Transcript of Proceedings arrears or aeaien ORE ER NH - PUBLIC HEALTH SERVICE "HEALTH SERVICES AND MENTAL HEALTH ADMINISTRATION & ea Tenty-Fourth Meeting ‘of the ane ne "NATIONAL ADVISORY COUNCIE ON REGIONAL MEDICAL PROGRAMS, | Reckville, Maryland Tuesday, 3 August 1971 ACE - FEDERAL REPORTERS, INC. Official Reporters A . 415 Second Street, N.E. eee Washington, D.C. 20002 ~~” (Code 202) 547-6222 NATION-WIDE COVERAGE CR-3036 GIBSON ng 1 DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE 2 co Public Health Service @ 3 Health Services and Mental Health Administration 10 1] Twenty-fourth Meeting of the @ 12 NATIONAL ADVISORY COUNCIL ON REGIONAL MEDICAL PROGRAMS 13) 14} 16 17/ ” ~ Conference Room G-H Parklawn Building -18 Rockville, Maryland 19 Tuesday, August 3, 1971 “20 @ 21) : 22 | 23 24 Ace ~ Federal Reposters, Inc. 25 10 1h @ 12 4 13 14 15 16 17 18]. 19 20 21 @ 2H 22 23 24 Ace ~ Federal Reporters, Inc. 25 4 DR. MARGULIES: I believe we can begin the meeting with just a couple of sort of technical announcenents, one of. the most isgnificant of which is that these microphones have been moved fairly close to the end of the table and we are recording the meeting so that we can check back on what the wise words were passed around the table. So please don't lean back from the microphone but lean into it, and then we will have no difficulty getting things properly recorded. Before we begin, I also must remind you that there is a confidentiality requirement and a conflict of interest statement which goes with participation in these Council meetings, and I think we are all aware of them so I won't bother you by reading them through. | We do have some people I would like to introduce before the meeting begins so that you can all be fully acquainted with one another. Some of these are new members of the Council and some of them are new members of the staff. There are six new Council members, not all of them able to be | present at the time of this meeting, and I will introduce those who are present, but I'd like to mention first of all that Mr. Ogden, who is a member from Spokane, Washington, was unable to attend today, and Mrs. Mars, who comes from Virginia, was also unable to attend because both of them couldn't make arrangements as lateas they were informed. 10 7 @ 12 13 14 16 17 18 /19 20 e 21 22 23 24 Ace ~ Federal Reporters, Inc. 25 Among the new members I'd like to introduce Dr. Tony ‘Deen, -Komaroff,' who is here on my right, who's had some experience with regional medical programs which may or may not be helpful-4 we'll see; Dr. John Merrill, who is one of the people who, among other qualifications, is an expert in the field of kidney diseases. I'd like to point out that we now have two kidney experts which relieves Mrs. Wyckoff considerably in her responsibilities as a kidney expert. Mr. Sewell Milliken, who among other things brings reer ney, us direct and full-time involvement in comprehensive health planning where he's a director of the state agency, an@ will be able to clarify for once and for all any kind of confusion regarding regional medical programs and comprehensive health planning, so it's up to you. And Dr. Watkins from New York, who is also a new member, who is seated here directly on my left. I'd like to also introduce and ask them to stand as we go through some of the new staff members who have been added and who members of the Council would at least be able to recognize if only fleetingly this morning. The first are the group of commissioned officers who came onboard the first part of July, Dr. Elvin Adams, Dr. James Cleeman, Dr. Paul Cohart, Dr. Jeffrey Crandgal, Dr. Martin Greenfield, Dr. Kenneth Joslyn, Dr. Michael Newman and Daniel Nemzer. 10 i @ 12 . 13 14 15 16 17 18 20 21 22 23 24 Ace ~ Federal Reporters, Inc. 25 And I'll just go through the list of new staff members other than the commissioned officers, and ask them to rise as we go through them. The list if fairly long but they are also fairly important, so I'm eaeee to introduce them. Charles Barnes in Grants Management -- not here. Richard Clanton in Regional Development. That's an old title. We're not using that any more. Mrs. Shirley Fairley, Smoking and Health; Dr. John Farrell; Robert Handy, Office of the Director; Calvin Jackson, Smoking and Health; Mrs. Glinter Johnson, Systems Management; Dr. Alan Kaplan, Professional Division; Mrs. Nancy McGuire; Roger Miller, Grants Management; Spero Moutsatsos, Planning and Evaluation; Jeffrey Passer, who is not here today; Roland Williams, Systems Management. . These are all people who will be added to our general responsibilities and potentialities and they will be available for you to know and for us to work with more effectively. I'd- like to call your attention now to the minutes of the last meeting for any kinds of comments or questions -~_ I'm sorry, let me stop the proceedings. I'm so used to the fact that you're here all the time that I made a terrible error. Ed