*EO(D 1 431 SPECIAL ACTION REQUEST Colorado/Wyoming Regional Medical Program Purpose: The purpose of this request is to raise the current recommended National Advisory Council level for the Colorado/Wyoming RMP from $1,102,346 to $1,252,346.effective July 1, 1972. This recommended increase of $150,000 is exclusive of any EMS or Community Based Manpower Educational System applications (out-of-phase supplements) which might be presented to this meeting of the Council membership. Rationale of Request: The Colorado/Wyoming RMP was-approved for Triennial status and was awarded developmental component funds by the November, 1971 NAC. At the time the Region submitted its application, a tight-funding policy was in existence since all Regions had suffered a 12% reduction some 4 months earlier. Because of this reason, the Colorado/Wyoming RMP had submitted a three-year application which requested a most conservative budget proposal. All activities which had been approved by the RAG were rated utilizing a priority system. This process allowed only 9 of the 24 approved activities to be included in the application in order for the request to stay within the limited funding forecasted for the Region. As a result, an additional 12-15 proposals could not be considered for funding during the first year of the Triennial which started January 1, 1972. Additionally, at the end of this calendar year, only 3 of the 9 project activities currently being funded are due to terminate. These terminations will provide only $73,000 for new activities next year. Also, of - paramount interest is the fact that several new activities have already been stimulated'which have a direct bearing on the new mission of this Region. One such activity is entitled, "Student Health Program for Migrant Agricultural Workers and Rural Poor." This proposal has come about through the leadership of a Chicano who now serves on the RAG. This particular type of activity had been strongly recommended by the site visit team which had visited the Program in-September, 1971. Conclusion: RMPS staff are of the opinion that this Region is beginning to move and needs additional funds in order to pursue those activities which have been stimulated with developmental component funds. In view of the tight turn-around monies available next year, we feel that an increase of $150,000 (d.c.) for each of the next 2 1/2 years, starting July 1, 1972, would be a good investment. If approved, this Region would be receiving an increase of approximately 15% over the pre April 1971 level. Respectfully submitted, Mid-Continent Operations Branch May 25, 1972 .2 Com.,nonent And Finnnclnt Stimrnnry Anniversary Apollcation IE C I f D v D F.@ i'T qEIIT CURII YFA@_ YF/,R YRIS AWARD #COU.'@C'L FUIM I 'IC OPER. fECO,"G,2@'DED 'REQUEST x SARP YF,AR T,FVFT, REV. coal 1,020,400 CORP 93Z,846 Sub-(,oiitracts 415,757 577,500 OPER, ACTIV. DISAPPROVED 'DF,VET, COIT. 134,860*') Yes or 1', F,ARMARKS., V 125,000 ,T,T),,-F (125,000) ,y (@,40) 111,826(d( cities (i@T45) 5.2,810 (.-15,550) (dci) @BES Y@51 See Below P,Iin DIRECT 1,348,603 1 800,boC,'-D' 1,732,760 1,425,000*@, R F, 2L@, F, S -, F D2,750,577 COJNCIL APPROVF'N TEVEL 1,800,000 NON-Rl4PS nnd TIZCO,V,E Under 2/8/72 Nr@C Policy, the approved RF N@C level for @Lhe first year of th6 KANSAS Tri erni um prevail s June t972 klithdra,,,in by KRo',P R'EVIEII CYCI PLUS kidney funds of $125,0'00 This amount inc Iti4e s. $125 000. f or #4-0 and $3 9', @5-0. for #45 @*'--**Pendl'.ng is the fiNIlowing requ6sts: CBES, $123,3.04:-(for one year) Current program request 1,732,760 CBES request 123,304 $1,856,064 -Revi.sed 5/25/72 KANSAS REGIONAL MEDICAL PROGRAM Anniversary Application within a Triennium PART I Staff Briefing Document Page Face Page. . Map of Kansas Subregions . . . . . . . . . . . . . . . . . . 2 Kansas (State) Profile . . . . . . . . . . . . . . . . . . . 3 Component and Financial Summary . . . . . . . . . . . . . . . 4 MIS Breakout of Request (06-07 period) . . . 5- 6 Accomplishments, Problems, Issues. . . . . . 7 Staff Review Report. . - - - . 8-10 RMP Review Criteria . . . . . . . . . . . . . . . . . 0 . 0 11-13 PART II Kidney -- not applicable PART III Funding History (01-07 period) KDIP Funding Statement Summary of Core Feasibility and Planning Studies KRMP Core Breakdown and EEO Breakdown KRV,P RAC and Committee Data PART IV KRMP Trip Report: Staff Visit KRMP Trip Report: Staff Evaluation Report: Meeting of Dr. Margulies, KRMP Staff PART V Advice Letter PART VI Management Assessm,ent Visit not applicable PART I R4S STAFF BRIEF@a'G DOC FEGION Kansas OPERATTONS Eastern Mid-Continenr, BRANCH South-Central Z7 Wester.-. BRANCH rYPE, APPLICATION: B LAST RATING Tel. No. 443-1790 Room 10"15 E7 IAL Feb. 197 1 DATE BRANCH CHIEF Michael J. Posta C&7 lst ANNIV YEAR SARP BRANCH STAFF Mary E. M@hy Z7 2nd ANNIV YEAR Z7 REV. COM. RO. REP. Ray Maddox eL7 OTHER ZV OTHER Staff Last @%t. Assin't Visit 10/7 Chai,man LAST S. V. Mar 4-5 197 1 -; Chair,,im Alexander M. Schnddt, M.D., @l'..aff Visits, last 12 mos. (DaLes, Ch Is Name and Type of Visit) /i6/71 - Technical Site Visit - Cc=rehensive Nephrolo@@ r@rain. Prog. MC Francisco Oonzales, M.D4 12 1 - -,,ET Eva]-T-aL@icn -iisit Harold O'Flahe 1-Y ai Z' zi.avs-@,7 icL L L KAJOR EVENTS @l. CH OCC IN THE R'PGIOIN @(,.II\TG alE RMP SINCE ITS LA.ST FEVIEW in 197 1 Ki'disAS L@TS r)f, tl?? (7/1 2. 366--'L,al and Rehabilitation SePvice Contract of $55,800 to Atchison, TO'Oeka and Santa l,b Memorial Hospitals Inc. to exolore a possible FHO (r@y 172) IDIP EVE, NTS 10 I@ m Anderson, forTrer @@ctor,of Planninc, Services Kansas Blue Cross-Blue Shiel-@ Topeka, and Regional Advisory Council @rrber, a-,opointed l@ Associate Director 2 . Mr, Roy C. Hoi e nc)r,,iinalu-ed and app--oved as Chai- Re@Lonal Advisory Counci . i@irs. Tom Gordon approved as Vice-Chaii-r;an. 30 SubreFaonal Office changes: (1) Northwest (Colby) Coordinator resigied; (2) Flint H'--,' (E,.@6ria) Coordinator resigned and office closed 7/71; (3) Central (nureat.Bend) CoordinE,,tor resigied 2/l/72- (4) l@orthcentral (Salina) Coordinator resi@ed. Coor-l-ina- mp acemnts appointed to Great Bend and Saliiia. KA@SAS RFGIONAL O,:DICAL P,ROGRAM Subregional Areas anc: Office Locations July 1, 1971 "CATOR tiaotrag F;4iLLI SMi7'ii REPUBLIC t4ARSHAt-L t4EMAIIA BRO" CIL A R PA COLBY I Sol Wi@47A SCOTT Lagci I ASC GFEAT R@CE 4 i Lroq vc@y F1149LIf GiL ci c WED ,Aar ICHA CLARK @VOR QRPER FUIONAL CL@CTERISTTCS Kansas @ encotrpases the State of Kansas.(82-OL18 sq. r@ules) Counties - 105 Congressional Districts - 5 POPUIATION (1970 Census) Total Population: 2 249,loo Popu-lation Density: 27 per sq. i-aile. % Urban: 66 % Non-White: 6 (Amri 8 can Indians. ,700) AGE DISMIBIEION % Under 1 yrs.: 33 % 18 - 65 yrs.: 55 % 65 yrs. & over: 12 @INCOIC Tv-erage Incorne per Individual @1970) $318011 U.S. Average - $3,910 MORTPJJTY RATES per 100 ooc (1968) Kans@ U.S. Heart Disease 3bO.b T7 2-.'6 Cancer 157.2 159.4 " ar I-esi ons -Afl', NS) Vascu 115 4 105 8 40 All c uses, all qqes 97Q.0 @065-i- FACILIT]FIS AND RESOTJRCES Tch-cxu Medical School - Univ. of Kansas School )f Medicine i,o69/70 - Student Erirol-i@lent: 497 1969/70 - Graduates: -'L-'L9 Pro fessi.onal. Nursing.-, Scho6is 19 Sdnools - 5 Colle,--e Affiliates Accredited Schools for health Professionals Cyto @chnology - 3 (Hospitals: 1 -- Medical Centers: 2) Medical Technolo,@ - 9 '9adiologLc Technology,- 22 (Hospital or Medical Center Based) Physical 'Iherapy @- 1 Inhalat-li n Therapy - 3 HOSPTTALS - Co ty General and V.A. General No. Beds Short Tem l@ 11@, 13 Long Ten'n (special) 1 154 V4A. (General 2 947 .POSTER ans - Non-Fiedera.'l II.D.s and D.O.s (1967) M.D. Grou-p Praci,!-ces (1969) ve: 2,388 Single @l)--cia'lty: 24 @Inadtive: 292 Genera 1 71"1,ac'ullce: C'-l Ratio: 106 actiie per 100.,OOO population Multispecialty: 5 U.S. Rate: 132 per 100,000 populeL,41on Graduate Nurses 4 IVERSARY APPLICATION COMPONENT AND FINANCIAL SUMMARY ANN D T FUNDING YR'S AT,]ARD COUNCIL 05 OPER. RECOMMENDED REQUEST E7 SARP COMPONENT @EAR LEVEL L3 REV. COM. 1/l/70-6/30/71 CORE and 932,846 1,020,400 577,500 OPER. ACTIV. 415,757 DEVEL4 COMP. DISAPPROVED 134@860 EARMARKSI: 111,826(dc) Kidn ode Cities (#45) 52,810(dc) 1,732,760 RMPS DIRECT 1,348,603 4PS INDIRECT 413,441 414,387 1,,762,044 47 1 NON-RMPS and INCOME loi@AL BUDGE-!' REQUESTED 2,750,577 COUNCIL 1,900,000 ROI @-Withdtawn by KRMP REGION Kansas June 972, REVjEiel CYCLE REGION - KANSAS MARCH 17,1972 RM 00002 06/72 BREAKOUT OF REQUEST RMPS-OSM-JTOGR2 06 PROGRAM PERIOD (4) t5) NOT CURRENT CURRENT NTIFICATION OF ( LI I TOTAL IDE COMF()NENT CONT WITHINI CONT. BEYON")L APPR. NOT NEW# APPR. PERIODI APPR. PERICOI PREVIOUSL PREVIOUSLY DIRECT I INDIRECT CF SUPPORT Of SUilPORT FUt4OLD APPROVED COSTS I COSTS COOO P,40CPAM CORE U-OTO-ZTV-EL-C-P@ll-EN-T COt',PONEtiT PRI 001 GREAT BE DUCATICNAT. Pi -Ia2jL3Z() ----- 122-,32Q-l 021 KT:,SAS MEDICAL LIPR,%RY Si - - - -- - - - - - - QQ a 040 UEVEL (IF Co@;"tElIENSIVE Ni 041 C,%@'@CER I!,FGRMATEL;N SERIVII - ----------------- - -- --- - -- - - - - C,@'@CLP CARE r-ONTl-'4UING El 044 NLi@(.@f- LLit4[CiAN flf@CGRA14 04 5 PIt:r@@ L C II Y @tE ALT H - a-, I:-? I ! 046 14EAL I) I SERV I-@ES Tik AI Pi ING I LTI J.. ---------- 047 DIA@FIES DETECTION AND El II Z@QCLQ I 048 Pf4C)BLEM CPIE%TEU MEOICALI I 04q S@TA@ED 8A,4AG:;tl@ENT ENGINEI I 050 HEALTH OCCUPATIONS PROMCI T[ZBUL PP@Ony@tMS-' _$22.000 t S262t860 1 $1*7329760 1 $4l4t367 1 $29147tl47 TOTAL *Wi@hdrawn by l'IRMP MAFTCH 17,f972 REGION - KANSAS BREAKCIJT OF REQVEST RM 00002 06/72 PROGRAM PERIOD AMPS-OSM-JTOGRZ (4) IDE4TIFICAT ION OF COMPONEt4T CONT. WITHINI CC4T. BEYONOI APPR. NOr I NEW, NOT ACCOL YEAR TOTAL I APPR. PERICCI A;l@IR. PE;ZICCI PREVIOLFSLY I PREVIOUSLY DIRECT I I ALL YEARS I CF SUPPORT I OF SUPPORT I FUNDEv' I APPROVED COSTS I JOIRECT COSTS I COGD PROGRAM CORE ODOO DEVELOP-IIENT COMPONEN-T PRI --I -1 s 001 GP.LAT BEt4D EDUCATICNAL PI - -20 cl.,:j M- - I I E23 K t, N S A @t4 E Ti C t.-L @ I -0 R-A-R Y-5 I 340 C E V E T- C-F U@M 1-t -E H E N S 1 V E N I 041 CANCER INTORMATION SERVII I 042 CA!4CER C4;(E CCt.@Ti.@,Ul@4G El 044 NTRSE CLlf4lClAh PRCGRAP I I s 1 045@ lOPFL CITY HEALTH MANPOWI --E? --- 046 HCAL"@L SEPVICES TRAININ'@L 1 4 4 D.Q.0@ IA64JODD-1. 01. 7 C)lAtiETES DETECTION AND El I I S.IOXQQQ-I- $3QXQQO-l t -@.E.LQCO I 048 PPI;I)LE-4 ORIENTED ME31CALI . ..... ....... I s@QOO I 049 i SHAPED H-'NAGEME.NT ENGINE I 050 HEALTH CCCU;>ATIO.14S PROMOI -TOTAL S 9@,7@2 1 $313,276 1 $l,8O4wO $3 9536,'Iaa *Withdrawn -by.-K-RMP. FEVIEW CYCUI Jme OUSTANDING ACC94PLISIEOZ@ITS BY H,'iP since Fiat__ 197 1 1. Regional Advisory Council redirected ProFrai-a activity from a project oriented dire ction to on@ with major er,@has 1 s on iiiiorovement in the distribution of rredica. care services throug-i @gionalization. 2. @ had an active role in data co.@i-latiori on which were based the plans for. estab shm,--nt of the Uni-v. of Kansas School of Medicine at V,ich-2Lta State Univ. (I,,7,' pending Kansas Le@lsl.aL@ion. YailP,actively assisted WSU College of Health Rela@ue Professions in getL-ing undeniay and supports it in part. 3. Nogotl*lations are mdc-ntay to develop several cities, in addition to Wichi:u-a.1 as Area Health Educatio,-i or Area Health Service Centers, namly, TopelONE14T CURPF'IT 09 YEAII 1 @5 YEAR RECOMIL9@,DED YR'S AWARD COUI"C'AIL FM;DING -04 OPER. RECOi'@IIDED 'REQUEST SARP YEAR TEVEL REV. C014. 788,286 947,034' CORE Sub-Contracts OPER, liCTIV. 6305066 708,345 approved but DEVEL. CO!