@'. II. SUMMARY INFORMATION AND DATA ON REGIONAL MEDICAL PROGRAMS A. PIIP GRANT FU NDING (as of 12/72) B. EMPHASIS OF P14P GRANT FUNDS C. LEGISLATIVE AND ADMINISTRATIVE HISTORY D. APPROPRIATIONS AND BUDGETARY HISTORY E. DEMOGRAPHIC FACTS F. ORGANIZATIONAL STRUCTURE OF A REGIONAL MEDICAL PROGRAM 1. Overall Organizational Structure 2. Regional Advisory GrouDs 3. Cormttees and Local Advisory Groups 4. Grantees of Regional Medical Program 5. Program Staffs G. PRIMARY PURPOSE OF RMP OPERATIONAL PROJECTS (FY71, 79) H. PATIENT CARE DEMONSTRATIONS (as of 12/72) I. RMP GRANT ACTIVITY IN CATEGORICAL DISEASES (as of 12/72 J. CATEGORICAL DISEASE E14P8ASIS OF RMP OPERATIONAL PROJECTS (FY71, 72) K. SPECIAL TARGET POPULATION BY RACE OR ETHNIC GROUP L. COURSE REGISTRATIONS IN RMP-SPONSORED EDUCATION ACTIVITIES - FY72 A. RMP Grant Fundinq s of 12/31 (a /72) Number of Grants ............................................ 56 Number of projects funded out of grants ..................... 978 Number of positions supported by grants: Number of Program Staff .................. 1400 Number of Project Staff .................. 2292 Total positions supported by grants ..................... 3692 Projects level ...................................................... $64.6 Core Support ........................................................ 41.9 TOTAL ................................................................ $106.5 FY73 Amended Budget: Increase or 1973 Estimate 1974 Estimate Decrease Grants and Contracts $55,358,000* -0- -$55,358,000 *Includes $2.5 million for emergency medical services systems. B. Grant Funds Emphasis of (Dollars in Thousands) As of FY71 'FY72 % 12/31/72 % 'j-0 0 2 9..5 $31,700 29.7 Patient Care Demonstra- $14,256 20.3 tions, which directly benefit patients 2. Manpower training and 12,429 17.6 '2-.,239 19,2. 20@000 18.8 utilization 3. Continuing Education of 75,677 10.9 10@788 9.7 10,300 9.7 existing health professionals 4. Health Services Research 2,193 3.1 2,695 2.4 2@600 2.4 and Develooment 5. Program Staff Activity 33,743 47.9 43,560 39.2 41,900 39.3 a. Program Direction and (9,111) (27) (11,761) (21) (11,313) (27) administration b. Project Development, (7,423) (22) ( 9,583) (22) ( 9,218) (22) Review and Management c. Professional Consulta- (8,773) (26) (11,326) (26) (10,894) (26) tion and Community Liaison d. Plannina and Feasi- (6,074) (18) ( 7 841) (18) ( 7 542) (18) bility Studies e. Central Regional and (2,362) ( 7) ( 3,049) ( 7) ( 2,933) ( 7) Other Services TOTALS -$70,298 100.0 $110,983 tloo.o1$106@500 100.0 HIG,qLlGfITS OF C. LEGISLATIVE AND ADMINISTRATIVE HISTORY OF REGIONAL MEDICAL PROGRAMS L964 DECEMBER The Report of the President's Comission on Heart Disease, Cancer and Stroke presented 35 recommendations including development of regional complexes of medical Lacilities and resources. 1965 JANUARY Companion administration bills--S.596 and H.R. 3140--were introduced in the Senate by Senator Lister Hill (Ala.), and in the House by Representative Oren Harris (Ark.), giving concrete legislative form to presidential proposals. OCTOBER P.L. 89-239, the Heart Disease, Canccr and Stroke Amendments of 1965, was signed. The Commission concepts of "regional medical complexes" and "coordinated arrangements" were replaced by "regional medical programs'.' and "cooperative arrangements," thus emphasizing voluntary-linkages. DECEMBER National Advisory Council on Regional Medical Proarams met C, for the first time to advise on initial plans and policies. 1966 FEBRUARY Dr. Robert Q. Marston appointed first Director of the Divi- sion of Regional Medical Programs and Assoc. Director of NIH. APRIL First planning grants approved by National Advisory Council. 1967 FEBRUARY First operational grants approved by National Advisory Council. JUNE The Surgeon General submitted the Report on Regional Medical Programs to the President and the C-o@gress, s rizing progress made and recoi@iending its extension. 