had his back turned to me, but very ably representing the | veterans Administration and most of the rest of the world, and specifically representing Dr. Musser of the Veterans Administration is Dr. Ed Friedlander, who is down there on the right sporting a new mustache. Mr. Friedlander spent a number 1 a number of years with the Regional Medical Programs in whick 3 he tried as well as he could to make them understand the better @ 3 ways to do things and having succeeded, he left for the veterans 4 Administration about six months ago -- 5 MR. PRIEDLANDER: Almost ten months now. ‘ DR. MARGULIES: We're glad to have you here. ; I would like to have you consider the minutes of the : May 11 and 12, 1971 meeting. I understand there is one 9 omission, that there was a kidney proposal which by accident 10 was not included in the report and that will be inserted, in 7 case no one else noticed the error. If there are any other > errors, omissions or alterations which you would iike to @ 13 introduce, they can be considered now. Otherwise, we will 14 assume that they are acceptable. 15 We will in the future be reporting not minutes ef this 16 meeting, but a summary of them, to the coordinators immediately ° after the Council meeting. Now, we were doing it quite rapicly for a period of time. We then improved our process and slowed “it up by two months , so we will further improve that improvec ad process and we will expect to report the general highlig ghts of “° this meeting to the coordinators within a period of about 45 © Z to 72 hours after the meeting is over. 22 Before we go on to any other discussion, 1 would iixe " to have you consider the future meeting dates which have been 24 Aes Federal Reporters, Ine. listed here for you. - 10 HW @ 12 13 14 15 16 17 18 19 20 e 21 22 23 24 Ace ~ Federal Reporters, Inc. 25 DR. ROTH: Just a moment before we leave the minutes of the last meeting, the council took action and approved a short I guess you would have to call it policy statement which I think had as a purpose transmission to the Secretary of HEW, and I have not seen this reptoduced as part of the oo minutes or in any other way part of the business of the copes} Do you recall the statement to which I refer? — DR. MARGULIES: Was it Council meeting before last? Was this one that was prepared by Council and sent from Council to the Secretary? DR. ROTH: No. this was in addition to that. DR. MARGULIES: Was it the missions statement? DR. CANNON: It was left out of the minutes of the previous meeting and the minutes of the last meeting made mention of that and asked that it be included. DR. ROTH: Yes. Let me say, at the last meeting I was not present at the first session. I was only here for the second day, so I was not around at the time of the approval of the minutes and I don't know what happened except it was omitted in the last minutes, and my understanding was that it had bee noted and was to be reproduced or added in subsequent minutes. DR. MARGULIES: We'll check on that and make sure that it's there. DR. ROTH: I move its inclusion in reports and minutes 10 a @ 12 13 14 15. 16 17 18 19 20 21 @ | 22 -- 23 24 Ace ~ Federal Reporters, Inc. 25 of this meeting. DR. MARGULIES: All right. DR. CANNON: Second. DR. MARGULIES: It's been moved and seconded that that report be included in the minutes of this meeting. All in favor say “Ave.” .. ("Ayes") DR. MARGULIES: It will be done. I'd like to have you consider now the schedule for the euture meeting dates. Some of them are to be reaffirmed and some of them are to be considered for the future. Those that had already been agreed to are November 9 and 10 for the next meeting and February 8 and 9 for the subsequent meeting. The others are May 9 and 10 of '72 and August 15 and 16 of '72. We regularly cross-check these against any other major meetings which may present a conflict, and to the best of our knowledge, these are as clear as they can possibly be iconsidering the busy schedule everybody has. Well, if there are no objections, we will consider those the accepted meeting dates. I'd like to spend a little time with you now dis- cussing some of the event which have taken place since the last meeting which we had with ‘the Council and try to bring some of the newer Council members up to date on events which maybe cover a little longer period. I will omit the event whict 10 i eo. 12] 13 14 15 16 17 18 19 20 21 22 23 24 Ace ~ Federal! Reporters, Inc. 25 ‘to have entered the same particular part of the turf that I was “urgently by the coordinators of the Regional Medical Programs | represented the medical schools in the country; they represented people who are deeply concerned with health and with Regional -in the understanding of RMP in the Office of the Secretary. impressed me the most, which was on May 18 when Iwas proceeding homeward and was struck down by an errant automobile which chos: occupying at the time, and te-1l you that six days later we held a meeting with