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I.

Regional Medical Programs
Report to Congress -- P.L. 91-515

INTRODUCTION AND SUMMARY

The initial concept of Regional Medical Programs was to provide a
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vehicle by which scientific knowledge could be more readily transferred
to the providers of health services and, by so doing, improve the
quality of care provided with a strong eiiphasis on heart disease,
cancer, stroke, and related diseases. The mission of Regional Medical
Programs: as originally conceived was, broadly stated, to assist the
health professions and institutions of the.Nation in their efforts to
improve the quality of care and to organize and develop preventive,
diagnostic, and treatment services directed toward the control of
heart disease, cancer, stroke, and other related diseases. This
original mission strongly reflected the program's origin, namely the
President's: Commission.on Heart Disease, Cancer and Stroke. In its
report, that Commission recommended that a major national effort be
mounted to reduce the toll from these diseases which account for 75%
of all the deaths in America. ‘During the legislative process an
awareness of the need to involve all health providers and institutions
in an attack upon this problem, and a recognition of the potential
which regionalization of service patterns and education would bring,
led to the concept of regional "cooperative arrangements" among pro-

viders as the principal means (or mechanism) to be employed in the

pursuit of that end.

The implementation and experience of RMP over the past six years,
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coupled with the broadening of the initial concept especially as
reflected in the most recent legislation extension (P.L. 91-515),

has clarified the operational premise on which it is based -- namely
that the providers of care in the private sector, given the opportun-
ities, have both the innate capacity and the will to provide quality

care to all Americans.

The concept and the reality of the Regional Medical Program has
‘evolved and changed considerably since the enactment of the initial
authorizing legislation (@.L. 89-239) in October 1965. Its goals have
been broadened considerably; and there is every reason to believe that
these goals. will be expanded and altered in future years as the major

health problems and needs of the Nation change.

It is RMP's approach rather than its goals (or mission) which is
unique. For RMP, as a mechanism, has and continues’ to be a functioning
and action-oriented consortium of providers responsive to health needs
and problems. It is aimed at doing things which must be done to

resolve those problems.

RMP is a framework or organization within which all providers can
come together to meet health needs that cannot be met by individual
practitioners, health professionals, hospitals and other institutions
acting alone. It also is a atructure deliberately designed to take

into account local resources, patterns of practice and referrals, and
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needs, As such it is a potentially important force for bringing
about and assisting with changes in the provision of personal health

services and care.

RMP also is a way or process in which providers work together in
a structure which offers them considerable flexibility and autonomy in -
determining what it is they will do to improve health care for their
communities and patients, and how it is to be done. As such, it gives
the health providers of this country an opportunity to exert leadership
in addressing health problems and needs and provides them with a means
for doing so. RMP places a great corollary responsibility upon
providers for the health problems and needs which they must help meet

are of concern to and affect all the people.

Insofar as mission is concerned, it has become clear that RMP shares
with all health groups, institutions, and programs private and public,
the broad, overall goals of (1) increasing availability of care, (2)
enhancing its quality, and (3) moderating its costs -- making the organ-

ization of . Services and delivery of care more efficient.

Among government programs RMP is unique in certain of its salient
characteristics and particular. ‘approaches. specifically that (1) it
is primarily linked to and works through providers, especially practic-
| ing health professionals,which means the private sector largely; (2) RMP
essentially is a voluntary approach drawing héavily upon existing’ health

resources; and (3) though RMP continues to have a categorical emphasis,

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to be effective that emphasis frequently must be subsumed within or

made subservient. to broader and more comprehensive approaches.

RMP's more specific mission and objectives, as outlined and =
discussed below, are the product of the above broad, shared goals on

the one hand and its unique characteristics and approaches on the other.
II. LEGISLATIVE AND ADMINISTRATIVE BACKGROUND

In addition to extending the RMP legislative authority through

June 30, 1973, P.L. 91-515 made a number of changes in that authority.

Among them:

(1)
(2)

(3)

(5)

(4)

Explicit contract as well as grant authority was provided.
"Kidney disease"! was specifically added as a categorical
disease concern of RMP. |

The scope of the program in non-categorical terms was consid-

erably broadened. specifically the attention of RMP was

directed to -

(a) ‘Strengthen and improve primary care and the relationship
between specialized and primary care."

(b) ‘Improve generally the quality and enhance the capacity |
of health manpower and facilities available to the
nation."

(c) "Improve health services for persons residing in areas

with limited health services."

‘Requirements with respect to Regional Advisory Group compo-

sition were expanded. Most importantly, RAG membership had
to include representatives of "health planning agencies."
Required areawide CHP agency review and comment on RMP appli-

cations prior to their final consideration by Regional |

' Advisory Groups (which must approve all RMP operational pro-

posals) and submission to RMPS,
e (6) Expanded National Advisory Council on Regional Medical
Programs membership to 20, with specific provision made.
(a) "One person outstanding in the study or health care of
. persons suffering from kidney disease."
(b) Four public members. |
(c) The Chief ‘Medical Director of the Veterans Administration
as an ex-officio menber. |
(7) The so-called Multiprogram Services authority under Section 910
was significantly broadened to allow grants to public or non-
profit or private agencies (including but not limited to RMPs)
to - . a ; | |
© (a) “Assist in meeting the costs of special projects for
| improving or developing new means for the delivery of
health services concerned with the diseases with which
this title is concerned."
(0) “Support research studies, investigations, training, and
demonstrations designed to maximize the utilization of ;

manpower in the delivery of health services."

~

The above changes have been or are in the process of being imple-

mented administratively and/or reflected programmatically.

©

Kidney Disease

@ _ Since the categorical scope of RMP was broadened to specifically

include kidney disease, a growing number of Regions have submitted pro-

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posals in this disease area. Kidney disease. treatnent capabilities

now are being expanded in 20 Regions. The current annual level of

RMP grant: funding to these RMPs for kidney disease activities is about
$2.1 million, which is roughly double ‘the level of funding prior to

the enactment of P, L. (91-515, alittle over one year ago. New awards
made (or pending final action), during that period have equalled $.8
million. (in addition, RMPS is continuing to support by contract home
dialysis, transplantation, and other demonstration and training projects
relating to kidney disease, at a current annual level of approximately

$4 million.)

Recognizing ‘beforehand that requests and approvals very probably
_ would exceed RMPS' ability to fund kidney disease activities, specifi-
cally end-stage treatment programs, the National Advisory Council early
on adopted'a policy according top funding priority to those proposals
which in effect build upon and/or 1ink up with existing resources and
programs for end-stage treatment of kidney disease. The aim is to
expand present capacity and services thus making treatment available

to increased numbers of people over larger areas of the country; in
short, to maximize the number of additional people served and treated

within the limited funds and other resources, such as specialized

facilities and trained manpower, presently available.

Thus, proposals funded generally have fallen into one or another
of two broad categories. Specifically, G) those where a modest

increment has allowed the expansion ‘in the capacity of ‘existing integrated
dialysis-transplantation programs or (2) those that would help provide.
the element(s) presently missing but needed (c.g., tissue typing lab-
oratory) in order to put together a comprehensive program for end-stage
treatment of high quality. Particular encouragement is being given to
programs of an inter-regional character, those serving or linking
several (or parts of several) Regions, so that the duplication of
expensive facilities and services may be avoided, scarce manpower might
be better used, and the patient suffering from renal failure might

reCeive optimal treatment and care.

Scope of Program

-. The categorical disease emphasis of RMP has in recent years been a
major issue; and in the 1970 legislative extension the explicit broad-
ening of the program's scope to include all "other major diseases" was

proposed.

Although this expanded language was not retained in the bill finally

enacted, P. LL. 91-515 did broaden RMP's scope significantly. For as already

noted, the amended legislation incorporated specific changes with respect °
to strengthening primary care, improving services for those presently
underserved, developing new means for the delivery of health services,
and maximizing the utilization of health manpower as part of RMP's

mandate.

Quite apart from these legislative changes, experience in recent
years and the directions increasingly pursued by most Regions clearly
indicates that the categorical emphasis on heart disease, cancer, stroke,

and kidney disease is, operationally at least, viewed as an important
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6 focus rather than a narrow program restraint or limitation. Though
the issue perhaps is not entirely a moct one, the following suggests

that it largely overlooks what Regions have actually been doing.