1968 MARCH Companion bills to extend Regional Medical Programs itere,intro- duced in the House by Harley 0. Staggers (W.Va.) (H.R. 15758) and in the Senate by Senator Lister Hill (Ala.) (S. 3094). OCTOBER P.L. 90-574, extending the Regional Medical Programs for two yea-rs,was signed. Changes were: include territories outside of the 50 States; permit funding of interregional activities, permit dentists to refer patients; and permit participation of Federal hospitals. 1970 JAN.-OCT. Bills extending RMP introduced; hearings held. OCTOBER P.L. 91-515 was signed into law. New provisions: emphasis on primary care and regionalization of health care resources; added prevention and rehabilitation; added kidney disease; added authority for new construction; requi-red.-reviei,; 'of R%IP appli- cations by Are,@,,.,ide Comprehensive Planning agencies; emphasized health services delivery and manpower utilization. REGIONAL MEDICAL PROGRAMS APPROPRIATIONS AND BUDGETARY HISTORY (Dollars in Thousands) Fiscal Fiscal Fiscal Fiscal Fiscal Fiscal Fiscal Fiscal Year Year Year Year Year Year Year Year 1966 1967 1968 1969 1970 1971 1972 1973 Authorization .......... $ 50,000 $ 90,000 $200,000 $ 65,000 $120,000 $125,000 $150,000 $250,000 Amount appropriated for grants .......... 24,000 43,000 53,900 56,200 73,500 99,500 90,500 N.A. Amount actually available for grants 1/ ........... 24,000 43,934 48,900 72,365 78,500 70,298 135,000 51,836 Amount actually awarded for grants .......... 2,066 .27,052 43,635 72,365 789202 70,298 110,983 2/ - 1/ Includes unspent funds carried forward from previous year minus amounts held in reserve by the Office of Management and Budget. 2/ Does not include earmarked amounts for Emergency Medical Services ($8.0 million), Cancer construction ($5.0 million), Health Maintenance Organizations ($9.2 million), Contracts ($1.2 million), and evaluation activities ($.6 million). Amount available per amended FY 1973 budget. E. DEMOGRAPHIC FACTS There are 56 Regional Medical Programs which cover the United States, Puerto Rico, and the Trust Territories of the Pacific. The Programs include the total 1972 population of the United States (estimated at 207 million) and vary considerably in size, funding, and geographic characteristics. * LARGEST PROGRAM In population: California (20 million) In size: Washinpton/Alaska (638,000 square miles) * SMALLEST PROGRAM In population: Northern New England (445,000) In size: Metropolitan Washington, D.C. (1,500 square miles) * GEOGRAPHIC BOUNDARIES: Number of Programs which primarily Encompass single states ........................... 34 Encompass two or more states ...................... 4 Are parts of single states ........................ 11 Are parts of two or more states ...................7 * POPULATION: Number of Programs which have Less than 1 million persons .......................5 1 million to 2 million ............................ 11 2 million to 3 million ............................ 14 3 million to 4 million ............................7 4 million to 5 million ............................8 Over 5 million .................................... 11 * FUNDING LEVEL RANGES: Programs with Less than $500,000 ................................ 4 $500,000 - $999,999 ............................... 19 $1 million - $1,499,999 ........................... 8 $1.5 million - $1,999,999 ......................... 17 $2.0 million - $2,-499,999 ......................... 