i iii@ i ii i il ! 1 ii t ii il I i @ iiiiiiiii I @ i . .1 * m E 0 F ii I.' AL T 11, E'D UC A T I 0 N i) r P A R T N T A N D W E. L FA R,E Health Services and Mental Health Administration Division of Regional Medical Programs National Advisory Council on Regional Medical Programs minutes of the Meeting May 11-12i 1971 ilding Parklawn Bu conference Room G/H Dl:,PAICEME141' OF IIEALTli, EDUCATION AND WL,'LFARE PUBT,IC fiLALTil ST,,RVICL di'al. Program National Advisory Council on Regional Me c Minutes of the Twenty-third Meeting 1/ 2/ May ll-IZ, 1971 The National Advisory Council on Regional Medical Programs convened for its twenty-tiiird meeting at 8:30 a.m.., Tuesday, May 11, 1971, in qbnference Room G/11 of the Parklawn Building, Rockville, Maryland.- Dr. Harold Margulies, Director, Regional Itedical Programs Service, presided over the meeting. The Council members present i-yere: Dr. Michael J. Brennan Dr. Clark li. Millikan Dr. Bland W. Cannon (5/11 only) Or. Alton Octisner Dr. Michael E. DeBake Dr. Russell is. Roth (5/iZ only) y Dr. ltruce W. Everist Dr. George I,' Sc ire n(-r Mr. Harold it. Illyies, Jr. Mrs. Floret-ice R. Wyckoff Dr. Alexander M. McPiiedran Dr. Joliii D. Cliase/for Dr. Mbss(-,r A listing of RMP staff meribers, and others atteridiiip is appended. CALL TO ORDF,"R AND OPENING RFLMARKS. The meeting was called to order-at 8:45'a.iq. on May 11 by Dr. Harold Margulies. 11. -It@iTRODUCTION OF NEW COUNCIL iNIEMBER Dr. Margulies introduced Dr. George E. Schreiner, Professor of Medicine and Director, Division of Neplirology, Georgetown University, @t?ashin,,Lon, D. (,. ite also introduced Dr. Johii D. Cliise. re@,)r(:iseritliic" I)r. .trusser of t'lic VoLeraiis A(Iiiiiiii.-;tritioll. Dr. r4,irl@,,Ljli.es );eiteril iniit)tincemetits, .3rt(i calleti Lo t;iEt sL.i'L,eiiteiiL oi-i "(,oiifLict of Iiiter@st," ill Liie itiforiiL@iLion I/ Proteeclins,s of meetings are restricted unless cleared by the ()fiice of the Administrator, LIShiliA. The restriction relates to all material submitted for discussion at ttie,meetings, the supplemental material and all other official documents, including the agenda. 2/ @Fot the record, it.is nn,!:e(l that Treinbers absent themselves from the' 1, t oils - f i(, i r @@"I.LLil a coal resi)c ve inst lict of interest mi.@,iit occur. This procedure does not, of course, apply to en bloc actions onlv when the application is under individual discussion. 2 IV. CONFIRmA:rio@; OF FUTURE @fLETING DATES The Council reaffirmed,the following dates for future meetings: Au ust 3-4, 1971 November 9-10, 1971 February 8-9, 1972 Cray 9-10, 1972 CONSIDERATION OF MliNUTES OF THE FEI@RUARY 2-3, 1971, Mf,,E'I'IiW The Council considered and approved the minutes of the February 2-3, 1971, meeting as written with one addition: "Council discussed the need for assurance of quality in health care services and agreed to concern itself with prob ems of health care quality control." VI. REPORT BY DR. MARGULIES A. Appropriations The AdministratioA's 1972 appropriations request would hold @IP grant funds at $70 million (the fiscal year 1971 apportionment) through fiscal year 1972. In the House hearings the decision to maintain this level was questioned closely. No House mark-up has been announced and tile Senate Committee will not hear testimony on tile bill until September. B. Health Insurance Interest in Health Insurance remains high on all sides. The number@ of bills before the Congress on this subject continues to grow, but as yet there seems to be no clear trend toward the support of any one proposal. C. Area Health Education Centers The concept of Area Health Education Centers, greatly stimulated by the Carnegie Foundation report,- is now embodied in two b-@lls before the Congress. One plans administrative responsibility for Area Health Education Centers in the Regional @ledical Program, the other would result in assignment of responsibility to the National Institutes of Health. The Area Health Education Center is as yet not fully defined, probably 'ble agency built around fjealtli 'will be a cbimnunity based, gratit-clif,,l care institutions and practitioners, affiliated wi.th health educational and Lrainiiio, institution.-,, including a university health science center. 