7 Connecticut's continuing central thrust towards regionalization
of services) comprehensively defined, around the conmunity
hospitals in that State. | |

* The early efforts of the California RMP in the Watts-Willowbrook
area of Los Angeles” “and, more recently, their efforts which

have been instrumental in leading ‘to OBO funding of community
health networks in San Francisco and Los Angeles.

* New Jersey's s continuing efforts to help with the health
‘problens: of poor urban blacks which have entailed working

© closely with and supporting Model Cities programs in many cities

_ in, that State.

* Georgia’ s concern with improving and linking emergency care
services generally in an eleven-county area in the southeastern
part of ‘that State. | |

* The technical assistance, feasibility studies, and other support
provided by the Metro New York, Ohio Valley, and West Virginia
RMPs this past year to- groups and communities interested in
developing HMOs. , |

* The major contributions made by the Arkansas, Mountain States,
and Northern New England RMP to the development of Experimental
Systems proposals funded last year.

© * Maine's efforts in promoting and assisting with the development
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of a medical school in. that State.
* The pilot sickle cell anemia programs funded recently by the

Michigan and Western Pennsylvania RMPs.

This reality and the broadened legislative mandate are, it will be
seen below, reflected in the "new directions" and priorities of Regional

Medical Programs at both the national and régional levels.

Relationships with CHP”

The changes made by P.L. 91-515 have served to reinforce the relation-
ships and cooperation between Regional Medical Programs and Comprehensive

Health Planning.

The new legislative requirement that RMP Advisory Groups include
health planning agency representatives was interpreted to mean representa-
tives of State and areawide CHP. agencies specifically and implemented
accordingly. While most RAGs previously included CHP representatives, such
cross-over ‘representation has increased significantly. There are, based
upon the most recent information available, 149 State CHP representatives
on RMP Advisory Groups and 124 areawide CHP representatives. In addition,
there are over 250 CHP representatives on other RMP working committees and
task forces. (Conversely there are 850 RMP representatives serving on the

Advisory Councils and other committees of both State and areawide CHP agencies..

The review and comment requirement was implemented effective May 1,
1971. As of that date all RMP applications submitted had to include the

comments of the appropriate areawide CHP agencies. Information available

at that time indicated that cooperative ‘review mechanisms had already been
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established with 107 funded areawide agencies and with an additional 69
such agencies not yet funded by CHP . Furthermore, 46 RMPs. also were

providing State CHP agencies with the opportunity to review their proposals.

It is still too early to determine what the effect of this review and
comment by CHP agencies will be, It certainly should help over time to
insure that activities and efforts proposed by RMPs are consonant with
the local needs and problems as perceived by communities and expressed

through their CHP areawide planning efforts and priorities.

Decentralization to Regions

One salient characteristic of the RMP mechanism is the large degree
of regional (or local) autonomy which Regions have had and exercised.
Singular legislative expression of this is that all operational proposals
submitted to RMPS for Council review and recommendations must be approved

by that Region's Advisory Group.

a

Another major step in this direction was taken in mid-1971 with the
decentralization of project review and funding authority and responsibil-
ity to the 56 RMPs. Now Regions are, if their own review processes meet
defined minimum standards, given primary responsibility for deciding (1) the
technical adequacy of proposed: operational projects and (2) which proposed

activities are ‘to be funded within the total amount available to them.

Although it is assumed that the review process of all Regions meet
the prescribed standards, or can with minimal changes or adaptations, RMPS

is verifying this through a series of staff visits and examinations of
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their review processes. It is anticipated this verification procedure

will have been largely completed by June 30, 1972,
National Review Process and Selective Funding

The Council and national review process now are assessing RMPs largely

in terms of their overall program and progress. No longer is the téchnical

adequacy of individual projects or discrete, singular activities the

primary focus or concern..

This change from project to program review has led to, and indeed
necessitated, the development of program review criteria, aimed at

assessing each Region's (1) performance to date, (2) the process and

| organization that has been established, and (3) its proposal for future

activities. These criteria and a corollary scoring system have been used

‘on a trial basis over the past six months, found operationally adequate

and workable, and are being incorporated as an integral part of the national

review process.

As a result, Regions are how being ranked or grouped in terms of
quality ~~ A) those which. have demonstrated the greatest maturity and
potential, (B) those which are generally satisfactory in their performance
and progress, and (C) those which are below average. This in turn has per-

mitted RMPS to implement a stronger policy of selective funding.

Under this selective funding policy, which was formally initiated this
fiscal year, those Regions which have demonstrated outstanding maturity
and potential and and whose proposa?s are most nearly congruent with the
expanded RMP mission ‘and national priorities, are being awarded proportion-

ately greater increases.
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}. I. PROGRAM DIRECTIONS AND ACCOMPLISHMENTS

The broadened concept of Regional Medical Programs, with its emphasis on
improving the availability, efficiency and quality of care, sets the
framework within which specific objectives and program priorities are
developed. Within this framework, Regional Medical Programs have
identified four areas of program concentration, the principal objectives
of which are to:
(1) Promote and demonstrate among providers at the local level
both new techniques and innovative delivery patterns for
_ improving the accessibility, efficiency, and effectiveness of
health care. This might include, for example, encouraging
provider acceptance of and extending resources supportive of
© . Health Maintenance Organizations. In relation to new compre-
| hensive health care systems, emphasis will be placed on
assistance in developing and implementing mechanisms that
‘ provide quality control and improved standards of care, ‘such
as performance review mechanisms.

(2) Stimulate and support those activities that will both help
existing health manpower to provide. more and better care and
will result in the more effective utilization of ne kinds
and combinations of health manpower. Further, to.do this in
a way that will insure that professional, scientific, and

‘technical activities of all kinds (e.g., informational,
training) do indeed lead to professional growth and develop-

© ae ment and are appropriately placed within the context of
(3)

(4)

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medical practice and the community. At this time emphasis
will be on activities which most effectively and immediately
lead to provision of care in urban and rural areas presently
underserved.

Encourage providers to accept and enable them to initiate
regionalization of health facilities, manpower, and other
resources so that more appropriate’ and better care will be

accessible and available at the local and regional levels.

"In fields where there are marked scarcities of resources,

such as kidney disease, particular stress will be placed on
regionalization so that the costs of such care may be moderated.
Foster close cooperation and coordination with other health
programs. Experience to date has shown that the Regional
Medical Programs can best help to improve the overall effective-
ness of the health care delivery system by working with and
contributing to related Federal and other efforts at the

State, local and regional levels. Cooperative Linkages with
the Comprehensive Health Planning agencies and the Experimental
Health Services’ Delivery Systems of NCHSRED are prime targets
to provide effective organizational frameworks for identifying

and utilizing community health resources.

During 1970 and 1971 the Regional Medical Programs may be said to have
become fully operational in attempting to meet these objectives.
Indeed, of the 56 Regional Medical Programs that were established, for

planning purposes, 55 are now operational, with the 56th region

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moving toward operational status. As-such, for varying
periods of time ranging from over four years to only a few. months,
these programs are now involved in activities especially designed to

meet the health needs of their own Regions.

The approach of these Regions is reflected in certain broad areas of
accomplishment which are being realized around the country.
* All operational Regions, the new as well as those which made earlier
starts, have developed a base for effective regional planning and
‘decisionmaking through broad representation and participation of health |
institutions, organizations and individuals on the planning committees ,

‘and the Regional Advisory Groups of each Region, |

The Regional Advisory Groups, which serve as the policy-making body
of each Region, and are responsible for the selection and content of
proposals sent forward for funding, have grown to include 2,700

‘individuals.

In addition, each Region also has a variety of task forces and
planning committees designed to ensure broad-based participation.
Some 12,000 health professionals and public representatives are on
"Regional Medical Program planning committees and local action groups.
These represent a variety of health and health-related institutions,
‘including all medical schools, every state medical society, health
departments, cancer and heart associations, many other voluntary and
public agencies, and over 2,100 hospitals. “This widespread,
voluntary participation in RMP by literally’ thousands of health

‘professionals and “hundreds of health institutions is an important
 

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strength and characteristic of the program. °

The 56 Regions are moving in a variety of ways to achieve their
objectives.. Perhaps one of the most important roles is played by
the professional (or core). staff in each Region. These have developed

to include over 1,500 full-time persons.

