NOTE.—DO NOT USE THIS ROUTE SLIP To SHOW FORMAL CLEARANCES OR APPROVALS ya s/os- AGENCY BLOG. Me. Garde If _ Diem? N07 (CO APPROVAL CJ REVIEW CI PER CONVERSATION CO SIGNATURE = =©(] NOTE AND SEEME 1 AS REQUESTED C] COMMENT =] NOTE AMD RETURN [1] NECESSARY ACTION yor YOUR INFORMATION =~ ( PREPARE REPLY FOR SIGNATURE OF REMARKS: Repert on Artheeli's Cm- eC evEencet Dv. Peh( has egies (Fold here BUILDING MEMORANDUM DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE TO FROM PUBLIC HEALTH SERVICE HEALTH RESOURCES ADMINISTRATION BUREAU OF HEALTH RESOURCES DEVELOPMENT Acting Director DATE: 7 Division of Regional Medical Programs January 23; 1975 Mfeee ee Public Health Advisor SUBJECT: Trip report; Arthritis Conference, Kansas City, Missouri, Jan. 19-20,1975 This an interim report on the conference. There is to be a Conference Report, but that will not be available earlier than late February. The conference expressed its desire that the traveller undertake to draft the arthritis report. I acceded to this request by indicating that I had made preliminary arrangements with Mr. David Shobe for the writer staff of the Arthritis Foundation to assume this task if circumstances prohibited my ability to effectively carry out this responsibility. The Arthritis Conference was Chaired by Dr. Roger D. Mason, Senior Vice President for Health Affairs, Blue Cross/Blue Shield, Omaha, Nebraska. More than 100 persons participated in the conference, representing arthritis program and project directors, and some of their staff, RMP Coordinators and arthritis program administrators, and some of their staff, the writer (DRMP), and Dr. Lawrence M. Petrocelli, Director of Arthritis Activities, NIAMDD. The above participating groups included representatives from the conference sponsoring, and host organizations. Dr. Gordon R. Engebretson, Director Florida RMP, participated in the conference proceedings as the representative of the Program Account— ability and Reporting (PAR) group of the NARMPC. The conference was organized to devote attention on the first day primarily to substantive aspects of the pilot arthritis program to identify its characteristics, and associated needs and opportunities. The output from these discussions was presented to the conference orally, and in written form at the end of the first day as background for the second day's deliberations. . The first day's material was developed through short talks on five (5) selected program areas, a luncheon talk by Dr. Engebretson, a dinner talk by Mr. David Shobe, on the new arthritis law (PL93-640), and six (6) workshops. These workshops addressed pilot program aspects of physician, allied health, and patient education, demographic factors, and arthritis services, and service deployment. The focus of the second conference day is most succinctly characterized by the question, "Where do we go from here?" A panel discussion wa s presented first to explicate overall arthritis program documentation and assessment, vs. project evaluation. Four (4) workshops followed to discuss, and bring back to plenary session recommended conference perspec- tives, positions, and proposals regarding Program Documentation, Care Delivery Initiatives, Special Report Opportunities, and Program Continuity. The afternoon was devoted to hearing the workshop reports, and conference action on workshop recommendations. All of the materials needed to prepare an accurate and comprehensive conference report are not yet at hand. However, there are enclosed mater- ialsabout and from the conference which elaborates on this brief report. These are: Exhibit 1. Conference Program Exhibit 2. Roster of workshop Co-Moderators 1/Exhibit 3. Responses to Program Interrogatory 1/ Exhibit 4. Summary of "A Workshop" reports (first day, A-1 through A-6), Exhibit 5. Instructions to Evaluation Panel Exhibit 6. Summary of "B Workshop"reports (2nd day, B-1, through B-4), including recommendations. All of the second day workshop recommendations were supported by a majority vote of the conference. However, there were a number of modifications which cannot be accurately reflected until the writer receives a transcript of the Monday, January 20, plenary session, 1/The Program Interrogatory was a simplified application of a brainstorming technique. The objectives were to obtain overall conference participant input to the respective A workshops, and to quickly involve the participants in (a) thinking about mutual concerns, and (b) stimulating thought proces- ses about matters which would be addressed in the workshops. The extent to which these objectives were met is moot; minimally, the conferees obtain- ed insight about the spectrum of viewpoints shared by their colleagues and associates on the question subjects. The Interrogatory process required a question to be asked orally, and res- pondents were given one (1) minute to record their responses on 3" x 5" slips of paper. These slips were immediately collected, and later reviewed for categorization in written pages referred back to the respective