cn
Program Direction and Management Services

fl
|

|

 

Increase or

 

 

 

1971 Estimate 1972 Estimate Decrease
Pos. Amount Pos. Amount Pos. Amount
Personnel compensation
and benefits .... . 67 $788,000 67 $871,000 -— +$83 ,000
Other expenses .... -- 710,000 -~ 666,000 - 44,000
Total ... =. 67 $1,498,000 67 $1,537,000 ~~ + 39,000

 

The program direction activity provides for a central staff needed in
planning, directing, and evaluating the broad scope of program activities in
the RMPS; maintains effective communications and information links with
the 55 local regional medical programs and the general public, and provides
administrative management services. |
February 10, 1971

 

|
Composition of Direct Operations, Technical

Assistance and Disease Control and Program
Direction and Management Services

1972
Pres. Budget

Direct Operations
Office of Director - Div. of Opera. & Devel. 16

Grants Review 22

’ Grants Management 11
Regional Development 19
Grants and Contract Policy 5
Organizational Liasion , 7
Systems Management di
Total 91

Technical Assistance & Disease Control

 

Office of Director - Prof. & Tech. Devel. 6
Continuing Education & Training 14
Operations Research & Systems Analysis 8
Clinical Specialty Branch - 22
Kidney 38
Smoking & Health 29

Total 117

Program Direction & Management Services

 

Office of Director 8
Communications & Public Information 10
Administrative Management 29
Planning & Evaluation - 20
Total a 67
ae
~ ATS
ToTAt
ii.

12.
13.
14,

15.

16.

General Questions

Regarding the training of allied health personnel, we find a number

of your programs are involved in such activities (Maternal and Child
Health, Family Planning, Health Services Research and Development.)

Isn't this duplication? Could you describe some of your activities

in this area.

We have heard much about Health Maintenance Organizations and assume
HSMHA will play the chief role in developing them. What are your
plans to develop such organizations? What exactly will be the
function of HSMHA in setting up HMO's?-

To. what extent have you decentralized HSMHA programs? Are decisions
on grant awards now made in the regional offices?

Regional Medical Programs

We note that the 1972 grants obligation level for Regional Medical
Programs is expected to be $75 million as compared with $70 million
in 1971 and $78.2 in 1970. What do you think the impact will be on
the 55 Regional Medical Programs?

How does RMP fit into the national effort of improving the delivery
of health care services?

What is RMP's role in the training and continuing education of

physicians?

What are your long-range plans for RMP in the area of kidney disease?

I note you are maintaining a level program in Smoking and Health
Activities? What are your future plans? Will the termination of
TV cigarette advertising have an effect on this program?

What is the status of the mobile coronary care units? What are the
relative priorities of these versus the intensive care coronary
care units? ‘.
General Questions

In 1971 approximately 39,000 allied and other health personnel
will be trained through activities funded out of the RMP
appropriation. In addition, over 25,000 emergency health
personnel, i.e., firemen, ambulance drivers, and policemen,
will receive training.

A better description of the RMPS role might be given through an
example. In Alabama, the RMP is sponsoring training programs
for allied health technicians through the cooperative use of
funds, manpower, and facilities already in existence at the
junior college and vocational technical training schools level.

The Regional Medical Programs Service and the 55 Regional Medical
Programs have a unique set of technical and organizational resources
available for the development and support of Health Maintenance
Organizations. The professional/technical aspect of the program
has been implemented through the development of regional cooperative
arrangements among providers of health care. The Regional Medical
Programs incorporate a set of attitudes and values towards local
autonomy and program flexibility which are in accord with the
Administration philosophy of decentralization and pluralism.

There are three major areas in which RMPS and the Regional Medical
Programs can contribute to the development and support of Health
Maintenance Organizations:

1. Establishing and maintaining systems for measuring the
quality of care.

2. Improving the access to health services through better
uses of health manpower.

3. Supporting continuing education systems which will
maintain and upgrade the quality of care in HMO's.

In conjunction with the findings and implementation of the FAST
Task Force, steps are being taken to decentralize "Project review
and ‘funding responsibility directly to each Regional Medical Program.'