A primary role of the professional staffs is to serve as a facilitator
for cooperative planning and joint programming. Because of its net-
work of relationships, the RMP staff can serve as a convenor of

multiple-interest groups to solve local problems.

The staff may encourage health groups to develop joint efforts
rather than institute autonomous programs. This involves development
of regional linkages which demonstrate methods of institutional
planning to avoid duplication of effort, and sharing of resources
and facilities to improve efficiency, such as joint employment of

certain professionals or common laboratory services.

The professional staff has played another important role in serving
as a technical resource and providing consultation services to health
organizations such as hospitals, Comprehensive Health Planning
agencies, educational institutions, Model Cities, OEO, and others.
Professional staff also support many central regional resources,
such as data systems, evaluation resources, information networks,

and parts of the manpower training system.
hd

* The Regional Medical Programs are working to improve the health care
system directly through operational projects as well. The movement
toward redirection of grant funds is reflected in the areas of
program emphasis of the nearly 600 operational activities. Activities
emphasizing organization and delivery of patient services and the
training of new types of personnel are increasing, while funds for
continuing education and planning are decreasing. Almost one-fifth
of RMP operational funds are now in ambulatory care activities such
as neighborhood health centers and out-patient departments of
hospitals. FO

* Moreover, these professional staff and operational activities are
leading to the creation of important institutional linkages among

hospitals, practicing physicians , and medical centers which affect

and improve the whole system of delivering medical care.

Within these broad areas of program direction, program accomplishments

and problems can be looked at in relation to specific areas of focus.

Innovations: and_Inprovenents in Health Care Delivery Systems

New techniques and innovative delivery patterns that lead to improved
accessibility, efficiency and effectiveness of health care are being
developed and tested under RMP auspices. The need for improvements in
health care delivery patterns “is evidenced by the poor utilization of
physicians and allied health manpower in most medical trade areas;

the acute lack of such manpower in rural and ghetto areas; the rising
cost of medical care, particularly for hospitalization and related
services; the uneven availability and accessibility of health services,

again most scarce in rural and ghetto areas; and the development of

over-specialization in medicine due, in part, to the rapidity of
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medical scientific advances.

Out-Patient Care
In an effort to promote greater out-patient care, for example, Five
community hospitals in Massachusetts have begun home care programs
through the efforts of the Tri-State Regional Medical Program and the
Massachusetts Hospital Association. - Such programs will provide
continuity of care for hospitalized patients after discharge, as well
as reduce the length of stay: in the hospital. To date, one hospital
has achieved a fully coordinated home care program with excellent
multi-disciplinary input. Three hospitals are planning to hire full-
time nurse coordinators and have opened a much improved information
interchange with the local Visiting Nurse Association. One hospital
moved the Visiting Nurse Association right into the hospital building

and also appointed a full-time qualified nurse as coordinator.

Accessibility in. Inner-city Areas
A variety of activities attempt to improve accessibility in imer-city
areas where the problems are more concentrated. The New York Metro-
 politan Regional Medical Program, for example, has undertaken a
program, administered by Harlem Hospital, for stroke management of
Blacks in the Harlem inner-city area of New York. The activity has
three facets: intensive and follow-up care of the stroke victim;
screening and surveillance of potential victims; and training of inner
city residents as community health aides to assist in follow-up and
surveillance activities. In addition, the RMP funds help to support

the hospital's hypertension clinic, ‘which reports that all but one of
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the patients referred there in the last year have had their ailments
brought under control solely through regular out-patient visits.
Preliminary mortality statistics reveal that ‘the mortality rate of
stroke patients admitted to Harlem Hospital has dropped from 48 to

27.4 percent in the nine months since the project's inception.

Rural Health Delivery Systems
In rurai areas and in concert with related Federal, state and local
programs , specific efforts are being directed to encourage the providers
of health care to make care availablé and accessible to those areas
where there is a distinct scarcity of resources. In the State of
Washington, for example, because of a physician. manpower shortage, the
isolated community of South Bend and surrounding areas were about to
“Jose their hospital until the Washington/Alaska Regional Medical
- Program stepped in to organize community, State, and Federal interest
_and resources to save it. Not only aré new physicians locating in
South Bend but additional services beyond those formerly offered are

now available.

Rural health care systems cannot be developed in isolation nor can
"there be a set pattern for their design. They must be based first |
on the mix of services available in each area with other services
added where the need exists. The emphasis needs to be on bringing
the available services together in a systematic approach to meeting
health care needs. The Tennessee Mid-South RMP: has helped plan for a
. Comprehensive health care program in an isolated communi ty in eastern

Tennessee and Kentucky in cooperation with the Ohio Valley RMP and the
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Appalachian Regional Commission. Through RMP support it has been
possible to link three jsolated rural clinics in a mountain valley
of eastern Tennessee for the first time by telephone, so that the clinic
nurses can communicate with one another and with the physicians on

whom they depend for consultation and support.

Emergency Health Care Systems
Another area which will.be receiving increasing emphasis by Regional
Medical Programs is emergency health care systems. Systems are needed
which bring together better transportation services, communication which
would tie hospitals, transportation facilities and other emergency
organizations into rapid response systems, and emergency medical centers
with specially trained physicians and nurses. Once again, care must
be taken to assure that such systems are integrated with the total health

care delivery system of a community or region.

RMP's and Technological Innovations
Regional Medical Programs are supporting activities which provide .
opportunities for increasing the rate of implementation of systems
innovations , new technologies including automation, and changes in
delivery patterns, particularly those developed’ through the efforts of
the National Center for Health-Services Research and Development. As
Health Maintenance Organizations and Experimental Health Services
‘Delivery Systems reach operating status, RMP's will, where appropriate,
link their demonstrations to those ongoing service. systems so as to

effectively improve the quality of care provided by the latter.
21 |

Health Maintenance Organizations
In relation to Health Maintenance Organizations in particular, Regional
Medical Programs are becoming involved in developmental activities in
a variety of ways. Because of their provider linkages, the RMP's can
act as catalytic agents to bring together the various elements of the
health care system, provide an environment conducive to planning, and
give staff support and technical assistance as necessary. In this way,
Regional Medical Programs will support organizations which have the
potential for becoming Health Maintenance Organizations. In addition,
subsequent to the establishment of HMO's, Regional Medical Programs will
be actively engaged in the professional aspects of planning for manpower
programs , mechanisms for monitoring the quality of care, ambulatory and

emergency medical care services, centralization of laboratory facilities,

. data systems, etc.

Development activity by the Ohio Valley RNP, for example, includes receipt
of a HSMHA planning grant at a level of $51,250 to assist community
interests in planning an HMO for the Louisville, Kentucky area. After
moving the proposal to the stage ‘of funding, it has turned over ‘major —
responsibility to the Falls Region Health Council, the Areawide CHP.

agency for the area. The RMP continues to contribute about 2 man days

per week to this Louisville effort.

'

Quality Standards
As new and more effective comprehensive health -systems are developed,
such as Health Maintenance Organizations, rural health delivery systems,

and emergency health systems, there is a need to ensure’ that the care
® . . .
22

provided meets quality standards. The need for.such assurance is.
particularly pertinent in terms of the new HMO's which are designed to
bring together a comprehensive range of medical services in.a single

organization.

To provide guidance in this area, RMPS as the lead agency in HSMHA has
taken the responsibility to develop guidelines for review of the quality
of medical care delivered by HMO's, and to design procedures and criteria
for both internal and external medical audits. RMPS has also developed
under contract with the Inter-society Commission for Heart Disease

Resources the Heart Guidelines.

As the END program and other comprehensive health systems are developed,
it is expected that the 56 Regional Medical Programs will be involved in
implementing the guidelines and evaluating their impact on the processes

of care of individual and institutional providers.

Manpower Development _and Utilization

Regional Medical Prograits is and will be promoting a broad array of
manpower activities, designed around the central concepts of enabling |
existing health manpower to provide more and better care, and training
and more effective utilization, of new kinds of health manpower. Among

new areas of program priority are Area Health Education Centers .