work- shops. Questions 13, 14, and 15 (not here available), were posed later as a reflection of conference enthusiasm; No. 13 from the floor during the Interrogatory, and Nos. 14, and 15, by Dr. Engebretson in connection with the panel discussion on Program Evaluation, January 20. The 13 questions were posed in between the five opening session speakers on January 19, The questions were: How can arthritis physicians achieve optimal util- ization of their skills? How can arthritis services deployment be defined, How can the allied health role as service extenders How can the arthritis capabilities of several provi- der institutions be coordinated for better care deliv- very? (The responses to this question were lost in the mass of generated paper slips, and could not be How can patient vulnerability to non-prescribed How can existing, or proposed, arthritis services be made more responsive to demographic characteristics How can family physician resistance to education in How can the deployment of arthritis services improve How can continuing education in arthritis be main- tained for practicing allied health personnel? How can an arthritis center best support, or back up How can patients be motivated to follow prescribed How can demographic information be accumulated through How can special needs of children be addressed by Affected Question Workshop Sequence Question A-1 1 A-6 2 or characterized? A-2 3 be improved, or expanded? A-5 4 reported.) A-3 5 medications and devices be reduced? A-4 6 of the locality? A~1 7 arthritis be reduced? — A-6 8 the integration of local resources? An~2 9 A-5 10 community services? A-3 11 regimens? A-4 12 current program activities? Genéral 13 arthritis resources? Panel 14 How can the approach used to evaluate drugs be used to evaluate education, training, and services? As suggested above, a speaker was scheduled for each meal period. At the Sunday luncheon, Dr, Gordon R. Engebretson, Coordinator, Florida RMP, discussed the adaptability of a PAR-developed cancer program evaluation procedure to the arthritis program. He also offered PAR assistance in reporting, and assessing this program. At the Sunday buffet dinner, Mr. David Shobe, Director of Government and Community Affairs, Arthritis Foundation, described and discussed the "National Arthritis Act of 1974", P.L. 93-640. At the Monday luncheon, Dr. Evelyn V. Hess, University of Cincinnati Medical Center, discussed the standard nomenclature and data base for arthritis developed by her staff under the auspices of the American Rheumatism Association. Administrative arrangements for the conference were superbly organized and directed by Mr. Charles Hine, Kansas RMP, and Mr. Gordon Waller, Executive Director, Kansas City Division, Arthritis Foundation. For instance, plenary sessions and workshop reports were performed by a team of Court Reporter students made available at no cost by a Kansas City business school; workshop Co-Moderators were able to dictate air reports, All sections of the conference proceeded on schedule, and participants generally satisfaction with the meeting. A number of noteworthy results may result, all of which cannot be reported at this time. For instance, it appears that PAR will organize and execute overall program documentation; PIMA Health Systems, Tucson, Arizona, has funds and resources to. support evaluation of many, if not all projects; and the allied health participants proposed to organize a special arthritis program session at their annual meeting this year at New Orleans in June. Enclosures EXHIBIT 1 . EXHIBIT 1 ARTHRITIS CONFERENCE Kansas City, Missouri January 19 -- 20, 1975 Sponsors Hosts Amer, Acad. Orthopaedic Surgeons KC Div., Arthritis Foundation Arthritis Foundation Kansas RMP Participating RMP's oe CHAIRMAN _ Roger D. Mason, M.D. PROGRAM Sunday, January 19 8:00 a.m, Registration, | Mezzanine Floor, Ballroom Assembly Room 8:45 a.m. Conference Convention Colonial Ballroom Welcome Conference Charge Introduction of Chairman 9:30 a.m. Program Interrogatory | Mr. Matt Spear 10:20 a.m. Coffee Break, 10:30 a.m, Program Presentations Cost Evaluation of Patient Care System E. R. Convery, M.D. Developing Rural Services Elam Toone Jr., M.D. Enlarging Allied Health Roles . Paul Young, M.D. Developing Pediatric. Services Balu Athreya, M.D. Nursing Outcome Criteria _ Janice Pigg, R.N. 12:00 Noon LUNCH | | | Grand Ballroom SPEAKER 1:30 p.m, Workshops Physician Education Music Room Allied Health Education Tower 22 Patient Education Private Dining Room 4 Demographic Factors Private [ining Room 3 Arthritis Services Junior Ballroom . Service Deployment Private Dining Room 1 3:45 p.m. Coffce Break 4:00 p.m. 6:00 p.m. 7:00 p.m, 2 - Program Plenary Session Colonial Ballroom Workshops Reports Adjourn Cocktails Buffett Dinner Monday , January 20 | . 