4 $2.5 million and above .............................4 * MEDIAN FUNDING LEVEL: $1.1 million F. 1. ORGANIZATIONAL STRUCTURE OF A REGIONAL MEDICAL PROGRAM and Prograu Staff (fiscal agent) Responsibilities and Relationships There are three major components of a Regional Medical Program at the regional level: The Regional Advisory Group; the grantee organization,, and the Chief Executive Officer (often referred to as the @ Coordinator) with his or her program staff. - Regional Advisory Group: The Regional Advisory Group has the responsibility for setting the general direction of the RIP and formulating program policies, objectives and priorities. - Grantee: The grantee organization manages the grant of the Regional Medical Program in a manner which will implement the program established by the-Regional Advisory Group and in accordance with Federal regulations and policies. - Chief Executive Officer (Coordinator): The grantees full-time employee who has day-to-day responsibility for the management of the RMP; he is also responsible to the Regional Advisory Group which establishes program policy. The Chief Executive Officer and his program staff provide support to the Regional Advisory Group and its subcommittees, including local advisory groups where they exist. F. 2. Regional Advisory Groups PURPOSE: The Re(yional Advisory Group (RAG) is the organized voluntary 0 o y o health providers and consumers in each R,\T which has responsibility for program and project determinations and overall program direction. A Regional Advisory Group, throuah membership composed of representatives from most health interests as well as many consumers in the Region, attempts to identify critical health needs in the area; develops, reviews, and approves appropriate activity proposals designed to meet those needs; and monitors and evaluates funded programs. The Regional Advisory Group has final decisiormiaking authority concerning prooram content and policy in each P,,,IP. SIZE: @'\TGES, FY 1972 FY'69 2.,500 total membership Size No. of RAGs 45 average group size 10 - 39 - 21 FY'70 2,700 total membership 40 - 69 - 27 48 average group size 70 - 99 - 6 100 -129 - 1 FY'71 2p743 total membership 130 -159 - 1 49 average group size Total 56 FY'72 2@667 total membership 48 average group size COIAPOSITIOIN: Regional Advisory Groups are cor@mosed of volunteers, both health care providers and consumers. @lakeup of these groups has changed somewhat over the years since Reuional Medical Programs have been in existence. Nledical center officials., for example, have decreased from 16% to 9% of the representation. Consumers, on the other hand, have experienced increasing representation from 15% of the 1967 membership to 25% by the end of fiscal year 1972. Practicina physicians have also generally increased. Category of RkG Representation 1967 1971 1972 Practicing Physicians 23% 28% 7@ Hospital Interests 12 13 12 Medical Center Officials 16 8 9 Voluntary Agencies 12 8 7 Public Health Officials 7 5 6 Other Health IVorkers 8 11 7 Members of the Public 15 21 25 Other 7 6 8 F. 3. COMMITTEES AND LOCAL ADVISORY GROUPS PURPOSE: Regional Advisory Group committees have major responsibilities for: (1) Program activity development and review; and (2) monitoring and evaluation of funded activities. Most are composed of experts in a given field a-,id as such have significant influence in terms of the scientific and professional competence of program activities. The last two years has been a marked increase in the number of planning, review and evaluation committees, giving these functions an added and much needed emphasis. Local Advisory Groups, although they are tied to the Regional Advisory Group (in many instances membership of the bodies overlaps), serve primarily in a liaison and program development capacity at the community level. Generally, they attempt to foster cooperation among local health organizations and consumer groups, and in many instances provide linkages with CHP area-wide groups. Local groups serve as reactors to community needs and problems and relate these, as well as