‘

The basic concept of RMPS efforts in this area will be that better use
can be made of existing manpower assets. Within a given situation, this
requires an accounting of the types a manpower already there, a task or

labor analysis of the a of services ‘which each type of manpower
z5

performs , and an effort to determine how the total services rendered can
be increased by reorganizing the work: structure of this same manpower
group. The concept of having the least expensive unit provide as much
of a given health service as is consistent with quality care is essential
here. If certain medical functions currently being done by professionals
are capable of being transferred to a less expensive type of personnel,
either existing manpower can be retrained to acquire this skill, or new

kinds of heal th. manpower can be developed to ‘take over these functions.

New Categories of Manpower
Many Regional Medical, Programs have conducted studies to determine the
need for, willingness to accept and feasibility of training categories
of manpower to extend the services of physicians. Most of these are
related to the physician's assistant Concept Some RMP's are designing

such projects and have funded operational activities in this area.

In North Carolina, the Physician's Assistant Program at Duke and Bowman
Gray is an effort to provide a well-trained and educated assistant at

the intermediate professional level who, by working with the physicians,
can complement physician services and thereby reduce the physician man-
power shortage. RMP is also’ cooperating with other HSMHA programs in the
preparation of family nurse practitioners who will also augment the
services of physicians. ‘The North Carolina RMP, for example, is utilizing
its linkages with the Region's practitioners to interpret the program

to them and to encourage the identification of nurses for training from
the communities where the need exists. To provide a desirable legal
structure for the utilization of the professional assistant, in terms of

such problens as licensure and malpractice, the Region is supporting work
24

on the development of model medical manpower legislation.

Improved Utilization of Existing Manpower
Virtually all Regional Medical Programs have projects designed to augment
‘the knowledge and level of performance of health professionals and para-
professionals. Many of these projects lead to improvements in the utili-
zation of personnel. Perhaps the greatest R\P thrust in this area 7 the
training of coronary care unit nurses; over 7,000 registered nurses and

licensed practical nurses have been trained to date.

The New Jersey RMP, in an effort to improve manpower utilization, is
supporting a program to standardize coronary care unit training programs
for licensed practical nurses, so that they can function with the same
protection and legal sanctions as registered nurses. Given a high turn-
over rate among coronary care unit trained registered nurses, their use_
as supervisors and teachers of licensed practical nurses may represent

better utilization of professional nursing personnel.

Other manpower and trdining activities, although basically designed to
provide continuing education for professional and allied health personnel,
have important spin-off benefits. A recently completed program to upgrade
the quality of continuing education at a community medical center in Columbus,
Georgia, for example, has contributed to substantial growth in the city's
physician population and the establishment of the medical center as an

areawide continuing education resource for smaller neighboring hospitals.

As the basis for the program, the medical center in Colunbus established a
regular -university-affiliated’ teaching program with the Emory University

School of Medicine. Local physicians were sent to the University for a
newly organized clinical training program, and then, on return to the
medical center in Columbus, set up similar clinical and didactic training
for their associates. As part ‘of its upgrading, the medical center at
Columbus was selected by the Georgia RMP as one of five community hospitals
across the State which would become areawide continuing education

facilities. In addition, approximately 28 new physicians have been attracted
to the town during two years of the project, while there had been no.

increase in the previous eight years.

-Area Heath Education Centers

As part of this effort to: improve manpower utilization and development,
Area Health Education Centers will be a major new initiative. Grant funds
at a level of approximately $7.5 million will be available in 1972 for
initial organizational and development efforts and operational programs
aimed at providing the necessary structural linkages among cooperating
institutions. a Centers will provide a means to improve the distri-
bution, supply ,, utilization and efficiency of health manpower in an effort

to enhance the delivery of health care in remote or “urban areas currently

underserved.

Linkages between health service organizations and educational institutions
will be established to provide students both academic education and clinical
practice appropriate to their discipline. Students will have the
opportunity to learn their skills in settings which promote the team
concept of comprehensive health service. The network of institutions

linked together to carry out the functions of the center will provide means
of extending advancements in health to communities. By utilizing existing
health care facilities in combination with educational institutions to

educate needed health personnel, both the quality and quantity of health
26

care can be increased in underserved areas.

A current effort in the Watts-Willowbrook project in Los Angeles generally
reflects the type of program which could be developed. This is an effort
to develop a new academic community which would function within an acute
general hospital, the Martin Luther King, Jr. General Hospital, in the
deprived central area of Los Angeles County.. The primary aim is to
improve the quality and quantity of health care in the community. Training
and educational components will revolve around patient services and as a
spin-off will provide outpatient and’ inpatient health services to the area.
The program includes undergraduate training and continuing education of
community health practitioners. It is anticipated that the project will
in. the near future include a community mental health center, a school of
allied health professions, and a clinical research building with residence
for house staff. The project also calls for the provision of technical
assistance and resources to other educational and health care institutions
in the Watts area for the purpose of developing additional training

programs for health care personnel.

Regionalization and Institutional Linkages |

Regionalization and new organizational arransements are major themes of
Regional Medical Programs. ‘Working relationships and linkages among com-
munity hospitals and between such hospitals and medical centers are among
“the primary concerns “of the program. . The Linking of less specialized
health resources and facilities such as small community hospitals with
more specialized ones is an important way of overcoming the maldistribution

of certain resources, and thereby increasing their availability and

enhancing their accessibility.
27

The development of regionalized ‘professional and institutional Linkages
aids in linking patient care with health research and education within
an entire region to provide a mutually beneficial interaction. It also
helps to emphasize the delivery of primary care at the local or community
level, while promoting specialty care as the province of the medical

center and larger community hospitals.

In North Carolina, community development of comprehensive stroke programs
has been initiated, with a central coordinating unit at the Bowman Gray
School of Medicine. A broad range of activities is being undertaken,
including publication of guidelines for community stroke programs, edu-
cational activities such as training programs for nurses, annual stroke
workshops, stroke consultation service for physicians through the cooper-
ation of the neurological staffs of the three medical centers, and a
fami ly-patient education unit, designed to help patients and their

families learn to cope with the long-term effects of stroke disability.

Working relationships between communi ty hospitals and the medical center
or among community hospitals themselves can upgrade local capabilities,
thus moving the delivery of semispecialized care closer to the local level.
In Oklahoma, for example, continual electronic heart monitoring services
comparable to those available in large urban hospitals are being intro-
duced into small community and rural hospitals as a result of a State-wide
coronary care program initiated by the Oklahoma RMP. Some 43 monitor-
equipped beds for heart attack victims, or attack-threatened patients, in
25 small communi ty hospitals have been linked by special telephone lines

to 10 central, monitoring hospit tals. Specially trained nurses in the
28

central monitoring unit help monitor remote patients and when an

abnormality is detected confer with local staffs by telephone “hot lines.”

Kidney disease is one area in whicti the development of integrated regional
systems can prevent the duplication which has characterized certain other .
specialized resources, It provides the opportunity for a planned and

organized model of how ‘such scarce resources can be linked together

efficiently.

In Wisconsin, the Regional Medical Program and the Kidney Foundation of
Wisconsin are supporting the development of a comprehensive renal disease
program. Each year in Wisconsin about 140 persons enter the final stages
‘ of renal disease who are judged good candidates for kidney transplants or
artificial kidney machine dialysis. Until recently, the latest advances
in the care of such patients were high in cost and not uniformly available
Statewide. The Wisconsin project is designed to develop a Statewide
cooperative kidney transplant program to reduce expensive, ‘long delays in

transplantation and to prevent tissue mismatches. This comprehensive

effort also includes establishment of . a program of dialysis located within -

patients' homes and in strategic community hospital satellite units. A!
prevention and early detection program is underway as well, providing -
local physicians with information and inexpensive testing kits for

detecting kidney disease.

Cooperative Relationships with other Health Programs
The ‘passage of P. L.. 91-515, the legislative extension of Regional Medical

Programs, Comprehensive Health Planning, the National Center for Health
29

Services Research and Development, and other health components , resulted
in an increased emphasis on the need for improved coordination and co-
operation with other health programs. Experience - to date certainly
suggests that the Regional Medical Programs can best help to improve the
overall effectiveness. of the ‘health care delivery system by working with
and contributing to related Federal and other efforts at the local, State |

and regional levels.

