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Td II. SUMMARY INFORMATION AND DATA ON REGIONAL MEDICAL PROGRAMS ©

A.

RMP GRANT FUNDING (as of 12/72)

EMPHASIS OF RMP GRANT FUNDS

LEGISLATIVE AND ADMINISTRATIVE HISTORY

APPROPRIATIONS AND BUDGETARY HISTORY

DEMOGRAPHIC FACTS

ORGANIZATIONAL STRUCTURE OF A REGIONAL MEDICAL PROGRAM

aOFraNnN

Overall Organizational Structure
Regional Advisory Groups

Committees and Local Advisory Groups
Grantees of Regional Medical Programs
Program Staffs

PRIMARY PURPOSE OF RMP OPERATIONAL PROJECTS (FY71, 72)

PATIENT CARE DEMONSTRATIONS (as of 12/72)

RMP GRANT ACTIVITY IN CATEGORICAL DISEASES (as of 12/72)

CATEGORICAL DISEASE EMPHASIS OF RMP OPERATIONAL PROJECTS (FY71, 72)

SPECIAL TARGET POPULATION BY RACE OR ETHNIC GROUP

COURSE REGISTRATIONS IN RMP-SPONSORED EDUCATION ACTIVITIES - FY72
RMP Grant Funding (as of 12/31/72)

Number Of GrantsS....cccceccccerc een er eee teseencenreccssennes 56
Number of projects funded out Of grants.......eeeeeeerereees 978
Number of positions supported by grants:

Number of Program Staff......ssseceeeeves 1400

Number of Project Staff... .ceeceeeeeees 2292

Total positions supported by grants......eseeeeeeevceres 3692

PrOjectS LOVE]... ccc ese cece cece eee e nee e reese ee eenseeneareeeeserees $64.6
Core SUPPOFt.. ccc cee ee cece cere n teen eect ereeeereteurerereeesenss 41.9

FY73 Amended Budget:

 

Increase or
1973 Estimate 1974 Estimate Decrease

 

Grants and Contracts $55,358, 000* -0- -$55 358,000

 

*Includes $2.5 million for emergency medical services systems.
' Emphasis of REP Grant Funds

 

(Dollars in Thousands )

 

 

 

 

 

 

 

 

FYT7L % FY72 | % 12/31/72)  %
1. Patient Care Demonstra- $14,256 | 20.3 | $92,700) 29.5 | $31,700 | 29.7
tions, which directly
benefit patients
2. Manpower training and 12,429) 17.6 2i,239| 19.2. 20,000 | 18.8
utilization
3. Continuing Education of 7,677 | 10.9 10,788 9.7 10,300 9.7
_ existing health
professionals
4, Health Services Research 2,193 3.1 2,696 2.4 2,600 2.4
and Development
5. Program Staff Activity 33,743 47.93 43,560 39.2 41,900 39.3
a. Program Direction and (9,111)} (27) (11,761)| (27) (11,313) |(27)
administration
b. Project Development, (7,423)| (22) ( 9,583)} (22) ( 9,218) |(22)
Review and Management
c. Professional Consulta- (8,773)) (26) (11,326) (26) (10,894) ](26)
tion and Community
Liaison
-d. Planning and Feasi- (6,074)| (18) ( 7,841)) (18) ( 7,542)1(18)
bility Studies
e. Central Regional and (2,362)| ( 7) ( 3,049)| ( 7) ( 2,933)}( 7)
Other Services
TOTALS “$70,298 | 100.0 {$110,983 | 100.0 $106,500 {100.0
1964 DECEMBER

1965 JANUARY

OCTOBER

DECEMBER
1966 FEBRUARY

APRIL
1967 FEBRUARY
JUNE

1968 MARCH

OCTOBER

1970 JAN.-OCT.

OCTOBER

HIGHLIGHTS OF
LEGISLATIVE AND ADMINISTRATIVE HISTORY
OF REGIONAL MEDICAL PROGRAMS

The Report of the President's Commission on Heart Disease,
Cancer and Stroke presented 35 recommendations including
development of regional complexes of medical facilities
and resources.

Companion administration bills--S.596 and H.R. 3140--were
introduced in the Senate by Senator Lister Hill (Ala.), and
in the House by Representative Oren Harris (Ark.), giving
concrete legislative form to presidential proposals.