'I'ItL- 'AliLC ul'd be natural and important concern of the Re., wo a -ional 3 Medical Program. In turn the Regional 1-iedicil Program wil.1 under f their s be ssociated with the center, because 0 any circumstance a -thancei, common interest in ei ient of health care services. D. Health Maintenance Or@,,anizitions_ 'Z"ll"S is cooperating closely with other li;,"'Al efforts to develop Health ?Iaintenance Organizations. Ti-iere li.-i@- becii established a iiitioral clearin-,;Iiouse. in liS'-PIA to 'keep recor,ls and oversee II] ii,@110 Ictivitic!s, responsfl)ility for tlicir development is in the liL'@@ 1 be especially useful in the early phases .,)@fices. " flj,ii!s wil by assisting in the convening of those who must meet to-ether and by obtaining for them 'necessary consultation and other required supporting material. They will be of value later in the establishment of an effective health care system particularly by assisting ill,14"10 efforts to monitor the quality of care beiii- provided. P,14P@ has the specific. responsibility for developing guidelines and criteria for the monitor- ing of quality and for developing a concept and I,,uidelines for health maintenance. E. Physicians' Assistants -i@j Se-rvic@ Commission has established cr ades for Pliysician's As@jzli:aifts, most @'i whom will be employed by the Veterans A(Iiiiinistration. The Director of @TS serves as a member of an executive committee advising the Corimission of the qualifications to be established for the grades GS 7, 9, and 11. RWS continues to have with NC@ISIZ&I) a keen interest in Physiciants Assistants development and will partici pate in the further definition of PAs, their functions, tlieir 16gal status and their limitations. F. Recent Developments in the Regional Medical Prosra-@ns Service o Council and ReV iew 1. An expanded focal point for services t .Committee is being develop.@d. The charter of this office of .-"ouncil and Coanittee Affairs will be circulated when the reorgani- k-@n plan is completed. The Operations Divisi6t is developing four geographically organized desks. " Eal--ii of these will provide a spectrum of services for a. designed group of Regional @tedical Pro,.,rar.1s. Each will be served by designated liaison personnel. cf the -rafession6 -P 1 and Technical Division. Since the last Council meeting, the LI-CL@@EmpJ.oyiiir-@nt 3 program in RKPS his been developing rapidly. Not only because it is an agency of government, but al.so because Tnission@ is to the whole citizenry, RMPS caniio tserve its 4 criininates against minor!-ties or women.. I,'ot only ill P,'IPS but in all the lips, both F-qual Lmploy-nient opportunity and minority 17vidence of re are major concerns Froup access to health ca t:s will be.c;ouglit.in 11.1 program reviews. adhe@ence to these concep ON Atll'o@IATI,'D lirALTli rLs,i,ip4,(; Vil. RLPOWF OF SUIICO,,LMITTEI,, I)r. I.I,icliael Brennan, Chairman of the Council's Sul)coririittee on Automation, reported the following a@ the Coi-imiLtee s considerations and recommendations concerning automated mul.tiphasic health testing as an IUIP investment: A. "At this time eleven Regional Medical Programs have funded 'pro- jects that feature automated multiphasic health testing. The our- pos-es of these projects present a fair representation. of @he purposes for which patient health status data are required. B. :'Nutomated Health Testing is very costly. The influence of the projects in which it appears on regional deployment and utilization of health care services is highly unpredictable. For these reasons Council recommends that no new projects featuring automated health esti be funded. C. "The Council further recommends that the I)irector, IOIIIS, and the appropriate Regional Medical Program, coordinating with the National Center for Health Services Research and Development, Community Health Services, the National Center for Health Statistics, the National institute o General Medical Sciences and other interested agencies,, institute consultation and investigation to: 1 Provide market and financial analyses and advice to avoid loss in post-grant operations of. projects currently funded by Regional Medical Programs; 2. Build into @IP.and other projects base line data, defined goals and measures of progress for cohorts of persons whose initial multiphasic tests were positive, negative and refused, among such populations As urban and rural poor, emplo,,-ees' froups, hospital and clinic patients, to help resolve iebate about the effects of mull,-ipliasic testinF, on