@. Linft-,rided yeg or 110 EAP14ARKS: KTr)lirEY -0- Di-sanoroved Kidney @k?4- 74,576 4: Ilealth Trng. @,23 (CBES) See bel.o.i,) EMS @'25 See below** R14ps I)TRFCT ]@,418,352 1,741,000* 11,829.955 1,725@000 RPQUESTED 2,449,24n conlc I'L AI'PROVED LEVET, 1,741 000 l@ NON-RI-TS and it@COME *11-nder 2/8/72 National Advisory Council REGION Mountqin States @policy the approved NAC level for the first @year of the triennium prevails. Ma@/Jtine 2 t97 .REVIEW C@ **Also pending are the following requests 01 02 03 EMS 3755576 234,945 CBES 219,575 182,000 100,000 Current Prog. Request 1,829,955 Total is Request 2,425,106 5/23/72 VIOB/RMPS Page 1 RMPS STAFF BRIEFING DOCUMENT OPERATIONS Eastern Mid-Con /-7 South Centrll rx7 Western REGION MOUNTAIN STATES REGIONAL MEDICAL PROGRAM BRANCH - BRANCH ryPE APPLICATION LAST RATING Tel. No. 443-28 Room i. 2 TRIENNIAL 197- DATE BRANCH CHIEF Richard.. BRANCH STAFF James A. Sm-ith Lxl lst ANNIV YEAR /x / SARP pEp. Dan Webster 2nd ANNIV YEAR LI REV. COM. RO OTHER /-7 OTHER Last Mgt. Assm't Visit N/A 19i Chairman LAST S.V.Mardh 197 1 Chairman Clar aix@.tn's Name and Type of Visit) aff Visits, Last 12 mc (Dates, Ch 1971 Jessie Sa Staff visit to observe the ReRibnls Droie t review anel. Major Events Which Occurred in the Region Affe,ting the MT Since Its Last Review in 197 1 Alfred Popma, M.D., Coordinator, retired in December, 1971 after five years of service to the program. His deputy, John Gerdes, Ph.D., was hamed interim coordinator until a new coordinator is appointed. Dr. Gerdes is a candidate for the job. The other significant happening for MS/RMP during the past year has been the emergence of long suppressed feelings of discontent with its grantee, WICHE MS/RMP complains that the grantee (WICHE) maintains undue restraint on the programmatic efforts which hinders the Region from being responsive to many of the hew national priorities. The Region feels that its progression of development and maturity is at the level where it can consider the possibility of becoming a nonprofit corporation. WICHE is resisting that notion, maintaining that the success of MS/RMP to a large degree has been through its affiliation with them. Currently, it appears that the two parties art workiftg toward an acceptable compromise. WICHE will probably remain as grantee, but extend more programmatic latitude to the MS/RMP. Page /Aountain 5tates Re8lonol /AeJlccil Pro8rom IDAHO MONTANA NEVADA WYOMING REGIONAL OFFICE - Boise SUBREGIONAL OFFICES o Idaho - Boise 0 Montana - Great Falls 0 Nevada Reno 9 Wyoming - Cheyenne Page 3 ADDITIONAL Mountain States P-'4P (Wiclie) INFORMATION 3/72 Ge6graphv and Demograohy 4 State area: Idaho, Montana, Nevada, Wyoming; interface with Colorado-Wyomihg and parts of Intermountain Land Area: 435i643 square miles ation (1970 Census compared with 1960) Total in 000's 1970 Per Capita 1970 1960 (1970) Income Idaho 694 667 8.7 $3206 Montana 713 675 4.8 3381 Nevada 489 285 4.2 4544 Wyoming 332 330 3.3 3420 (,U.S. Total 2.,228 1,957 3910 Average Rounded to 2,230,000; average density 5.1 per sq. mile increase of 14% compared to 1960 Median age: (1960) each State below U.S. average of 29.5 Perc.ent Urban: Idaho 54%; Montana 53% Nevada 81%; I-lyoming 61% 4 State average - 59% urban4, 41% rural Metropolitan areas - 1970 preliminary population, compared with 1960 -1970 1960 Billings, Montana 86.1 79.0 Boise, Idaho 109.4 93.15 Great Falls, Montana 79.7 73.4 Las Vegas Nevada 2-70.1 127.0 Reno 120.0 84.7 665.3 457.6 Non-white - 95,100 (4.2% of 4 State total) Bla('@ - 34,500 Other 60,600 (mainly Indian and Spanish-surname) Vital Statistics - mortality rates (per 100,000 @( 1967 U.Sl Idalio Montana Nevada in Heart disease 364.5 305.9 326.5 239.6 31-2.4 Malignant neopl- 157.2 131.3 142.9 122.7 130.2 Vasc. lesions 102.2 95.1 96.7 68.9 91.4 (off. CNS) Diabetes 17.7 18'.7 20.1 11.3 16.5 Br neho Dneumonia 14.8 18.8 17.0 20.7 27.3 O(excl.'infl. & pneum) Accidents (1968) 57.5 79.5 79.4 85.1 89.2 Page 4 Mountain States (continued) Facilities and Resources Medical School - 1 developing 2 year school Univ. of-Nevada, Reno; first class (24) to enter fall of 1972 Allied Health Sch - Idaho State Univ. coil of Medical Arts, Pocatello Professional N Licensed Practical Nurses 15 - each affil. with school Idaho - 4 (4 College or Univ. affil..) district or college Montana - 6 (4 College affil.) 5 - 4college or high s,ch affil. Neva(la - 2 (2 University based) 8 - 6hosp; 2 priv. schools Wyoming.-7_L(3 College affil.) 2 - 1college based Total 1,5 fl3 college or 30 (20 are high school or university based) college affiliated) cal Technology Schools'of Radiologic Tech o Schools of Medical Tec,,noio Idaho - 6 Idaho - 7 Montana - 4 Montana - 6 Nevada - 3 Nevada - 7(2 Univ. based) Wyoming - 1 Wyoming - 2 spitals) 22 (20 at hospitals) 14 (each at ho cytoteclinology training - no schools Z. Community General and V.A. General n te@ s gi Short-term ec V.A. General T s Beds Beds # Beds Idaho 48 2,879 1 37 1 172 3,841 1 228 2 256 Montana 56 Nevada 17 1,951 --- 1 224 Wyoming 27 1 825 2 698 1 174 4 963 5 826 148 10,496 *1965 report -142 short term, 8814 beds 5 V.A. General hospitals, having total of 826 beds Special Hospital Facilities 1969 idaho-Mont@Aa nevada W@oming Intensive CCU 17 19 9 13 1 4 1 3 Cobalt Therapy Radium 5'. 8 5 2 Isotape Facility 6 7 5 4 Renal dialysis Impatient 4 5 4 1 Rehabilitation Impatient 3 0 2 2 Page 5 ower llhvslcians Non-Federal Graduate Nurses 1966- Empl. in Active kDs and DOs 1967 Not empl. Nursing -,MD DO Total Inactive Total in nursin_& (-adi.) I.daho 610 37 647 29 3049 1090 l@34 Montana 656 40 696 30 3404 916 2483 %levada 423 28 451 26 1533 470 1060 Wyoming 293 13 306 16 1621 410 1209 Total 1982* 118 2100 101 9607 2886 6706 Ratios of active practicing physicians About 70% were actively range from 89 per 100,000 population employed in nursing. in Idalio to 102 in Nevada. Average Average ratio for region for region is 94/100,,OOO compared about 301 per 100,000 with national average of 132. compared to 313 for UiS. as a whole. *Of the total active practicing MDs (1982) 802, about 40%, are in general practice. The majority of the remaining are specialists; a small number are hospital based And a smaller number are in other professional activities. Group Practices 1969 Single General. multi- By State Total Specialty Practice Specialty Id-aho 28 10 7 11 Montana* 36 5 9 22 Nevada 27 18 2 7 Wyoming 10 2 4 4 Component_and Financial Summar@Annivernary Anplicatlon Page 6 YEAR YEAR RECOI*IENDED COMPONENT CURPE?IT it FMING YR'S AWARD COU'NCIL v o4 OPEP,. RECOi4MFNDED 'REQUEST SARP REV. com. YEAR LEVEL 947,034 CORE 788,286 u -- u Sub-Contracts 630,o66 7o8,345 OPER. ACTIV. 0 100,000 Yes or No DEVEL. COMP.-- EARMARKS: KIDNEY Kidney #24 0 74.5-76 Health Train- ira #2@ 219,575 Network 0 li5ll'3000 2,049,@30 R@TPS Z;l ECT i@4180@92 RELUESTED 449 0 q4o COUNCIL 1,741,000 APPROVED LEVEL NON-RMPS and 374@000 INCOME Mountain States RMP REGION June t972i,REVIEW CYCLE eceive $354,588 for. i-llr-ie 04 Year is be@ extended to 9/1 and the ivegion will r -rd-of $1,772,940 for 15 months. the three month extension resulting in a direct aost awa REGION - MOUNTAIN MARCH 17,1972 OREAKCUT OF REQUEST KM 00032 06/72 05 PROGRAM PERIOD R14ps-osm-JTOGRZ (2) t 4 1 IDENTIFICATION OF COMPONENT CONT. W[THINI 'CONT. BEYONDI APPR. NOTINEWV NOT I CURRENT CURRENT I cd APFR. PERICtl APPR. PERICDI PREVIOUSLY PREVIOUSLY DIRECT I INDIRECT I TOTAL I P4 OF SUPPORT I OF SUPPORT I FUNDED APPROVED COSTS COSTS cooo CORE 1 s94 7. il 34 12@6&7 I-Ilsist.6al 1 0000 DEVELOPt4ENTAL COMPONENT I I I --- - I I - I sleo.ODD-1 002 PROGRAM IO PROVIDE COACNI I I -ll5-dl2 I S12S,200- 003 YfjU.IITA[tj STATES TUMOR l@ll I I I 216SLQQO-l 143,566 1 -=@U- I DDT CO@4T[NUING EDUCA71ON FOR] I I. I b LI-RSI N G @ E YA DA - ------ -.L 164.lnl1 oii cciilpiuipig ERUCATICN FC$tl I -- --L--152AI2(L] .15.L2R6 I S&A.356 ;iZ- CORONARY CARE TRAINING Si I I U41UNESL'Lo&tlo----- - I--ll2.Lfigm I Jkl"5jLt 11,3_a 6 61 013 CUNTZ'iU[t.G EDUCATION FCRI I I I . I I 181,276 1 127 1 s=Aii2-i ots Cc,%TlhulKG EDUCATION FCRI I @ l@ I IJAAia -1 163,901 1 21 NEW MAt@PoWER FOR THE MOUI I I I I I-- I I S199,311 1 023 P.EGTCNAL AREA )iEALTH EDUI I I I I --- LAII -- I - ----I 1 I--121@@ 11219,575 1 -135,612 1 -1255,2471 024 KtU4EY DISEASE CONTROL PI I I I I I I I p@'I til&!i -- I I SZ4 576 L S74,576I lil.769 1 186,345 1 5-25 PFtE-DEVELOPM-%TL PLANItINr. I I I I ' I I' LUER Hmn .I- Islas1 114,216 1 TOTAL $1000000 $407#976 1 S2tC49*530 1 $412*401 1 S2v46Lo931 1 MARCH l7tl972 REGION - MOUNTAIN BREAKOUT OF REQUEST AM 00032 06/72 06 PROGRAM PERIOD RMPS-OSM-JTOGR2 (2) (4) IDENTIFICATION OF COMPONENT I CCNT. WITHINI CONT. BEYONDI APPR. NOT I NEWI NOT I A DiTi@L "YE A R TOTAL I I APPR. PERIODI APPR. PERICOI PREVIOUSLY I PREVIOUSLY I CIRECT ALL YEARS CF SUPPORT GF SUPPORT FUNDED APPROVED COSTS IDIRECT COSTS I cooo CORE B;5-0-@7@iTC-PMENTA-L CO-MPONENT O@P-ROGRAM TO PROVIDE CORONI I ZB3 MCUNIAIN STATES TU?I.UR INI I I I 007 CCITINUING EDUCATION FORI I 1 164,101-1 31-1- CONTINUING EDUCATICK, FCRI I I 152,370 1 (;CFTONAPY CARE TRAINING Si I S12,808 1 013 CONTINUING EUUCATION FORI I 5. 406 1 7 el - @'4 - 75 CONTIfli(Nr, EI)UCATICN FCRI 0 157,701 1 -oi2- NEW MAIIPCWER FUR THE MOUI I REGLL[Iti I L I 1 --112@21 ]-- 112()- 091 1 -1 S294.6il I 023 PEGIOttAL AREA HEALTH EDUI I I I I I I I S234@945 I 123A.ARA5- I I 1454,52t) I Zi4 KIDNEY DISEASE CONTROL PI I t 112 slael2.576 I 025 PREDEVELDPMNTL PLANNING -ANn IIAL=AUF.FICFR H-40 I I Sig TOTAL $1,13L#433 I $2000000 S642,036 SIP9739469 $490229999 .. . - @ - I- .-I . I . r aL t: Re v i c@.; c I e I 197 72 BY )t, since The reorgan ization of RAG from a unwieldy group of 156 members to one of 30 is one of the Region's most significant achievements. This refinement of RAG has resulted in a more effective working RAC, that has increased awareness of their responsibility for the direction of the program. Other significant achievements has been the success of the Region in gaining acceptance of new concepts of health care delivery such as the nurse family practioner and Ht4O development. Also, the Region has led the way In sponsoring continuing medical education in nontraditional methods through participation and involvement in WAMI. 1AS/RMP has recognized the need'to shift to a more balanced program which is not so heavily oriented to continuing education. This is reflected by the new projec.ts: (1) Kidney Digeaie Control, and (2) Predevelopmental Planning and Liaison Officer.for HMO, which are directed to developing health services. PRItiCIPAL PPOBIXIIIS the past., the grantee (WICHE) has maintained a close and careful scrutiny 14S/R'MP. program activities. On one occasion, it actually restrained the MS/RMP core from accepting an Experimental-Realth Ser44ice Delivery Contract. nt in programmatic decisions by the grantee is seen as a problem This involveme by the region. The selection of a nev coordinator could have considerable implications in the future development of the MS/RMP. no ities on core and project staffs has presented a problem. The lack of mi r The acting-coordinator admits the region has not faced up to this issue. The ever continuing squabble between the (Kountain,-State RMP, Colo'rado/Wyoming RMP and 'Intermountain) over territorial rights is causing problems'. XS5Ur:.S, REQUIRING ATrElITION O'Ll REVIE.IIERS F year of its triennium (05 operatio.nal year) the region or the second is requesting $2@049$530 for support of Core, Developmental Component, seven continuation projects and 4 nqy projects. This figure ex6eeds the Regioo's Council Approved level ($I$511,000) by $538,530. The complete lack of minority staff, professional or,supportive, on core and project staffs needs attention. James A. Smith DATF@: Mountain States 1. COALS, OBJECTIVES, AND PRIORITIES (8) --The region's goals of Subregional Centers for Continuing Education, Health Services for Rural Residents, Stimulating Health Man- power Development and Specialized Centers Development have not been changed or altered from those originally proposed in the triennial application. Site visit report (3/71) states that the region seems to have very adequately assessed its needs, problems and resources; objectives and goals are congruent with National priorities. To some extent, funding of operational programs to date appear to have been developed with political considerations in mind to give each of the states a share in activities. Site visit report approved this concept. New program proposals of New Manpower for the Mountain States Region, Health Training' Network, Kidney Disease Control Program and Predevelopmental Planning and Liaison Officer for HMO's appear to be congruent with the region's stated goals and objectives. