ struction, etc. — Lo) oa Ill. 3 Personal service oriented activities tend to become self-defeating un- less provided with a certain amount ‘of technological assistance. At present, 20 percent of the Nation is underserved in relation to health services and promiged improvement cannot be made without appropriate technological assistance. . There are a great many places, Dr. Wilson stated, where without at all interfering with the position of the pro- fessional-patient interface, we can still do things a lot more effec- tively. Dr. Wilson indicated that he had some “considerable fecling" | that in the future there will be a substantial investment in the field of technological improvement. He asked the Council to keep this in mind when considering opportunities for sponsoring new activities through RMP. “ REMARKS BY MR: GERALD R. RISO Mr. Riso indicated’ that he had only been with HSNHA for a few weeks. He outlined a number of matters, however, which are expected to command his special attention during the next several months... These include (1) improving HSMHA's ability to identify health care needs; (2) de- veloping better relationships among research activities within HSMHA; (3) identifying health delivery practices of significant value; (4) pro- moting the introduction and practical application of such practices; and (5) promoting relationships between HSMHA programs. Very great interest in HMOs has developed as a result of the Department's efforts in this area. A very practical and pragmatic approach will be taken with respect to providing assistance and stimulating HMO develop- ment. Among other things, an attempt is being made to correct several widely held misconceptions about. HMOs. First, there is and will be no element of .compulsion in HMOs. Second, HMOs are not intended to be a substitute for health insurance, and third, the responsibilities of HMOs will not actually be as broad as ‘the term "health maintenance" would seem to imply. . Lae oe . « "While the Government does not ‘have the ability to respond to every ex~ - pression of interest in developing an HMO, HSMHA is in a position to provide modest financial assistance to some HMO developers. It is pre- _pared to provide advice to developers concerning (1) whether they should proceed further (2) reevaluate what they already have done, or (3) desist fron their efforts to organize an HMO. - a The Department does not contemplate insuring continued operation of all. HMOs. Some are expected to fail and we will learn from their experiences. 4 it is the Department's intentions to syphon off those groups which should not be encouraged, to encourage those which show truly good propects, and to improve those which appear to have good prospects, put marginal performance. At the present stages of HMO develop- ment, it is expected that a number of HNO's currently in the plan- ning and development stage will reach a decision within the next six months on whether or not to proceed further. . The initial grants and contracts for planning and developing HMOs -. “=< sOwere made between May and July 1971. A second round of applications was submitted in July. Awards on the basis of these applications are expected to be made before the end of the calendar year. Two more application cycles are planned prior to the close of the fiscal year in June 1973. fhe original set of grants and contracts made between Nay and July of this year are currently being examined in relation to geographic spread and types of sponsorship, and this will have some effect on the future pattern of awards. : The average planning grant for HMOs has been $100,000 to $150,000. In the future some more modest grants in the neighborhood of $25,000 to $50,000 will be made to prospective Hi0 developers to explore + whether they should proceed further. Some of these smaller-grants will probably go to rural areas. At the close of his presentation, Mr. Riso made the following points in response to questions raised by various members of the Council: 1. The definition of the quality of care within the confines of the HMOs is the responsibility of the RMP Program. 12: HSMHA has not developed an "ABC of eligibility" which might be , - a good idea, but, if there are churches or other small groups which would like to be involved in HMO and have questions -con- ' - cerning their eligibility, they should contact the HMO program Director within the appropriate HEW Regional Office. 3. Funding levels for the November HMO review cycle will be modest and the magnitude of activity in the February and June review will be determined by legislation, and the geographic and spon- sorship pattern that evolves from earlier awards. , IV. ANNOUNCEMENTS ‘A. Appointment of Dr. Hinman Ge Dr. Nargulies introduced Dr. Edward J. Hinman, the new Director ese} ” of the Division of Professional and Technical Development, RMPS. 5 tinguished career, most strikingly . Dr. Hinman has had a very dis lth Service Hospital in Baltimore. as Director of the Public Hea B. Loss of Dr. Klieger .Dr. Margulies next announced the sudden passing of Dr. Phillip Klieger, who for many years has been part of the Regional Medical Programs Service. Dr. Klieger most recently served as Chief of the Office of Committee and Council Affairs. The condolence of~ RMPS has been expressed to Dr. Klieger's widow and his family. Responsibility for Committee and Council Affairs will now be -picked up by Mr. Kenneth Baum. V. CONFIRMATION OF FUTURE MEETING DATES - The Council reaffirmed the following dates for future meetings February 8-9, 1972 May 9-10, 1972 Council then set