quality of and access to health care services and the regional deployii-,#.!n.t and lization of health care resources; uti -ize@systems anal s nd all 'available epidemiologic 3. Utii y is a information to stimulate natural histories of diseases and identify those for which.secondary prevention might be feasible c and and ac eptable in cost; 5 -ilys(!s of tlie- results of multi 4. Conduct riulti-variant an, ity that It cotild phasic testiiio to investigate the possibil. improve diagnostic application of the tests." COUNCIL ACTION: The Council unanimously adopted the above recoinmen- dations of the Subcommittee on Automated I,lLtltiphasic Ifealth Testing. In this regard, please note that the recommendation in Section B establishes a newt l@CX for Regional Medical Programs Service. --vi-i-i@- ADMINISTRATION OF REGIONAL MEDICAL PROGRAM G,@'TS Dr. Margulies reported briefly on a limited test by which our site visitors or Review Committee have.ranl,,ed Regional Medical Programs in terms of their overall effectiveness. This type of activity will become increasingly necessary' if changes in levels of avail- able grant funds are to be accommodated in a selective fashion rather than across-the-board additions or reductions for all programs4 A. The Professional Jud rl It Comparison To date, very broadly conceived criteria of effectiveness have been employed in the review of our grunts. At the last meeting of the Review Committee the programs of fifteen Regional Medical Programs were considered. After the formal actions were completed, the members of the.Revie@; Committee agreed to try informally to rank those programs for overall effectiveness. The procedure con- sisted simply of distributing the fifteen Regional Medical Prograas into "quartile" groups; the results were highly consistent. There were several instances of identical quartile assignments, and in almost all cases the differences in assignments were not more t an one quartile apart. This informal, no-record exercise was conducted as an extension of the entire review process and app ared to e workable. B. The Grading..L@TI) Another approach to,compar-;Ison of Rep:,ional Medical Pro5,,ram effective- ness can be made by grading or scoring the performance cf each on an absolute scale. This adproach-has not been given a full trial. Earlier this year numerical. grading was used in alimited way on several site visits to Regional Medical Programs. The results of these trials havelghown.less consistency among the graders than did the Review Committee'-- comparison of the fif@een regions. C. Ef f ects of I n@Ln @ReZ, "@-Rils In the long@run, administrative actions and advisory group recommen- dations which result from such determinations of relative merit pri- f T@ 6 THE ADMINISTRATO',t'S SESSION ssed with the Dr. Vernoti E. Wilson, Administrator, IISMilA, discu Council events and trends that have implications for the future. Ai Consumer interest in qua ination It is not unlikely that the basis of advisory council actions as well as the actions themselves will become public records. In- creasing consumer group interest in program processes reduces the latitude for unsupported judgment. This Council seriously should consider development of a rating syst em as a basis for its decisions on grants. The interest of career.consunier advocates in this field is rooted in a widely held opinion that professional judgments should be openly determined and intelligible to the lay mind. There. is need for a system that the consumer advocates can under- stand and apply to reach the same results as does the Council. There is, also a widespread misunderstanding of @iP by people who see it as an implement of Federal control of health care. It is also said that RI.IP performance is spotty, does not yield true national coverage, and that -RW is not as closely related to the universities as it should be. We see the flaws in these arguments, but their proponents are not easy to convince. In @ip the Federal Government has a good channel for working with@ the providers but the relationship is not always easy to clarify. We must continue to emphasize the process And not only the content of RMP in our judgments. The need is for a foundation of under- standable judgments on which credibility can grow. B. Two bills to establish Area Health Education Centers have been placed before the Congress. One would place