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VOL. Vill, NO. 3

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HSA APPLICATION SUBMITTED

RAG Observations on
HSA Document

The Lakes Area Regional Medical
Program, Inc. Regional Advisory Group
provided formal endorsement of the
Grant Application for provisional
designation as a Health Systems Agen-
cy. This document was prepared by
conjoined staffs of RMP, CHP and coun-
ty governments. It was the sense of the
committee that a positive stance be
taken on the document submitted, but
at the same time acknowledging
problems and deficiencies which are in-
herently the product of time constraints
placed upon the process.

The criteria for judgment and the
ranking given are appended to this
report and provide the framework for
the discussion. It was decided that an
inventory of the problems currently
identified should be used by the various
committees established to improve the
substance of the document as it relates
to by-laws, staff structure, funds and
other categorical items. The following
specific observations were placed on
record:

(1) The constraints placed upon us
between October 16, 1975 and January
19, 1976 did not take into account the
inertia of the community decision-
making process.

(2) The foregoing hindered the pre-
education process, which was felt
necessary for informed decisions.

(3) The By-Laws Committee should
make careful revision on the means
whereby funds should be endorsed and
disbursed; an acceptable system of
checks and balances — both fiscal and
legal.

(4) Article Ill, Section 10, page 32 —
the question of dropping a board
member “without cause” was seen as
problematic terminology and lent a feel-
ing of insecurity to those appointed to
the governing body. The interpretation
was that a member of the board who
goes through a lengthy and detailed
election process shall remain vulnerabie
to summary dismissal. (continued on page 2)

 

weet ME sos
Dr. Bronk signs approval for HSA/WNY.

Grants Management
Function

The Lakes Area Regional Medical
Program, Inc., the corporate body for
the Regional Medical Program, is plan-
ning to remain in operation as a fiscal
service to the community.

The fiscal organization was created as
of March 1, 1972 to offset the high rate
of overhead (58% of salaries and wages)
charged by the Research Foundation of
the State University of New York. It is
estimated that RMP will have saved by
June 30, 1976, approximately $900,000.
This represents the fee which would
have been paid to the Research Foun-
dation less the comparable costs of per-
forming the same functions as an in-
dependent corporation.

in addition to the savings LARMP,
inc. provided nearly instant response to
questions posed by Staff Administrators
and project personnel. Delays en-
countered at the Research Foundation
in placing employees on the payroll (six
weeks was not an unusual delay for the
first paycheck} melted overnight. Part-
time employees are paid within a week
of submitting their timesheets.

In areas of purchasing, LARMP, Inc.
provides the same care as the Research
Foundation. Purchase requests are com-

pared to the project budgets to insure
(continued on page 3)

Lakes Area Regional Medical Program

MARCH, 1976

Fiscal Board
Registers Concern

February 20, 1976
Nicholas J. Galluzzi, M.D.
Regional Health Administrator
Public Health Service, Region Il
Office of Grants and Contracts
26 Federal Plaza
New York, New York 10007

Dear Dr. Galluzzi:

The Fiscal Board of the Lakes Area
Regional Medical Program, Inc. wishes
to go on record as approving the
regulatory and planning component of
the Health Systems Agency Application.

We wish to register the following con-
cern. There should be no dismantling of
the developmental process (irrespective
of label or aegis) as a result of this deci-
sion. The community of consumers
should be fully apprised of the fact that
support in developing health services
and education under the current legisla-
tion cannot be expected.

Funds to fulfill this function, namely
DEVELOPMENT of health resources are
crucial to capitalize on past and present
efforts which are the products of a
mature and established community
planning and implementation process.
The capacity to initiate self-supporting
projects in the health service area is be-
ing eliminated.

Please see attached booklet —
“Challenge and Achievement” which
provides an index of the deprivation in-
herent in the lack of developmental

money.
¥ Sincerely,

Allan Korn, Ph.D.
Chairman of the L.A.R.M.P.,
inc. Fiscal Board

 

 

Annual General Meeting
Saturday, April 24, 1976

Dr. Theodore T. Bronk, President,
Lakes Area Regional Medical Program
Regional Advisory Group, has an-
nounced that the last Annual General
Meeting of RAG will be held on Satur-
day, April 24, 1976.