8:00 a.m. 9:45 a.m, | ; 10:00 a.m, 12:00 Noon 1:30 p.m. Colonial Ballroom Call to Order Roger D. Mason, M.D. Cash Bar Grand Ballroom Roger D. Mason, M.D, Panel Discussion - Program Evaluation . Gordon R. Engebretson, Ph.D., Moderator « - 0, Lynn Deniston, M.P.H. Evelyn V. Hess, M.D. Uarl W. Schwartz, vima Healtn systems Coffee Break Workshops Care Delivery Initiatives Program Documentation Special Report Opportunities Program Continuity LUNCII Speaker Plenary Session, Colonial Ballroom Workshops Reports | Recommendations Plenary Deliberations Adjourn Private Dining Room 4 Music Room f SS eae zColonia | toom Tower 22 Grand Ballroom Roger D. Mason, M.D. 2 eae teat ee eee cen eR See teen i ‘, f a EXHIBIT 2 EXHIBIT 2 ARTIRITIS CONFERENCE Meuhlebach Hotel Kansas City, Kansas January 19 - 20, 1975 Workshop Co-Moderators Sunday, Jan, 19 . : Charles tourte HetTe, m.0. Physician Education Varren-~Katzs—1LD. Russell T. Schultz, M.D. Allied. Health Education Marjorie C, Becker, Ph.D. Robert Godfrey, M.D. Patient Education : Frank E. Emery, M.D. William G. Sale, M.D. Demographic Factors _ 0. Lynn Deniston E. L. Angie Hebbeler . Arthritis Services Gene V. Ball. M.D. John L. Magness, M.D. Service Deployment Raymond EF. H. Partridge, M.D. Donald L. Riggin Monday, Jan. 20 “te F. Richard Convery, M.D, Carl H. Eisenbeis, M.D. Program Documentation Special Report Opportunities Ivan F. Duff, M.D. John L. Kline 4 Care Delivery Initiatives Roy L. Cleere, M.D. C. H. Wilson, Jr., M.D. Program Continuity Ephraim P. Engleman, M.D, Paved David. Shebe es EXHIBIT 3 EXHIBIT 3 A-1 PHYSICIAN EDUCATION How can family physician resistance to education in arthritis be reduced? A. Services Make back up more available. Emphasize team approach; include practioner. Don't take away his patient. Access to peer review to assess care effectiveness. Assure reports back to physician of what center did, found, recommends. One-to-one contact. Help locate allied health personnel in their offices. Help establish 2-way refferal. See patients together. 9. Increase assistance opportunities from centers. sno LO CON) ONT te ww NO B. Education Through professional societies. Use Simpler educational tools; eg; cassettes. Distribute bulletins and journals. Devise more appropriate motivational methods. Teach on their home ground Center-office interaction improvement. Make continuing education available to TV at convenient times. Strong programs such as state symposiums. Educate patients to seek care wisely. OQ. Identify the prospective ratio of arthritis patients. ~~ LO COM! OVUN fete ht — General ] AF work with AMA 2 Financial insentives, other incentives. 3 Don't talk down to local physician. 4. Patient feedback. 5. Solicit private physiciam participation. 6 Differential fees (higher) for arthritis Rx/ 7 Establish need in community for practitioners services in arthritis. 8. PSRO controls for quality care. 9. Direct patient (consumer) demands. 10. Public pressure. ll. Start low key development of trust, and give local physician credit for delivery role played. A~l Physician Education How can arthritis physicians achieve optimal utilization of their skills? L. Through education of Primary Care Physicians. 2. Conducting workshops in Rheumatology. Give clinics to instruct other medical and para-medical personnel. Ww 4. Learn about knowledgeable needs of local practicing physicians. 5. Prepare a broad base of consultation systems to Primary Care Physicians 6. Delegation of responsibility to others within their field of accomplishments. 7. By consulting with non-professional personnel expecially trained in arthritis. 8. Restrict practice to Rheumatology only. 9. Computerize patient records. 10.. Aw6 SERVICE DEPLOYMENT As regards the general procram of existing arthritis services, the first question that was raised was how the najovity of care of arthritis patients is provided, and it was quite clear that this was with the private physician, particularly with the local medical practitioners. The auestion was raised as to whether physicians have any idea as what is available to arthritis patients in the area, Many services may be available that the ohysician is nnaware of. It was also apparent that many services that are available compete rather than cooperate with one annther. The nee here appears to be directory of resources. The question was raised as to whose responsibility it is to oversee this directorv of resources, and, of course, the question was also -vaisec as to “ltimate’s who orcanizes the deployment of the arthritis services that are available. Circumstances that effectively inhibit servires: “eploymen* an? use were Giscussed. Some of these are: one, the physicians are conservative by nature; two, a fear that vreferrina patients to other clinics or facilities, that these patients will be lost to them} three, poor educational physicians as to what an arthritis service can offer; and four, suspicion %f qnvernment finance services, Other inhibiting factors of deplovment and utilization of services are financial ones, particularly on the part of the patient and the ability of the patient to pay. It was felt that more use should be made of insurance carriers to pay out-patient fees, and sin-e *his is undeveloped, this could be a further factor that shoul? be