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - @.econ,i,-,ended Action: ACCO@f.DLISH@MENTS AND IMPLEMENTATION (15)--ES/RNP has provided the momentum for expansion of the role of the nurse in health care services in rural areas. Two nurses training at Stanford's Nurses Practitioner Program are now providing primary health care in two remote mountain communities. @/RMP developed an outstanding coronary care training program in Montana which set the pattern for similar programs in Idaho, Nevada, and Wyoming. The RAG reports that as a result of this program, the majority of small remote hospitals now have special units with trained personnel. MS/RMP has been instrumental in the development and support of the Mountain States Tumor Institute located in Boise, Idaho. For the first time, patients in this region have close access to a highly specialized diagnostic,treatment, and educational program. 'MS/RMP continuing education efforts for nurses have resulted into four separate state ..programs that have@ a common thrust, training for the nurse outside the campus setting. eloped and supported the Montana Medical Education and Research Foundation through MS/RMP dev .@@@which representatives of all health professions and the educational institutions have been @'@'.--.,:'brought together in-a common bond. A total of 105 continuing education programs for @,.i.@22 health professions have reached 4,909 participants. The RAG report states, 'W/RNP program activities are now proliferating through cooperative arrangements and co-funding which not only extend limited RMP dollars, but reinforce and qnrl hpalth orizaniiations. YSIRNP is now Page 11 untain States James A. Smith I)AT 3. CONTINUED SUPPORT (10) The region's policy for technical review requires the reviewers to ascertain whether there is a reasonable plan for the continuation of the proposal after RNP funding has expired. M/RNP phased out Project #9, Cardiac Care Training/Nevada, after two years of operations because it did not meet stated objectives. Four projects are stated to terminate at the end of this (04) grant period ending May 31. Only one, Project #8, Inhalation Therapy, will not be continued to some extent. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - @mmnded Action: 4. @IINORITY INTERESTS (7) MSIRM has two minorities represented on a 30-member RAG. One black and one Spanish surname. There are no minorities working on core or project staffs in either professional or nonprofessional positions. Minorities account for approximately 5% of the total population in the region, 0 - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- - - - - - - - - - - - - - - - - RECONMNDED ACTION: Page 12 James A. Smith COORDINATOR (10) The coordinator, Alfred Popma, M.D., retired in December 19'71, after serving five y ears in that cap ac i ty . H is d eputy , Tohn Gerd es , Ph . d. ,was appointed interim coordinator until the RAG makes a final selection out of a field of 65 applicants. Dr. Gerdes is a candidate for the job. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - ..ecomrended Action: 6. CORE STAFF (3) The programmatic operation of core is decentralized into sub-regional offices located in each of th e f our s tates . The @central core of f ice wh ich f unctions in an adminls trative and coordinating capacity, is located at Bosie, Idaho. The site visitors to the region in 1971 reported that the @IRW core reflected a broad range of profess ional competence and had been highly effective. Page i3 James A. Smith DATE! ountain States DI 7. REGIONAL ADVISORY GROIJP (5) The RAG was reorganized in 1970 from an original group of 160 members down to a more manageable and effective number of 26. However, the site visitor in 1971 found the smaller new RAG to be largely weighed ith medical people w and generally inadequate in minority, allied health and consumer interest. In response to advice from RMPS to broaden the representation of the RAG, the Region increased the membership from 26 to 30 members. The four new members were selected from nominees chosen to represent minorities and non-health related consumers. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - ded Action: 8. GRANTEE ORGANIZATION (2) The site Visit report of March, 1971, found no reason to question the Western Interstate Commission for Higher Education (WICHE) role as grantee agent for the MS/ P. WICHE as the "backdrop" for MS/RMP seemed to the site visitors to be A reasonable and functional organization that providesstrong management expertise. However, there are currents of discontent on the part of some members of the MS/RMP staff and RAG regarding what they consider WICHE's over zealous involvement in programmatic affairs. They see WICHE's responsibility limited to fiscal management and accountability. These differences have surfaced and the RAG has begun deliberations to determine whether MS/RMP should remain with WICHE as grantee or form a separate non-profit corporation. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 'RECOMMENDED ACTION: Page 14 JaMr.-q Slgith T)ATE Mountains. States PREEARRI) 9. PARTICIPATION (5) The site visitors-reported that practicing physicians and organized medicine .are significantly supporting and participating in the program. Many community hospitals,.including their boards and staff are firmly committed and involved. The involvement of nursing professionals is extensive. In general, there seems to be satisfactory political and economic interaction in the MS/RMP. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - --- - - - - - - - - - - - - Recommended Action: 10. LOCAL PLANNING (3) The Regional AdvisoryGroup reports that the advisory boards and councils of CHP, Model Cities, Community Action, Division on Aging and others include RMP representation. Also, RAG or staff members frequently serve as consultants on projects developed by these agencies. The RAG recognizing the need for close dialogue and relationships with these local planning agencies has thought about the possibility of a general chairman of health for all four (Model Cities, CAP, CHP, and RMP) agencies. Page 15 Mountains States Ryf James A. Smith 11. ASSESSKP-,NT Ol,' NEEDS AND PESOLIRCI--,S (3) The site visit ors reported that the Regionb efforts in determining its needs, problems and resources have been adequate in most respects. However, planning efforts appear to be limited to the immediate future. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- ,ecomme-.ided Action- 'I 2. MANACE@ENT (3) a'he retirement of Dr. Popma could raise the (luestion as to whether the ex6ell6nt management of core activities will continue. However, Dr. John Gerdes his deputy, is well qualified and has Dr. Popmals endorsement for appointement as his replacement. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - ZEC %NENDED ACTION-. Page 16 Mountain States PTZF-R P@T) RY! -Tamas A. Smi-th 13. EVALUATION (3) The site visit,report stated that MS/@IP evaluation methods are under ver\l capable direction, and evaluation for the program is of very high quality In response to advice from RMPS to develop better feedback fo program and project evaluation to the RAG, the RAG has formulated a four-member evaluation committee. This committee will assist staff in the development and dissemination of evaluative information to assist RAG in decision- making. - - - - - - - - --- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- @Recommen8ed Action: 14. ACTION' PLAN (5) MSRMP has established a rating system which is used by RAG to establish priorities for all operational and supplemental projects. The priority rating procedures appear to carefully asses whether the programs are congruent with national and regional goals. Page 12 James A. Smith RMP-, Mountain States RMP EREPARED 5. COORDINATOR (10) The coordinator, Alfred Popma, M.D., retired in December 1971, after serving five y ear,3 in that capacity . Ht deputy , Yohn Gerdes, Ph d. ,was appointed interim coordinator until the RAG makes a final selection out of a field of 65 applicants. Dr. Gerdes is a candidate for the job. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- R-ecommended Action: 6 . CORE STAFF (3) The programmatic operations of core is decentralized into sub-regional offices located in each of the four states. The -central core office which functions in an admint trative and coordinating capacity, is located at Bosie, Iddio. The site visitors to the region in 1971 reported that the M/RW core reflected abroad range of professional competence and had been highly effective. p b 2 I a- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - S RECO@NDED ACTION: a, Page 18 IMP; Mountain States RMP PARF.T) RY James A. Smith k," 17. IMPROVEMENT OF CARE (4) The complexity of this region is manifold. This is-a four-state region that contains not only vast rural areas but also urban concentrations. With the limited funding available, the region feels it can be the most effective through their programs to up-grade the skills and knowledge of the health care providers. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Recommended Action: 18. SHORT-TERM PAYOFF The /,'O/RIAP's operational programs to improve the availability and quality .of health care in the region is beginning to pay off. The RAG reports that the.Coronary Care training project has'provided most of the small isolated rural hospitals with trained staff. Also, through the support and development of the MS/Tumor Institutefor the first time, cancer patients in the region have access to a high quality treatment center. Page 19 Mountain States dL EIZEARED U.. aamgs A, 5.%ith 19. REGIONALIZATION (4) The RAG reports that MS/RMP efforts toward regionalization has done much to dissipate the historic sectionalism in each of the Mountain States. There Ate few, if any, areas in the Region which have not felt the thrust of MS/RMP-supported continuing education@ich professionals now consider a tight as well as an obligation. The patient in an isolated area, as well as the health practitioner is benefitting from this impact. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - --- - @comnended Action: 20. OTHER FUNDING (3) MS/RMP is formulating an increasing number of co-funded and con"jointly sponsored programs. The MS/Tumor In6titute.with 365,000 local funds and coronary care ttaining--Southwest Idaho with 9,000 dollars, illustrate this trend. - - - - - - - - - - - - - - - - - - - --- - - - - - - - - - - - - - - - - - - - - - 'RECO@NDED ACTION: NTORANDUM DEPARTMENT OF HEALTH, EDUCATION, AND NVELFARE PUBLIC HEALTH SERVICE HEALTH SERVICES AND NLENTAL HEALTH ADNFINISTRATION TO Acting Director DATE: April 18, 1972 Division of Operations & Development FROM Director, Regional Medical Programs Servic SUBJECT: Action on April 10-11 Staff Anniversary Rev iew Panel Recommendation Concerning the Mountain States Regional Medical Program Application RM 00032 May/June 1972 Accepted (date) Rejected (date) Modifications: Comnone'nt AnL4 Financial Summary_- Anniveranry Applicati2n C014PONENT CUPPEL;T YEAR YEAR RECOMIE'.IIDED 'CJYL YR'S AWARD coul,, FUTMING 04 OPER. RECOIOENDED 'REQUEST SARP YEAR 'LEVEL REV. COM. CORE 788 286 947,034 Sub-Contracts -@o -0- OPER. ACTIV. 