The exact location will be announced.

 

 
_ Lakes Area Regional Medical Program
: Continuing Education Programs—1976

DATE LOCATION
March 18. . Sheraton East,
es “Buffalo, New York
‘March 27.. Sheraton East,
2 Buffalo, New York
April, 6 Sheraton East,
Buffalo, New York
April 29 Holiday Inn,
Batavia, New York
May -4 Cameo Restaurant,
Wellsville, New York
May 12 Sheraton East,
Buffalo, New York
s~May 19 Sheraton East,
Buffalo, New York
“May, 1976. Niagara Falls

Spring, 1976: Buffalo, New York

TOPIC

Cancer Teaching Day
Mammography and Xeroradiography

“Living with Hemophilia—
Comprehensive Care”
Genetics Program

Cancer Teaching Day
Chemotherapy and immunotherapy

Cancer. Teaching Day: Adjunct
Therapy in Various Forms of Cancer

Health Education Program

Aging Program

Hypertension Program
Hypertension Program

if interested in attending any of these programs, call
Mrs. Patricia Hoff, .A.N., at 835-0728

RAG Observatlons on HSA
(continued from page 1}

(5) The advice to the legislative
leaders was routinely from the existing
power structure and not a broad-based
advisory process. This was seen as in-
herently a problem of the law and the
regulations thereto.

(6) The whole area of staffing creden-
tials in relation to function was seen as
important but should not be locked in
prior to the appointment of an Executive
Director. It was recognized that staff and
staffing procedures and obligations
would be susceptible to the constraints
on funding which currently appear to be
considerable.

(7) Criticism of the degree of com-
munity involvement and the support of
appropriate organizations and groups
seen necessary to the success of the
proposal re-enforced the comment of
an inadequate time-frame seen in Sec-
tion | of this report. It was, however,
seen vital that the document containing
the chronology of public education,
public meetings, etc. be taken into con-
sideration as a major effort to inform all
interested parties.

(8) The committee was informed that
the by-laws are still subject to refine-
ment by the By-Laws Committee. It was
recommended that:

(a) the deliberations of this committee
be brought to the by-laws committee,

(b) that the by-laws can be changed
much more easily before their formal
adoption by the designated board,

(c) the importance of the Nominating
Committee was emphasized.

(9) The activities to perform the
overall assessment of the document was
rated as good. However, there is no
emphasis on community education.
(The inadequate time-frame for con-

struction of the document was a recurr-
ing theme throughout the discussion). A
suggestion made, but not acted upon,
was that professional interdisciplinary
advisory committees be established to
assist the deliberations of the HSA
governing board. During general dis-
cussion the observation was made that
the advisors to the board and sub-area
councils need not be members of either
body.

(10) The consolidated reporting form
revealed that the benefits in relationship
to costs were assessed as average or
below by more than half the responders.

(11) It was agreed that constant
monitoring and evaluation was a crucial
component if we are to provide
evidence of responsible management of
the federal buck and to avoid duplica-
tion. It was suggested that the
sophisticated tools already developed
by the RMP be used in the future and
not reinvented during the coming
period. Current data collection
mechanisms should be carefully used to
portray cost effectiveness.

(12) Major concern was voiced about
the funds applied for and the fiscal
viability of the agency under construc-
tion. it was thought there was adequate
flexibility in the HSA/WNY structure to
provide for improvement and develop-
ment. This was seen particularly as a
feature in the ability of the Regional Ad-
visory Group to expand and change in
response to federal priorities and man-
dates.

(13) The committee agreed that great
reliance should be placed on the sub-
area councils. Furthermore, that the in-
dividual members of the sub-area coun-
cils should represent that council as a
body and not be the spokesmen for the
categorical group or profession with

(continued on page 4)

Plan to Continue

Educational Programs

The Lakes Area Regional Medica!
Program has developed a successful
approach to continuing education.
Programs are not only presented in the
metropolitan area but also offered in
strategic regional locations. This ap-
proach provides health workers with
quality programs within easy access.