dJevelopec,. It was noted that with the National Health Act heina Aiscussed in Congress, greater propaganda emphasis in the next siz nonths shnonld be put on the financing and methods of financine in the arthritis field, All areas of concern for arthritis patients shonl? be coverec, he role of the present region or medical program in adAine to or Changing attitudes of local physicians and patents or referrals aqiven, it was “elt, particularly by physicians in rural areas, that there was a marked impact and that these physicians were becorine much more familiar with arthritis problems an‘ handline shem with oxeater ease. There was also a better utilization of services. The use of para-medical personnel was discussed, who Cirects them, what is their role linking the local physician anc patient, and the Rheumatolo- qist and patient. The need for early diaqnosis and the development of Aiaanostic centers was emphasized, utilizina peripheral facilities for continuation of the program, It was clear that there was a creat neec for phvsi- cians and patient education as to what can be provider, Some Aiscussion was achieved of the priorities, whether one shoul? cencentrate on quality versus quantitv of care, and it was cenerally falt that the first priority was to increase the available arcess to re“ical care by arthritis patients. EXHIBIT 5 EXHIBIT 5 PROGRAM EVALUATION Panel Discussion Monday 8:00 a.m. January 20, 1975 Moderator: Gordon R. Engebretson, Ph.D. Deputy Director, Florida RMP Telephone: 813/253-0931 Member: Program Accountability Reporting A cooperative group from the RMP's formed to develop national descriptive and evaluative information about RMP programs. Participants: O. Lynn Deniston, M.P.H, Program in Health Behavior, SPH 2 University of Michigan Telephone: 313/764-9494 Evaluation of Michigan program, and others Evelyn V. Hess, M.D., F.A.C.P. Professor of Medicine University of Cincinnati Medical Center Telephone: 513/872-4701 Developer ARA standard data program Carl W. Schwartz PIMA Health Systems Telephone: 602/881-4770 Evaluation of Arizona program and others This will confirm our telephone conversations regarding the need for a panel discussion on program evaluation at the arthritis conference in Kansas City, January 19 - 20. The panel is scheduled on the enclosed program for 8:00 a.m. Monday morning, January 20. This timing is poor with respect to the assistance with program evaluation factors which may be needed in the Sunday workshops. It is suitable, however, with respect to the crucial conference workshops schedulled immediately after the panel discussion. The experiences you individually encounter on Sunday may permit specific semmentary during the panel discussion with regard to substantive project evaluation, as distinct from overall arthritis program evaluation, or assessment limits. Page 2 Background: The pressures under which the arthritis grant applications were developed contributed to a generally poor response to program eval- uation requirements. Lack of staff at DRMP prevents development of this program element. The rapid phase-out of DRMP, and the transitory position of the RMP's makes followup of arthritis program evaluation impossible. A meeting last November with representatives of the organizations which are sponsoring the conference resulted in consensus and agreement to convene the conference, seek to assure that the experiences of the grant program are documented, and reinforce the evaluation/assessment forces which exist. Panel Problems: What scale or intensity of evaluation is appropriate with regard to the various kinds of projects being undertaken? What scale, or intensity of assessment is appropriate with respect to the total program, or identifiable sagments of it? How should these tasks be accomplished? What resources are available to undertake them? How reasonable are the costs involved? Commentary: I am enclosing for background two of the better suggestions for evaluation which were received in response to our call for sugges- tions last Fall (No. Carolina, and Colorado-Wyoming). If any of you have material which might be helpful to project and program heads, you may wish to bring handouts (150 copies). We will have reproduction facilities at the conference, and the Kansas RMP will make its facili- ties available if you cannot bring copies. EXHIBIT 6 EXHIBIT 6 PROGRAM DOCUMENTATION 8-1 BASIC AGREEMENTS . 1. Documentation according to objectives. 