P.L. 89-239, the Heart Disease, Cancer and Stroke Amendments

of 1965, was signed. The Commission concepts of "regional
medical complexes" and "coordinated arrangements" were replaced
by “regional medical programs''’ and "cooperative arrangements,"
thus emphasizing voluntary linkages.

National Advisory Council on Regional Medical Programs met
for the first time to advise on initial plans and policies.

Dr. Robert Q. Marston appointed first Director of the Divi-
sion of Regional Medical Programs and Assoc. Director of NIH.

First planning grants approved by National Advisory Council.
First operational grants approved by National Advisory Council.
The Surgeon General submitted the Report on Regional Medical

Programs to the President and the Congress, summarizing
progress made and recommending its extension.

 

 

Companion bills to extend. Regional Medical Programs were intro-
duced in the House by Harley 0. Staggers (W.Va.) (H.R. 15758)
and in the Senate by Senator Lister Hill (Ala.) (S. 3094).

P.L. 90-574, extending the Regional Medical Programs for two
years,was signed. Changes were: include territories outside
of the 50 States; permit funding of interregional activities;
permit dentists to refer patients; and permit participation of
Federal hospitals.

Bills extending RMP introduced; hearings held.

P.L. 91-515 was signed into law. New provisions: emphasis on
primary care and regionalization of health care resources;

added prevention and rehabilitation; added kidney disease; added
authority for new construction; required review of RP appli-
cations by Areawide Comprehensive Planning agencies; emphasized
health services delivery and manpower utilization.
REGIONAL MEDICAL PROGRAMS
APPROPRIATIONS AND BUDGETARY HISTORY

(Dollars in Thousands)

 

Authorization,.,..... ase

Amount appropriated
for grantS....2eeeee-

Amount actually
available for
grants 1/......eeeee

~ Amount actually
awarded
for grants.....s-eee

 

Fiscal Fiscal Fiscal Fiscal Fiseal Fiscal Fiscal Fiscal
Year Year Year Year Year Year Year Year
1966 1967 1968 1969 1970 1971 1972 1973

$ 50,000 $ 90,000 $200,000 $ 65,000 $120,000 $125,000 $150,000 $250,000
24,000 43,000 53,900 56,200 73,500 99,500 90,500 ‘ NLA.
24,000 43,934 48,900 72,365 78,500 70,298 135,000 51,836 *
2,066 27,052 43,635 72,365 78,202 “Fy 70,298 110,983 2/ -

 

i/ Includes unspent funds carried forward from previous year minus amounts held in reserve by the
Office of Management and Budget.

2/ Does not include earmarked amounts for Emergency Medical Services ($8.0 million), Cancer construction
($5.0 million), Health Maintenance Organizations ($9.2 million), Contracts ($1.2 million), and
evaluation activities ($.6 million).

* Amount available per amended FY 1973 budget.
DEMOGRAPHIC FACTS

There are 56 Regional Medical Programs which cover the United States,
Puerto Rico, and the Trust Territories of the Pacific. The Programs
include the total 1972 population of the United States (estimated at
207 million) and vary considerably in size, funding, and geographic
characteristics.

* LARGEST PROGRAM

In population: California (20 million)
In size: Washington/Alaska (638,000 square miles)

* SMALLEST PROGRAM

In population: Northern New England (445,000)
In size: Metropolitan Washington, D.C. (1,500 square miles)

* GEOGRAPHIC BOUNDARIES: Number of Programs which primarily

 

Encompass single StateS...cssesereeseees sewer eee e dd
Encompass twO OF MOre StateS..erereseeecees sececee 4
Are parts of single states......-- seeecececccceceedld
Are parts of two OF MOTE STALES... seers eeessevees 7

* POPULATION: Number of Programs which have

Less than 1 million personS.....seeeeeccereeeeeens O
1 million to 2 million..... cence cecceatccceeeoesoedd
2 million to 3 million.........eeeeee est eessssess 14
3 million to 4 million...... ccc eee eae easccevensees 7
4 million to 5 million....... re)
Over 5 million......-ccceeeeeas ceececceecccceeseoedd

* FUNDING LEVEL RANGES: Programs with

 

Less than $500,000......cceeceeccenecccreeceereeee 4
$500,000 - $999,999......-208. sac en cece sere eecs eee ld
$1 million -— $1,499,999. ....ceeceeereceseeeeeenees 8
$1.5 million - $1,999,999. ccc ccc ccccccceccsececeedl/
$2.0 million ~- $2,499,999...... eee ccacccvcscsesere 4
$2.5 million and above....resesceeceescecesvreress 4