the Secretary which had been requested rather asking the Secretary to meet with them and a number of other interested people to discuss Regional Medical Programs; how he viewed their present status; how he viewed their future; and that meeting was held on that date. Dr. Russell Roth was there, not representing the Council necessarily, but representing the interest which he has in medical care in this country. There were a number of other individuals and, by a series of happy events, they the coordinators; they represented the staff of the Secretary; — they represented the Kidney Foundation, and a number of other Medical Programs. I think that it's fair to say that the meeting was a remarkably successful one and in subsequent conversations I have had with people who attended it and have had some sort of later reason to consider it it seemed to be a kind of a turning point I suppose there were about three kinds of interests ~ 10 1 © 12 13 14 15 16 17 18 19 20 e 21 22 23 24 Ace - Federal Reporters, Inc. 25 10 which were most impressive to me and I don't know whether they were the same as would impress other people or not. Perhaps Russ would like to comment on it as we go along. One of then was that the assemblage of indivicuals there was able to address about all of the kinds of issues and all of the potentialities that RMP is associated with. There was the view of the medical school. There was the view of the Comprehensive Health Planning people. There was the view of the practicing medical profession and so on; and it pretty well swung around over a short period of time everything we were concerned with. And it seemed at that time that the Secretary and the staff of the Secretary found what they were being told impressive and believable. . Secondly, I think that there is little: question but that the strong support we got at that time that I had not fully anticipated came from the Secretary's staff itself. People who were there who represented people directly in his office, the comptroller's office and others were saying extremely positive things about the Regional Medical Programs . at a time when we were starved to hear exactly those things, and I think it was most convincing. =. | ' Finally, when Secretary Richardson was summarizing the kinds of new legislative programs which are anticipated and the general pattern of changes in health care delivery as viewed from the federal position, he talked about the 10 V1 { @ 12 13 14 15 16] 17 18 19 20 e 21 : 22 23 24 Ace ~ Federal Reporters, Inc. 25 ll unavoidable conclusion that if all of these various kinds of programs are to be developed -- talking about national health insurance; talking about some kind of regulation of the insurance industry; talking about the development of area health education centers; health maintenance organizations; the whole panoply of federal initiatives -- he said that this obviously, if it was to be rational, required some kind of regionalization of resources. He also recognized the argument which I think has. been our core argument defending RMP, that we do represent the most effective way of dealing with the private health care system; that the program which, this Administration has laid out is one that depends almost completely on the way in which that private system is able to perceive what they are doing and be responsive; and that RMP represented the best available mechanism for carrying out those kinds of relationships. He summarized by saying that it was very possible ‘that the Regional Medical Programs would be the key element in the kinds of changes which needed to be carried out. Those weren't his exact words but it was pivotal point or key element or something of that kind. And all of us came away with the feeling that there was a higher level of understanding than we had anticipated and from our point of view there was a sense of optimism which we had not always been able to feel in the past, although there has been enough of a tough history of 10 i eo. 12 13 14 15 16 17 18 19 20 21 @ " 22 23 24 Ace — Federal Reporters, Inc. 25 “until we see the positive results. ‘ have been accidental or may have been preplanned, was that the | Secretary had preconditioning in respect to RIP because in the 12 funding, etc., in this program so that I don't believe that an; of us could go away with wild enthusiasm for what may happen Russ, would you like to comment on that session? DR. ROTH:: Well, the only addition that I might make is that one extraordinarily significant development, which may early days of Tri-State he was involved or had some connections 1 with the development of Tri-State and found them in general unimpressive; and so his concept of RMP naturally was inevitably colored by a rather adverse opinion of the way things had been going in fri-State in its pre-Leona Bumgardner Gays, I guess that's about the best way to say it, and Bob Lawton (?) who is known to many or most of you was there and able to give him a