2. Can document: effort 3. Do not expect to measure outcome other than by numbers. lk, Documentation at end of one year is of value primarily with reference to future planning. The processer identified as being measurable by numbers and amenable to cost analysis were: 1. Training persons 2. Personnel trained 3. Centers established 4, Patients treated It was emphazied that most programs were designed to expand services by education and outreach. Therefore, documentation will be numerative, and not intended to provide conclusion regarding training effectiveness and quality of care. Documentation should be prepared so the following elements can be identified: 1. Effort 2. Performance 3. Adequacy h, Efficiency 5. Process B-1 Workshop Recommendations RMP should provide common data collecting system for uniform docu- mentation. Documentation should be reviewed and evaluated by sub-units of: RMP, AF, and AAOS. Summaries should be made available to all interested parties. SPECIAL REPORT OPPORTUNITIES B-2 In addressing ourselves to the charges given to us, we would philosophize the stree on reporting the achievements of the arthritis RMP initiatives were to place emphasis on primary patient care--~ NOW. That majority of the projects are now doing this is reflected in their activity reports. This concept of responding to the needs of patients == of doing something for them now-- should be protected for fostered in the realization of the National Arthritis Act which in its language places stress upon research. In all of the 29 projects, education is éither a major or a mbknor outcome. Education should really not be aimed at any one group: it should, rather, enchance the activities of all concerned, i.e. physicians, allied health professionals, patients, their families and the public. Because of the multiplicity of efforts to design good educational materials, it i s suggested that a national clearing be established. This, it is emphatically suggested, should be the Arthritis Foundation-- this is reflective of the decisions make in the AHP and Physicians Educational Workshops. It Is suggested that educational materials be designed in response to documented patient, physician and alliebd haealth professional wants, needs and demands. Ths educational clearing house should actively seek out and maintain relationships with other pertinent organization dealing in the divilopment of educational materials. In this workshop eight out of the 12 projects’ Represented were actively seek out and maintain relationships with other pertinent organizations dealing in the development of educational materials. in this workshop eight out of the 12 projects represented were actively collecting ''data''. We encourage these activities in. the light of the estab- lishment of a national arthritis data base. We demand that the responsibility for data generated in the arthritis initatives be in a repositary accessible and responsive to meet the needs of the field. It is recommended, because of lack of uniformity in reporting, that each project immediately remipt coples of their data collecting instrument to Dr. William Campbell associated with the Tennessee Regional Medical Program arthritis project. He will only assemble and disseminate the instruments as information to the project people. It is also rec~ ‘mmended that central collection and dispersion of data be undertaken by the public accounting system (PAR) or some other appropriate entity but under the specifications of arthritis as delineated, for instance, by Dr. Hess and her committee. | In the future it is recommended that high priority be assigned to evaluation of: (1) long term efficacy of comprehensive (optimal) arthritis management versus episodic care, i.e. the usual type of clinical care; (2) the effectivenss of the nurse practicioner versus the physician. A cooperative report based upon the contributions of everyone involved in the training of nurse practicioners in arthritis is desirable. | Third party reimbursement of alliedhealth professionals should be explored in a copperative report with the hope including allied health professional care serveces as a reimbursable item. It is recommended that likages be established between the various levels of care providers: this will optimize their utilization. Among special studies that should be reported we list: (1) Arthritis in Industry; (2) Alabama's Medical Information Service by Telephone, i.e. the MIST program modified to the needs of practicioners with arthritis patient problems; (2) the Western Pennsylvanaia Regional Medical Program which defines the lack of knowledge, gearing of their educational efforts thereby, and providing follow-up evaluation of their efforts. Through out this conference very little has been said about the methods and problems of outreach into the community. We wish to inform that this is what the RMP is all about. A cooperative report based upon our individual experiences is certainly in order so that methologies used, the solution the problems which we have encountered are not to be lost. In conclusion, we are all agreed that experiences from this initative should form a basis for activities to be sponsored by the National Arthritis Act. \ ‘ * ‘ 3. RECOMMENDATIONS Establishment of a national clearing house for educational materials, efforts and methodologies. This office is to actively seek out and maintain contact with other pertinent organizations dealing in the development of educational material. Because of lack of uniformity in data collection, each project should immediately remit copies of their data collecting instruments to Dr. William Campbell, Bioengineering Medical Program, Department of “.