the following subsequent meeting date: , . . August 15-16, 1972 indicated that con- For the information of the Council, Dr. Margulies g the number of Council sideration was being given fo the idea of reducin meetings to 3 a year, rather than 4, VI. CONSIDERATION OF MINUTES OF THE AUGUST 3-4, 1971, MEETING considered and approved the minutes of the August 3-4, 1972 ‘The Council meeting. SOL SI FORA i Be Lu ENP ee Te Rec pe Rattan ange seer am arenes oe VIL. REPORT BY DR. MARGULIES A. . RMP National Meeting in January, 1972 There will be a National Meeting of Coordinators in St. Louis on January 17-20, 1972. Members of the Council will be invited to attend. The Conference will cover a number of topics about which there is a High level of interest such as? Area Health Education ~ Centers, Health Maintenance Organizations and improved utilization of health manpower. RMPS Reorgania: toa The RMPS reorganization previously announced to the Council has been put into’effect and the geographic operations desks have in fact, been put into action. Status of Revised RMPS Regulations RMPS has for some time been developing an updating of the Regula- tions for the program. Some new material has been prepared in draft by the Office of the General Counsel. The Council will have the opportunity tis. -.iy and make recommendations on any proposed new Regulations. - Among other things, the Regulations being developed will deal with some issues which have been troublesome, particularly the proper relationships between the grantee agency, Regional Advisory Group, Coordinator end core staff. These have now been defined with some clarity, but as with all regulations there will remain room for in- terpretation which is going to be the responsibility over time of the Council. Participation of Minorities and Women _on Advisory Groups The Departmer*-2as expressed a desire to increase the participa- tion of women on advisory groups and it is anticipated that the two ladies presently on the Council will be joined by others as the present vacancies are filled. Some reflection of the RMPS's hope to create a better balance in terms of minority membership and the balance between the sexes can be seen in the present make-up of the Review Committee. This . group is now at full strength and new members include: Miss Dorothy E. Anderson, Assistant Coordinator, Area v, California ; Dr. Gladys Anerum, Executive Director, Community Health Board, Seattle : ~~ Mr. Willian J. Hilton,~Director, Illinois State Scholarship Commission, Chicago , Dr. William G. Thurman, Professor and Chairman, Department of Pediatrics, University. of Virginia, Charlottsville, Virginia Mr. Robert E. Toomey, Director, Greenville Hospital Systen, Greenville, South Carolina 7 E. Current Status ef Area Health Education’ Center There appear to’ be three possible developments with respect to area health education centers: (1) that there will be no legis- lation; (2) that the primary responsibility for AHECs will be placed in the National Institutes of Health; or (3) that the - primary responsibility for AHECs will be placed in RMPS. ‘The Regional Medical Program legislation contains all of the necessary authority for AHEC development. Regardless of the =. legislative outcome, it is quite clear that RMP will be in- . volved with AH®¢---nd in any event, will be working closely with the Burea..;Health Manpower Education at NIH, and the Veterans Administration. There appear to be two concepts of Area Health Education Centers: (1) an expansion of the activity revolving around a university health science center, and (2) a community based activity pro- viding service with educational activities playing an essential but not dominating role. The second model in which the certifi- cate, diploma or degree is subordinate to the service performed has the best chance of becoming a viable and effective institu- tion. De. Endicott, {:izector of the Bureau Health Manpower Education ! : ‘ at NIH, does vt believe that AHECs should be a mere extension of the university health science center or a satellite thereof. RMPS and NIH will be working on AHEC in any event, and there is no significant difference in their respective goals. F. Status of Section 907 Section 907 is that part of public law 91-515 which requires RMPS * to develop a list of hospitals that can provide the most recent advances in the treatment of heart disease, cancer, stroke, and kidney disease. The Guidelines for heart disease, cancer and stroke have been produced under contract previously. These t either provic:: us serve as a basis for developing the appropriate institutional -. . Rochester Motion made by Dr. Schreiner - Seconded by Dr. Merrill Approve Project 21, but with negotiation by “sta£f on the basis of Council discussions. (Transcript page 91, line 17, November 10.) The motion was unanimously approved. . 18 SEATTLE CANCER CENTER The Council adopted a resolution concerning the propésed "Seattle Cancer Center." A copy of the resolution, as edited for dis- tribution, is attached. ADJOURNMENT The meeting was ‘djourned by Dr. Pahl at 11:55 a.m. on Novenber 10, 1971. . ’ I hereby certify that, to the best of my:.knowledge, the foregoing minutes and attachments are accurate and complete. Harold Margulies ,‘\M.D. Director Regional Medical Programs Service oy . . “ , : 4 ‘ i ‘ « STATEMENT BY NATIONAL ADVIS ONY COUNCIL ON REGIONAL MEDICAL PROGRAM ON CANCER COSTER TO SERVE HEY REGION X . (Novenber 10, 1971) e- The National Advisory Council on Regional Medical Programs recommends us the following principles to povern the program of a Cancer Center to be located in a major medical center in the area served by HEY Region X, for the construction of which $5 million has already been appropriated. 