RMPS and the National Advisory Council will continue to have responsi-
bility for the establishment of national priorities, the development
of policy and program guidelines, long-range planning, design of
performance evaluation techniques and the review and approval of

new and continuation Program grants from a general program point

of view.
ll.

12.

13.

-2-

In an effort to provide closer coordination with the DHEW Regional
Office structure, one RMP staff person is being placed in each of the
ten Regional Offices. In part, this meets a need for a greater flow
of information and coordinated planning to ensure that the activities
of the relevant Regional Medical Programs are consistent with and
strengthen the overall health plans of the Regional Health Directors.

Regional Medical Programs

All ‘the RMP's will feel the effects of the cutback in 1971 fromw~
$78.2 million to $70 million. Each will be reduced by around per-
cent in its operating level. While some redistribution of funds is
anticipated in 1972, the overall level will remain constant at $70
million with an additional $5 million earmarked for construction of
a cancer research facility in the Northwestern part of the United
States.

By holding obligations to $70 million in 1971, we can carry forward
$34.5 million into 1972 making our request for new authority in 1972
much smaller than in 1971.

Regional Medical Programs Service supports grants and contracts which
on a regional basis bring together in a common effort the local
medical centers, hospitals, and other health care facilities, health
care providers and other resources to systematically identify health
problems and to undertake the solutions by conducting programs through
voluntary commitment of regional resources. These programs will bring
about an increased, effective use of medical knowledge, make more
efficient use of physical and human medical care resources and help
remove barriers which impede entry of patients into the health care
system, while maintaining major focus on those diseases which are the
greatest causes of morbidity, disability, and death in the United States.

First, it has been a strong force in stimulating a renewed interest
in the need for continuing education. It has stimulated programs to
solve every day needs of practioners and patients including programs
which consider costs or access to care.

A second activity is directed toward the solving of immediate problems
and needs of the practioner. A program such as the M.I.S.T. program

in Alabama, which allows the physicians removed from the medical center,
to call the center and receive free high quality consultation on medical
problems is one example. Other programs, such as the Stroke Project

in Oregon have shown the physicians how to better utilize allied héalth
personnel ~- thus reducing costs and improving manpower utilization.
14.

15.

-~3-

The long-range plans of the Kidney Disease Control Program aim at
the development of national capability to extend the life-saving
therapies of hemodialysis and transplantation to the 8,000 - 10,000
new end-stage patients each year who are considered medically to be
good candidates for these therapies. At present, we are meeting
less than 20 percent of this need.

Information and experience gained from contracts and grants supported
over the past several years have provided us with a level of competence
to mount a national program to provide capability for adequate kidney
disease patient care. The program will focus on systems of care centered
on selected transplantation centers buttressed by adequate home dialysis
patient support, and coordinated with cadaver organ procurement
facilities, training, and high capacity donor-recipient matching

methods. Maximum reliance will be placed on utilization of existing
facilities, and patient care organization.

Everything known about cigarette consumption suggests that the
educational efforts of the voluntary agencies and the Federal Government
should be greatly increased. Yet available free radio and television
time has and will inevitably decline since cigarette advertising was
taken off the air. So long as television time exists in any amount,
the voluntary agencies and the Government must fill it with the best
and most effective messages they can. But, at the same time, they
must now broaden their programs in the other media. This is
particularly necessary for the Government, whose program is vital to
the total effort and whose materials in many cases are used by the
voluntary agencies.

This mass communications effort, however, is not sufficient by itself

to solve the problem. In addition, the current program of the
Clearinghouse must continue in the following areas:

1. School and community programs to reach young people.
2. Occupational and community programs to reach adults.
3. An expanded program with the health professions.

4. Continued efforts to encourage self-protection through

less hazardous smoking among those who are unable to
stop smoking.
16.

-4-

Of the six mobile coronary care units currently supported, four
are in their last year of funding while the other two (Iowa and
Metro. New York) may be supported for one more year.