__ Engineering, Science and Mechanics, University of Tennessee, Knoxville. The central collection and dispersion of data is to be undertaken by the public accounting system (PAR) or some other appropriate entity, but under the specifications and guidance of Dr. Evelyn Hess. Eventrually, high priority must be assigned to (1) definement of the long term effectiveness of different modes of health service delivery employed in the important types of arthritis and (2) the effectiveness of the nurse practicioner versus the physician. A cooperative report based upon the contributions of everyone involved in the training of nurse practicioners is desirable. Third party reimbursement should be explored in a cooperative effort. The final recommendation is to establish a cooperative report, reflecting outreach experiences in the arthritis project. In conclusion, we are all agreed that experience from this initiative should form a basis for activities to be sponsored, in the future, by The National Arthritis Act. CARE DELIVERY INITIATIVE B39 Summary | Room: 4 Monday, Jan. 20, 1975 Dr. Roy Cleery Dr. C. H. Wilson Denver, Colorado Atlanta, Georgia The workshop explored the prevailing pattern of Arthritis Care Delivery in the past which has been a primary care physician, 1 on | delivery system. A number of weaknesses of this system where pointed out: 1. A lack of property utilization of allied health discipline in the care of the patient with arthritis. 2. Since all care and patient education in this system is derived primarily through the physician, this requires an inordinate amount of time and often is less effective than using experts in the allied health disciplines: . 3. This prevailing concept has inhibited full functioning of some of the allied health disciplines because of the ambiguity of legal systems based on this with regard to legal liability. 4. Frequently the physician is of innated in delivering primary. care, that he is unable to participate in continuing education activities. Only one strength of this system was pointed out and that was the very significant rapport developed between patient and primary care physician. It was felt that this could be transfered and shared with other members.of the health team without decreasing any effectiveness of care. In exploring the impact of the regional medical program on the health system a number of project discriptions were explored and discussed, varying from a traveling clinic concept over large areas to deliver care and for screening and diagnostic processes, to a more stable perminant clinic development program in community hospitals. It was felt that all of .these had had a significant impact as demonstration projects fitting the demographic situations for which they were designed. The major effect is in the demon- stration of the team approach to the delivery of services, as well as educa- tional opportunities for those involved in the care of the arthritic patient. It was felt that these projects are significant enough that they need to be continued for a longer period of time to effect proper evaluation of their impact, as well as for continued delivery of primary health services. | It was felt that if there was a gap period in which there is a loss of .funds before proper evaluation can occur much ob the potential impact of these systems will be lost, due to the collapse for lack of support. Therefore, it was felt that every effort should be made to continue interm support of these projects. It was the concensus of the workshop that a number of recommendations should be made: CARE DELIVERY INITIATIVE Resolutions of workshop: 1. {It is recommended that as many as possible of the Care Delivery Project of the Arthritis Program be continued beyond the present grant period by asking that immediate funding be made available, effective July 1, 1975 to keep these programs going during the time period from close of RMP to grant of the Arthritis Funds through the National Arthritis Act. 2. The Arthritis Initiative Project should be extended, where there is a promise of learning from them, until such time as this learning can be demonstrated. Potential sources are Unexpended Project Funds, other RMP resources, Industries, etc. 3. Another source of continuing funds would be through extending contract benefits with health insurance organizations such as Blue Cross and Blue Shield. . 4h, That this conference request the National Arthritis Act Task Force to consider extending funding care delivery into areas where there are not now centers. 