We plan to continue educational
programs (teaching days) on a self-
support basis. Programs may be sup-
ported solely through registration fees
or through support by sponsoring agen-
cies.

Our continuing education component
has the expertise necessary to assist
private agencies who may wish to spon-
sor their own teaching days. Staff are
available to work with such groups in
the initial planning phase, assist with the
administration of the program and will
be available at the actual presentation of
the program. Interested agencies may
call LARMP, Inc. for more detailed infor-
mation. We will assume all major
responsibilities involved in the program
and guarantee a successful teaching-
day. Our record of service and previous
experience in conducting teaching days,
workshops and seminars for various
health related agencies and educational
groups will attest to the advantage of
our service.

Should you desire this support ser-
vice for your next educational program
contact Mrs. Patricia Hoff at 835-0728.

 

In
Memoriam

 

Joseph Reynolds

Last month, we were all shocked and
saddened at the untimely death of
Joseph Reynolds. Those of us familiar
with his industry, his enthusiasm for the
Telephone Lecture Network, his drive,
and the familiar beard, were all sadden-
ed by this event. For those of us who
knew Joe in many facets, his loss as a
friend and colleague cannot be un-
derstated.

The Regional Advisory Group of the
Regional Medical Program made a
resolution of condolence to his wife and
family. The staff all wish to go on record
as extending their heartfelt condolences
and tremendous sense of loss.

Joe Reynolds put the Telephone Lec-
ture Network on its feet and it will re-
main a fitting testimonial to his con-
tributions to the Western New York
area.
   

Best Wishes, Tony

Since the earliest days of the
Regional Medical Program, Tony Zerbo
became a well known character in the
role of editor of this paper and as Public
Information Officer for the Lakes Area
Regional Medical Program. He has
known our organization from the time it
was called the Health Organization of
Western New York (HOWNY), to the
time it was called the Regional Medical
Program of Western New New
(RMP/WNY), until we changed our
name to Lakes Area Regional Medical
Program (LARMP) in deference to our
Pennsylvania colleagues.

It is always difficult to relinquish the
services of a loyal colleague who not
only discharged his professional role
but provided ail of us with a social en-
vironment and distractions inherently
necessary for good morale. We all wish
him well in his new position as Director
of Public Relations for Blue Cross of
Western New York.

Grants Management

(continued from page 1)
adequate funding levels, bids are re-
quested where necessary, purchase
orders are used to insure adequate con-
trols, and payment follows upon assur-
nace of receipt of material.

Financial reporting has been ad-
vanced to the fifteenth of the month
following the report period. The reports
now prepared show line items within the
total award and relate expenditures and
encumbrances to each expense code.
The balance available for future expen-
ditures is clearly displayed.

In recognition of the above advan-
tages, the Board of Directors composed
of Allan Korn, Professor of Marketing,
SUCB, Chairman, Herbert Bellamy, Buf-
falo Civil Service Commissioner, !rwin
Felsen, M.D., Wellsville, N.Y.. Maynard
Parker, retired Hooker Chemical ex-
ecutive and Peter Zaleski, Vice Presi-
dent, Buffalo Savings Bank, have
agreed to extend the fiscal services to
the community beyond June 30, 1976.
They have agreed to continue their ser-
vices as directors to insure the success
of this venture. These men believe that
the services now performed for the

Regional Medical Program can be
offered to grants recipients at a very
reasonable overhead rate. While the
rate is partially a product of the volume
of grants managed, a commonly
accepted rate is 10% of the total grant.
in comparison to the Research Foun-
dation’s current rate of 64% of salaries,
the 10% will convert to somewhere
between 15% to 20%, depending upon
the amount of salaries in a given grant.

As a result of the Board’s decision, ef-
forts currently are under way to change
the corporate name so that it will better
describe the function of grants manage-
ment.

Anyone interested in making use of
the services of this organization should
call the Lakes Area Regional Medical
Program, Inc., 835-0728 and speak to
either Dr. Ingall, Mr. Robert Miller or Mr.
Morgan.