The National Advisory Council has advised RMP's to fund no new
mobile units. It feels that the investment in the study of their
value has been adequate and that funds should be diverted into
the demonstration of more comprehensive and cost effective systems
of coronary care.
@ | 4/16/71

 

 

_
MOBILE CORONARY CARE UNITS .
- aT
Regional Medical Program Project and Location Latest Funding
: . (Totals)
Washington-Alaska RMP #27 ~ Feasibility Study Treatment - Emergency
Myocardial Infarction - Seattle $ 47,400
Oregon RMP #13 - Mobile Emergency Cardiac, Providence .
Hospital - Portland $ 8,700
Ohio State RMP #6 - Sudden Death Mobile Coronary Care
Unit -— Columbus $120,500
Metro New York RMP #1 - Mobile Coronary Care Unit - St. Vincent

Hospital Medical Center ~- New York City $ 81,600

Metro Washington, D.C. RMP #12 ~ Mobile Coronary Care Unit - Montgomery
@ County, Maryland $ 90,000

Mobile Intensive Coronary Care Unit -
Mason City $ 62,000

Iowa RMP - #13
II.

II.

REGIONAL MEDICAL PROGRAMS

 

 

Program Summary

The Regional Medical Programs Service provides the instruments
required to enhance the capacity of the health care system to furnish

- services of satisfactory quality to all Americans.

Regional Medical Programs Service: (1) supports grants and contracts
which on a regional basis bring together in a common effort the local
medical centers, hospitals, and other health care facilities, health care
providers and other resources to systematically identify health problems,
commitments, and undertake the solutions; (2) furnishes professional and
technical assistance and advice to the Regional Medical Programs, States,
local communities and other relevant health agencies; (3) conducts programs
through voluntary commitment of regional resources to bring about an in-
creased, effective use of medical knowledge, make more efficient use of
physical and human medical care resources and help remove barriers which
impede entry of patients into the health care system, maintaining major

1/ Number of regions. South Dakota included in 1971 and 1972.

Key Issues
A. The cutback in Budget Authority in 1972.
B. The way the reductions will be made.
C. The move away from categorical emphasis.
Budget Summary (Dollars in thousands)
1970 1971 1972
Estimate Estimate Estimate
Activity or Subactivity Pos. Amount Pos. Amount Pos. Amount
“Regional Medical Programs
Grants..... scene cerees 55 1/ 78,202 56 1/ 70,298 56 1/ 75,000
Direct operations..... 98 1,301 91 1,799 91 1,851
Technical assistance &
disease control
Regionalization
activities......... 27 1,526 50 2,543 50 2,57€
Smoking and health.... 29 2,239 29 2,172 29 2,189
Kidney disease.....e6: 38 4,401 38 4,096 38 4,11€
Program direction & .
management services... 88 2,833 67 1,498 67 1,537
Total......0. 280 90,502 275 82,406 275 87,27]
IV.

~2-

focus on those diseases which are the greatest causes of morbidity,
disability, and death in the United States; (4) facilitates and provides
professional guidance at the regional level to other governmental and
private efforts aimed at improving the organization and delivery of
health care; (5) administers specialized pilot or educational or
monitoring programs in the field of kidney disease and smoking and
health, which have significant importance in improving personal health
care and in contributing toward the accomplishments of Regional Medical
Program goals.

Program Goals

In order to insure maximum benefits from the funds available in 1972,
there will be a re-examination of all 55 Regional Medical Programs with a
view to reducing and redirecting funds from areas which appear less than
clearly related to goals and objectives of Regional Medical Programs
Service. It is expected that such activities will -include improved and
expanded service by existing physicians, nurses and other allied health
personnel; increased utilization of new types of allied health personnel;
new and specific mechanisms that provide quality control and improved
standards and decreased costs of care in hospitals; provide early detection
of disease; implement the most efficient use of all phases of health care
technology; and play the necessary catalytic role to help initiate necessary
consolidation or reorganization of health care activities to achieve
maximum efficiency.

Program Operations
The Regional Medical Programs Service provides support of 55 Regional

Medical Programs with operational grants as follows:
Funds Available

 

 

 

Net Operational Grants Current Program Period
Awarded to Date _ (Level as of 12/31/70)
Total $254.2 . $95.0
Program Direction - Project $ 91.5 $39.8
Development, Planning
Operational Projects $162.7 $55.2
Activity Emphasis - Projects $162.7 $55.2 _
Education & Training 88.1 29.1
Demonstration of Care 53.1 ; 21.7
Research & Development 21.5 4.4
Disease 162.7 55.2
Heart 45.9 14.1
Cancer 17.1 6.5
Stroke ' 17.4 7.1
Related (Diabetes, . 16.4 6.5

Kidney, Pulmonary)
Meet A Ane t AAT 465.9 21.0
55 REGIONAL MEDICAL PROGRAMS

 

 

 
Ii.