very authoratative updating on the change of scene in Tri-State RIP and to cite him chapter and verse about things that were very familiar to him in the Boston area, and I think this was very important in changing the preconditioning in the Secretary's mind. -I think that this was probably the single most significant bit of testimony that was given at that meeting. Other than that, I would share all of Harold's views on the general nature of the meeting. DR. MARGULIES: Thank you. 10 1 @ 12 13 14 15 16 17 18 19 20 ® 21 22 23 24 Ace — Federal Reporters, inc. 25 13 Now, I think what will now happen depends on a number of activities which are currently going on. At the meeting, the Secretary spoke of the fact that he was requiring of - staff some clearcut recommendations for him by July 1 on how the federal health strategy would specifically be implemented; | what kind of functions would be carried out; where the assign- '“ ments would properly be placed; and indeed, within a few days, we were involved in that kind of conversation between, in our r particular case, Health Services and Mental Health Administratigr ‘rand the Office of the Secretary. It became clear during those kinds of discussions that the role of RMP was constantly being deliberated and that there were some clearcut and specific kinds of duties and opportunities that we would have, that they very frequently centered around the issue of measuring and attending to the general issue of the quality of medical care, and that this was / constantly emerging as a bigger and bigger issue. In fact, as discussions have proceeded, the question of the quality of medical care as one measures it for the entire community at service, regardless of the kind of health care system, has been given more and more attention in the Administration and there has been more and more recognition of the fact that the RMP is the natural kind of device to deal with the quality issue, and not only with the quality issue but with a good many others. Now, it will be interesting to see what in the 10 11 @ 12 13 4 ‘14 15 16 17) 18 19 20 22 23 f 24 Ace — Federal Reporters, Inc. 25 14 appropriations process and I need to bring you up to date on whe re we stand with that and see what happens thereafter. It's a difficult thing to evaluate the total effects of the current appropriations interest because there is more than RMP involved. There is, as I think anyone who is at all sensitive to political affairs present -- as well as a certain amount of political tug-of-war between Congress and the Executive and possibly even between Republicans and Democrats -- I can't judge that kind of thing -- nevertheless, the House appropriations reported out a rather marked increase for the Regional ‘tiedical Programs. Well, let me back up a little bit to bring you up to =| date on what occurred. Late in the last fiscal year, there was a supplementary appropriation passed which did add $10 million. ‘to the appropriations for RMP. This was finally considered within the last month of the fiscal year and was added to the » $34.5 million which had been placed in reserve. So we have , i for this fiscal year $44.5 million in reserve. , If that had been undisturbéd and if the recommendatio: of the Administration had been preserved in House action, we 4 would have ended up with -- we'll just stick with the level of 21 @ | grant -- we would have ended up with a level grant figure of $70 million. ‘The House chose to add $30 million to that figure and this is what passed through the appropriations committee and is the present state of understanding in the House. The 10 1] © 12 13 14 15 16 17 19 20 @ 21 22 23 24 Ace ~Federat Reporters, Inc. 25 ' year that's already halfway through or beyond that. The Senate ' been passed by the House which now gets us up to a figure, if ' dt would be actually distributed to us, which is far and away because these are very large amounts and there are other events Senate held their hearings very recently. They are being pushe¢ to complete their appropriations hearings much earlier than they have in the past so that the business of carrying out be clarified a little instead of trying to plan for a fiscal added $40 million I understand to the $30 million which had above what we had been considering and what has been available to us in the past. It's going to be a very interesting question to see how this finally. comes out in negotiations between the Congress, HEW, the Office of Management and Budget, Health Services and Mental Health Administration and the Regional Medical Program Service. I find it very difficult at this point to fix on any . reasonable figure which we are going to finally come out with in RMPS which are entering into the considerations, partly because both of the appropriations acts in the health field - are going to provide funds well above what the Administration has requested across the board. This makes a difference not only for RMPS but for a good