_ Comprehensive Health Planning |
One of the most important of these links is with the Comprehensive Health
Planning agencies. Cooperation between Regional ais Programs and
Comprehensive Health Planning agencies in particular is being fostered

through emphasis on their complementary roles.

Increasingly, the Regional Medical Programs, with their strong provider
links, are being viewed and used as an important technical, professional
and data resource by State and Areawide Comprehensive Health Planning
agencies in their planning for personal health services. In turn,. Regional
Medical Programs are looking to Comprehensive Health Planning agencies to
express the health needs of the total | community from the consumer's point

of view and in effect to help set priorities for the Regional Medical

Programs efforts.

The legislative extension of both RMP and CHP included ‘changes. designed to

promote closer coordination between these programs. One change requires
that the Regional Advisory Groups viich ‘advise the TAP's include repre-
sentatives from health planning agencies. Similarly, the CHP agencies are

required to have representation of Regional Medical Programs on both State
30

and Areawide Comprehensive Health Planning Advisory Councils. To date,
more than 800 individuals have been appointed to fulfill these require-

ments of cross-representation.

Another legislative change requires that Areawide Comprehensive Health
Planning agencies have the opportunity for review and comment of Regional
Medical Program applications before they are approved by the Regional
Advisory Group. Although this requirement applies only to the Areawide
CHP agencies, there has been extensive cooperation in terms of review

by the State CHP agencies as well.

Other areas of cooperation include joint data collection, processing or
analysis, staff sharing or regular joint meetings , and sharing of equip-
ment and facilities. In Kansas, for example, the RMP and the State CHIP
agency have jointly funded both a State data bank and a State Health Man-

power Information Program. Currently they are also cooperating on the

systems design for a Health Information System and on a Consumer Inventory
Study in Northwest Kansas. The RMP Core Research and Evaluation staff also

provide consultation to CHP.

Experimental Health Services Delivery Systems
Another health program which involves close RMP cooperation is the Experi-
mental Health Services Delivery Systen effort, funded by HSMHA. The
EHSDS program aims to test whether a commnity management structure can
improve the organization of the delivery system, and to determine whether
such an approach can achieve greater integration and coordination of
Federal funds.. Regional Medical Programs are closely involved in these

efforts in such places as Arkansas, Boise, Idaho, East Los Angeles, and

Varmnant
31.

In Vermont , the Northern New England RMP and the State CHP agency jointly
produced the successful application for an Experimental Health Services
Delivery System. Funded by the National Center for Health Services Research
al Development at a level of $932,000 for a period of two years, the
program involves the implementation and evaluation of a series of experi-
mental, regionally integrated community health systells in the geographic

area of Vermont, and possibly contiguous areas of New Hampshire and New

York states.

A variety of different tasks are being assumed by the agencies involved in
Vermont. The State CHP agency, for example, is involved in defining the
nature of public accountability in Experimental Systens, and defining the
requirements of a regional planning-management system. The Regional Medical
Program is determining how various components of the community health system
can be integrated into an experimental model. The RMP will also provide a
data base and health systems analysis capability. RMP has established a
data base which can describe health and health care delivery in terms of
demographic and socio-economic characteristics of the communities being
served; manpower, facility and dollar resources available; utilization,
supply and distribution aspects of the existing health care delivery
process; and outcome, as measured by morbidity, mortality and patient

satisfaction.

Veterans Administration
Some 83 Veterans Administration hospitals are currently involved in
activities with Regional Medical Programs. This includes participation on

RMP Regional Advisory Groups as well as operational activities. The

*®
32

California Medical Television Network operating out of UCLA, for example,
is funded in part by the RMP and includes a package of 36 videotape
programs distributed annually to 30 participating VA installations in the

western United States.

Model Cities
Regional Medical Programs also have working relationships with some of the
Model Cities programs, including technical and planning assistance and
operational programs. A Model Cities Health and Nutrition Program has
been developed by the Alabama RMP to’meet the nutritional needs of the
chronically il1, dependent pre-school children, and pregnant adolescents
in the Tuskegee-Macon County Area. Twenty nutritional assistants, after
completing a six months training course at the Tuskegee Institute, will
work with the rural poor to implement. the program objectives. These
individuals will be trained to observe family nutrition practices, instruct
and counsel in sound nutrition practices, assist in preparing teaching
materials and make follow-up home visits to assist with menu planning,
food buying and cooking skills. ‘They will also assist with dietary

surveys and work with community groups.

In concert with the broad range of public and private health organizations
and institutions, and other Federal, State and local health programs,
Regional Medical Programs can work to provide an effective organizational
framework for identifying and utilizing community health resources, SO
that continued innovations in health care planning and delivery systems

can be made.
Exhibit I~

Budget and Grant History
(Dollars in thousands)

 

 

FY 1966 FY 1967 FY 1968 FY 1969 FY 1970 FY 197i, FY 1972

 

Authorization. . 2... 0. eee $50,000 $90,000 $200,000 $65,000 -$120,000 $125,000 $150,000

. Appropriation: grants... . . . 24,000. 43,000 53,900 56,200 73,500 99 ,500 90,500
Amount available for obligation*. 24,000 43,934 48 ,900 72,365 78,500 70,298 135,000 .
Amount obligated - grants... . 2,066 27,052 = 43,635 = 72,365 78,202 70,298 . we

“cat” ts ss sum pam nme umm cms mm cu coe cut tiem wee con um mm mm mah teh sy cme inh ey mem me a Oe Wawel erm ee mee mh eae Oe me es me et nee OA OO me OS mm oe Om ee me ee te mE we Oe me oe tie we eh ee om ae oe me om Sin ee ee mm meme

Regions in:

Planning Status... ... 0. 7 44 A 1 1 1

Operational Status... wee oa 4 3° 55 55
Total RMP's . 7 48 - 54 55 5 56 56

 

* Includes carryover amounts

   
_ LISTING OF REGIONAL, MEDICAL PROGRAMS

Exhibit II

 

 

 

 

 

REGIONAL | ALABAMA ALBANY ARIZONA
JESIGNATION
SOGRAPHICAL Alabama Northeastern New York and con- Arizona
)VERAGE tiguous portions of Southern ,
. Vermont and Western Massachusetts
)PULATION 3,444,000 1,900,000 1,773;000
STIMATE (1972)
NDS |
"ATLABLE: IN 1,052. ; 1,136 865
“SCAL YEAR -,
71 -Cin 000's)
oc —s—s«dT'S. Richardson Hill, Jr., M.D. ‘IErank M. Woolsey, Jr., M.D. Dermont W. Melick, M.D.
Coordinator - Coordinator Coordinator

ORDINATORS

 

Alabama Regional Medical Program
P.O. Box 3256
1108 South 20th Street

| Birmingham, Alabama 35205

John M. Packard, M.D.

Director

Alabama Regional Medical Program
P.O. Box 3256 -

1108 South 20th Street ;
Birmingham, Alabama 35205

Albany Regional Medical Program

Albany Medical College of
Union University

47 New Scotland Avenue

Albany, New York 12208

 

 

Arizona Regional Medical Progr
University of Arizona

College of Medicine .
4402 East Broadway, Suite 606
Tucson, Arizona 85711 | °
 

 

 

 

 

"REGIONAL ARKANSAS BI-STATE CALIFORNIA

DESIGNATION

EOGRAPHICAL Arkansas Southern Illinois and Eastern California plus Reno-Sparks

OVERAGE Missouri and Clark County (Las Vegas),
Nevada .

OPULATION 1,923,000 4,700,000 19,953,000

STIMATE (1971)

UNDS

VATLABLE IN 1,363 ' 1,147 | 8,357

ISCAL YEAR

971 -(in 000's)

ROGRAM . Charles W. Silverblatt, M.D. William Stoneman III, M.D. _| Paul D. Ward

Coordinator Coordinator ‘Executive Director .