630,066 708,345 approved but 1)EVET,. COMP. unfunded ioo,ooo r No EARMARKS-. xi DITEY -0- 74,576 Disapproved Ki:pendi- ture of grant funds to both the P-',IP rnd CIIP as their ci'anting agencies. Accountability for the expenditure of grFiiit funds throughout the- year is. based on the budget requests submitted to the two sponsors. @At the beg.inning of the grant year, Core staff establishes a ratio of @@M-CHP grant support requested and awarded. Then as grant funds are spent the costs are attributed to P@,T and Cl-iP grants on the basis of the 'ratio. Thus costs incurred throughout the year are charge to the two sponsors on a prorata basis. The demands placed upon I,--IPS dictate that more accurate accounta- bility should be based upon expenditures ii-id not budce-t estimates. 'A system should be developed and implemented throuoh which -ra,-it expenditures are periodically identified and allocated between and CHP grant support. The minimal requirements for suc,i a-systei,.i will be developed jointly bet- ween the P-IIPS and CHP. The CIIP has been contacted to initiate joint development of minimal acceptable grant fund accountability requirements. RE@GIONAL ADVISO@RY GROUP Al\'D CORPORATION The duplication of responsibilities and membership between the NSR@T Regional Advisory Group and the Coi-poration.has been the source of considerable confusion and some concern. The difficulty in understanding the organization at this level results from thinking of the Corporation and RAG as separate bodies, each with its own identil--y,-i,,Iien in reality there' is little difference. Intervie@.7s with 'NSL@IP officials and a review of the By-Lai4s bear out this conclusion. As an example, there is only one set of By-Lai.:s which'incorporates both Corporation and RAG rules. Again, it must be kept in mind that except for the semantics, there is virtually no dif- ference in the two. Ori ginally it was the plan of NSKT that there be only one gr-oup and that the incorporators would also be the RAG. The Regional lledical Programs Service would not permit this arrangement and required that there be both a corporate body and a Regional Advisory Group. To satisfy this requirement, NS%'IP added more members and designated them as non-corporate members of the RAG. The 67 Corporate members remained as voting members of the 82 member RAG. Although all RAG members may vote only Corporate members may hold off-ice in the RAG or be a committee chairman. The dual nature of membership in the Corporation and RAG and of the By-Laws is inconsistent with the basic need for the RAG to be separate and distinct from the gra'ntee. To remove the appearance of dominance by the Corporation, the Corporate membership should be reduced to the minimum number necessary to meet the legal requirements of the State of New York and to provide the fiscal, personnel and other administrative affairs of NSI@'.IP. This small Page 4 group should be considered as the Board of Directors of the Corporation and should conduct its iffai-rs in periodic meetings ipart from the total R@i, C. There is no objection to the Board of Directors being Ti,,C@,P.Ibers of the RAG; however, they should not hold office. The designations of corporate and jion-corporat(-@ members should be removed. The B),--La@qs should be re-i,7ritten to establish the regional Advisioi-y Group as aii independent, self-Fustainii-ig entity responsible for all program decisions. It should not coiicern itself with the administrative deli- berations of the Board of Directors. OF CONTROL The Executive Director shares his time equally between P-%D-l and CHP activities and in addition, is responsible for the management of the Core offices a-,id supervision of the Core staff. On the surface this would -appear t'o be a herculean'task. In reality, the Executive Director does not perform his managerial duties without assistance. The combined r,,'T-CIIP staff is organized into three Divisions; namely, Administration, Program Development and Evaluation, and Sub-Area Planning. Eacli6Division is headed by an Associate Director'i,;ho is responsible for the management of his Division and who reports directly to the Executive Director. Appro-,,)riate delegations of authority have been made in writing to the Associate Directors to carry out their day-to-day duties and to service the appropriate committees of the RAG and CIIP Council. The Associate Directors also serve as-Deputies in the absence of the Director and in the performance of'tlieir assigned responsibilities, relieve'the Executive Director of a great amount of detail. The team concludes that the span of control of the Executive Director and the supervisory staff is reasonable and that responsibilities and delegations of authority have been assigned in a manner to provide for a properly managed program,. The team did not review the management practices and actions of the supervisory staff and, therefore, draws no conclusions on how well the staff is directed below the Division level. P@ge 5 SUl,-FOLI,- appro-,@. 13% overlap Clip in incifiberst-iip Pd-@ G Council. (82 tri-,nbers') (119 1.0,-ibc@rs) Bd Directors Aiins & Goals Exec. DEPARTMENT OF HEALTH, EDUCATION. AND WELFARE Director, Regional 1-fedical Programs Service Marc-'q 27, 1972 IIIROUG',I: Acting Director, Division of Operations & Development, @@-TS Chief, Grants I-lanagement Branch Division of Operations & DeveloDment Regional IL--dical Programs Service Visit to Nassau/SuffoL'r, Regional 't4edical Program to Resolve the Problem of Accouatability of iUTS Funds/ Enclosed is a copy of 1-ir. Miller's subject report indicating alternatives for adininisterin- the subject pro-raL-s grant funds. We have two decisions C> C, to make: 1) flow to satisfy expenditure in the current budget period, and 2) llcw to simplify an existing complex situation. To facilitate Accounting for cucrent budget expenditure, I feel that Mr. Miller has indicates that detailed re-cords must be maintained to identify the efforts of the employees in the pursuits of the two grant @rograms to the ,xtent that tiiey are able to charge costs appropriately. 'fhey have tried this on a weekly, one-time basis and have slia4n that to a great extent it can be a-co-,nplished. This we must do in order to batsify requirements,based on two separate budgets and awards. For those activities th-t c-rinot ;)e identified oi a spec,.-':ic percentage of efforts basis, I concur in I,lr. 1-filler's reco.@ndations tki-t the percentage established in the budget as miarded be applied. '.Lhis @Tould be communicated to the grantee so that there will be a basis for future audit. With respect to future years, I stronoly urae that we pursue a joint award with CIIP. This is what Dr. Ilastinc.,s would like to do and has so stated orally to me. If you concur, we will pursue this matter with CHP and appropriate offices. It is ironic that this program is viewed by both It-[P S an d CHP as b c in gso-@thing iess than we would hope tlie'-pro-ram could be. This point might well be one for consideration when and if we review a budE t jointly with CIIP. In a jointly-funded grant, a percent of support is established by the programs and is fu.-ided on that basis unless during the year--the efforts vary, In that case, the grantee should advise us and request an appropriate revision to the budget. If the volume of business in the future remains as it is, in all likelihood we would be the lead agency. OFFICE SURNAME, DATE 11 OFFICE SURNAME I OFFICE SUP-NA2,iE L E nn rn) Mn \\ /7 Page 2 Director, RMPS My alternate reconnendation for future years would be to require the organization to beco-,ic separate. As Mr. Miller points out, total costs would then be increased and we would probably not end up with that clean a br@ in the total picture anyway. We should be glad to discuss this matter with you. Gerald T. Gardell Enclosure cc: Official Grant File Nash/Stolov Mr. Chambliss Mr. Miller Board File CM/ GTGarde 1: rc' -,.3/27/72 MEMOI,tANi)U2, 1)11.UIN L @L I 'L@rl- @ ,1.@ - -1 . @ . -@ I I I .1 @ @- . . --- - -- -- PUBLIC HE,@t,Tli SERVICE HEALTH SERVICES AND @IENTAI, HEALTH ADI\IINISTRATION 00 Chief, Grants Management Branch' DATE: March 20 1972 Division of Operations and Development Grants Management Officer FRONI Grants Management Branch, DOD SUBJECT, Visit to Nassau/Suffolk Regional Medical Program to Resolve the Problem of Accountability for IOIPS Funds The individuals participating in the discussion of this subject from both the Grantee, RMPS and the Regional Office were as follows: Mr. Glen Hastings, Coordinator, Nlassau/Suffolk RMP, Mr. Harrison Owen, Associate Coordinator, I\Iassau/Suffolk RMP, Mrs. Elaine Kaldor, Accountant, Nassau/Suffolk RMP, Mr. Gerald Hunt, Grants Management-Officer, Region I and Mr. Roger Miller, Grants Management Branch, @NIPS. The Nassau/Suffolk organization c.urrently allocates expenditures to its two Federal Programs based on the relative amount awarded by each Program. The basis for allocation, however, does not include funds set aside for direct PDIPS "project" activities. The basis for distribution is RMPS funds provided for Core activities versus CHP Federal and matching funds provided for the same type activities. As the grant funds are spent the cost attributed to FIIP and the CIIP grants are distributed on the basis of this ratio which at the present time is 61.8% RMP and 38.2% CHP. Where contributory funds from either @IP, CIIP or matching varies substantially, then the percentage ratio of each programs' contribution to the total, is revised And a retroactive adjustment for the entire budget period is made, to reflect the current level of contribution by each program to the total. The grantee's-method of recording its expenditures, is to enter all joint RMP and CHP expenditures in the RMP cash disbursement ledger. once this is accomplished, at the end of each monthly period the CHP portion is allocated from each expense nomenclature account in the cash disbursement ledger at the contributory percentage of 38.2%. This journal entry in effect, represents the transfer of the CHP portion of its total expenses to the CHP program; the balance naturally represents the RMP's share of its expenditures. Since generally accepted accounting procedures dictate that an allocation of expenditures should be based on actual experience rather than initial budget .estimates, I felt it was my assignment to determine a means of resolving the above situation. During the week immediately prior to mv visit the staff of the Nassau/Suffolk organization prepared individual time-sheets by employee, whereby each employee accounted for their time on 15 minute intervals for an entire weekly period: A careful review of these time-sheets by the members Participating in this group indicated that time fell into three major categories which were (1) directly attributable to @IP activities, (2) directly attributable to CHP activities, or (3) falling into a category that could not be specifically identified to either program. Chief, Grants Management Branch, DOD 2 Based on the review of the records and the ensuing discussion, it was resolved that we would come up with'five alternatives solutions to this problem. These are as follows, and are discussed in greater depth in a latter section of this memorandum: RECO'i4MENDATIONS: 1. Combine the organizations by issuance of a joint award under the joint funding concept. 2. Completely separate the organizations by requaring two separate staffs at two separate locations. 3. Allocate costs as presently operating. 4. Prepare a time study on qu arterly basis for all employees to determine what portion of effort is devoted to each program. If it is found that a larger portion of effort is devoted to one p- gram than the au-ual funds provided then it would be recommended that the operational program be adjusted accordingly. 