possible solutions, to decisionmaking bodies at the regional level. NUMBER AND SIZE: Comparison 1969-72 1969: = 864 10,163 Total Membership 1971: = 875 12,426 Total Membership 1972: = 850 12,315 Total Membership Note: Total membership of these groups overlaps considerably with Regional Advisory Groups; in addition, committee memberships overlap to some extent with each other, so that totals shown are based on numbers of memberships rather than numbers of individual members. F. 4. GRAliTEES OF REGIONAL MEDICAL PROGRAMS PURPOSE: Each Regional Medical Program is fiscally administered by a grantee which may be a public or private non-profit institution, agency, or corporation. The grantee is responsible for management of the RMP grant in such a manner as to implement the program established by the Regional Advisory Group and in accordance with federal regulations and policies. This includes primarily fiscal control, fund accounting, and administrative support. Categories of Grantees, Fiscal Year 1972 Grantee 56 Universities 33 Public (26) Private 7) Other 23 New agencies/corporations (16) Existing corporations 3) Medical societies 4) F. 5. PROGRAM STAFFS PURPOSE: Program staffs are the salaried employees of the 56 Regional Medical Programs. Their functions include planninu and development studies, feasibility studies designed to assess the potential of prototype programs for larger scale application, and professional consultation to community health groups and institutions. In addition, they are responsible for operational project development, review and management, including the provision of staff support to the Regional Advisory Group and its committees. SAMPLE ORGAINIZATION CHART: Coordinator or Chief Executive Officer Program Administratio Program Operations Health Care Manpower and '-ty Control Delivery Systems] Edu-cation ,hanisms SIZE: Comparison of staff size in full-time equivalents, fiscal years 1969-72: FY 1969 - 1,546 total FY 1971 - 1,640 total 28 average 29 average staff staff FY 1972 - 1,374 total 25 average staf f COMPOSITION: Program staffs attract persons with a variety of pro- fessional and technical competencies. Staff composition as of June 1972 included the following specialties and categories: Education ill Administration/Management 119 Medical Sciences 149 Other Sciences 76 Health-Related Occupations 123 Public Info./Relations 52 (e.g., health planning Other Prof. and Technical 11.0 hospital administration) Secretarial/Clerical 569 Social/Behavioral Sci--nces 66 1,375 F.T. 0 PRIMARY PURPOSE OF RMP OPERATIONAL PROJECTS. (FY 1971 and FY 1972 With Net Change in That Period) FY 19 7 1* - FY 1972* Net Change No. of Amount (in No. of Amount (in Amount (in Primary Activity Projects thousands % Pro_iects thousands % thousands % - Training Existing Health Personnel in New Skills a/- 144 $10,154 22 200 $13,266 17 $ 3,1'L2 31 Training New Categories of Personnel b/ 16 921 2 55 3,566 5 2,645 +287 Continuing Education c/ 149 9,578 21 186 12,031 16 2,453 + 26 Patient Care Delivery Demonstrations 104 10,008 22 158 17,098 22 7,090 + 71 Combination 1/2 Training 1/2 Patient Care Demonstrations go 8,887 20 185 14,611 19 5,724 + 64 Coordination of Health Services 56 2,965 7 142 11,055 14 8,090 +271 Research and Development 35 2,772 6 51 2,559 3 213) - 8 Data Collection/Statistics (Not included in data),. 