QORDINATORS

 

Arkansas Regional Medical Program
500 University Tower Building
12th at University

|Little Rock, Arkansas 72204

Bi-State Regional Medical Program
607 North Grand Boulevard
St. Louis, Missouri 63103

 

 

California Committee on

. Regional Medical Programs
7700 Edgewater Drive .
Oakland, California 94621
 

 

 

 

REGIONAL CENTRAL NEW YORK COLORADO-WYOMING © CONNECTICUT
DESIGNATION

a Syracuse, New York and 15 sur-
EOGRAPHICAL tounding counties and Bradford Colorado and Wyoming Connecticut
QVERAGE and Susquehanna counties in Dos

Pennsylvania

OPULATION 1,700,000 2,150,000 3,032,000
STIMATE (1971)
UNDS .
VATLABLE IN 896 1,123 1,514
ISCAL YEAR

971 (in 000's)

 

ROGRAM
JORDINATORS

 

 

John J. Murray

Acting Coordinator, Central New '
York Regional Medical Program _

Upstate Medical Center
State University of New York |

1750 East Adams Street

Syracuse, New York 13210

 

Howard W. Doan, M.D.
Director, Colorado-Wyoming
Regional Medical Program

410 Franklin Medical Building |

2045 Franklin Street .
Denver, Colorado 80205

 

 

Henry T. Clark, Jr., M.D.

‘Coordinator .

Connecticut Regional Medical
Program .

272 George Street

New Haven, Connecticut 06510.

 
 

 

 

 

 

REGIONAL © FLORIDA GEORGIA GREATER DELAWARE VALLEY
DESIGNATION
GEOGRAPHICAL Florida Georgia Eastern Pennsylvania, the
JVERAGE southern part. of New Jersey an

. the entire State of Delaware

OPULATION 6,789,000 4,590,000 6,200,000
STIMATE (1971)
INDS
VAILABLE IN [1,448 - 5 1,983 "| 2,433
ISCAL YEAR oO
971 (in 000's)
ROGRAM Granville W. Larimore, M.D. M. Charles Adair, M.D. Martin Wollmann, M.D.
OORDINATORS State Director Coordinator ‘Executive Director

 

Florida Regional Medical Program
1 Davis Boulevard, Suite 309
Tampa, Florida 33606

 

Georgia Regional Medical Program

Medical Association of Georgia - .

938 Peachtree Street, N.E.
Atlanta, Georgia 30309

J. Gordon Barrow, M.D.
Director

Georgia Regional Medical Program
| Medical Association of Georgia

938 Peachtree Street, N.E.
Atlanta, Georgia 30309

 

Greater Delaware Valley
Regional Medical Program

551 West Lancaster Avenue

Haverford, Pennsylvania 19041

 
 

 

 

 

REGIONAL HAWAII ILLINOIS INDIANA
DESIGNATION
Entire State of Hawaii, plus |
EOGRAPHICAL American Samoa, Guam, and the Illinois Indiana
OVERAGE Trust Territory of the Pacific
‘Islands (Micronesia)
OPULATIGN 970,000 9,100,000 4,200,000
STIMATE (1971)
UNDS
VAILABLE IN 938 1,794 . 1,275

ISCAL YEAR
&73 (in 000's)

 

ROGRAM
CORDINATORS

 

Masato M. Hasegawa, M.D.
Director

Regional Medical Program of Hawaii

1301 Punchbowl Street:
Harkness Pavilion ©

Honolulu, Hawaii 96813

 

Morton C. Creditor, M.D.
Coordinator

Illinois Regional Medical Program
122 South Michigan Avenue
Suite 939

Chicago, Illinois 60603 -

 

Robert B. Stonehill, M.D.
Coordinator
Indiana Regional Medical Prog
Indiana University

School of Medicine
1300 West Michigan Street |
Indianapolis, Indiana 46202
 

 

 

 

REGIONAL INTERMOUNTAIN IOWA KANSAS
DESIGNATION
EOGRAPHICAL Entire State of Utah, and portions | Iowa Kansas. ~
QVERAGE of Wyoming, Montana, Idaho,

< Colorado and Nevada

OPULATION 2,073,000 2,825,000 2,249 ,000
STIMATE (1971)
JNDS
VAILABLE IN 3,383 - 754 1,869

ISCAL YEAR
971 (in 000's)

 

ROGRAM
JORDINATORS

 

|Salt Lake City, Utah 84112

 

Robert M. Satovick, M.D.

Coordinator -

Intermountain Regional
Medical Program

50 North Medical Drive

 

Harry B. Weinberg, M.D.
Coordinator

Iowa Regional Medical Program
308 Melrose Avenue

Towa City, Iowa 52240.

 

 

Robert W. Brown, M.D.

‘Coordinator

Kansas Regional Medical Progra
5909 Eaton Street
Kansas City, Kansas 66103

 
 

 

 

 

REGIONAL LOUISIANA MAINE MARYLAND
IESTGNATION

ee i. . Entire State of Maryland and
OGRAPHICAL Louisiana Maine York County im Pennsylvania,
VERAGE . less envitons of Washington, D.

and Montgomery County, Marylanc

iPULATION 3,643,000 994,000 3,222
TIMATE (1971)
NDS
‘ATLABLE IN 776 871 1,998
SCAL YEAR ,

71 (in 000's)

 

OGRAM
ORDINATORS

Joseph A. Sabatier, Jr., M.D.
Director
Louisiana Regional Medical Program

{2714 Canal Street, Suite 401

New Orleans, Louisiana 70119

 

 

{Manu Chatterjee, M.D. |
.| Coordinator
Maine's Regional Medical Program _

295 Water Street -
Augusta, Maine 04330 °

Edward Davens, M.D.

Coordinator

Maryland Regional Medical Progr
550 North Broadway

Baltimore, Maryland» 21205

 
 

REGIONAL

METROPOLITAN WASHINGTON, D.C.

 

 

 

 

MEMPHIS MICHIGAN

DESIGNATION
_ ; Western Tennessee, Northern
EOGRAPHICAL Mississippi, Eastern Arkansas and District of Columbia and contiguous; Michigan
OVERAGE portions of Kentucky and Counties in Maryland (2) and oe

< Missouri Virginia (2)
OPULATION 2,399,000 1,800,000 8,875,000
STIMATE (2971)
UNDS
VAILABLE IN 1,907 1,217 2,292
ISCAL YEAR
971 (in 600's)
ROCRAM | James W.-:Culbertson, M.D. Arthur E. Wentz, M.D. oo Gaetane M. Larocque , Ph.D.
OORDINATORS Coordinator - Coordinator ‘Acting Coordinator

 

Memphis Regional Medical Program
1300 Medical Center Towers
969 Madison Avenue

|Memphis, Tennessee. 38104

 

 

Metropolitan Washington, D. Cc.
Regional Medical Program |

2007 “Eye Street, N.W.

Washington, D.C. 20006:

Michigan Association for
Regional Medical Programs
1111 Michigan Avenue, Suite 2(
East Lansing, Michigan 48823

 

 

 
 

 

 

 

 

REGIONAL MISSISSIPPI " MISSOURI MOUNTAIN STATES
DESIGNATION
SECGRAPHICAL Mississippi Missouri, exclusive. of most of States of Idaho, Montana,
(OVERAGE Metropolitan St. Louis Nevada and, Wyoming
%OPULATION 2,217,000 3,200,000 2,228,000
SSTIMATE (1971)
*UNDS
\VAILABLE IN  |1,168 2,282 | 1,764
7ISCAL YEAR
1971 (in 000's)
"ROGRAM Theodore D. Lampton, M.D. Arthur E, Rikli, M.D. . Alfred M. Popma, M.D.
“OORDINATORS Coordinator Coordinator Coordinator and Regional Dire:

Mississippi Regional Medical Program
University of Mississippi
Medical Center

{2500 North State Street
| Jackson, Mississippi 39216

 

 

| Missouri Regional Medical Program

406 Turner Avenue - Lewis Hall .
Columbia, Missouri 65201

 

 

Mountain States

_ Regional Medical Program
305 Federal Way - P.O. Box. 57
Boise, Idaho 83705 °

 
 

 

 

 

REGIONAL NASSAU-SUFFOLK NEBRASKA NEW JERSEY
YES IGNATION .
?OGRAPHICAL Counties of Nassau and Suffolk Nebraska New Jersey,
WVERAGE (Long Island) of the State of

. New York

YWULATION 2,540,000 1,484,000 7,168,000
STIMATE (1971)
INDS
TAILABLE IN 794 626 “$1,351

“SCAL YEAR

 

171 (in 000's)

SOGRAM
\ORDINATORS

 

Glen E. Hastings, M.D.
Coordinator -
Nassau-Suffolk Regional
Medical Program, Inc.
1919 Middle Country Road

|Centereach, New York 11720

 

Deane S. Marcy, M.D.