5. Place a restriction on the RMPS grant award that funds could not be used for tho Core activity that would result in more than a 50-50 split of Core costs between those funds provided by the RMP program and the CHP pro,-am inclusive of both Federal and matching shares. Based on my study of the entire situation, the following are my pros and cons to the above recommendations which I am listing in priority order with one being my most favored recommendation: 1. I feel the most efficient recommendation which would encompass the least problems would be to joint fund this entire operation with a combined grant of RMP and CHP funds. Since RMP provides -the major portion of funds for the operation of this organization, this option would include RMPS admiristration of the total grant. Since RMP is now extending the grant to this organization to August 31, beginning 9/l/72, the CHP grant and the RMP grant would be on the same fiscal period. Since there are costs of the combined operations that dannot be specifically identified with either one program or the oth,r, I am of the opinion that this option would be the most feasible. In addition, since Dr. Wilson has proposed this concept, "ir- would be a feather in the cap" of RMPSto be one of the first programs to attempt to implement such a concept, with the results of the implementation being made available to the Administrat'or. 2. My second recommendation would'be to require the grantee to prepare a time study on a quarterly basis utilizing a period of an entire week each quarter as the basis for the allocation of costs to 3. Chief, Grants Management Branch, DOD each program. In discussions with the Nassau/Suffolk representatives on this recommendation, they feel that if a hypothetical situation resulted where 30% of time could be specifically allocated to CHP and 30% of time could be specially allocated to RMP, and 40% of total time fell into the category of both, they were of the opinion that they could make the managerial decision to allocate the time into either category as they saw fit, to come back to the current allocation ratio of the 61.8% and 31.2%. I did not agree with their conclusion, since I feel that the time that fell into both categories would have to be allocated 50-50, and if'this study indicated a disproportion of effort based upon funds provided, they would have to redistribute their program activities accordingly. 3. l'y third recommendation would be to place a restriction on the RMPS award to this organization, that RMPS funds could not be used for the Core activity, in a larger percentage than those funds provided by either Federal or matching fundi by the CHP program. The representa- tives of the Napsau/Suffolk program were adamantly opposed to this proposal since they said it @uld severely restrict their operations. 'I felt, however, that since Mr. Hunt indicated that their is little or no community involvement in CHP, that such action would force them to stimu-.atc r-)mmunity involvement in CHP to obtain increased local support for tne CHP operation which in eff-ct, allow them to put more RMP funds into the Core activity. I realize this suggestion is harsh in nature, but I feel we may have to take such action if this is the recommendation that is proposed. 4. My fourth recommendation would be to allocate costs based on the original budget estimates as is the current practice. Although I am completely opposed to @his proposal, this is the procedure the Nassau/Suffolk organization would like to continue following. CHP programs are de- creasing while funds available to the RMP program are increasing. As a result of this situation, continuation of the current method of allocation could eventually evolve -'-n RMPS picking up 90% of the total Core staff salaries ai,d related expenses while CHP would only be picking up 10%. It.is currently the practice of Suffolk County, who contributes a pnrtion of the matching share to the CHP project to be very restric- tive as far as the amount of funds that are actually provided for the CHP operation. Suffolk County is trying their best to cut costs in view of a potential deficit, and as a result the Nassau/Suffolk CHP operation is looking forward to less of a contribution from this county. A lower contribution from Suffolk County by $5.00, in effect, results in a lower contribution from Nassau County of the same amount and a lower contribution from the Federal Government of twice the amount. So a loss of $5.00 from Suffolk County results in a tota oss of $30.00 to the CHP program. 5. My last and.least favored recommendation would be to completely separate the organizations. This in e.ffect,. would solve the problem, but would result in increased,administrative costs to both the RIIP and CHP for duplicate staff in all administrative areas. I feel that taking such a step would be an extreme measure since I do feel that there Chief, Grants Management Branch, DOD is some merit to having these organizations combined and within close proximity to each other. I am willing to discuss all of the above recommendations at lenath and write a letter to the Nassau/Suffolk Regional Medical Program indicating the recommendation selected for adoption by the Nassau/Suffolk organization. I indicated upon leaving the Nassau/Suffolk organization that we would inform them of our decision within the next week, so that the site visit team visiting the Nassau/Suffolk organization during the last week of March would be aware that this area has been resolved. Iler cc: Dr. Margulies Dr. Pahl Mr. Chambliss Mr. Nash/Stolov JVI iV/1 kJ l@ @ i N @ U IVJL PUBLIC IILAI,'Fll SI-"ItVICi-, IlrALTH SLIKVICLS AND MENTAL I-ILALTII AD,\41NIS'I']tATION DATE: March 21, 1972 r I@'or the Record FROi\f Edward T. Blomquist, M.D. SUBJECT: Post-Mini SARP Meeting, March 20, 1972, Nassau-Suffolk Regional Medical Program Renal Organ Donor P ram Purpose of Program - To procure cadaver kidneys from 24 donors each year from seven named hospitals in which there is a physician committed to the program. Part time physician coordinator and a secretary will be employed to administer the program. Participating surgeons and hospitals will be paid a standard fee for service Cost for developing and training procurement teams for maintaining transplantation registries, and for payment of cadaver kidneys will be $27,060 for the first year. Jitient selection, histocompat,-.bility testing. and transplantation will 2 performed at facilities located in New York City. Action - RecomT-erd approv-1 of application as submitted for the first year of operation. Futur.2 funding will be determined after review of application from Metropolitan New -York Region requesting support for a Tri-Regional (New York City, few Jersey, Nassau-Suffolk) Transplantation Program is reccived. Home Dialysis Tra. am Purpose of Program - To develop 50 validated, modular, single concept lessons and tes s@for homa dialysis patients after a period of studying dialysis units in New York City and after developing patient behavioral objectives. Costs are projected for the firs!: year only. During the first year, 6 validated lessons and tests will be completed at a cost of $31,200. Action - Disapproval with advice to s@ek consultation from mature home dialysis training programs, as previously recommended by staff. Information for Local Regional Medical Program The objective to train the majority of patients for home care is admirable but the time and expense of the proposed program is excessive. It is page 2 - For the Record rccoi,,liiiciided that full idvaiitige be talcon of the experience and teach- iiig aids now available at nature home training dialysis centers. Specifically it is recommended that contact be made with such resources as the Northwest Kidney Center in Seattle, Washingtonand those listed by staff in earlier letters of advice. Furtlier,it is recommended that the anticipated caseload of patients needing dialysis and transplantation be reviewed. The quoted rate of 70 patients per million population needing dialysis requires validation. Purther,the need for expanding existing dialysis facilities as implied in General Objective 1 requires additional study. Edward T. Blomquist, M.D. Region: Nebraska Review Cycle: June 1972 Type of Application: Anniversary prior to Triennium Rating:- 298 B Recommendations From SARP /X-X7 Review Committee Council /-7 Site Visit 02 03 Recommended Level of Funding $725,000 $700,000 eview Committee concurred with the funding-recommendations of the March 30-31,1972 Site Visit Team and agreed that the Nebraska RMP has demonstrated substantial progress by adequately responding to the eight specific issues raised in the June 11, 1971 RMPS advice letter. The recommended $725,000 funding level included full support of the Program Staff in the amount of $4ol.641 which includes $25,000 for the initiation of small planning and feasibility studies. *he Review Committee accepted the Ad Hoe Renal Disease Staff Committee and.the site Vist,tor's recommendation to disapprove Project #6 entitled, Kidney ContinUina Education Program and Project #7 entitled, Renal Dialysis Trainin2 Proposal. In this connection, th;-reviewers strongly suggested that the Program develop a comprehensive statewide plan before pursuing any specific operational activities in the kidney disease area. When comparing last yearts Program Staff Budget with the current request reviewers agreed the proposed increase was justified. The Reviewers believed that the additional four Program Staff will greatly strengthen programmatic efforts needed to develop a Triennial Application. Members of the Review Committee were impressed with the progress achieved especially since it had been accomplished within a six-month period. Favorable comments included the increased involvement of the RAG membership, its vasti improved review process, its committee structure and its monitoring of ongoing @ y activities. Reviewers recommended that the composition of the RAG and its supporting committees should be strengthened through the addition of more minority group representation and allied health disciplines, CIO, nt and Financial Summary Anniversary Application Compone COMPONENT CURRENT Of YEAR 02 YEAR RECO14MENDED YRIS AWARD FUNDING 01 OPER. SARP YEAR COUNCIL RECOMMET]DED, REQUEST REV. LEVEL C M. CORE 232,196 3.76 11641 4ol,641 0 Sub-Contracts 0 OPER. ACTIV. 267,804 405,556 323,359 DEVEL. COMP. Yes No(X) EARMARKS: KIDNEY #6 4,640 Di sapprovecr KIDNEY #7 44,198 Disapproved RMPS DIRECT *500,000 782,197 725,000 REQUESTED 850,120 COUNCIL APPROVED LEVEL 790,070 NON-RMOS and INCOME REGION Nebraska @June 197 2 Review tyc for the 12-month budget p riod 7/71-6/72i Reg $500,000 was awarded e ion has been extended two months to accommodate the three cycle review system. A pro-rated amount of $88,834 has been awarded for the two month extension. MEMORANDUM DEPARTMENT OF I-TEAI-:FH, EDUCATION, AND N%'ELFARE PUBLIC IIE.,%L-I'll SERVICI" -III-"ALTII Sl-"I@VICES AND ',NILN'FAL, IJEALT14 ADIvflNISTRATION TO For the Record DATE: March 23, 1972 FRONI Edward T. Blomquist, M.D. ,SUBJECT. Post Mini-SARP Meeting, March 20, 1972, Nebraska Regional Medical Program Kidney Continuing Education and Renal Dialysis Training Programs Purpose of Program - To produce 6 unspecified one-half hour t6acbing tapes at the Good Samaritan Hospital in Kearney, Nebraska, for use in undescribed training courses to be given an unknown number of patients and public groups and To develop an inadequatelydcscribed multidisciplinary continuing education program in r-tal care for hos-pital personnel. cost - $48,838 over one year Action - Disapproval. During the scheduladsite v-Ls-Lt to Nebraska, atten- tion should be drawn to t-ae instructions for the preparation of kidney grant application as punished in November 1970 and as contained in the p-sit@on paper dated January 1972. Particular emphasis should be given r to the need for a comprehensive regional plan on which specific projects can be related. Advice to ReRion - The reviewers found the applications incomplete. They had difficulty understanding what contributions the propose programs would make in the absence of better documented need and plans for a regional renal disease Drogram. Comment§ contributed by local consultants were noted. In the opinion of the reviewers, the criticisms raised by local consultants, Drs. Touhave, Smitll and Holmes, had not been corrected. Specifically, the plan of action is still not adequately documented and quantitated to give the reviewers confidence that the objectives can be met. RIIPS STAFF BRIEFIliG DOCLNEN'T E Or PATIOI;S Eastern /x I mid-cc,,t. -7 Western WION Nebraska BRANCII South-Centr'l f 'CH BRA14 VPE APPLICATION: None U.IOIT RT.TIIIG Tel. No. 443-1790 Room 10-15 -TRIEh'14IAL 197 DATE BRANCII-CIIIEF Michael J. Posta LU lat'AN14IV Y 0 SARP FF Frank Zizlavsky FAR BRANCII STA 2nd. AN14IV YEAR L7 REV. COM. RO REP. Ray @ddox OTHER L7 OTHER Last 14gt,. Assm't Visit Feb. 11-13 1970: Chairman Tom Simoods AST S.V. April 107 1 Chairman Joseph W. Hess, M.D. taff Visit& Last 12 mos. (Dates Chairiran s Name and Type of Vigit). 