the authorization in Title IX (R.YLP) of the Public Health Service Act; the other, which is the Administration!s bill, would place the authority in the National Institutes of Health. We must be prepared for either eventuality, and in either case both the RMP and the Manpower Bureau of the tqlli will find their activities affected by the pro- gram. The Departinent's proposal is being presented as part of the proposal for extension of the Health Manpower Act. C. Tlie'Willard Committee report has been circulated arnonp, a @lipiited@nuinber of administrators and advisors but has not been ublislied The document was kept brief by design, 'atid some of its p c-onCe LS are rather broadly stated'. Some of its ideas already p iiav6 been incorporated in testimony presented before C6ngression@il and more will be.presetited, for example, in testimony t 7 1-ii.c,;s Cecilia Conratli, Chief, C:cntiiluil-i@', 1.,ducatioii an,i 'Frail-lill"p -iiid oi)jc,.@tives concerniii5,, .II) Sspokc on (:otjrcil and T-,@IP pc)'icies of the century, 60 percent of health health manpower. At the turn workers were @I.D.1s, now 84 percent of health workers are not About 70 percent of health workers are women; many of their jobs are low pay, little requirement for independent judp,- @liaracterized by: ment, special turnover and dropout problems, entry at the' hi,-,h school leveli and re-entry through established training or re-traininp,. one of every two health workers entered with less than three years of college education. One of every five had less than full Iiiph school education.. Slany jobs gcope and severely limited in opportunities ate routine, n;trrow in 31 for advancement. Refresher trainiii for re-entry of dropouts, once enthusiastically el advanced as a means of rel evin- shortages of help, has not succeeded as hoped--too many of the trainees limit their availability to part- time or intermittent work. RMP is going to be involved in manpower problems because it.is the logical channel for provider concerns. I-lith regard to our relationship to CHP and NCHSR&D, Dr. Marp.,.ulies stated that it is important that R@FPS retain its identity and avoid assumption of CHP responsibilities. It is also important that R,@IPS and NCHSR&D work more fully together. The basic guide to W411 develop anent now and in the coming years will be found in the Federal lieal th strategy. If it is to be a maximum service to this country, TM) will work with increasing effectiveness through all of the mechanisms which are available--Clill, R&D, local orl?,anizations, etc.--to maintain or improve the quality of health care while emphasizinl.,, increased accc-ssi- bility, better distribution of manpower, greater productivity of health system and increasing efficiency in the delivery of services. XI. EXECUTIVE SESSION The Coun ssion met and endorsed the RMP5 mission cil in Executive Se statement. xii REVILW OF APPLICATIONS.- RECO,,LMENDAT10" o ,i 1/ @4S FOR ACT1 ARIZONA REGIONAL M@',DICAL PROGRAM - 101 00055 5/71. ii plemental) No additional funds are recommended for this Reyional %i'edical Program at this time. The reque§t for additional core support is specifically disapproved. The Region may rebudget, funds into any of the projects in line with its own priorities. This action coincides with Review Committee recommendations. BI-S'TATE REGIONAL MEDICAL PROGRAM RM 00056 5/71 (Supolemeiital) Additional direct cost funding in a reduced amount is recommended as follows: Ist Year - $16,750 2nd Year - $15,850 3rd Year - @15,850 While the Region may rebi.idget available funds into either of the jects included I,---.'this application, Council considers two pro Project #16 - To Develop a Model for Testing Physician Continuipi. Education .- innovative and Project #15 A Public Education Program on Harmful Effects of Cig_@@t e@S t@l :L@n was considered low priority. This action coincides with the recommendations of the Review Committee. CALIFORNIA REGIONAL MI-I'DICAL PROGRAM RM 0OU19 5/7i.1 & 5/71.2 mental) Region may rebudget available funds into Project #41 Patient Monitoring (Area I), in line with its own priorities. Council defers consid&i-@-tion of Project #85 - C!Lo@e Lin e'aical Prog for Train'n Effort of Regional M c rams and Model Cities in the Allied health Professions - Area I pending program site visit of June 1971. This action differs from the recommendations of the Review Committee only in relation to Project #85. 