many other prograns and creates some budgetary problems which I'm sure are going to be the subject of a lot of fighting and struggling and negotiation. y programmatic efforts -- I hope that's one of the reasons -~ can 16 ] ‘One would think that out of all this, with a change 9\| in attitude toward RMPS, with the very marked increase in @ 3|| appropriations, with al large reserve which has been carried 4 over to this fiscal year, that we are going to end up with a 5) larger sum of money with which to run the program than we have 6l| had during the past year. But the size of that is going to be 7\| difficult for us to calculate and the best we can hope for is gi| a very rapid conclusion of deliberations so that we know where 9|| we stand as early as possible in our plant. 10 One of the reasons why this is desperately important . 11 || is because we have to calculate even before the review process © . 12|| has been completed what kind of distributional grant support 13{) we should make in order to maintain the Regional Medical 14] Programs at their fullest possible function, making some kinds 15] of calculations now which will be meaningful next June. if we 16|| fail to do that in an efficient manner, we'll find ourselves 17|| in the middle or two-thirds through the year completely off 1g|| balance fiscally. 19 So we will have to stay very close to what is likely 20 to happen and make some calculations on what we should co and 2) @ 22 || money will be available. act as quickly as possible when we know definitely how much 4 23 Now, there may be some comments on this or perhaps 24|; some of you have something to add to it. Ace — Federal Reporters, inc. 25 DR. ROTH: Harold, would you venture any opinion as ti 10 11 @ 12 13 4 3 14 15 16 17: 18 | 19 20 . oT “money or allocations of that money to do things that RMP has ; 22 23 24 Ace ~ Federal Reporters, Inc. 25 ‘| program for something that hasn't become law yet; so that such a 17 the contingencies that are implicit in the House $30 million and the Senate's additional $40 il Lion in terms of grants of that not been doing? Do I make myself clear? DR. MARGULIES: Yes. In the kinds of discussions which we have been having with them, I think that there has been a growing understanding, both in the Senate and the House, that the directions of the RMPS which are represented by the missions statement are those which are appropriate to our activities. I think there remains a strong interest in categorical activities but in a much less splintered fashion than we have seen in the past. There are specific kinds of activities which have emerged in the discussions in the appropriations hearings to which I think we'll have to pay some attention. Certainly they are concerned with health manpower. Certainly they are concerned with a stronger kidney program. This has emerged in the discussions regularly I think. There has been expressed an interest in better emergency care which is frequently centered around the care of the acute coronary but which I understand has to be based on a broader kind of consideration. Now, in the Senate hearings, there is a kind of under- standing that one does not propose the use of funds in any discrete programs as the are health education center were not a 10 1 @ 12 13 14 15 16 Vv 18 19 20 @ 21 22 23 24 Ace - Federal Reporters, !nc. 25 1é part of our discussion, but as Senator Magnuson saic, "sie" LL talk about that when it exists. It doesn't exist." But I think the area health education center kind of concept has been clearly of interest to them. We really didn't discuss in our own presentations health maintenance organizations and I'm not sure that, at least on the Hill, the relationship between RiP and HHOs has been very greatly explored excepting for one aspect of it, and that's the part of it which has to do with attention to the kind of health services which are provided through an HMO and special concern for the quality of care which may emerge from any kind of an HHO type of an organization. Herb, you were there for the senate hearings. Would you like to add anything to that? DR. PAHL: I think the only thing I would add is the Chairman was most gracious and lectured the Administrator on the need to spend the monies that Congress appropriates; also was interested in exploring some of the kinds of uses to which we have been putting our funds; and seemed most receptive to all the statements that Dr. Wilson made. It was a relatively brief monologue by Chairman Magnuson, coming very late in the day, and it was a pleasure to hear following some of the prior conversation about some of the other activities in the health services. DR. MARGULIES: There is clearly some money which wil. - 10 1 12 13 4 15 16 17 18 419 Ace ~ Federal Reporters, 20 21 22 23 24 Inc. 25 ‘in the northwest part of the United States remains firm and up as a further issue or not I don't know. 19 be used for construction, but regardless of what level of grant support we