IIl.

IV.

Vv.

KIDNEY DISEASE CONTROL

Key Issues .

A. The relationship of kidney activities to the goals and activities
of the Regional Medical Programs.

B. The development of coordinated hemodialysis and transplantation
. capabilities to provide end-stage therapy to the 8,000 - 10,000
treatable Americans who fall victim to kidney disease each year.

 

Budget Summary 1971 . 1972
Estimate Estimate Increases
Pos. Amount Pos. Amount or Decreases
Kidney Disease 38 $4,096,000 38 $4,118,000 +22 ,000

Program Summary

The Kidney Disease Control Program is concerned with developing,
testing, evaluating and demonstrating methods to prevent and control
kidney disease. ,

Program Goals

Initial steps will be taken in 1972 on a long-range program to
develop interrelated kidney programs aimed at providing therapy for
the 8,000 to 10,000 Americans who fall victim to kidney diseases
annually and are considered to be the best medical candidates. The
Program will provide a model plan for the development of organized
kidney disease programs building on existing hospitals and health
facilities. Health planners in medical service areas who seek
assistance will be provided technical assistance in planning and
developing kidney disease programs based on the operational, cost
and medical data obtained through dialysis and transplantation,
kidney organ procurement and related contract projects. In. selected
critical areas, minimal core support will be provided to help
initiate key resources required to organize the initial elements of
an integrated service program.

Program Operations

The Kidney Disease Control Program is being integrated into the
Regional Medical Programs. Previously the Program operated on an
annual appropriation of direct operating funds, of which approximately
80 percent was allocated to contract projects with hospitals, medical
schools and societies, and research firms. Since 1967, the Program
~2-

has funded 12 training centers in the development of home training

‘for kidney hemodialysis. Nearly 550 patients have been accepted into
these training programs and 350 have graduated to home dialysis. While
final data will not be completed until 1972, home dialysis has been
demonstrated as the most economical way to treat selected hemodialysis
patients without sacrificing quality of patient care. Studies are
continuing at seven project sites for kidney organ procurement which
are reducing technical problems related to the procurement, preserva-
tion, and transportation of cadaver organs.

In the Kidney Disease Program the provision of comprehensive and
end-stage kidney disease treatment will continue being studied through
three "limited care dialysis" projects. To be completed in 1972, these
projects involve testing ways to provide chronic hemodialysis at a level
between the hospital and the patient's home. Good dialysis candidates
who are not eligible for home training are being provided dialysis
therapy in low overhead-low cost facilities. In addition, Regional
Medical Programs Service supports 17 kidney projects at a funding level

of approximately $1,462,000.
I.

il.

iit.

Apdé

Relationship of Regional Medical Programs
to

Comprehensive Health Planning
National Center for Health Services, Research and Development
Health Maintenance Organizations

Key Tssues

A. Effect of "B" agency review on new projects funded by a Regional
Medical Program.

B. Impact of decentralization and revenue sharing on the Regional
Medical Programs.

Goals

It is expected that an increasing portion of available funds will
be directed toward the’ following general areas:

Operational activities with increased emphasis on regionalization
of health resources and services, with the focus on strengthening
linkages between those institutions providing specialized care,
such as the medical centers and affiliated hospitals, and primary
care, being provided by smaller community hospitals, neighborhood
health centers, and other community health facilities.

Conjoint and collaborative efforts with Areawide Comprehensive
Health Planning agencies and similar agencies which foster community-
based planning and programs that can begin to materially effect
resource allocations/distribution for health at the local level.

Activities which encourage and support the development, operation
and success of the emerging Health Maintenance Organizations.

Program Operations

The Regional Medical Programs, with their strong provider links,
are being viewed and used as important technical, professional and data
resources 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 and to set priorities.
-2-

Together, Comprehensive Health Planning and the Regional Medical
Programs Service provide an effective organizational framework for
identifying and utilizing community health resources which makes it
possible this year to institute further innovations in health care
planning and delivery systems. Communities and the health care providers
within them will be encouraged to establish carefully planned systems to
furnish comprehensive care to an identified population. The success of
this approach will exploit the strengths of Regional Medical Programs to
convene the key provider and consumer groups needed for planning and
implementation of these critically important activities.