1/@ All amounts are direct costs only and unless otherwise specified refer to-a'12-month period. 9 C)27 5/71 (StiT)pleniental) RM 00 IOWA REGIONAL 14',DICAL PRO(, Add.itional direct cost funding is recommended for the Iowa Pj4p as follows: ist Year $43,500 2nd Year $35,272 3rd Year @3 6,719 Region may rebudget funds into any of the projects included in the application except for Project 1,119.- Renal Failure Management Trainin in line with its own priorities. This action differs from the recomn) dations of the Review C mnlittte en 0 but incorporates the recorimendations of the Ad iloc Panel on Renal I)iseases. KANSAS RLGIONAL ML'DICAL PRO-@PLM RM 00002 5/71 This Region is approved for triennial review with direct cost un np recommended as follows: Ist Year,- $1,800,000 2nd Year - $1,800,000 3rd Year $1,800,000 The request for developmental funding is disapproved. -,ipreliensive Ne rorram is Project #40 - Development of a Co approved in line with the recommendations from the special review by a renal specialist and the site visit team. This action coincides with the recommendations of the Review Corimittee. MAINE @GIONAL MEDICAL -PROGRAM - RM 00054 5/71 (Su@:L @m n@t l@) Additional direct funds are recommended for this application as. requested: $27,896. This action coincides'with the Review Committee recommendations. MISSISSIPPI REGIO!@AL MEDICAL PROGML RM 00057 5/71 (Anniversary) No additional funding is recommended for the @lississi.ppi P1411 at this. time. The request for developmental funding is not approved. The Region may rebudget available funds into the projects ill tile application, including Project #17 -Renal I)isease Program in line witli,its priorities. 10 MISSISSIPPI @IP CONT.. A program site visit is recorimended to help this Region's core staff, P-j@G, and Planning Group focus priorities on health needs of Mississippians; staff assistance is also recommended. This action coincides with the recommendations of the Review Committee and inc'orporates the advice of the Ad Hoc Panel on Renal Diseases. MISSOURI REGIONAL MEDICAL PROGRA14 RM 00009 5/71 (Triennial) This Region is approved for triennial review at the following direct cost levels: lst Year.- $2,500,000 2nd Year $2,012,000 3rd Year 'YI,8251000 The r6quest for developmental funding is disapproved. The recommendations of the Review Committee regarding funding hould be conveyed allocations among the major program elements s to the Region. This action differs froin the Review Committee only in the level of funding recommended for the first year. Council felt that $300,000, rather tiiait $250,000, would provide for -.r@ore orderly phasing Out Of the computer and bioengiiieerin@ activities. GRA'L Pli 0.0032, 5/71 (J'ric-nnial.) 1-10 U LN'f A I.,4 srATES RI"GlOiNAL MDICT,,L PRO riii-, ',@e,,.-,ion is approved for triennial review with direct cost fuiidiii,,; levels as follows,: Ist Year' - $1.,741,000 2n(I Year -1 $1,r,ll,ooo 3rc.1, .'Ieir$1,366,000 .'rii(-- request for developmental funcliti,, is ipf)r(-)ve(l. te 'd Funding for Project #3R - 'kt(naL@til States TuTnor Institu is approve for two additional years only. at such The interest in forniiig a separate Nevada R14P is recognized; time as, an application is received and acted upon, the funding recommended for the Mountain States IOW will have to be re-reviewed. This action coincides with Review Conmittee recommendations. itm 00016 5/71 (Triennial) NASSAU/SUFFOLK RI".(;!.ONAI, MFDICAI, PR.OGRAT e,l for tlic, operational status is al)prov rllree yf-,ars direct cost fundiitp, is recommended as follows: 3rd Year $908 043 ist Year.- $829,755 2nd Year - $868,408 ress during first year. site visit should be made to review prog A First continuation application should be reviewed by Committee and Council, with idea of increasing funding level if progress permits. This action coincides with recommendations of Review Committee, except that Council did not develop a policy on computerized EKG as requested by-Committee. Council requested a staff paper on this subject for consideration at a later time. Therefore, the Region is'not prohibited from utilizing its funds for this activity if program priorities so dictate. NEBRASKA RI-"GIONAL MLDICAL PROGRAII - RM 00069 5/71 (Triennial) Status as a separate @IP. Is approved for Nebraska. Three years direct cost funding is recommended as follovis- Ist Year - $790,070 2nd Year - $790,070 3rd Year $440,653 The Region shoul d be advised of serious concerts about direction of program. 