30 2,354 3 2,354 TOTAL 594 $45,285 100% 1,007 $76,540 100% $51,255 + 69% a/ New Skills for Existing Personnel - training aimed at enabling the person trained to assume new responsibilities in the already chosen career field or adding skills in a different but related health field (e.g., coronary care training for nurses, career mobility for licensed practical nurses . b/ New Personnel - development of training programs for such new categories of personnel as physicians' assistants, nurse practitioners, and community health workers. c/ Courses aimed at maintaining or improving the level of practice of the health professional. Patient Care Demonstrations I%Thich ITiT)rove Oualit 12/ 72 Accessibility, and Organigation of l@Icalth Services No. of Projects Amount Coronary and other intensive care 95 $6.2 Million activities .................................. Expanded and improved ambulatory care in neighborhood health centers, clinics, and outpatient departments ....................... 213 18.1 Million Expanded and improved home care and I= 4.8 Million term care .................................. 79 Other activities such as mobile units, specialized care services, and non7intensive 141 10.0 Million in-hospital care ............................ Emergency medical services .................. 61 10.7 Million RMP Grant Activit in Categorical Diseases y (As of December 31, 1972) 14umber of Activities Aniount Hypertension ....... 00 ...... 7 $8061746 Heart Disease ........ 93 4,865,557 84 5,408,714 Cancer ........................... Stroke ............................ 58 3 956,861 Kidney Disease ......... *;.o ...... 0 79 6:673,646 Pulnionary Disease ................. 31 20462,200 Diabetes .......... *.... 0......... 11 682,926. sickle Cell Anemia ........ 2 131,414 ,@@365 249988,064 CATEGORICAL DISEASE EMPHASIS OF RMP OPERATIONAL PROJECTS (FY 1971 and FY 1972 With Net Change in That Period) FY 1971* FY 1972* Net Change No. of Amount (in No. of Amount (in Amount (in Disease Projects thousands) % Projects thousanLI --7. thounsands) % Heart Disease and Hypertension 156 $11,684 26 124 $ 7,439 10 ($ 4,245) -36 Cancer 89 6,208 14 98 6,526 9 318 + 5 Stroke 65 5,499 12 57 4,192 5 ( 1,307) -24 Kidney Disease 22 3 74 6,246 8 4,728 +311 Pulmonary Disease 22 2,479 5 35 2,875 4 396 +16 Diabetes and other related diseases 19 1,055 2 42 2,315 3 1,260 +119 Yiulticategorital/ Comprehensive 221 16,843 37 577 46,947 61 30,105 +189 TOTAL 594 $45,286 100% 1,007 $76,540 100% $31,255 + 69% *Total current funding level, which includes some funds obligated in prior years. SPECIAL TARGET POPULATION BY RACE OR ETHNIC GROUP (RMP Operational Projects for FY 71 and FY 72) FY 1971 FY 1972 Net Change No. of Amount (in No. of Amount (in Amount (in Race or Ethnic Group Projects thousands) % Projects thousands % thousands % Black 29 $ 3,933 9 69 $ 8,202 11 $ 4,269 +.109 American Indian 4 312 1 8 682 1 370 + 119 Spanish American 4 168 27 2,176 3 2,008 -+1,195 Oriental 1 188 0 0 188) - 100 Other/Combined 8 832 2 43 5,962 8 5,130 + 617 Not Relevant 548 39,852 88 860 59,518 78 19,666 + 49 TOTAL @J94 $45,285 100% 1,007 $76,540 100% $31,255 + 9 COURSE REGISTRATIONS IN @-SPONSORED EDUCATION ACTIVITIES FY 72 (Listed by Type of Training Received and Discipline of Recipient) CONTINUING NEW SKILLS FOR NEW TOTAL DISCIPLINE EDUCATION EXISTING PERSONNEL PERSONNEL c/ No. Percent Physicians (ND/DO) 46,328 10,140 56,468 297. Dentists 1,442 197 1,639 1 Nursing Personnel 36,301 25,072 146 61,519 32 A'@lied Health Personnel 23,011 12,362 1,205 36,578 18 Hospital/Nursing Home P@rsonnel 10,414 694 11,108 6 Medical, Dental and Nursing 6,106 1,139 7,245 4 Students Other 8,582 9,579 1,064 19,225 10 TOTALS 132,184 59,183 2,415 193,782 100% a/ Continuing Education - courses aimed at maintaining or improving the level of practice of the health professional. b/ New Skills for Existing Personnel - training aimed at enabling the person trained to assume new responsibilities in the already chosen career field or adding skills in a different but related health field (e.g., coronary care training for nurses, career mobility for licensed practical nurses). C/ New Personnel - development of training programs for such new categories of personnel as physicians, assistants, nurse practitioners, and community health workers.