5. That personel in the Arthritis Programs contact the governors in their states for input into the composition of the health councils. That . contact with the council then be continued to seek funding through the National Health Services Planning and Delivery Act. ‘ ‘ : PROGRAM CONTINUITY B-4 The discussion was opend by listing the variety of funds being utilized by the arthritis projects which includes arthritis chapter funds, some private sources, certain support from The National Institutes of Health, as well as fees for services. In the latter category it was indicated that in most cases, these are currently being paid by patients but that project directors have applied, or are applying, for reimbursement of these fees by Medicare, Medicade, or other third party payers. Dr. Mason said that the Federal government is now directing a variety of mechanisms that pay for nearly one-half of all medical care, but third party payers are responsible for another major part but the amount and type of payment {ts a negotiated factor. The question was asked as~to which A.H.P.'s are reimbursed and how third party payments are made. Dr. Mason stated that if they are reimbursed, it is usually limited to in-patient services and that the rates are often at the same rate that those paid to physicians. In some states, however, rates have been reduced by law to a lower fee schedule. Patient education services are also reimbursed on an in-patient basis. No participants indicated that they were receiving any state funding ' for their projects. The question of future funding revolved around four central issues: 1. The possibility of additional RMP funds which may either be in the balance of 29 regional programs or being held by 0.M. Matt Spear stated that there is also the Continuing Resolution which provides up to 78 million dollars during fiscal 1975, but which specifies that these funds should be used only for transition. _ 2. The second and third points concerned new authorizations. The new regional health planning, development and resources act was reviewed. It was pointed out that project funds were unlikely to be available until in late 1976. “ 3. The National Arthritis Act was also discussed particularly the section dealing with screening and detection It was pointed out that if funds are made available to implement this section, that tt is possible they could be applied to some of the current RMP Programs. kh. The fourth area of future funding discussed was the possibility of: approaching governors and state legislators to authroize continuance of specific programs in which local persons would not otherwise be benefited. The discussion ended with the recommendation that all Arthritis Foundation Chapters in areas where RMP programs are currently in existence insure publicity for these programs, and, where possible, try to secure continuing funding for those projects for which public funding will no longer be available. Draft of Arthritis Conference Resolutions Kansas City, Missouri, January 20, 1975 Workshop B-1: Program Documentation Approved 1. RMP should provide a common data collection system for uniform documentation of the present projects. Approved 2. Documentation should be reviewed and evaluated by sub- units of RMP, AF, AAOS, and other concerned professional organizations, and they should develop a plan for future documentation of arthritis activities. Approved 3, (Same) Workshop B-2: Special Report Opportunities Approved 1, A national clearinghouse should be established for educa- tional materials, efforts, and methodologies through the ' Division of Long Term Care, or the Arthritis Foundation, and these agencies should seek out and maintain contact with other organizations with educational materials. Approved 2. (Same) Clarified: request for followup support is to be issued, and procedure determined by responses, Approved 3. Central collection and dispersion of data should be under- taken by the PAR, or some other appropriate entity, under the specifications and guidance of the AF Computer Committee. Approved 4. (Same) Clarified to be a comparison of comprehensive arthritis care to episodic care. Approved 5. Third party reimbursement should be explored in a coopera~ tive effort by this (conference) group. Approved 6. (Same) Workshop B-3: Approved Approved Approved Approved Approved Workshop B-4: Approved 1. 5. 1, Care Delivery Initiatives It is recommended that as many as possible of the care delivery projects of the arthritis program be continued beyond the present grant period (June 30, 1975), by availability of RMP funds, or requesting Congress for a supplementary appropriation, to keep these programs going during the interim period between the close of RMP and the time that funds become available under P.L. 93-640, so as to be able to complete and evaluate present activ- ities with regard to their effectiveness, and potential association with future arthritis programs. (Same) (Same) That this conference request the Commission to be established under P.L. 93-640 to investigate areas where there are not now arthritis centers which might nevertheless be deter- mined appropriate sites for allocation of P.L. 93-640 grant or contract funds, (This resolution received strong vocal dissent with respect to (a) possible duplication of existing P.L. 93-640 terms, and (b) appropriateness with respect to the perceived main thrust of P.L. 93-640.) (Same) Program Continuity (Notes do not elaborate on the written summary report).