'A site visit shou ld be made to assess progress during the next year. First year continuation application should be reviewed by Committee and Council. This action coincides,with Review Committee recommendations except for level of funding recommended for third year. Council fcols that l@ef,,Ion must provide more substantive information about plans to utilize funds during third year. NORTH CAROLINA.RLGIoliAL MEDICAL PROGRAM RM 00056 5/71 (Triennial) This Region is approved for triennial review with the following direct cost levels recommended: lst,Year $2,049,000 2nd Year $2,049,000 3rd Year.- $2,049,000 equest for develon-,ler.,l The r funding Is approved. 12 NORTH CAROLINA @P CONT. A specific exception is made to Council policy regarding support of basic education for Project #32 - Career Ladder Nursin Education. The funding level does not take into consideration funding for Project #28 - A Proposal for the Care of Patients with Chronic further technical review. Uremia - which is def erred for This action coincides ,,:-'@.,--@coiniiiendations of both the Review Comi@-aittee. and the Ad tioc Panel oi', '"----.ial I)isetses. NORTIIE STLW,4 OHIO ICAL PROGRAM - P14 00064 5/71 (Ann A RI:GIOIIAL MED Funding is recommended .at the committed level, $766.,lE;7 (Direct Cost), for one additional year. The Region may rebudget available funds into any of the propose new projects, except ]!earth Careers in Ohio, in line with its own priorities. IU-IPS staff should explore with this Pe5,,ion, as 1-7011 as ot,,,er !'e,-io!ls servitiF, Ohio resi("ents. ways to provic,e a iiiorc.,. effective, efficient organization for regic.-.- m -'O. Cou (-, v es e(lical pro-rar,,-@Lii),.- in O'fi-i ncil beli it may be necessary to' have at least two ,'I,",Ts serve the State, but trie possibility for a unified IC'Lll should also be explored. Site visits should be iiiade as necessary. li@ his Action differs from Review Coinmittee recoiiirnendatioii8 in that an alternative. other than one Ohio I is suggested and that the number of site visits may be negotiated. NORTIIWE8TERN OIIIO RL@GION'Al, @ttDICAT, PROGRAM P,@l 00063 5/71 (Annive sar3L) Fundin@ is recommended at the following, level for one, year only: $6',')7,304. ritis recommendation provides for continuation of core and on-goinp, ictivities at present rate of expenditures however, Reg@'on Tiay rebtidget available funds into new projects in line with its own priorities, excep@ for Health Careers in Ohio. ILMPS staff should explore with this Region, as well as other fle@,,ions serving Ohio residents, ways to provide a more effective, efficient organization for regional medical prograrim).iip, in Ohio. Council believes it may be necessary to have at least two R14Ps serve the State, but the possibility for a unified PIIP should be explored. 13 i i.o @,T CONT. NOitritwEs,rEitN 01. Site visits should be made as necessary. The request for developmental funding is disapproved- This action differs from Review Committee recommendations in that an alternative other than one Ohio F14P is suggested and.that the number of site visits may be negotiated. 5/71 (Triennial) OHIO STATE REGIONAL @ILDICAL VROGRAM RM 00022 ied- funding at the The request for triennial review status is den committed direct cost level is recommended for one year only as follows: $714,075. The request for developmental funding is disapproved. The Region may rebudget available funds into projects Included in this application, with the exception of Health Careers in Ohio in Core, Project 1129 - Home Dialysis llropram and ;@ject '130 - I'Lo.@ain o@ r@ i@i Lo n @e e@ction, in line with its own priorities. PIMPS Staff should explore with this Region, as well as other Regions serving Ohio residents, ways to provide a more effective, efficient organization for regional medical programming in Ohio. Council 'MP s s believes it.may be necessary to have at ).east two P, erve the State, but the possibility for a unified RMP should also be.explored. Site visits should be made as necessary. This Council action coincides with recommendations of Ad Hoc Panel on Renal Diseases regarding approval of Project #27 - Cadaveric Transr)lant Program and #28 - Pediatric iephro Center, but no additional funds are recommended. OHIO VALLEY REGLONAL M@,I)ICAL PI?OGRA@L lal 00048 5/71 (Stiy)plemental) ilioiial direct cost fur-idiiiy, iq Add recoitiiietide(i as follow.": lst Y-Uar - $98,010 2rcl Ye@tr - $9,@,410 3r(I Y(.