* MEDIAN FUNDING LEVEL: $1.1 million

 
ORGANIZATIONAL STRUCTURE OF A
REGIONAL MEDICAL PROGRAM

 

 

 
   
   
   
   

Coordinator

 
 
   
     
 

  
    
 

     

and
/ Program \
/ Staff \
/ \
/ YY \
/ \ 7
/ >» \
/ y% \
/ \
/ / \ \
/ _ — eye ee
/ \
Grantee / Regional
(fiscal / \ Advisory
agent) \ Group and

Committees

wees cermin meee menos eammnesmm mmm ity, seamen commen

Responsibilities and Relationships

 

There are three major components of a Regional Medical Program at the
regional level: The Regional Advisory Group; the grantee organization;

and the Chief Executive Officer (often referred to as the RMP Coordinator)

with his or her program staff.

- Regional Advisory Group: The Regional Advisory Group has the
responsibility for setting the general direction of the RMP
and formulating program policies, objectives and priorities.

 

- Grantee: The grantee organization manages the grant of the
Regional Medical Program in a manner which will implement
the program established by the-Regional Advisory Group and
in accordance with Federal regulations and policies.

- Chief Executive Officer (Coordinator): The grantee's full-time
employee who has day-to-day responsibility for the management
of the RMP; he is also responsible to the Regional Advisory
Group which establishes program policy. The Chief Executive
Officer and his program staff provide support to the Regional
Advisory Group and its subcommittees, including local advisory
groups where they exist.

 
Regional Advisory Groups

* PURPOSE: The Regional Advisory Group (RAG) is the organized voluntary

body of health providers and consumers in each RMP which has responsibility
for program and project determinations and overall program direction.

A Regional Advisory Group, through membership composed of representatives
from most health interests as well as many consumers in the Region,
attempts to identify critical health needs in the area; develops, reviews,
and approves appropriate activity proposals designed to meet those

needs; and monitors and evaluates funded programs. The Regional Advisory
Group has final decisionmaking authority concerning program content and
policy in each RMP.

SIZE: _ RANGES, FY 1972

 

FY'69 2,500 total membership Size No. of RAGs
. 45 average group size ;

10 - 39 - 21
FY'70 2,700 total membership 40 - 69 - 27
48 average group size 70 - 99 - 6
100 -129 - 1
FY'71 2,743 total membership 130-159 - 1
oo 49 average group size a
Total 56

FY'72 2,667 total membership
48 average group size

COMPOSITION: Regional Advisory Groups are composed of volunteers, both
health care providers and consumers. Makeup of these groups has changed
somewhat over the years since Regional Medical Programs have been in
existence. Medical center officials, for example, have decreased from
16% to 9% of the representation. Consumers, on the other hand, have
experienced increasing representation from 15% of the 1967 membership to
25% by the end of fiscal year 1972. Practicing physicians have also
generally increased.

Category of RAG Representation

 

1967 1971 1972
Practicing Physicians 23% 28% 27%
Hospital Interests ~ 12 13 12
Medical Center Officials 16 8 9
Voluntary Agencies 12 8 7
Public Health Officials 7 5 6
Other Health Workers 8 11 7
Members of the Public 15 21 25
Other 7 6 8
 

COMMITTEES AND LOCAL ADVISORY GROUPS

PURPOSE: Regional Advisory Group committees have major responsibilities
for: (1) Program activity development and review; and (2) monitoring
and evaluation of funded activities. Most are composed of experts in
a given field and as such have significant influence in terms of the
scientific and professional competence of program activities. The last
two years has been a marked increase in the number of planning, review
and evaluation committees, giving these functions an added and much
needed emphasis.

Local Advisory Groups, although they are tied to the Regional Advisory
Group (in many instances membership of the bodies overlaps), serve
primarily in a liaison and program development capacity at the community
level. Generally, they attempt to foster cooperation among local
health organizations and consumer groups, and in many instances provide
linkages with CHP area-wide groups. Local groups serve as reactors to
community needs and problems and relate these, as well as possible
solutions, to decisionmaking bodies at the regional level.