get, the designation of a cancer treatment facility -~ 7 there will be due attention paid to that. There has been no other great discussion about the use of RMP funds for construction, and whether that will come DR. ROTH: Would I be correct in assuming that in this preparation for classical eventualities of increased money, that the Council might well take a hard look at doing more with 910 proposals than we have? We've been holding most of the 910 stuff back, but as I read the picture, 910-type of RMP activity would have substantial appeal in supporting the increased appropriations? DR. MARGULIES: I think that's perfectly reasonable. Our feeling has been that the Council would give first priority, based upon prior discussions, that any increased funds we may get to strengthening Regional Medical Programs which have been hurt pretty badly by the restricted funds in the past, and I think our first consideration would clearly be toward invest- ments where our strengths are in the RHPs and where they have been hampered by reductions; but certainly the possibility of the Section 910 funds being used is a high one for consideration For those who are not familiar with that section of our legislation, it refers to an arrangement whereby there can - 10 i: © 12 : 13 14 15 16 17 18 19 20 4 21 @ ! 22 “ 23 24 Ace — Federal Reporters, Inc. 25 “iq 20 be a combination of interests among Regional Medical Programs to support activities which cut across regional lines, so that we can use a different kind of mechanism for developing major -~ ’ activities, sometimes of national interest, sometimes involving several regions together, which may require a coalition of effort and level of cooperation which has not always been the essential part of the individual Regional Medical Program. We've had a number of proposals of that kind, but with the restricted funding we have been unable to act on then, and I think the possibility, if we get significant funding increase, of developing that is a good one. Probably the prime reason why we have not -- well, there have been two reasons why we haven't used it.in the past. One is we really needed to put everything we had available into the support of individual RiMPs; and the second is the rather strange phenomenon, which says that if you use a new section like 910 everyone assume there's more money that goes with it, and when it's all coming out of the same pot that creates great confusion. That happens regularly. As soon as you say well, we're going to put so much effort into some kind of activity. there's an assumption on the part of most people that somehow we found more money, but that -- if that wasn't the case it would be disturbing. | Any other comments on this? (No Response) 10 7 @ 42 13 14 15 16 17 18 19 20 21 22 23 24 Ace - Federal Reporters, Inc. 25 21 There are some other legislative activities which are going on in which we are very deeply concerned. They happen not to be in our legislation but they are of very prime interes4 to us, and that has to do with the area health education center concept. You may recall this is an idea which was introduced formally in the Carnegie Commission Report and became very soon thereafter a part of the Administration's efforts to improv health care delivery. Briefly speaking, it is a newly described but pre- viously existing community~based activity supported by grants in all likelihood, which would combine the health delivery mechanisms in the community with the health educational activities; therefore, it includes, among other things, the hospitals, nursing homes, out-patient facilities ~- it would include junior and community colleges which are training health Manpower, nursing programs in hospitals, etc., with a link with the university health science center, designed in such a way that the educational activities and the service responsibilities are all part of one mechanism and are located, initially at least, in areas where there is a need for better health services These are usually described as either being in a rural area where health needs are great or in the inner-city where the problems are not so much those of geography as they are social and economic barriers to good health delivery. in 10 11 @ 12] 13 14 15 16 17 18]. 