National Group
Elects Engebretson

The national health association made
up of the nation’s 53 Regional Medical
Programs has elected Gordon R.
Engebretson, Ph.D., as its new leader.
Directors of the National Association of
Regional Medical Programs chose Dr.
Engebretson, Director of the Florida
Regional Medical Program, to lead the
organization in what is a critical period
for the nation’s health resource develop-
ment agencies.

He succeeds John RF. ingall, M.D.,
Buffalo, New York, Director of the Lakes
Area Regional Medical Program. Dr.
Engebretson had high praise for Dr.
Ingall who had directed the Association
through the period when its
membership grew from a handful to one
thousand representatives of major
health interests from all over the United
States.

Orderly Transition Study

The Public Accountability Reporting
Group (PAR) has contracted with HEW’s
Health Resources Administration to
conduct a transitional study. The two
major objectives being the consolidation
of RMP technical processes for use by
Health Systems Agencies, and to draw
conclusions which have major impor-
tance for health related programmatic
operations at the federal, state or local
level. A study is being done to avoid the
problems and delays that frequently oc-
cur with major program changes.
Congress has mandated an orderly
transition from existing programs to new
Health Systems Agencies and other
organizations.

LARMP has systematically reviewed,
collected and sent information to the
Public Accountability Reporting Group,
that will assist in the study. The purpose
of the study is to make available infor-
mation about RMP processes and the
products which will assist planning and
resource development.

H.S.A./W.N.Y. Application Goes
Through Proposal Review Process

One of the provisions of Public Law
93-641 states that the Secretary of the
Department of Health, Education and
Welfare shall give priority to any
application submitted for designation as
a Health Systems Agency if any R.M.P.
and C.H.P. within the Health Service
Area covered by the application indicate
their approval of this application. (Sec.
1515 (b (4))

Accordingly, Lakes Area Regional
Medical Program has put the applica-
tion for designation of the Health
Systems Agency of Western New York
through its usual proposal review
procedure used in the past for all
proposals submitted to it for funding.
This process involved sending copies of
the application to reviewers in each of
the eight counties of the new Heaith
Service Area of Western New York.
These reviewers were asked to rank and
comment upon the manner in which
various aspects of the application have
been carried out. A special two page
proposal review form was prepared for
this purpose.

Their replies were compiled into a
single report which was submitted to the
Program and Proposals Review Com-
mittees who came together in a joint
meeting on February 11, 1976, to con-
sider the application. Formal support
from each of the eight county com-
mittees was also received and
presented at this meeting.

The joint committees voted to ap-
prove the proposal and to send along
this recommendation plus commentary
on certain elements of the application to
the Regional Advisory Group Board of
Directors. This latter body met on
Thursday evening, February 19, 1976, at |
which time they too voted their approval
of the H.S.A. application. The final steps
then, in fulfilling the mandates of the law
occurred when the R.A.G. approval was
transmitted personally by Dr. Ingall the
next day to the Department of Heaith,
Education and Welfare Regional Office
in New York City.

Update on HSA Board

Until the review process at the Region
Il level and forma! designation is made,
this body does not gain authority under
the HSA law known as P.L. 93-641.

HSA Continuing
Education Available

Continuing Education about the
Health Systems Agencies and their role
is a commitment of the Regional
Medical Program, and we would cer-
tainly invite any inquiries and provide
speakers for those groups who wish to
have the basic framework and the
responsibilities of that organization por-
trayed.
51 Selected for HSA
Board — More Needed

The Nominating Committee is review-

ing biographical sketches of nearly 300
individuals nominated to fill the remain-
ing 28 At-Large seats on the 79-member
provisional HSA/WNY Governing Board.
Action on the Nominating Committee’s
slate by the 51 members thus far ap-
pointed is expected shortly.
The first 51 individuals to be seated on
the Governing Board received their ap-
pointments either from one of the eight
county sub-area advisory councils or by
the chief elected official in their county.
This dual or mixed nominating process
produces two classes of membership.
Class A members are appointed by the
sub-area council and Class B members
are appointed by county government
which combined form the 51 members,
who then select the 28 at-large
members.