@;ir ke@;ioti may rc-btidl;eL funds iiito tiny projects include(.! in t!ii-, application, except that Council questions the advi.sil)il.ity of iiij-titin-,, Project ii24, Intensive Coronarv Care Unit 14urses 1'raiiiin?,, at this point iii the Re,.,,ion's development. This action 'Coincid(.,!s Revievi (-committee recommendations. 14 ',GIONAL @@DICAL PROGRIOI P@l 00023 5/71 (Triennial) OKLAIIOIMA R- The request for triennial funding is disapproved; direct cost funding for one year is recommended as follows: $913,500. rov d. The request for developmental funding is di.sapp e A site visit is recommended to assist this l@egional Medical Program in developing specific goals and objectives, before it sul)i-,iits a Triennial application next.@-'!@!)ruary. This action'coincides with Review Committee recommendations. PUEWRO RICO REGIOIN'AL @IEDICAL PROGRAM - PuM 00065 5/11 (Anniversary) Funding is recommended for Region's second operational year at the following direct cost level: $939,762. The request for developmental funding is disapproved. Region may rebudget available funds into any project included in this application in line with its priorities. This action coincides with Review Committee recommendations. SOUTH CAROLINA RI,"GIONAL @fl@"DICAI, PROGRAM I)IM 00035 5/71 (Triennial) Region is approved for triennial funding, at the following direct cost.levels, pending a favorable site visit report an Project #55 Chronic Renal Disease Education and Service Pro r@@. Ist Year $1,550,000 2nd Year $1,550,000 3rd Year $1'550$000 Request for developmental funding is approved. Region may rebudget fundi.,..into projects included in this application in line with its owri priorities, except for those activities which be precluded by Council policy; i.e., Project 1152 - Health Manpower and the fellowships in lt46 Hematologic Malipnancies..... This action incorporates the advice of Review Committee and the Ad lloc Panel on Renal Diseases. SUSQUEIIANNA VALLRY RI-,GIONAT. MEDICAL PROGRAI-1 RM 00059 2 71 & 4/71 .KDc- r @!Lu eilt t@) Appro-val.of $100,000 supplemental funding is recommended for one year with the followin@ conditions! 15 SUSQULiiANNA VALLEY RM' CONT. 1. The R gion engage effective leaderrliip on its core staff; e 2. The Region study and make necessary hanges in the RMP c organization to assure a v iable Regional Advi sory Group,, viable medical center involvement and a viable grantee; 3 IZi@nS make available sufficient, experienced staff resources to assist Region in its study and subsequent program changes. The request for developmental funding is disapproved. 'This action essentially coincides with reconi-m endations of t6e Review Committee. TRI-STATE REGIONAL MEDICAL PROCFM4 - Rlf 00062 @@il a@) Action on the application for funding a New England Facilities for End-state Kidney Disease is deferred, pending Council study of a technical site visit report. This action coincides with the recommendations of the Review Committee and the Ad floc Panel on Renal Diseases. WESTERN PENNSYLVANIA REGIONAL MEDICAL PP.OGRA-14 - RY, 00041 5/71 (Triennial) Approval for triennial funding is recommended at the following direct cost level: Ist Year - $1,450,000. 2nd Year - $1,450,000 3rd Year ?I,45031000.* The request for developmental funding is approved. Funds for Project #14 - Renal Disease - are disapproved as recommended by the Ad I-loc Panel- on Renal Diseases. Region may rebudget available funds into any project included in the application provided they ard consistent with Council policy. Attention is called specifically to policy issues related to activities In Project #10 - Ilarly Care for SusDected Coronary Patients - and Pi--oject #13 Buckt@ Pulnionarv Disease P@oj@.@t Council notes that the Region has not presented specific' project plans to utilize the funds requested in the second and third years of the triennial period. If RMPS staff should find a disproportionate share of the funds proposed in the second and third years are for activities not previously studied b,.- Council, the application should be reviewed This ictioti essentially coincides with recoiTi!neii(iitions of Revir-,,,/ (,'ot@iinittec. 