In concert with the evaluation efforts available from the National
Center for Health Services, Research and Development and with the
Partnership for Health program, we truly believe that the Regional
Medical Programs have the potential to meet even the most optimistic
of expectations.
© Budget Summary

 

 

Obligations
(Dollars in thousands)
1971 - 1972 Difference
Pos. Amount Pos. Amount Pos. Amount
Regional medical programs:
GYAaNtS... cece ccc e ccc eececenes -- $70,298 -- $75,000 -- +S$4 ,702
Budget authority....+-.+..ee- -- (89,500) -- (40 ,500) . . (=49,000)
Direct operations.......+..... 91 1,799 91 1,851 + 52
Technical assistance and
disease control: -
Regionalization activities... 50 2,543 50 2,576 -- + 33
Smoking and Health......:.... 29 2,172 29 2,189 -- + 17
Kidney. ccssccccccssecvcvesees 38 4,096 38 4,118 -- + 22
Program direction and
management Services....--+.-- 67 1,498 67 1,537 -- + 39
Total Obligations......... 275 82,406 275 87,271 -- + 4,865
Total Budget Authority......-..- -- 101,608 -~ 52,771 -- ~48 837
REGICHNAL MEDICAL PROGRAMS

55 regions--54 RMPs operational

RMP (1) supports grants and contracts which, on a regional basis, bring
together local medical centers, hospitals, and other health care facilities,
health care providers and other resources to systematically identify health
problems, commitments, and undertake solutions; and (2) administers
specialized pilot or educational or monitoring programs in kidney disease
and smoking and health.

Key issves
Cutback. in budget authority in 1972
Way reductions will be made oO

Ve. +
aS LS

Move away from categorical emp

ee

wee
|

RMP Grant Punding (Actual throuch 12/31/1970)

No, of STANCES eee e cece eee c cree eeereeeereeeeeess 55 (54 are operational)

No. of projects funded out of grantsS....+-esees 600
No, of positions supported by grantS.....--2--. 4,550
PLOJECES LEVEL... cc cece reece ere creer ere esc ecrresrsecrecrreceee
Care support:
Administration and planning. .....ceceeeeeeeeeeesee 8.9"
Project support and asSistance.....eeeeeeererrees 31.3M
Subtotal. cecccccccccc ccc cercccersseeeereseereesaewscers

Total.ecccccccccccccvcccccrscccccceccrsesesaseesseesasecareres

are toy

$55, 2M

39, 8M

95 .0M
Emphasis of RMP Project Funds . "

Patient care demonstrations,
which directly benefit,
patientSprrrcecceccecccccccevcceecccccessseesees $2L.2 M. 38%

 

Manpower training and
UELLIZALLON; ce cece eee ween reer ener eeenceeecese 2h.9 M. Log .

‘Other activities such as
' communications networks,
improved patient record
systems, and coordination
OF SELVICES. cece ese ee rece cer cec cee eesereseceses Gol M. LTH .

 

The last two also lead to
expanded and improved care, .
but indirectly. ccc sece cece cece eeetererenctescees D902 M, 100%

*

ass
x
Patient Care Demonstrations which Improved Quality and Availability

he $21.2 million wnich patient are Girectly benefitting from is helping pay for -

Coronary and other intensive care activities which presently

 

 

. encompass li} Coronary Care Units and 8 mobile units. ...ecccceseees $13.8 M.
Expanded and improved ambulatorv care in 2 neighborhood !
health centers, clinics, and outpatient GOPALUMENES + ser eresereeree 3.9 M.

. Expanded and improved extended and home Care... cece rece eee cece ces 2.2 M.
Other activities such as emergency and transportation services..... 1.3 Me
—— 21.2 M.

- Patients Directly Benefited

Roughly 240,000 patients have benefited directly during the past year from RMP
assisted pabient care demonstration activities. The breakdown by broad disease
category is as follows:

‘Heart -= 45,150 of whom 12, 800 were treated in RMP assisted coronary care units.
- 70,370 of whom 06,500 were screened for cervical and other cancers.