The names of the 51 Class A & B
members, were included in the Applica-
tion for designation and funding of the
HSA submitted to the U.S. Department
of Health, Education and Welfare and to
the State Governor’s Office on January
19, 1976.

The Nominating Committee reviewing
names for the remaining 28 at-large
seats are being guided by the legal re-
quirement to insure that the consumer
portion of the HSA Governing Board is
broadly representative of the social,
economic, racial and linguistic
segments of the Western New York
Community. The Nominating Committee
also recognizes its need to identify and
recommend individuals who have a
regional perspective in their concern for
health needs of all Western New York.
Inherent in this process is the mandated
requirement to achieve the widest
possible representation from the
numerous components of the health
care delivery team including but not
limited to physicians, dentists, nurses

and other physical and mental health
professionals along with representatives
from acute care and long term
hospitals, health professional schools,
health insurers, and public and private
health agencies.

The Nominating Committee is com-
posed of individuals selected by each of
the county delegations represented on
the 51 member governing board, and
has met on January 29, February 10 and
February 17.

The Nominating Committee has a
most difficult task and, according to one
of its members, recognizes that it can-
not create a perfect system of represen-
tation. They are, however, committed to
doing the best job possible.

Editorial

The application of the Health Systerns
Agency for Western New York was sub-
mitted to the Region !! Office of the
Department of HEW to meet the
deadline of January 19,1976. The
deadline to be met following the
issuance of regulations in October was
very short, particularly in view of the in-
trusions of the holiday season and the
restrictions inherent in the focal climate.

The grant application for the con-
ditional designation was constructed by
the conjoined staffs of the RMP, CHP
and County Governments. It is a public
document and was exhibited as such in
8 Western New York County Cierk Of-
fices as well as 8 Western New York
Public Libraries. There should certainly
be no feeling that access to this docu-
ment has been restricted. Furthermore,
the RMP and the CHP Agencies have to
review the grant submission in its
current form so that additions,
modifications and refinements can be
added. Tne document itself can be seen
at either 2929 Main Street or at the
Genesee Building, Suite 300.

The document is the first stage in the
achievement of conditional designation
of a health systems agency for Western

New York. The powers of this agency
are the greatest we have seen in this
area and, as such, responsible input is
invited during the current review
process through the established RMP
and CHP agencies. There are factors to
be considered before designation of this
agency and it is important that all those
who are at all concerned with the
regulatory authority inherent in the HSA
should be well informed.

Information is most effective when it
is sought. Please inquire.

Current Status of National
Planning Director for HSA

Harry Cain, Ph.D., Social Work,
Brandeis University and expert in men-
tal health, planning and evaluation for
the Under-Secretary of Health and
Chairman of the Interdisciplinary Com-
mittee on HSAs, is the currently
nominated new director for the Health
Systems Agencies.

At the time of writing, it is uncertain
when the change over from Mr. Rubei to
Dr. Cain will take place. There is no in-
dication as to what effect this will have
on HSA development or the distribution
of funds for that purpose.

RAG Observations

(continued from page 2)
which he aligns. The regional concept
has to be a recurring theme.

(14) The advisory and decision-
making identity of the sub-area council
should be clearly identified in the
decisions made by the parent body.
Systematic feedback to the sub-area
councils was seen as crucial in con-
solidating their working relationship with
the parent body.

(15) As general comments, revisions
of the initial document were lauded in
the composite document and the com-
ponent of flexibility and susceptibility to
change needs emphasis and the
application would seem to be an ex-
cellent beginning.

 

Lakes Area Reglonal Medical Program, Inc.

2929 Main Street
Buffalo, New York 14214

FORUM is. published by the
Lakes Area Regional Medical
Program, Inc.

2929 Main Street
Buffalo, New York 14214

John R.F.ingall, M.D.
~ Executive Director

5 TANS ALL
34 N PFAPL ST
RUFF ALD NY

 
   
  
 
   
 

Non Profit Org.
U.S. Postage
PAID
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Permit No. 271

 

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