Coordinator

Nebraska Regional Medical Program
700 CIU Building

1221 N Street

Lincoln, Nebraska 68508

 

Alvin A. Florin, M.D.
Coordinator ,
New Jersey Regional Medical Pri
7 Glenwood Avenue

East Orange, New Jersey 07017
 

 

 

 

 

REGIONAL NEW MEXICO NEW YORK METROPOLITAN NORTH CAROLINA
DESIGNATION — -
EOGRAPHICAL New Mexico . New York City and Westchester, North Carolina
(OVERAGE Rockland, Orange, and Putnam ~ oe
Counties, New York
PULATION 1,016,000 9,266 ,000 5,082,000
STIMATE (1971) -
UNDS
VAILABLE IN 1,337 - ; 2,706 2,337
‘ISCAL YEAR | :
972 (in 000's}
ROCRAM James R.-Gay , M.D. I. Jay Brightman, M.D. EF. M. Simmons Patterson, M.D.
‘COORDINATORS Coordinator Director Executive Director

 

 

New Mexico’ Regional Medical Program
University of New Mexico

Medical School
920 Stanford Drive, N.E.

‘|Building 3-A

Albuquerque, New Mexico 87106

 

New York Metropolitan
Regional Medical Program

The Associated Medical Schools”

of Greater New York
2 East 103rd Street
New York, New York 10029

 

 

Association for the North Car«
Regional Medical Program

4019 North Roxboro Road

Durham, North Carolina -27704.

 
 

REGIONAL

 

 

 

NORTH DAKOTA NORTHEAST OHIO — NORTHERN NEW ENGLAND
DESIGNATION
SEOGRAPHICAL North Dakota 12 counties in Northeast Ohio Entire. State of Vermont and
(OVERAGE three contiguous counties in

< Northeastern New York

XOPULATION 618 ,000 4,115,000 445,000
iSTIMATE (1971)
‘UNUS
VAILABLE IN {509 ; 368 "} 800
“TSCAL YEAR

971 (in 000's)

 

ROGRAM
"OORDINATORS

 

Theodore H. Harwood, M.D.

Coordinator -

North Dakota Regional
Medical Program

41512 Continental Drive
{Grand Forks, North Dakota 58201

\Willard A. Wright, M.D.

Director
North Dakota Regional
Medical Program
1512 Continental Drive
Grand Forks, North Dakota 58201

 

David Fishman, M.D.

Acting Coordinator

Northeast Ohio , ;
Regional Medical Program |

10525 Carnegie Avenue

Cleveland, Ohio 44106.

 

John E. Wennberg, M.D.

| Coordinator

Northern New England

_ Regional Medical Program

University of Vermont
College of Medicine .

25 Colchester Avenue

-| Burlington, Vermont 05401
 

NORTHLANDS

NORTHWESTERN OHIO

OHIO STATE

 

 

 

 

REGIONAL

DESIGNATION
Central and southern two-thirce
EOGRAPHICAL Minnesota 20 counties in Northwestern Ohio of the State of Chio (61 count
OVERAGE , excluding Metropolitan
Cincinnati area)

OPULATION 3,805,000 1,381,000 4,660,000
STIMATE (1971)
UNDS ~ )
VATLABLE IN 1,251 431 360
TSCAL YEAR
972 (in 000's)
ROGRAM Winston R. Miller, M.D. C. Robert Tittle, Jr., M.D. William G. Pace III, M.D.
SORDINATORS Program Director Coordinator ‘Coordinator

 

Northlands Regional
Medical Program, Inc.
375 Jackson Street

¥St. Paul, Minnesota 55101

 

Northwestern Ohio

Regional Medical Program.
1600 Madison Avenue

Toledo, Ohio 43624 .

 

Ohio State Regional Medical
Program ;

1480 West Lane Avenue

Columbus, Ohio 43221 |
 

REGIONAL

 

 

 

OHIO VALLEY OKLAHOMA OREGON

DESIGNATION
EOGRABHICAL Greater part of Kentucky, South- Oklahoma Oregon
(OVERAGE west Ohio, and contiguous parts

< of Indiana and West Virginia
OPULATION 5,300,000 2,559,000 2,019,000

TINAT TE 97) '
UNDS
VAILABLE IN [1,172 963 930
TISCAL YEAR oe

 

$71 (in 000's)

‘ROGRAM
OORDINATORS

 

William H. McBeath, M.D.

Director § -

Ohio Valley Regional -
Medical Program ~

P.O. Box 4025

| Lexington, Kentucky. 40504

 

 

Dale Groom, M.D.
Director
Oklahoma Regional Medical Program

University of Oklahoma

_ Medical Center
800 N.E. 15th Street
Oklahoma City, Oklahoma 73104 .

 

 

J. S. Reinschmidt, M.D.
Coordinator
Oregon Regional Medical Progr:
University of Oregon

Medical School
3181 S.W. Sam Jackson Park Roi
Portland, Oregon 97201

 
 

 

 

 

 

REGIONAL PUERTO RICO ROCHESTER SOUTH CAROLINA
IESIGNATION .
OGRAPHICAL Puerto Rico Rochester, New York and 10 South Carolina
VERAGE surrounding counties .
(PULATION 2,690 ,000 1,234,000 2,591,000
TIMATE (1971)
NUS
AILABLE IN |938 611 1,478
SCAL YEAR
71 (in 000's)
OCRAM | Cristino R. Colon, M.D. | Ralph C. Parker, Jr., M.D. - Vince Moseley, M.D.
ORDINATORS Coordinator Coordinator Coordinator

 

Puerto Rico Regional
Medical Program

“1P.0. Box M.R.

Caparra Heights Station

{San Juan, Puerto Rico 00922

 

Rochester Regional Medical Program
University of Rochester

Medical Center
260 Crittenden Boulevard
Rochester, New York 14620

 

South- Carolina Regional
Medical Program

‘Medical University of South

Carolina
80 Barre Street

| Charleston, South Carolina 294(
 

REGIONAL,
DESIGNATION

SOUTH DAKOTA

SUSQUEHANNA ‘VALLEY

TENNESSEE MID-SOUTH

 

EOGRABHICAL
OVERAGE

os

_jSouth Dakota

27 counties in Central
Pennsylvania

Tennessee and Southwestern °
Kentucky - :

 

‘OPULATION
‘STIMATE (1971)

666,000

2,140,000

2,816,000

 

UNDS
VAILABLE IN
TSCAL YEAR

472:

626

"12,130

 

S71 (in 000's)

ROGRAM
CORDINATORS

 

John A.. Lowe, M.D.
Coordinator -
South Dakota .
Regional Medical Program
University of South Dakota -
Medical School

'|216, East Clark Street
Vermillion, South Dakota 57069

 

‘| David H. Small, Acting Coordinator

Susquehanna Valley

Regional Medical Program
1104 Fernwood Avenue, Box 541
Camp Hill, Pennsylvania 17011 °

 

Paul E. Teschan, M.D.

Director

Tennessee Mid-South
Regional Medical Program

1110 Baker Building

110 21st Avenue, South .

Nashville, Tennessee 37203
 

REGIONAL
DESIGNATION

TRI-STATE

VIRGINIA

 

Virginia (less, parts of

 

 

EOGRAPHICAL Texas Massachusetts, New Hampshire and

OVERAGE Rhode Island Metropolitan Washington, D.C.)
OPULATION 11,197,000 7,377,000 4,300,000

STIMATE (1971)

UNDS

VAILABLE IN 2,094 2,022 1737

ISCAL YEAR
971-{in 000's)

 

ROGRAM
OORDINATORS

 

 

Charles B. McCall, M.D.
Coordinator

Regional Medical Program of Texas
4200 Lamar Boulevard, North
Suite 200

jAustin, Texas 78756

 

Leona Baumgartner, M.D.

Coordinator

Tri-State Regional Medical Program

Medical Care and Education
Foundation, Inc. .

| 1 Boston Place, Suite 2248

Boston, Massachusetts 02108

 

Eugene R, Perez, M.D.