NUMBER AND SIZE: Comparison 1969-72

1969: = 864 10,163 Total Membership
1971: = 875 12,426 Total Membership
1972: = 850 12,315 Total Membership

Note: Total membership of these groups overlaps considerably
with Regional Advisory Groups; in addition, committee
memberships overlap to some extent with each other, so
that totals shown are based on numbers of memberships
rather than numbers of individual members.
* PURPOSE:

GRANTEES OF REGIONAL MEDICAL PROGRAMS

 

Each Regional Medical Program is fiscally administered
by a grantee which may be a public or private non-profit
institution, agency, or corporation. The grantee is
responsible for management of the RMP grant in such a
manner as to implement the program established by the
Regional Advisory Group and in accordance with federal
regulations and policies. This includes primarily
fiscal control, fund accounting, and administrative
support.

Categories of Grantees, Fiscal Year 1972

 

Grantee 36
Universities 33
Public (26)
Private ( 7)
Other 23

New agencies/corporations (16)
Existing corporations ¢ 3)
Medical societies ( 4)
© PROGRAM STAFFS

PURPOSE: Program staffs are the salaried employees of the 56 Regional
Medical Programs. Their functions include planning and development
studies, feasibility studies designed to assess the potential of
prototype programs for larger scale application, and professional
consultation to community health groups and institutions. In addition,
they are responsible for operational project development, review and
management, including the provision of staff support to the Regional
Advisory Group and its committees.

%

* SAMPLE ORGANIZATION CHART:

 

Coordinator or Chief
Executive Officer

 

 

 

 

Program
Administration

 

 

Program
Operations

 

 

 

 

 

 

 

 

© C :
Health Care Manpower and Quality Control
Delivery Systems Education Mechanisms

 

 

 

 

 

 

 

 

 

* SIZE: Comparison of staff size in full-time equivalents, fiscal years

1969-72:
FY 1969 - 1,546 total FY 1971 - 1,640 total
28 average 29 average staff
staff

FY 1972 - 1,374 total
‘25 average
staff _

* COMPOSITION: Program staffs attract persons with a variety of pro-
fessional and technical competencies. Staff composition as of June 1972
included the following specialties and categories:

Education 111 Administration/Management 119
Medical Sciences 149 Other Sciences 76
Health-Related Occupations 123 Public Info./Relations 52
(e.g., health planning Other Prof. and Technical 110
hospital administration) Secretarial/Clerical 569

 

© Social/Behavioral Sciences 66

1,375 F.T.
Primary Activity

Training Existing Health

Personnel in New Skills a/.

Training New Categories
of Personnel b/

Continuing Education icf

Patient Care Delivery
Demonstrations

Combination 1/2 Training |
1/2 Patient Care

Demonstrations

Coordination of Health
Services

Research and Development

Data Collection/Statistics

TOTAL

PRIMARY PURPOSE OF RMP OPERATIONAL PROJECTS:
(FY 1971 and FY 1972 With Net Change in That Period)

 

 

FY 1971%

No. of Amount (in
Projects thousands 4
144 $10,154 22
16 921 2
149 9,578 21
104 10,008 22
90 8,887 20
56 2,965 7
35 2,772 6

(Not included in data)

 

594

$45,285

100%

 

 

 

 

FY 1972 Net Change
No. of Amount (in Amount (in
Projects thousands & thousands 4
200 $13,266 17 $ 3,112 + 31
55 3,566 5 2,645 +287
186 12,031 16 2,453 + 26
158 17,098 22 7,090 + 71
185 14,611 19 5,724 + 64
142 11,055 14 8,090 +271
51 2,559 3 ( 213) - 8
30 2,354 3 2,354 -
1,007 $76,540 100% $31,255 + 69%

a/ New Skills for Existing Personnel - training aimed at enabling the person trained to assume new responsibilities
in the already chosen career field or adding skills in a different but related health field (e.g., coronary
care training for nurses, career mobility for licensed practical nurses).
b/ New Personnel - development of training programs for such new categories of personnel as physicians' o
assistants, nurse practitioners, and community health workers. .
c/ Courses aimed at maintaining or improving the level of practice of the health professional.
i
@

 

ehh

 

H.