19 20 21 e 22 23 24 Ace ~ Federal Reporters, Inc. 25 | bill, and there have been introduced in the House and in the 22 The area health education center was included in the legislation under the new Health Manpower Act only in the House Senate two proposals for the area health education center. One of them would place them in NIH in the Bureau of Health Manpower, and that's the Administration bill which has passed the House. The other would have placed them in Title IX which is the Regional Medical Programs, and because there was indecision between the Senate and the House about whether it should go to NIH or the RMP route, the Senate bill did not include area health education center when it went to conference with the House. }. This was done because they felt that the area health education center, along with HMOs, could be dropped out ot consideration of health manpower and considered under separate legislation. The last I heard they were in conference on that > issue,and unless we have a recent bulletin they haven't reached: a decision about whether ANEC would remain in as the House proposed it, and be in NUT, or would be dropped out and be up for consideration later, which is still not settled as to whether it goes to NIH or to RMP. In any case, the form that it was in in the House would require that a area health education center ‘be developed in cooperation with a Regional Medical Program wherever that activity was located, and there has been from the very time that 10 1 @ 42 13 14 15 16] 17 18 19 20 e 21 22 23 24 Ace — Federal Reporters, Inc. 25 ‘ crowd over there that deals with health manpower. We have been “working very well together and we have a good understanding of ’ what we're going to do, and in any case, whether it comes to ’ RMP or in NIH, there's going to be a way of working effectively ‘visits which we planned with them and they visited areas in ‘which they could get some understanding of what might be involve ‘ in an AHEC and pretty well blanketed the country. 23 | these considerations began a very close working relationship between RMP and the Bureau of Health Manpower -- the Bureau of Education -- well, I forget what they call it now, but it's that together. It will take a little while be fore we know how this comes out. In the meantime, the Veterans Administration has exhibited a high level of interest in area health educaticn centers. Earlier in the year NIH mounted a number of site Within the last two or three weeks, the Veterans Administration has carried out a number of site visits of its ' own. These have been, for obvious reasons, differently designed, but what the VA did, as I understand it -- and, id, you may want to comment on this further -- is to identify hospitals which are located in areas of need in the sense of having inadequate medical services and where there was already established a good working relationship with the Regional “Medical Programs. They then set up some site visits which included 10 1h © 12 “13 yy 14 "15 16 17 18 - &¢ 19 20 a | 21 © . + 22, 23 24 Ace — Federal Reporters, Inc. 25 ilvisits this week in Fresno, California. 7 it. So that one way or another, it's quite clear that this is ‘i with the coordinators, it's clear that the possibilities of an ~ 24 people from NIH, from RMP, from the Veterans Administration, from HEW Regional Offices, to a what the potentialities were for establishing hn area health education center which would include an investment and involvement on the part of the VA.. In our discussions the VA made it quite clear that they felt an RMP relationship would be a very desirable one, if not essential in all cases. Now, I think they have completed their rounds of site visits. If not, they are very close to it, but they were covering -- MR. FRIEDLANDER: Eight, and we finished the site DR. MARGULIES: And the VA has decided very clearly to make an investment in this direction and is going ahead with a rising interest; and as I move around the country and talk AHEC are very attractive to then, interests them greatly, and they recognize the possibility in RMP of doing with this kin of device the kind of things which they're well fit to do. Ed, would you like to comment further on the VA role in this? MR, FRIEDLANDER: No, only the VA role, it should be remembered, was generated really out of the President's health message which called for a closer relationship between the 10 11 @ 12 | 13| 14 15 16 17 18 19 20 21 @ | 22 ' geemed that the area health education centers were the ideal “kind of way to join the two together. ‘ until all the blocks were in place, it might be well for the ’ veterans Administration, as you say, to move out in cooperation i with the Bureau of Health Manpower and with the Health Services / Administration, particularly with the RMPs, and look at some 23 24 Ace. ~ Federal Reporters, Inc. 25 Administrator of the Veterans Administration and the Secretary of the Department of Health, Education, and Welfare; and it “~ It was Dr. Musser's feeling that rather than wait places which were identified as having potential for such an activity. However, it's clearly understood that the Veterans Administration and those people with whom we have talked to date, both in the VA installations and with the NIN in the Health Services Administration people, that only those things nn rane Ea which have a direct relationship to improved quality of care and improved relationships to this end with the community can neni be funded i ndé AYoug inistration providing some kind of a base which the area health education center can pick up once the legislative authority has been a Ge ee determined and authorization of funds has been mace. ~ .