‘Coordinator

Virginia Regional Medical Prog
700 East Main Street, Suite 10
Richmond, Virginia 23219
 

" REGIONAL

 

 

 

 

WASHINGTON/ ALASKA WEST VIRGINIA ’ WESTERN NEW YORK

ESTGNATION
GRAPHICAL Washington and Alaska | West Virginia 8 Western New York counties
VERAGE and Erie County in Pennsylvania
PULATION 3,711,000 1,744,000 1,985,000
TIMATE (1971)
NDS
AILABLE IN 1,644 721 "| 1,363
SCAL YEAR
7i (in 000's)
JGRAM - {Donal R. Sparkman, M.D. Charles D. Holland John R. F. Ingall, M.D.
JRDINATORS Director - Coordinator Program Director
- Washington/Alaska West Virginia Regional Medical Regional Medical Program for

_ Regional Medical Program Program Western New York

 

 

500 "U" District Building .
1107 N.E. 45th Street

‘\Seattle, Washington 98105

 

West Virginia University
Medical Center

| Room 2237, University Hospital

Morgantown, West Virginia 26506

 

 

State University of New, York
at Buffalo

2929 Main Street

Buffalo, New York 14214
 

“REGIONAL

 

 

 

 

. WESTERN PENNSYLVANIA WISCONSIN
DESIGNATION
EQGRAPHICAL |Pittsburgh and 28 surrounding Wisconsin
COVERAGE counties in Pennsylvania
COPULATION 4,284,000 4,418,000
STIMATE (1971)
UNDS |
VAILABLE IN {1,312 | 1,855 .
ISCAL YEAR aor
971 (in 000's)
ROGRAM Francis. S. Cheever, M.D. John $. Hirschboeck, M.D.
Coordinator Coordinator

COORDINATORS

 

Western Pennsylvania
Regional Medical Program
University of Pittsburgh

41217 Scaife Hall

Pittsburgh, Pennsylvania 15215

Robert R. Carpenter, M. D.

Director

Western Pennsylvania
Regional Medical Program

3530 Forbes Avenue ;

501 Flannery Building

Pittsburgh, Pennsylvania 15213,

 

 

Wisconsin Regional Medical Program
110 East Wisconsin Avenue
Milwaukee, Wisconsin 53202

 

 

 
EXHIBIT III

CHARACTERISTICS OF REGICNAL MEDICAL PROGRAMS
DEMOGRAPHIC FACTS

There are 56 RMPs which cover the entire United States and its trust
territories. The Programs include the entire population of the United
States (204 million) and vary considerably in their size and characteristics.
* LARGEST REGION |

In population: California (20 million)
_In size: Washington/Alaska (638,000 square miles)

* SMALLEST REGION

 

In population: Northern New England (445,000)
In size: Metropol + tan Washington, D.C. a, 500 square miles)

# SOME REGIONS ARE MAINLY URBAN (NEW YORK METROPOLITAN) , SOME RURAL
(ARKANSAS )

* GEOGRAPHIC BOUNDARIES: Number of Regions which

 

Encompass Single states... + 6 + e+e ees 33

Encompass two or more stateS .. 6 + ee es 4

-, Are parts of single states ...-......H1
. Are parts of two or more states... . 6 6 Bo er

* POPULATION: Number of Regions which have re

. Less than 1 million persons .....-+ ss . 5
. l million to 2 million. ..... 2... .1l -
. 2million to 3 million. .......+...+. 414
. 3million to 4 million. ....... oe ee, 8
4 million to 5 million. ........ oes 7

Cver 5 million. ..... be ee es « « Ll
REGIONAL ADVISORY GROUPS

 

 

SIZE:
1967 . a - 1849 Persons (Total)
_ +39 (Average Group)
- , 1969 . 2324 Persons (Total)
42 (Average Group)
1970 2481 Persons (Total)
45 (Average Group)
1971 2696 Persons (Total)
48 (Average Group)
- COMPOSITION OF REGIONAL ADVISORY GROUPS
7 FY '71 (10/71) | FY '70 (4/70)
' : Number _ Percent — Number Percent
Total 2696 100 2481 | 100
Practicing Physicians 726 27 656 26
Hospital Administrators 376 . 14 327 13
t Medical Center Officials 217 | , 8 259 10
Voluntary Agencies 200. - 7 212 ~ 9
Public Health Officials 150 © '. 6 134 | 6
Other Health Workers ~ 298 “41 - 216 9
Members of Public ~ 556 21 468 . 19

Other 173 6 29 «2=—Sts«#B
Yd) TASK FORCES AND COMMITTEES

NUMBER AND SIZE:
1969: 492 Committees in 54 Regions: 5,320 Total membership
1971: 410 Committees in 55 Regions: 6,379 Total membership

COMPOSITION:
Number - Percent —

By Profession (1969) (1971) * (1969) (1971)
Physicians 3273 3523 61 55
Nurses 486 580 - 9 9
Allied Health 672 802 ‘13 13
Other* 889 - 1456 17 23

Total 5320 6379 + 100 — 100

© (* Includes members of the public, hospital administrators, and others)

 

‘TYPE OF TASK FORCE/ COMMITTEE:

No. of Committees - Percent

--- (969) 971) 1969) (1971)
) Category 1969 L a ( ) ¢
Heart ; 65 Al 13 11
Cancer ~ 60 42 12.- -10
Stroke . . _ 54 36—C—ti il. 9
Other Disease
(including Kidney) 39 . 30 8 7
Planning & Evaluation ' 30 27 6 8
_ Continuing Education & .

- ‘Training 45 47 9 12
Health Manpower - 11 27 2. 4
Other 188 160 39 _39

Total 492 410 {00 100

@ , o
° . :
° *
.
 

REGIONAL HEADQUARTERS

 

Coordinating Headquarters Grantees
Universities I 3A
Public es (25) (27)
Private | a ( 6) | ( 7)
Other 5 22
Medical Societies (4) ( 4)
Newly Organized Agencies/ -
Corporations (18) (15)
Existing Corporations (3). ( 3)

REGIONAL MEDICAL PROGRAMS CORE STAFF

 

Core staff in the 56 Regional Medical Programs are involved in project
development, review and management, professional consultation and com-
munity liaison; program direction and administration; planning studies
and inventories; feasibility studies; and central regional services.

© * DISTRIBUTION OF CORE STAFF EFFORT BY FUNCTION

. Project Development... 6. ee ee ees +, 20%
. Professional Consultation ....... ee 29%
. Program Direction. .... See ee . « 22%
. Planning Studies . 6 6 eee eee ee es 14%
. Feasibility Studies ........ ek:
/ . Central Regional Services... eee ee ee 66
. Other... .. eee se eee se ee %
* COMPOSITION
! Core FTE
TOTAL : | - 1,584
Physicians * 184
Registered Nurses _ . — 63
Allied Health 37
Other Professional/Technical 677
Secretaries 623
 

OPERATIONAL PROGRAMS _

The LEVEL OF FUNDING as of 12-31-71 reflects the following program
emphases : ; :

Operational Activity Emphasis

 

Organization and Delivery .for

‘Patient Services .... ee ees we ee ee es 37%
Training Existing Health , uo .

Personnel in New Skills . . 2 1 1 ee ee eee wee ee we ee SG
Training New Health Personnel . 6. 6 ee ee ee ee ee ts %
General Continuing Education... . + + ee ee ee ee ee ee 20%

Other activities, such as communications
networks, improved patient record
systems, and coordination of services «1 + ++ ee ees 2. 9%

Categorical Emphasis

 

An analysis of all the cperational grants awarded to date along cate-
' gorical lines indicates the following breakdown:

Single Disease

Heart... 2. 6 6 6 we ewe 22%
Cancer . 2. 1 6 8 ws ees 12%
Stroke ..... ++ «+. 11%
Kidney ... ees wee (5%
Related Diseases .-... 7%

. Multicategorical ..... 43%

HOSPITAL PARTICIPATION IN REGIONAL MEDICAL PROGRAMS

 

Total # of . . Number Number
short-term participating participating
non-Federal in planning and in operational
hospitals operational activities
activities only

FY 1968 5,850 851 301

FY 1969 5,820 1,638 1,246

FY 1970 5,853 2,084 1,471

FY 1971 (est.) 5,880 : 2,693 _- 2,079