1. QThe center, to insure its perpetuity and achieve its ultimate, objectives, should have organizational relationshivs with a University Health Science Center and other medical educational, training and research facilities in HEW Region X, , 2. The Center should have adequate agreements with the granteé concerning accoun lability for program, facilities and equipment and, in addition, iaseena arrange for liaison and coordination with the Regional ? tedical Prograns in its entire area and with the CHP (a) and (>) agencies in the various States in Region X. ; ‘3. The Center should provide optimun care to patients with neoplasti ic diseases who are accepted into the Center and should assure that Giag..osis research, and treatment are determined through a coordinated nultidiscipiinary approach and that record~keeping and patient follev-un are ex mplary. 4, The Cences should be recogni. 22 as regional cooperative cancer center rather than the cing’ 2 rosé important institution in its field, and every effort should be made to insure adequate regional representation at the Center , 5 5. The Center should provide care to patients in the most humane manner possible with consideration of psychological and’ sociological problems, including errangements for housing the parents or relatives of patients who come from remote areas. . 6. The Center should assure communication, interaction, and cooperation “yith existing cancer r ae presran3, medical services, and . nospitals in the region and with the voluntary societies interested . in cancer, It should be able to focus on the problems of cancer ~ ‘research and cancer treatment all the relevant resources of the advanced technological community of the northwest region of the United States. 7. The Center should provide opportunity for education in the optinal care of cancer patients for medical students, residents , fellows, practicing physicians, and ; allied health personnel From througho nut turn we ’ ee NGs es eas | 2 The Center should have: (a) a Board of Directors which includes recognized leaders in the field of cancer in the area; (b) a Regicnal Cancer Council comprised of representatives from the various institutions and interests involved from throughout Region X which will promote regional cooperative arrangements; (c) a Scientific Comaittee which will coordinate cancer research, demonstration, training, and service; (d) an Advisory Comnittee of nationally and internationally recognized authorities in this field to provide seriodic review and consultation with respect to the efforts sponsored by the Center. The Center should provide reasonable assurance that there is an effective mechanism to provide the funds to maintain and operate the Center at the high level of administrative and professional competence appropriate to its designation as a major regional facility for cancer research and clinical management. * : . ATTENDANCL AT THE: NATIONAL ADVISORY COUNCIL MEETING November 9-10, 1971 RMPS REPRESENTATIVES IN RMPS_ STAFF . . REGIONAL OFFICES Mr. Charles D. Barnes Mr. William A. McKenna ‘Region I Mr. Kenneth Baum Mr. Robert Shaw Region II Dr. Edward T. Blomquist Mr. Clyde L. Couchman Region III Mr. Cleveland R. Chambliss Mr. T. H. Griffith Region IV Miss Cecilia C. Conrath _ Mr. Maurice C. Ryan Region V Sa Mr. Thomas C. Croft, Jr. Mr. 0. D. Robertson — Region VI Sar. Roy Davis Mr. C. R. Maddox Region VII ‘ pr. John Farrell Mr. Daniel P. Webster Region VIII Mr. Gerald T. Gardell Mr. Ronald S. Currie Region IX Mr. Samuel O, Gilmer, Jr. " -Mr. D. R, Hutchinson, Region X Mrs. Eva Handal Office of Comprehensive Mrs. Gloria Hicks — Health Planning Mr. Charles Hilsenroth Dr. Edward J. Hinman OTHERS ATTENDING Mr. Frank Ichniowski Mrs. Lorraine Kyttle Dr. Margaret H. Edwards, NCI-NIH Miss Carol M. Larsen Mrs. Frances Howard, NLM-NIH Dr. Harold Margulies . Mr. Gerald R. Riso, Special Mr. Roger Miller Assistant to Administrator, HSMHA Mr. Ted C. Moore Dr. Vernon E. Wilson, Administrator, HSMHA Miss Marjorie Morrill Miss Elsa J. Nelson Mr. Joseph Ott Dr. Herbert B. Pahl Mr. Roland L. Peterson Mr. Eugene Piatek Mr. Michael Posta Mr. Lawrence Pullen Miss Leah Resnick Mr. Richard Russell Mrs. Jessie Salazar Mrs. Patricia Q. Schoeni Mrs. Sarah J, Silsbee Dr. Margaret H. Sloan. Mr. James Smith Mr. Jerome J. Stolov Mr. Lee E. Van Winkle ~ Mr. Frank Zizlavsky 2) Ionian pe he Ange an eprint ean: ema etme mentee NATIONAL ADVISORY COUNCIL, ON REGIONAL MEDICAL PROGRAMS October 20, 1971 BRENNAN, Michael J., M.D. (72) President, Michigan Cancer Foundation 4811 John R Street Detroit, Michigan 468201 -. 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. (74) Senior Vice President Marsh & McLennan, Inc. 231 South LaSalle Chicago, Illinois 60604 HUNT, William R., M.D. (71) Commissioner . 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) Marland 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, Glark 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. (73) Ochsner Clinic 1514 Jefferson Highway New Orleans, Louisiana 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 or 2 National Adviso.y 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) 470 Lenox Avenue vO New York, New York 10037 4h, x, —_—_——_ . “—~SWYCKOFF, 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 CHAIRMAN Vernon E. Wilson, M.D. ‘ , Administrator Health Services and Mental Health Administration 5600 Fishers Lane . Rockville, Maryland 20852 RMPS -CMO