'November 21-24, 1971, Frank'Zizlavsky & Ray Maddox, Staff Visit JanuarZ 21, 1972, Frank Zizlavsky, Staff Visit lajor Events IThich Occurred in the Region Affecting the RMP Since Its Last Review n may 1971 1. NewCoordinator'- Deane-S. Marcy, M.D', its of-July 1, 1971. 2. Subregional offices Un!,versity of Nebraska andcreighton U-nivers@ty phased out -as of February 15 1972. 3. February 25, 1972 Community O'f'Creighton,'-Nebrarka, received- E'xperimental,Health belivery Sub-System site visit-fiom Nitiofigl Center-for.liealfh Services Research and D&velopment. *Com2onent and Financial Sut-.varv AiTniverso@t, 21.i cition 01 Current 02 Year 02 YE tTll COI-IFONr-.t\'T FUI@DING YR'S AWARD -c SARP OPER. R E 0'4- L@- I-, D F,D REQUEST Y EAR LEVTL L3 REV. COli. 232,196 @76,641 CORE and 267' 405,556 OPEP,. ACTIV. 804 DEVEL. CO',',T. EARIIATU' S: @iDl\'EY 4,640 #6 44 198 #7 Rtf-S DIRECT 500,000* 7SD,070 782,197 RMPS ITIDIRECT TDTAL NON-R@UIS and I @c o.@ T OT A L B V. 1)%t LT 0 was aw the-I -month .$500,00 REQUT-STR,D 850,12 budgetx@eriod d@72. Region has' been e ended t,*o m-)nths asV-3mmodate the thre-e -cycle REGION' @e@ra a COUNCIL rsvi Sysit m Apro-rated amount of 0,070 8 3 hl ttgn I ii Sr J,,ne' 197 2, RFVIL-W CYCL-Z- itrpRovED alwar d '3 e - two month estens-ion. 0 'N 0 REGION - NEBRASKA AP@@k IL 4, 1972 BREAKOUT OF REQUEST RM (JO068 1)6/72 RMPS-OSK-JTCGR2-@ (%2 PROGRAM PERIOD 1 5) (2) (4) (1) NOT CURRENT CURRENT :NTIFICATION 13F COMPONENT CONT. WITHINI CONT. BEYONDI APPR. NOT I NEW* TOTAL IAPPR. PERIODI APPR. PERIODI PREVIOUSLY PREVIOUSLY DIRECT INDIRECT. OF SUPPORT OF SUPPORT FUNDED APPROVED COSTS COSTS CORE NEP@-.@ASKA REGIONAL ?II ,@.UAJ.-2 641 LA COPOtiARY CAPE TRAINING Si Lil CORCt4APY CARE TRAINING Si IC COPCINARY CARE TRAINING Si L 3 i'iCjBl LE CA lialL 4 PUN- ICAT 10,'iS I EREPROVASC JIL@lp alln- Rl--La@!)@.EA.5-@ 5 NF3RASKA PPOJECT FOR RESI 1, 1.21- r n S45sad 6 KI'DNEY CLtITINUItIG EDUCAT 7 PENAL DIALYSIS TRAINING TOTAL $6739898 $108t299 $782tl97 $162,656 REGION - NEBRASKA APR IL 4t 1972 RM 00068 06/72 BREAKCJUT E)F REQUEST RMPS-OSM-JTOGR2A 03 PROGRAM PERIOD (5) (2) 4) (1) AC)DIL YEAR TOTAL' E@4TIFICATION OF COMPONENT- CONT. WITHINI CONT. BEYONDI APPR. NOT I NEW, NOT ALL YEARS APPR. PERIODJ APPR. PERIODI PREVIOUSLY I PREVIOUSLY DIRECT IDIRECT COSTS OF SUPPORT CF SUPPORT I FUNDED APPROVED COSTS 0.3 CORE @4EL)'ZASKA REGICTJAL Ml @ICAL ERO-,-AM I S398,439 I $775sO IA CORONARY CARE TRAINING St I f 1 156,656 IB CORONARY CARE TRAINING Si UPPOPT P4'IOGRA$4 I 1 S222408 IC COPC?;ARY CARE TRAINING Si UPPGF',T P"P LI----- I 3 q I CriLrl(@rjr'-,T TOTAL I( 511@6 3 MOBILE CANCER DETECTION U.4 T T 4 PUBLICATIONS CEIZEBROVASCI 778 $12, 1 127.,156 -ULAP-'@-2.EL@TFD DIS-E'XSF'; 1, 5 NECIRASKA Pt'IOJECT FOR RESI I 1. t- !&42,145 142,14@ 187.229 @6 KID-NEY CCNTINUING FDUCATI YON I!RC-GU- $4264r 7 RENAL DIALYSIS TRAINING t!A.76tg S33.748 182 94f2 I -PRNPOSAL- TOTAL $3989439 $939672 $492*111 $1,274,308 @9 12 13 1 14 is is NRMP AC IVITY SITES A K. Sioux DAWES SHERiDAt *Codf KEYA PAHA A CEDAR 0 W@ L.A., *0 he'll Box roo.0 siph W" THOIAAS @INE vmEELER RILL CA A tiADI r@04 Aso,#$*" BOONE GRANT HOOI(ER . A @E- McFt4ERS@- - LOGAN CUSTER I IREELEY Ubi-V PLATTE St fd-.d AAthw mo,th fkmd rly-A emenij St o A,"Id A@.,E C.... 0 LINCOLN SAUNDERS m-o,, POLK a I MERRICK *O.JCT ')EUEL A ossi 4po North ?Iaffo 00 to.h.0 Lncol@n lilb.)y &.4, SEWASCO DAWSO". IA@l I- YORK. -,K[Nti flop L OTOE &. t!-A.MILTI in' -ifi -1 "7@,5 -CLAY- rtLLM014E Sr "mid L KEARNEY CIIAIIE -d- *C. A rnONI iER GAGE c@ v.: AOAMS u@- UNOY RF@ILLOW 0 AN ;E F F CRIO B;Ogtf;t* (?"A* WEBSTER 1-d-.1. FURNAS FIMIlin A C,i A? Red ?.,d r t E,,ft A D. LEGEND NEBRASKA st.le of Miles 0 Learning Resource Center St.#* cop;fot co..Iy Soots 40 00 MADTSON Couoty N@41 Drug InEorinaLion & Tape Library POPUIATION KEY =Coronary Cire & ROCO@L o@ yoocoo a )n,000#.20,000 AMERICAN I.IAII COF.4PANY. INC. MMobile Cancer Detection Unit 50,ODO 1. looooo 5.(Wto 10,000 25,Lw Po soovo t,oool. 5,000 20.(IOOIO 25,@ U.d., 1.000 R,4 00068 -6- PROF ILE STATE OF NEBRASKA Geography: 93 Counties 76, 612.square miles Population: Total - 1,483,500 ( 1970 Census) Density - 19 per sq. .nile ( 1/3 as high as U.S. average of 57.5) Urban - 61.5 % ( 912,800) Non-White - approx. 1% ( 50.,800) Negro - 40,000 Other - 10,000 about 6,600 are Amer. Indians) Age Group: Under 18 yrs. 347. 18 - 64 yrs. 54 65 and over 12 Metropolitan Areas; Lincoln 166,000 Omaha,Nebr-538,700 Iowa Sioux City,lowa- 113,900 Nebr.*( Dakota Cty) 13,200 Average Income per Individual, 1969 Nebraska $3642 UOS. 3680 Political Information: Governor - J.-I. Exon (D) Senators - Carl T. Curtis, (R) Ronan L. !Iruska (R) Appropriations Conmittee Representatives - Cong. District I Charles Thone (R) 2 John Y. McCollister (R) 3 David T. Martin (R) - - - - - - - - - - - - Vital Statistics Rates* - Leading Causes of Death, 1968 Nebr. uoso Heart Disease - 407.1 372.6 @lign. Neopi - 176.3 159.4 Cerebro vasc. - 125.4 105.8 Accidents - 65.3 57.5 Related Diabetes 20.1 19.2 Arteriosclerosis 22.3 16.8 Bronchitis, emphy. 24.4 16.6 -Uuubd State of Nebraska -7- FACILITIES AND RESUURCES SCIIOOLS Medicine 1969 69/70 Enrollment Graduates Creighton Univ. School of Medicine, Onaha 316 73 Univ. of Nebraska,Co.11. of 14edicine,O@ha 397 94 Dental - 2 Creighton and U. of Nebr.,Lincoln) 422 Phar,mcy - 2 300 Nursing Professional 13 of which 4 are College or Univ. Based Licensed Practical - 7 Allied !iealth Schools 2Yr. Community and/or Cytotechnology - 1 Univ. of-Nebraska Junior Colleges 7 - majority Jr. Colleges Medical Technology - 9 Radiologic Technology- 9 Physical Therapy - None Medical Rec(,.ds - 1 - College of St. Mary FACILITIES Non-Federal Short and Long-Term General qospital@, 1970 Beds Short Tern Gen. & Special 101 9149 Hong rerm Gen.& 51-acial 2 334 - - - -- -- - - - - Veterans Admin. Genera' 3 850 Number of Hospitals wit%_Special Facilities, 1969 iccil 30 Cobalt Therapy 6 isotope Facility 11 Renal Dialysis 7 . Inpatient Rehab - Inpatient 9 Long-Term Care Facilities( ExLendod Care) 1969 Skilled Nursing lomes 152 9174 Beds Long-term care Units --5 1482 Beds -8- State of Nebraska i4ANPOWER Physicians Total Physiclans ( tncl. inactive) 1711 Total Active Practitioners, reporting 1439 (inc. interns and residents) 1188 Office-Based 251 Other Active Practitioners, by Specialty General Practice 506 Medical Specialties 258 Surgical Specialties 385 Other Specialties, Resear,ch, 290 admin. and other Group Practices: Total 81 Single specialty 37 General prac,;ice 17 Multispecialty 27 Doctors of Ust,:opathy ( as of Dec. 31, 1967) 32 Professional ..'urses. Actively employed in nursing 4,730 Not activel- employed in nursing 2,547 Licensed Practical Nurses! Actively enpl. in nursing 1,147 No,, actively e-npl. i-. nursing 348 Licensed Pharmacists ( in active practice) 1969 -1,020 X-ray Technologists 485 Radiation therapists( technologists) 3 Physical Therapists, 1970 members in active 60 full-time practice APT Assoc.) 9 part-time -9- BACKGROUND & HISTORY The November 1970 National Advisory Council approved the separation of South Dakota from the Nebraska-South Dakota RMP. To provide interim support for the Nebraska-South Dakota RMP's core staff and three projects (beginning January 1, 1970), the first year award was extended for six months until June 30, 1971 at the Region's current level of support. The February 1971 Council recommended approval of South Dakotals planning application for three years including support for their part of the coronary care activities for one year. Nebraska RMP was site visited on April 1-21 1971 because an initial application for operational status as a separate Region was submitted to RMPS. The site visitors assessed the program structure, achievements and capability. The site visit report, which received National Advisory Council concurrence, recommended that the Nebraska Regional Medical Program must develop and accomplish, as soon as possible, solutions to the following: 1. There is the need for stronger and more effective central program direction. The operating objectives and priorities need to be better defined and understood. 2. The role of the RAG should be strengthened. For example, the RAG should have a strong role in the selection of the Program Coordinator. It should display, also, its interest in his continuing education in program management. 3. The following documents should be developed and officially adapted by the RAG: a. Mechanism of appointment of Committees b. Objectives of each Committee C. Procedure for reallocation of funds within RMP d. Procedures for monitoring projects over programs e. Procedures for project development f. Procedures for project review g. Procedure for project termination 4. The role of grantee organization should be re-defined in a way which will delineate the manner in which its responsibilities and authorities are separate from those of the Regional Advisory Group. -lo- 5. The capabilities of already available resources on Core staff should be more effectively Utilized in program planning, monitoring and evaluation. 6. Available resources should be utilized more effectively in defining needs and carrying this through to project operation. 7. There should be organized plans for phasing worthwhile projects to funding mechanisms other than RMP. 8. There should be strong involvement of core staff and RAG in directing the course of the mobile cancer prO3ect. The May 1971 National Advisory Council recommended approval as a separate and new Region with operational status for three years at the current level with the following conditions: 1. The concerns of visitors be communicated back to the Region, 2. The review of the second year continuation request include a site visit to assess progress during the next year, and 3. The level of funding be increased if significant progress is achieved in the first year. Additional concerns are contained in April 1-2, 1971 site visit report. During June 1971, Harold S. Morgan, M.D. resigned as Coordinator. Deane S. Marcy, M.D. became the. n-ew: .@r-dimat@or, r-&s -bt -.July Il,"',1971. The Nebraska RMP is currently in its 01 operational year. The direct cost award for the present budget period is $500,000 and indirect costs amount to $125,639 (24.4%). The current budget period has been extended two months until August 31, 1972. The Region has submitted an Anniversary Application before the triennial requesting 02 year support of $782,197 direct costs for the following: I. Continuation support for Core 376,641 II. Continuation support for two ongoing projects 297,257 III. Support for four new projects 108,299 Total 782,197 Region Nebraslci Review Cycle ulle 197'@' OANDING ACCOIAPLISHMEUS BY RMP SINCE April 1-2 197 1 1. Region has defined RAG, Grantee, and Coordinator responsibilities. RAG has been actively involved in the Regions review process. 