16 xiii. ADJ 0 U RN M iL @N-r 1971. The meeting was adjourned at 1:45 p.m. on N4ay 12 I hereby certify that, to the best the foregoing of my knowledge minutes and attachments are accurate and complete. liarc Director Regional Medical 1'rof,.rims Service July 19, 1971 ATTENDANCE AT THE NATIgiiAL ADVISORY COUNCIT, MEETING MAY 11-12, 1971 l@MIS S'EAFI@ ITMPS SI'AFF CONI'. Miss Rhoda Abrams Mr. Alfred B. Kline, -Jr. Miss Mary K. Asdell Mr. John M. Korn Mr. Kenneth Baum Miss Julia J. Kula Mr. Earle Belue Mrs. Lorrine M. Kyttle Mrs. Simone D. Biren Miss Carol M. Larson Dr. Edward T. Blomquist Dr. Marian Leach Mr. Paul W. Boone Dr. Harold Margulies Mrs. Marilyn N. Buell Dr. Gordon MacLeod Mr. J. Edgar Caswell Mrs. Anne H. Mickelson Mr. Cleveland R. Chambliss Mr. Ted C. Moore Mr..Richard Clanton Mr. Bob Morales Mrs. Delarea T. Coley Miss Marjorie Morrill Dr. Veronica L. Conley Mr. Spero E. Moutsatsos Miss Cecilia C. Conrath Mr. Frank S. Nash Mr. Emil Corwin Miss Elsa J. Nelson Mt. Thomas Croft Mr. Joseph J. Ott Mrs. Mary L. Dana Dr. Herbert B. Pahl Mr. Roy L. Davis Mrs. Jeanne L. Parks Mr. Joseph L. De La r-!-t(,-nte Dr David Pearl Mr. Herbert P. Dunni-@@ Mr. Roland L. Peterson Miss Joan E. Ensor Mr. Eugene S. Piatek Mrs. Eileen U. Faatz Dr. Roger D. Platt Dr. John R. Farrell Mr. Michael J. Posta Miss Judith Fleisher Mr. Robert L. Quave Mr. Gerald T. Gardell Mr. William S. Reist Mr. Terrence T. Genz Mrs.,Es@elle Remer Mr. Sam 0 Gilmer Miss Leah Resnick Dr. James Gross Dr. Thomas J. Rice Mrs. Gloria Hicks Mr. Abraham Ringel Mr. Charles Hilsenroth Mr. Morton Robins Mr. George Hinkle Mr., Richar d L. Russell Mr. Paul Hoffstein Mrs. Rebecca R. Sadin Dr. J.ohn Holbrook Mrs. Jessie F. Salazar Dr. Daniel Horn Mr. Luther J. SLys Miss Dona E. Houseal Miss Theresa Schoen Miss Margaret Hulbert Mrs. Patricia Q. 3choeni Mrs. Mildred M. Felsky Mr. Robert E. Hutchings Mr. Frank Ichniowski Mrs. Mary L. Shovlin Mr4 Joseph T. Jewell Mrs. Eve S. Shunan Mr. James R. Jones, Mrs..Sarah J. Silsbee Dr'. Alan S. Kaplan Dr. Margaret H. Sloan Dr. Philip A. Klieger Mr. Dan M. Spain 2 RM)S STAFF CONT. Mr. Matthew H. Spear Mr. Jerome J. Stolov Mr. Lee G4 Teets Mr. Francis L. Van Hee, Jr. Mr. Lyman Van Nostrand Mr. Lee E. Van Winkle Mr. Frank G. Zizlavsky RMPS REPRE@SENTATIVES IN REGIONAL OFFICES Mr. William Ai McKenna Region I Mr. Robert Shaw Region II Mr. Clyde L. Coucliman Region III Mr. Maurice C. Ryan Region V Mr. 0. Dale Robertson Region VI Mr. C. Ray Maddox Region VII Mri Daniel P Webster Region VIII Mr. Ronald S. Currie Region IX Mr. Hugh S. Campbell Region X OTHERS ATTENDING Dr. Vernon E. IWilson, Administrator, HSMHA Dr. Robert Van Hoek, Associate Administrator for Operations, HSMHA Dr. Margaret H. Edwards, NCI, NIH Mrs. Frances H. Howard, NLM, NIH Mr. Wendell Maddrey, NCHSR&D, HSMRA Mr. Carl A. Taylor, OMB NATIONAL ADVISORY COUNCIL ON REGIONAL MEDICAL ROCRA',I,@ May 14, 197). McPIIFDRAN, Alexander M., M.D. (73) BRENNAN, Michael J., M.D. (72) Emory University Clinic President, Michigan Cancer Foundation 1365 Clifton Road, N. E. 4811 John R Street Atlanta, Georgia 30322 Detroit, Michigan 48201 CANNON, Bland W., M.D. (73) MILLI.KAN, Clark H., M.D. (72) Consultant in Neurology .9-10@ladison Avenue o Clinic Mempliis,--Tennessee 38103 May Rochester, Minnesota 55902 CROSBY, Edwin L., M.D. (71) OCIISNER, Alton, M.'D. (73) Executive President Ochsner Clinic American Hospital Association 1514 Jefferson Highway Chicago, Illinois 60611 New Orleans, Louisiana 70121 DEBAKEY, Michael E., M.D. (72) President and Chief Executive Officer ROTH, Russell B., M.D. (73) Baylor College of Medicine 240 West 41st Street Houston, Texas 77025 Erie, Pennsylvania 16508 EVERIST, Bruce W., M.D. (71) SCHREINER, George E., M.D. (74) ef of Pediatrics Director, Division of Nephrology orgetown University en Clinic Ge School of Medicine ton, Louisiana 71270 Washington, D. C. 20007 Id H., Jr. (74) ENES,, Mr. Haro Senior Vice President WYCI@OFF, Mrs. Florence R. (72) Marsh & McLennan, Inc. 243 Corralitos Road 231 South LaSalle Watsonville, California 95076 Chicago, Illinois 60604 HUNT William R., M.D. (71) EX OFFICIO MEMBER Commissioner County of Allegheny MUSSER, Marc J., M.D. IOI.Courthouse Chief Medical Officer Pittsburgh, Pennsylvania 15219 Veterans Administration Washington, D. C. 20420 CHAIRMAN Wilson, M.D. Vernon E. Administrator Health Services and Mental Health Administration 5600 Fishers Lane Rockville, Maryland 20852