Patient Care Demonstrations Which Improve Quality, 12/72
' Accessibility, and Organization of Health Services

Coronary and other intensive care
ACLLVILLCS. ccc cere eee cere eee een reaneeeerees

Expanded and improved ambulatory care in
neighborhood health centers, clinics, and

outpatient departmentsS....+-.+-- sae e wee ceees

Expanded and improved home care and long-
term care «...-+-- cece ete een ere eease eens

Other activities such as mobile units,
specialized care services, and non-intensive
in-hospital Care. .seeecessereecceererrescecs

Emergency medical ServiceS..+-++reseereceeesee

No. of
Projects

95

213

79

141

61

Amount

$6.2 Million

18.1 Million

4.8 Million

10.9 Million

10.7 Million
RMP Grant Activity in Categorical Diseases
(As of December 31, 1972)

 

Disease Category Number of Activities Amount

Hypertension, ...ssccesscccccesceee 7 $806,746
Heart DiS€aSC.ecccccscccccsovences 93 4,865,557
CANCOLececvecscccscccceseesceesees 84 a 5,408 ,714
Strokes. cccccvccccveseveccccessses 58 3,956,861
Kidney Disease. -cceccscescccccrece 79 6,673 ,646
Pulmonary Disease. .cecsccesccccece 31 2,462,200
Diabetes. ccccccccccccccesssccccces 11 682 , 926:
Sickle Cell Anemia..cscccccccccece 2 131,414

 

365 24,988, 064
Disease

Heart Disease and
Hypertension

Cancer

Stroke

Kidney Disease
Pulmonary Disease

Diabetes and other
related diseases

Multicategorical/

Comprehensive

TOTAL

*Total current funding

CATEGORICAL DISEASE EMPHASIS OF RMP OPERATIONAL PROJECTS
(FY 1971 and FY 1972 With Net Change in That Period)

 

 

 

 

 

FY 1971* FY 1972% Net Change

No. of Amount (in No. of Amount (in Amount (in
Projects thousands) 4 Projects thousands) --Z thounsands) 4
156 $11,684 26 124 $ 7,439 10 (S$ 4,245) -36
89 6,208 14 98 6,526 9 318 +5
65 5,499 12 57 4,192 5 € 1,307) ~24
22 ‘1,518 3 74 6,246 8 4,728 +311
22 2,479 5 35 2,875 4 396 +16
“19 1,055 2 42 2,315 3 1,260 +119
221 16,843 37 577 46,947 61 30,105 +189
594 $45, 286 100% 1,007 $76,540 100% $31,255 + 69%

level, which includes some funds obligated in prior years.
Race or Ethnic Group
Black

American Indian
Spanish American
Oriental
Other/Combined

Not Relevant

TOTAL

SPECIAL TARGET POPULATION BY RACE OR ETHNIC GROUP
(RMP Operational Projects for FY 71 and FY 72)

 

 

 

 

 

FY 1971 FY 1972 Net Change
No. of Amount (in No. of Amount (in Amount (in
Projects thousands) 4 Projects thousands 4 thousands &
29 $ 3,933 9 69 $ 8,202 il $ 4,269 +109
4 312 1 8 682 1 370 + 119
4 168 - 27 2,176 3 2,008 +1,195
| 1 188 7 0 0. - ( 188) - 100
8 832 2 43 5,962 8 5,130 + 617
548 39,852 88 860 59,518 78 19,666 + 49
594 $45,285 100% 1,007 $76,540 100% $31,255 + 69%
COURSE REGISTRATIONS IN RMP-SPONSORED EDUCATION ACTIVITIES Fy 72

(Listed by Type of Training Received and Discipline of Recipient)

 

 

 

CONTINUING NEW SKILLS FOR NEW TOTAL
DISCIPLINE EDUCATION a/ | EXISTING PERSONNEL b/ | PERSONNEL c/ No. Percent
Physicians (MD/DO) 46,328 10,140 -
56,468 29%
Dentists 1,442 197 - 1,639 1
Nursing Personnel 36,301 25,072 146 61,519 32
Allied Health Personnel 23,011 12,362 1,205 36,578 18
Hospital/Nursing Home Personnel 10,414 694 11,108 6
Medical, Dental and Nursing 6,106 1,139 7,245 4
Students
Other 8,582 9,579 1,064 19,225 10
TOTALS 132,184 59,183 2,415 193,782 100%

 

 

 

 

 

a/ Continuing Education - courses aimed at maintaining or improving the level of practice of the

health professional.

b/ New Skills for Existing Personnel - training aimed at enabling the person trained to assume new

responsibilitie

health field (e.g., coronary care training for nurses, career m

s in the already chosen career field or adding skills in a different but related
obility for licensed practical nurses).

c/ New Personnel - development of training programs for such new categories of personnel as physicians’
assistants, nurse practitioners, and community health workers.