2. Developed "Procedural Manual", "Administrative Policy Manial". (pg 13, 15) 3. Core Staff is developing outreach to community rather than strict confinement to medical comunity. 4. Good relationships with CHP exist. CHP is actively involved in RMP review process. 5. Assisted comunity of Creighton, Nebraska in developing an Experimental Health Delivery t Sub-systeim proposal. 6. RAG is active in terms of overall developmental aspect of programs . Nine functioning committees are involved. T. Program Coordinator has made successful accomplishments in reorganizing the MW. 8. Education projects seem to include a methodology for evaluation. 9. Inter-regional cooperative arrangements have been excellent. LO. Central program direction has been strengthened. PRINCIPAL PROB@ 1. f@ has clearly articulated its goals, objectives and priorities, however, they are not tim-framd and an overall plan for the Region does not emerge. 2i Program is still quite "project-oriented". 3. NRMP is not focusing its attention on LTroving the total delivery of health care. 4. Collection and use of data to determine funding priorities or delineation of program @direction. ere are no minority group m@ers on core staff or the various project staffs, nor on lWhe 9 G Committees. (One black on the RAG) Special health problems of Indians and migrant farm workers have not been addressed. 6. Too much conceptual planning (CHP responsibility). 7. Emphasis of kidney programs. 8. Needs should be defined before action statements on goals, priorities and objectives. @ ISSUES REQUIRING ATMWION OF REV The emphasis of NFMP is still categorical, and continuing education and trai@- they should be encouraged to broaden their health "Horizons". RAG should be encouraged to become more involved in the evaluation process. SUGGESTION: A "Planning and Evaluation C@ttee" to assist in monitoring overall program as well as specific projects and core staff activities. (Compare this to role of Planner-Evaluator, pg. 22.) 3. The data accruing from the Westinghouse Corporation study should be used as a basis for carrying out an overall needs assessment of the Region for developing a related 3-year plan of action. 4. Two part-time salaried positions of grantee being paid by Core funds. 5'Clarification of CHP 'lb" representative on RAG. 6. Future relationships with two medical schools. 7. Core staff position descriptions. 8. Position Of RAG chairmn and president of Nebraska State Medical Association (same) 9. Although manpower is a stated objective, what activities are planned. i e role of 2 "Kidney projects" in NRMP statewide Kidney plans. TABLE OF CONTEYRS NORTH CAROLINA REGIONAL MEDICAL PROGRAM ANNIVERSARY APPLICATION Staff BriefiM Document Pa-qe Face Page 1 Regional Maps 2 (;eography and Demography 4 Component and Financial SummaTy 6 Breakout of Request 7 Problems, Accomplishments, Issues 23 Review Criteria 27 Addendum to Briefinst Document 37 Organizational Structure 38 Regional Office Comments 43 Supplement to Application 46 RMPS STAFF BRIEFING DOCUMENT OPERATIONS Eastern Mid-Cont EGION North Carolina 00006 BRANCH /X7 South Centr'l Western BRANCH N/A LAST RATING Tel. No. 31740 Room in - 22 YPE APPLICATION TRIENNIAL April 1972 DATE BRANCH CHIEF Lee E. Van W@Li lst AN.NIV YEAR SAR.P BRANCH STAFF Bill Reist 2nd ANNIV YEAR REV. COM. RO REP. Ted Griffith OTHER OTHER is,*, Planned for 197' Last Mgt. ASSM,T V 1L. Early Chairman- Nov. 1970 ChairmanHenry'Lemon, M.D. (Comittee); Bland Camon, M.D.(Coiincil)o AS@V. Edward Coppola, M.D. (Consultant) RMPS STAFF* Dan Spain -, tallisits, Last 12 mos. (Dat6s, Chairman's Name and Type of Visit) Buddy Says, & Ted' Griffith November 15, 1972- Bill Reist- Met Staff- Attended RAG Meeting- Consulted on Migrant Projec March 7-9, 1972- Bill Reist- Met Staff- Obtain supplemental Information for AMlication- A REVIEW PROCESS VERIFICATION VISIT is scheduled for April 27, 1972 @jor Events Which Occurred in the Region Affectitg the RMP Since Its Last Review n May 1971 Eastern Carolina University in Greenville has been appropriated funds by the State legis- ature, for a 2 year Medical School and School of Allied Health. State Legislature has passed a bill which provides payment for dialysis of Kidney patents Legislation Research Committee has been appointed to study and make recommendations on EMS in North Carolina It will be announced on April 7, 1972 that University of North Carolina has been selected by NOiSRDas 'd-tegrantee for a University Center for Health Evaluation award North Carolina RW Map of Congressional Districts, Counties, and Selected Cities Metropolitan Areas: (11 Districts) @heville -135.4 liarlotte -406.0 )urham -188.8 @reensboro- V. Salem 598.9 Police 225.6 STOKES ILKES y .ME ETTEVIL coli@ EGIONS )RTH CAROLINA MULTI-COUNTY PLANNING R Establ.ished By Executive order Robert W. Scott overnor Of North Caroiina G May 7, 1970 ,q NORTH CAROLINA RMP RM 00006 3/15/72 Regional boundaries coincide with the State cts - 11 Counties - 100 Population (1970 Census) -- S,082,100 Land Area: 49,067 sq. miles Urban 45% Density 103 per square mile litan Areas: (5) - Total population of 1,SSS,000 Asheville - 135.4 Greensboro - Winston Charlotte -406.0 . Salem - S98.9 Durham -188.8 Raleigh - 225.6 Race: White -77% - 3,891,SOO e Distribution Un r 1 Y_rs _ 5, Negro - - 1,137,700 e Other - S2,900 18-64 yrs. - 57% (majority indians) 65 Over - 8% Home Based 17,307 Migration intoTState 9,OS3 0 1 ta 6,360 Per Ca-oita Income: North Carolina $3,188 - (Ranks #39) (197b) United States $3,910 - @-rta@: @aths per 100,000 population, 1967 NORTH CAROLINA U.S. Heart Disease 303.6 364.S Malignant neopl. 115.4 lS7.2 Vascular lesions (aff. CNS-Stroke) 105.2 102.2 Diabetes 1S.2 17.7 Broncho-pneumonic 11.0 14.8 (other) Accidents 67.2 S7.5 1970-1971 Enrollment Graduates Resources and Facilities: (3) Medical Schools Bowman Gray, Wake Forest 273 S8 Winston - Salem Duke Univ. School of Med. 383 80 Durham Univ. of N. Carolina 337 76 Chapel Hill (1) Allied Health School, University Based Bowman Gray School of Med.,Winston Salem Division of Allied Health Programs RM 00006 3/15/72 Professional Nursing Schools Practical Nursing Schools 40 - 17 are college or 37 Schools University-Based Accredited Schools - Allied Health Cytotechnology - 7 @dical Technology - 14 Radiologic Technology - 28 Physical Therapy - 2(University Based) Medical Record Librarian - 1 Hospital§-c eneral Hospital Special Facilities Short Te-nn 36 iccu Si Long Tenn- Cobalt 12 (special) 7 484 Radium 34 Isotope (g.eneral) 3 i,sos Facility 37 V.A. Renal Dial- 13 ysis (in-patient) Rehabil. 6 ower: (in-patient) Active 4,484 Inactive 199 osteopaths 21 Graduate Nurses, 1966: Actively employed in -nursing 12,126 Not employed in nursing 3,475 Group Medical Practices, 1969: Total 153 single Specialty 92 General Practice 18 multi-Specialty 43 RMPS/SCOB/DOD component and Financial Summary - Anniversary Application COMPONENT CURRENT YEAR YEAR RECOMMNDED YRIS AWARD COUNCIL FUNDING .04 OPER. RECOMMENDED REQUEST SARP YEAR* LEVEL REV. COM. CORE 558,193 643 9bi2 Sub-Contracts -0- <, XI (73 OPER. ACTIV. t,152,129 1-248@175 ,I)EVEL. COMP. 168,605- IBZ.8ql Yes or No RKS*. KIIDNEY #28 (145.400) AREC #41 (200,000) RMPS DIRECT 1,878,927 2,194,400 2.080-008 3,875,178 REQUESTED COUNCIL 'APPROVED LEVEL 2,194.4 NON-RNPS and INCOME 34,691 REGION North Carolina J ne 1971 REVIEW CYCLE The 04 year is being extended to 9/1 and the region will received $365, 733 for the two month extension resulting in a direct cost award of $2,244,660 for 14 months. REGTON - N CAROLINA MARCH l7*t972 BFTEAKCUT OF REQUEST RM 00006 06/7Z RMPS-OSM-JTOGRZ'el 05 pRorFtAM PERIOD (4) (1) 15) (2) CURRENT CURRENT II)E,'4TIFICATION OF COMPONENT CONT. WITHINI CONT. BEYONDI APPR. NOT I NEW, NOT DIRECT INDIRECT TOTAL APPR. PERICOI APPR. PERIOCI PREVIOUSLY PREVIOUSLY COSTS SUPPORT OF SUPPORT FUNDED A PPRE)VED COSTS CF :000 COQE STAFF 0- PMEKTAL 3 OFZE;7E'LC--- OMPCNENT Fr,i--El B@EIIC CONSULTATICN ANI t 7@O ..L Fylc@r ------ - --- -- 015 CCYPREFEP-SIVE STROKE PROI .125.0 ---- @TE TRAI @19 A ----------- - 026 N C EmPtiYSEIIA A.%D LUNG DI N- OZ8 CARE c@ PATli TS WITH CFl 029 CF)@IJED PHY ALF)H PERSON-%EL[ o3o CC@P'ZCIIE.'iSIVE RtiEU!'ATIC .1@gz? ICUAZO I 03L CARC!AC PA[ 032 CAPI@E,4 LAD',)ER P,UilStk.'G EDI 034 FA?IILY N,,PSE PRACTITICNEI -B--- --- --- I- ---- 112 ACULT S -@4.lt,,G ;7ROG@AR I 035 036 CUM; ,RE@IE,SIVE CANCER PRCI ---CgLf- sl5z4zbA-l- SZ?.736 I 039 t;EI-G-H.Bt-@RH-OO-D-FG-MT-CTRS Cl I --O@ 040 EZ)UCATIO'QAL Yt:ST114G SERVI 04t 'AREA tiEALTti ECUCATION CEI $14594GO $277,468 $29080PCOB $46OR480 1 $2954Ov488 TOTAL I $1,657tl4O I IO.ARCH II.L97Z REGION - N CAROLINA BREAKCUT OF REQUEST RM 00006 06/72 06 PROGRAM PERIOD RMP S-0 SM-J TO GR 2@f (5) (2) (4) IDENTIFICATION OF COMPONENT CONT. WITHINI CONT. BEYONOI APPK. NOT I NEW, NOT ADC'L YEAR I TOTAL I APPR. PERICOI APPR. PERICEI PREVIOUSLY I PREVIOUSLY olit[cy ALL YEAR$ CF SUPPORT OF SUPPORT FUNDED I APPROVED C057S JOIRECT CCSRS I COOO CGPE STAFF --- - --- 5-P TF T, T-A F C-L) ; -P 0- @E N- -T C)COO CEYLL 03 C) CTIC RNSULTATIUN ANI 015 CC!IIIRLIFNSIVE STPCJ@,E FIRCI - -r.?@@ ------- --- -- - --------- - - -------- -I 019 P)IYI@ICIAt@S ASSOCIATE TRAI - ----------- - - - -- - 026 t, C Emfllty@LMA AND LUNG 01 - - - - - - - - ---- - - - I- S13@U4 -L---- I 023 C-Ikt: (@f PATIENTS WITH CHI I 029 CUT@ED P)iY ALUii PERSCTJNELI I I I I 030 C C @N S I V E R ii E Utl,.@T I C I E L Y r-@.- P 0 Li. I': 1 1'3'1 P -' 0 C,,2 L CII.PUIAC PAI I 1 15 JUAa9.& 00 0 3 2 C,'@:li'F.P L.@P)LP t,",RSltiG 101 I 034 rt,@iLy i.,ui@SE Pil.ACTITICr,[l --?-- - ---- - ----------- - --- I 3 5 A(.ULI ',CP.LENING PP(JGRAM I -- - - -------- I- CANCER PRCI &276.L2.12 039 @.ElGliPCk@ICOD P.GMT CTRS Cl I I n I_ 16 1 .6z9.-I- 16@6Z2- 040 c@OUC.'@T.0@.AL TESTING SERVI 041 AREA HEALTH EUUCATILN CLI TOTAL S145,400 1 $74?719 1 $2*195*500 1 $4,275,506 I__@it9.75, 381 RMPS-OSM-Jtotlm@ll MAP Cift t)72 RFGln'4AL mFr]ICAL yPFt ()GP AM S e SUMMARY BUDGET tl TYP@ OF I FEBRUARY 1, 1972 DEADLINE ,EGIn', 1)6w APNL REQUEST DIRECT CF)ST Rmps RMPS PREVIOUS RMPS RMPS .OmPrl,14ENT PERSONAL PATIENT EQUIP. CONST. OTHER TRAINING DIRECT INDIRECT TOTAL YEAR DIRECT DIRECT IST YR IST YR IST YR AWARD ZND YR 39D YR NO. Svc CARE t FELLOWS. NEW NOT PREVIOUSLY APPROVED ,39 39#325 14#25,S 53,sst 61,629 31 681) 1,500 6,145 4-1 219343 38,143 7,5-)2 45,695 13te9l) 2.)o,(,.on 141 NEW SUB-TOTAL 47,980 19500 77,988 277#468 2l,8L)A 2999276 74,719 APPROVED NOT PPEVInLtSLY FUNDED )Zo I I fl, 4'1') if) 7 000 25,nOO 145,4')O 47,240 1 87,64,1 I 45,4f)O-. 40T PPEV SUB-TOTAL 1 1 1), 4)f) I'l,000 25,:)Ol 145,4,)O 42,240 IR7,640 145,4'@)O C',lk4TINIIATID'i WITHIN APPRNVED PERIOD OF SUPPORT r)4,330 29000 5 137*610 643994) 241,q39 685,879 558,193 839,765 IqB,eoo lR79$q3 )n3 4',l , I L@'4 r,.141 45, 25() 12,506 -T,756 62,550 )15 65v3l4 2t750 56,nO6 124,070 29,392 153946Z 109*000 -ilg 5(.)#794 66,no-) o,oon 124,7q9 27,090 ist,sag 169,662 176 5793sq 11,246 63,635 53#295 135,n34 ')29 2692rlT 29000 39,743 67,450 7955) 75,000 52,233 112,743, 13f) 1699';8 9,54D 76,498 3,922 30,42') 33,821 110,RT6 031 '- 28p3ZO 9,040 37,360 7,611 449'971 26,861 219236 f)32 359893 35,893 32,0(18 84,237 11.1,704 24,?D? 127,915 r)8,493 107,641 134 839659 11850 MARCH 11),1972 PFC.InN,\L mrf)JCAI. PPNG!)AMS ,rRVICE ItMPS-OSM-JT(IrMB MARCH 1)91972 REGIONAL MEDICAL PROGOAMS srRVICE RMPS-OSM-JTC(,MSV;,- SUMMARY BUI)GET BY TYPE f)F ST)OPOPT RECIQN M6 Nn CAROL REQUEST FEBRUARY ly 1972 DEADLINE DIRECT COST Cr)MPONE,'4T PERSONAL PATIENT EQUIP. CONST. OTHER FTMPS RMPS PREVIOUS Rmps RMPS TRAINING DIRECT INDIRECT TOTAL-- YE SVC - C/.R E . . . AR DIRECT DIRECT 9 FELLOWS. IST YR 1ST YR I s,.T' I yik AWARD 2"10 YR 3RD YR 035 37,986 179640 51;t626 8t233 63,859 74,176 9qvO24 )36 32t5l2 31750 66*()OZ 152,264 229736 175tOOO 9lt4l2 276t932- CNNT. WITHIN SUB-TQTAL 93/)tl@8 12,350 424,427 8,,')nn 1, 657, 4t). 