Stroke - 9,100 of whom 5,000 received rehabilitation services.
Other ~ 115,700 of whom about one-half received multiphasic screeching exans.

 

 

 

 

wk Bin
Monoower Training and Utilization

 

$24.9 million currently being spent will result in an estimated 173,000
physicians, nurses, and other health personnel being trained or, through
continuing education efforts, having their present skills upgraded.

Estimated numbers that will be trained:

 

 

 

 

Doctors Nurses Allied/Other Health Total

New DeOple...eeeseeeseceeces | 8,059 8,059
New skills..eecseseceseceees 13,383 39,495 56,363 109,241
Upgrading existing skills... 18,245 15,800 21,236 55,231
TOLAL.scseeeeeeeees 31,088 55,295 85,650. ~~. T72, 501

Physicians Providing Better Care

 

Estimated that more than 30,000 physicians will benefit from RMP supported
training activities, largely through upgrading of their existing skills. This
is over 10% of practicing physicians in the country. This number of physicians
serves an estimated patient population of roughly 23 million. “

erm lo
Funded as of 12-31-76

 

No, Amount
‘Kidney disease grants........0.006- Ses eeseeeesons 17 $1,462,000

Mobile Coronary Care Units... ese ce cece ceccecoece 6 oo 376,300
Montgomery County Mobile Coronary Care Project
$90,000 to be given to extend project through 12-31-71. This represents

final funding.

Seattle Mobile Coronary Care Unit

 

$20,000 additional to be given (for total of $47,498), through 12-31-71.
Completes 3-year project period. - ‘
| v
|

Budget History - RMP Grants

 

 

© (In thousands)
. oe 1966 © 1967 1968 1969 1970 1971 1972
Auth, (Grants).. $50,000 $90,000 $200,000 $65,000 $120,000 $125,000 $150 ,000
Appro. (Grants), 24,000 43,000 53,900 56,200 73,500 89,500 40,500 a/
+ bal. brgt.fwd a
from prev.yr. eee | 21,934 b/ 25,900 36,165 20 ,000 15,298 34,500
- amts,in re- ; ,
serve by BOB --- 21,000 30,900 20,000 15 000 34 500 ---
Amt,avail,for ;
obligation... 24,000 43,934 © 48,900 72,365 78,500 70 , 298 75,000 d/

Less: Obli-
gations...... 2,066 27,052 43,635 72,365 78,202 70,298 75,000

 

Lapse. ...ee. eee “<0 11, 982 c/ wo -o~ woe , one --~
Bal. carried ;
forward...... 21,934 4 900 5 : 265 ot 298 =e ry

a/ Appropriation request,
b/ Available through December 31, 1966, —
c/ Appropriated for 1966, availabie for obligation until” 12/31/66.

d/ Includes $5 million for construction of cancer treatment center in Northwestern
part of United States oe

on

wees

© : . '
Qs

Technical Assistance and Disease Control
(Dollars in thousands)
1971 1972
Estimate Estimate
Pos. Amount Pos. Amount

 

 

- Regionalization activities..... 50 $2,543 50 $2,576
Smoking and health......s..eee- 29 2,172 29 2,189
Kidney... ccc cece cece Sees s 38 4,096 38 4,118

Total.scccscccveeee 117 8,811 117 8,883

~

He

1972 Program Summary

 

Three "limited care dialysis" projects to be completed in 1972. (Olive View
Hospital, Los Angeles, California; Saint Francis Hospital, Honolulu, Hawaii;
and Minneapolis Medical Research Foundation, Minneaplis, Minnesota) Projects
involve testing ways to provide chronic hemodialysis at level between hospital
and patients’ home.

Long-range program to be started in 1972 to develop interrelated kidney programs
aimed at providing therapy for the 10,000 best medical candidates for dialysis
and transplantations. -

National Clearinghouse for Smoking and Health will continue its three phase
program of research, community program development and public education.

et
Regionalization Activity will continue to provide assistance in responding to
individual needs of the Regional Medical Programs. Continuing education for
health professions will continue to hold a place in the interests of local
Regional Medical Programs. ,