31)6,432 2,053tS72 19520*504 1 99?5ir38l.. PEQUEST TOTALS lvO94,568 23 t85,) 477,415 Ft, oon 2, (tan, of) 13 46n,480 2,540,488 1,520,504 2*1959500 tuirl'i T@l S 1.094,568 23,350 477v4l5 89'10() 2,')BD,008 463v48O 2954Dt488 1952OPS04 29-195,509' C.'IIPONFPJT COMPnqF-.NT 1111). TITIF YF Alt ),4 tjrlcp.@rikii,ir,r) CT;Z', CO'JTRNL HYPT A4D LIZAB 01 ')t,o @QtJrATIr)@'AL TFSTI@JG SFRVICR: TEST AND EVALUATION I t.5)FA lir,@ALTH E@IJ',ATIO-Y CE.N-TERS ')2 A CARE I)F PATIE,@ITS WITH C@4PONIC UREMIA C' Ir) C'IPF @TAFF ') " r)) ;;@VFI,(IPMENITAt. CP@PFINENT l@3 riAOLrric Cn@lSt3LTATn,l AN) Fr)IJCATInNAL SFRVICES 1) 5 STNUKE (15 cl:Z 0 rO A M I 1) tSS:)CIATE T;ZAI!JIPJR PRC;GRA.4 03 2 6 N C EI,4PHYS@tlti AN[) LUN(, I)ISCASE PROGRAM 02 1)29 Crl,'@FO PHY ALOH PfPS()Pl@JEL [@j E N C (%2 030 Cr)MPI)F@iF,%ISIVF RtiFtlItATIC FFVFR PREVENTION PROGRAM r)2 .') 31 COMP;ic,'IiENSIVF CAROJAC PACEMAKER EOI)CATION PROGRAM n2 ')32 CARE-FP LAN[)ER NI)PSING EDI)CATION 02 -) 34 FAMILY NIJRSR PRACTITIO'4ER ') 2 135 tf)ULT SCPFE,'.'114G PROGRAM 117 @)36 Cr))IPREHEtJStVE CANCER PR)GRAM 12 RMPS-OSM-JTU'7,Mt m HE(;INNAL MEL)tr.AL -RnrOAMS, CF I irri-jr. nf: An,iirriipjAi FTEGI(INAL MEDICAL PRORRAMS RMPS-OS)4-JTOGMRII@- ARcl*972 L[SRING OF Ant)ITI41PIAL REQTJEST FEBRUARY 1, 11)72 DEANLINF,- ,G,b.m.6 APOL., OTHER OTHFR TOTAL D@PO@EN'T 9-ps GRA4T RELATED INCOME STATE LOCAL FFNERAL NON-FEDERAL DIRFRT TOTAL FUNDS NU1414ER TOTAL INTEREST OTHER FUNDS FUNDS FUNDS FUNR)S ASSISTANCE THIS PERIOD NEW NOT PREVIOUSLY APPROVED 03q 539581 53r58l 451695 14f) 45#695 - -- --- 20f), nOO 2nltnoo NEW SUB-TOTAL 299, 6 219#276 APPROVED NnT PREVIOUSLY FUNORO 187#640 2.R l87v640 IOT PREV SUB-TNTAL 187,640 187,64n COIITINUATI(I@L WITHIN APPPNVED PERIOD OF SUPPORT 885,879 CI)OF) 885,879 n,Nnn 187,893 187,893__ 5T,756 57,756 115 li.3. 462 153,462- 1)19 1 51 i 88'3 63,635 026 6 3 ,',3 5 n7q 7c, , r)O'l 3@3,421) 3n,420 031 44,971 44,971 70,584 A3? 3-),893 '449691 127,915 334 1279915 63,859 1 .)35 639859 n36 175vOln t MARCII l-).1972 REGIO14AL MENICAL PRORRAMS SFRVICE ftmps-osm-jTOGMS 4 1 t- AI )I) I, iL uliu REQUEST FEBRUARY 1, 19 72 DEAR)L I t42 (%6 .140 CAROL ()THER OTHER TOTAL Cn4p,itiE,JT kmps r.RANT RELATED (NCIJME STATE LOCAL FEDERAL NNN-FFI)ERAL DIRECT TOTAL FUNDS NV.'413ER TOTAL 114TEREST, OTHER FUNDS FUNDS FUNDS FIJNn,.; ASSISTANCE THIS PERIOD CNNT. WITHIN SUB-TOTAL 29053#572 34#691 2tO889263 9EG1')N TOTALS 349691 2,5759179-- 2,541)#488 - --- - ------ M,AP' -919 72 PEGTnN4L mEnICAL PRnrTZAM$ 'VICE Ftmps-nSM-JTOGMS SUMMARY BI)OGET MY TYPE O', @nftT REQUEST FEBRUARY it 1972 DEADLINE PFr,ln,4 I), ISSCIUPI 4Ai@CH 10,11)1? P@FCI()%'AL '4Fr)IC&t. PPrl(;ftA.4S FRRVICF S(JMMARY lti)DC.FT iiy TY@ll- 'IF stjpp.,IRT N CAft(',LINA P.MP Sli!,P YR PEQIJFST MAY/JUNE 1972 kf-VIPw CYCLE [)cSK S(!UTH CFPIT'-AL R - M-i C(;Ra @IMPS HMPS RMPS Rmps TNT.L C 0 M P n N F N T cnP4PnN;:NT DIRECT INNIPECT TOTAI. DIRFCT OFRECT OIRECT P4 L) TITLE SuppnRr YFAR IST Yit IST YR IST YR 2ND YR 3RD YR ALL @%kS NEW NOT PREVI()USLY 6PPROVEr) )30 14@@ YGITT CTPS CG 10 , -42,; 14,256 53,50'@ 61,6Zq 1 0!7,, 9 54 @:T@CL HY,"T Al.;) 4," F 0 1. :,' @, T I L T c @ T I '! r, S'z P. V I ol -4,1,143 7,-;57 5,6q-) ill,091) .51, 2 33 Ct@ TEST Al@L) EVALUATICj%l )41 %.4FA HEALTH EDUC?.TlrjN CEN ot 2')", 00') 200,0@o TLRS NEW STJB-TOTAL 277.4f,@i 21,ROO 299,276 74,719 357,187 k@IOT PRE.Vlr"JSLY FUNI)@@D )?B (t.I!E (IF P.@Tl@@ITS WITH CtiP nj 1 4 -,, 4 O-) 4?1240 187i640 145,41o 29r", s@') r,'41C URFVIA .'40T P;ZEV SUB-TOTAL 145,4)-) 42,24(, 187,64n 14';, 4,),) 290,90,0 PFRIOR) OF SI.JPPORT C') n I CIRE STAT-F 05 641,q4l 241,939 RAI,,379 839,765 1,483,7@5 D') 0 .0 DFVF.Lf)P4FiNTAL Cfl"P('@-11@@IT 112 IST,RQA 187,AI)3 187,89-4 375,766 ')')3 OIA,3FT[I Ct,N@JL,TATlOt4 A14D Or) 49,2S') 57,756 45 , V I Cf.' STPI;KF PFZUG ;I Is 1 24 29,392 151,4f,2 124. (17" )lq AS@LICTAT@.' TPAT t)3 124,791@ 27, Jl)(% I -,I 'I B.) 124,799 N I Nf; P r It M ')76 N C FMP'IY'FkiA A@%4,) L(1'4G ni 02 -)@,399 11,246 63,635 135.034 187,423 sr.@';F Pi':;(.RA'4 ,)2 n C.Illlf,) Pi@Y Al ')if Pt'R@("@;JFL I;) 67, 4 5-) 7,-,50 75,,IOO 112.743 180,1-@3 114 I- ri c i,i o cr,,,PRrHrtisivF F 26.4qS 3,922 30,420 lll),876 137,',174 )31 P.@c (12 11,361 7 1,11 44,971 21,236 58,596 FF4t.KFR PQI@t,RA4 )37 CA;tFFk LAI)DFP NI)PSINR. rDU ()2 15,891 35,893 84,237 1 Z,'), I 3Z; CATICIN I nlv 71)3 I,) 7.641 1)34 FAMILY NT]RSF PIIACTITIONER ..02 24,207 1 27.9 1 li 211,349 li5 AUULT SCREEP41ilG Ppnrg,%m !%2 55,626 8,233 61,8'i') 9). OZ4 154,65n -CNNTTNUED ON NEXT PAGE- REGIF)NAL kiFnICAL PRO@'RAMS SERVICE @r(,.ION RMP S(JPP YR 01; SKJ@IMARY BU()GER giY'TYPr OF SLJPPRJRT -Cf)NT.- f)E SK SOUT@I CENTL?AL PFOIJEST MAY/JIJNF- 1972 RRVIFW CYRLE Ps RMPS RMPS R4ps TRTAL CC'@'4PC.iENT COMP@)NIFNT nlr(rCT ltl.'r)IH@CT TilTAL I)TRECT DIRECT n[RECT TITL@ SU,-'P')PT YEAR IST Yx IST YR IST YR 2t:D YR 3RD YR ALL 3 YRS 1)36 CO)JPqEHn,NSIVE CANCFR PROC 02 152,264 22,736 175,000 276,932 RAM 429#196 COIIT. WITHI@L SUB-TR)TAL 1.657,14,') 396,432 ?,151,572 lol)75,381 31632,521 T.)T 'tL5 46(',430 2 i 5 4) 4 R q 29105,50i 4 2 75,.5') 8 -M Ai' mF 0 1 C A L I'Rn f P V I r F -C!i I'll 11)7? PF.G(P,'@AL LISTIN(; OF Au;)[Tlll-'i&L REOUF.;R MAY/Jt)NF 197? RFVICW CYCLE N PI-P SLJPP YR r5 T @iF. k I)T@IF ti TOTAL COMPIINENT 12mps t',RA@IT RELATEL) I%C:IME STATE LnCtl. FFI)ERAL '4f)N-F! )FRAL r)IP.ECT TOTAL FIINOS @ILIMIIER TNTAL lil.'TEREST F U.\'I) S r u,it) S -i)hlf)S ASSISTA.NCE THIS PE@l,')D @@Ew qOT PREVICTJSLY APPROVED 53*581 53,591 5, f,'; 5 45,695 r'41 2 ') NE,d SuB-TOT.@L 299,276 APPROVE[) NI)l PRRVIOUSLY FU'4DFr) 2 4 7 t f-4,) 187,640 ',,,,3 TPS.EV SUi;-T()TL 197,640 Cn@4TI14UATIott WITHTN APPRI.)VEN PERIOD OF StJOPf)RT 865,871) I F;7 , fk-) I 57,756 57,7i6 153,462 5 l';I,462 olq 151,889 63,635 ,)26 7 5 2 7i, C)',- 30,42) 2,j 44,971 '131 c 44,-;71 032 34,691 70 , 5ki4 034 127,<)IS 1 27,'41 5 63,859 035 63,859 036 1 75 ()f)O 1 75 !)Oo REGIO@.IAL MEL)IRAL PporkAMS SFRVICC MAKC@I ll,),.1972 LISTIN(; @IF Al)[)ITlr.INAL F()NDS REUur-ST MAY/ -,E -VIEW Jij 11)72 RE CYC.LE PEGION 06 N CARRILINA RMP SUPP YR 05 OTHER nTIJFR TOTT.L %'IN-FFOCRAL DIRECT TNTAL FUNII)S ,'CqPnl,,ENT RIAPS RFLATEI) STATF LRICAL @rr)FkAL ASSIST.NCE THIS PFRIon TOTTL ITITFPF.ST OTiirR FI)NN.S $:L'NnS F U%'@)S CotiT. WIT.41N SIJP,-TOTAL 2,08S,263 7,0539572 34*691 kEGI,)N TR)TALS 2,575,179 34, t, "Rvvrr RFClfl-;-%L mFr-ICAL PI:(, 11), 9 72 PAGE 5 REGIONAL MEDICAL PROGRAMS SERVICE RMPS-OSM-LFKRFQJ MARCH RAps FUNDS RFOIIESTED REQUEST MAY/JUN 1972 REVIEW CYCLE r) El;t[)N 06 N CAROLINA Rmp.supp YR 05 (PERCENT OF TOTAL FUNDS REQUESTED) TNTAL PMPS FUNF)S OTHER SOURCEN TOTAL SUPPORT ---.-,RMPS 't TITLE ALL SOURCES OF TOTAL ()MPONENT NUMRER REQUESTED OF SUPPORT 885,879 too es5,679 0 COOD CORE STAFF 187v8gl 0 1979893 Ino ot)00 DEVELOPMENTAL COMPONENT -DUCATIONAL SERVICES 57 9 7-56. 0 57,756 lo@ - .- [)IASET$r@ CONSULTATION AND E C) 1539462 0 153t462 1 015 COMPREHENSIVE STROKE PROGRAM 151,889 10?) 1)19 PHYSICIANS ASS(@)CIATF TRAINING PROGRAM 0 6.4. 6",i 10 LUNG ',)ISFPkSF PROGRAM 63,645 ')26 N C EmpIlYSF M fA A4 1) n 1879640 I O') 187*64q ')28 CARE OF PATIENTS WITH CHRONIC UREMIA 0 750000 100 029 CONF.D PHY ALOM PEPSr)4NEL tN F N C 75,000 I n,) Compq HR-UMATIC FFVR-.R PREVENTION PROGRAM -4 0 3#),420 0,420 .FHF 030 NSIVF R 0 44,971 i3i COMP'AEHENSIVE CAQD[AC PArEmAKER FI)UCATION pFtnCPAM 44,q7l 84 51 '45,89-t 349691 70,5 SINR, FOUCATin.4 032 CAREER LADDER NUR 7,915 0 127.qlS 034 FAMILY 04URSE PPACTTTTNNER L2 n 63,8'i9 Ion ili@ (135 ADULT SCREENING PRr),@RAM 639859 1 7 r, , ') t.) ',) (I 17'i.00() ll,)O 036 CDMPREHFNSIVE CANCFct PROGRAM 539581 ' - -. 101) . a 53*581 NEIGHBORtIO00 MG'4T CTRS CONTROL HYPT AND ()IA 040 EDUCATIONAL TESTING SERVICE TEST &NO EVALUATION 45,695 n 4 .5,695 100 2,no, DO') 0 2 DO, 00t) ji) 0 t) 41 AREA HEALTH E-F)UCATION CENTERS qq 2*54C,488 34,691 2, 5715,179 REGION 6 TOTAL OF t7 COMPONENTS MARCH 0891972 REGIONAL-MEDICAL PROGRAMS SERVICE DESK SOUTH CENTRAL AREA RMP-OSM-PEM001 LIST OF-COMPONENTS REQUESTED Fz)R NEXT SUPPORT YEAR REGION C)6 RMP-SUPP-YR 05 REQUEST MAY/JUN 1972 REVIEW C-CLE COMPONENT COMPONENT NEXT DIRECT COST EST DATE OF NUMBER TITLE SUPPORT YEAR NEXT PERIOD TERMINATION COOO CORE STAFF 05 643,940 DODO DEVELOPMENTAL COMPONENT 02 IS7,893 003 TION AND EDUCATIONAL SERVICES 05 45,250 06/73 DIABETIC CONSULTA 015 COMPREHENSIVE STROKE PROGRAM C)5 1249070 n6/73 019 PHYSICIANS ASSOCIATE TRAINING PROGRAM 1.) 3 124,799 06/73 026 N C EMPHYSEMA AND LUNG DISEASE PROGRAM 02 52,309 06/74' 028 CARE OF PATIENTS WITH CHRONIC UREMIA 01 145,4r)O 06/74 029 CONED PHY ALOH PERSONNEL IN E N C 02 67,450 06/74 030 COY.PREHE@ISIVE PHEIJMAIIC FEVFR PREVENTION PROGRAM (%2 26,498 06/74 031@ CC!IPPEIIENSIVE CARDIAC PACEMAKER EDUCATION PROGRAM 02 37,360 06/7 -,-. . I ... -"- -. - . - .. -- - 032 CAREER LADDER NURSING EDUCATION 02 35,893 06/71- 034 FAMILY NURSE PRACTITIONER 02 103 708 06/74 035 ADULT SCREENING PROGRAM 02 55v626 06/74 036 COMPREHENSIVE CANCER PROGRAM 02 152,264 06/74 039 NEIGHBORHOOD MGMT CTRS CONTROL HYPT AND DIAS 01 3c), 325 -7 06/74 040 EDUCATIONAL TESTING SERVICE TEST AND EVNLUATION 01 38,143 06/73 041' AREA HEALTH EDUCATION CENTERS 01 200,OCO TOTAL REGION 06 COMPONENTS 17 2,080*UO8 MARCH 23*1972 REGIONAL MEDICAL PROGRAMS SERVICE PAGE I SUMMARY BUDGET CATEGORIES BY COMPONENT RMPS-OSM-JTOrM2 "19 PEGION (116 N CAROLINA REQUEST MAY/JUNE 1972 REVIEW.CYCLE PONENT COMPONENT COMPONENT COMPONENT COMPONENT COMPONENT COMPONENT COMPONENT COMPONENT com NO COOO NO DODO NO Or)3 NO 015 NO 019 NO 026 NO 028 NO 029 No 030@ I PERSONAL SERVICES 09364 22,748 l4t494 4479780. 35,830 58,884 45,150 43i243 10 SALARIES, WAGES 5,644 2,344 100036 3,459 21464 EMPLOYEE sENEFI.TS 56,550 4,279 69430 10*400 26,207 16.950 ,TOTAL 504,330 4OwlO9 659314 50,794 45958T It PATIENT CARE IN-PATIENT OUT -PAT I ENT TOTAL ECUIPMENT BUILT-IN 10,000 2,000 MOVABLE 2,000 29750 TOTAL 2t750 101000 2*000 IV CONSTRUCTION N EW MAJ ALT &REN TOTAL V OTHER C'@.'-.'S U L T ANTS 4*,IOO 3r2l6 Ifooo 5*000 249000. 4,200 SUPPLIES 10,000 Boo 11250 7,000 3,680 5*500 39743 [)MST TRAVEL 27,110 750 4y8OO 29500 29000 6#500 2, 500 1,000 - FRGN TRAVEL PENT SPACE 3,240 2tl4D--- 2,100 1,000 RETJT OT HE R 7,000 MIN ALT & PEN 1,500 i,ooo 5,000 12Z 2,000 PU BL I CA I 19N S 2tOOO 38,200 4:0,000 3,000 COTITRACTUAL 73,000 1879893 3,000. 2slOO C EJIAK UN I C A TI ON 12,000 1,191 3,000 2,000 COMPUTERS -51000 1, 300------ 2,405 .80000 10; OTHER i,ooo TOTAL 1379610 1-87,89,' 5tl4l 5690')6 66*005 6,802 25wCOO 39t243 99540 VI TRAINEE COSTS STIPENDS 8,000 OTF.EP BVOOC- TOTAL TOTAL DIRECT COST- 6431940 187,893 45t250 1249070 124#799 529389 1459400 67t450. 26t498 l2v5O6 29t392 27,090 119246 429240 7*550 3,922 INDIRECT COST Z4lt939 TOTAL DIR IND 8859879 187,893 57,756 153,462 151,889 639635 187,640 759000 30,4ZO MARCH 23vl972 REGIONAL MEDICAL PROGRAMS SERVICE PAGE 2 SUMMARY BUDGET CATEGORIES BY COMPONENT RMPS-OSM-JTOGM2-01+ REGION 06 N CAROLINA REQUEST MAY/JL$NE 1972 REVIEW CYCLE COMPONENT COMPONENT COMPONENT COMPONENT COMPONENT COMPONENT COMPONENT COMPONENT REG104 .NO 031 NO 032 NO 034 NO 035 NO 036 NO 039 NO 040 NO 041 TOTALS I PERSONAL SERVICES SALARIES* WAGES 24,451 32,566 73,00'J 32,818 75,011 28,800 16t3OO .1*0519439 EMPLOYEE BENEFITS 3,869 lt723 109658 5,168 79501 2t880 123POO5 TOTAL 28v320 34,289 839658 379986 829512 3lt680 169300 191749444 II PATIENT CARE IN-P AT I ENT OUT-PATIENT TOTAL III EQUIPMENT BUILT-IN MOV AOL E 1,850 3,750 1,500 23,850 TOTAL Ite5o 3,750 1 i 500. 23r850 IV CrNSTPUr-TION @4 EW MAJ ALT C REN TOTAL V OTHER CONSULTANTS 80300 10,000 6,800 62#316 SUPPLIES 1,500 49200 6,800 8#414 2,000 1,175 60*262 OMST TRAVEL 29500 1,604 5,t)00 zvsoo 7,050 300 29335. @68,449 FRG'4 TRAVEL RFP,T SPACE 2,140 2t98O 12, 90-,% P-E t4 I OT!IER io,too MIN ALT & REN 11 501) PUBLICATIONS 100 200 2,074 200 12,69b CONTRACTUAL 22#983 21000 200#000 567#076. COMMUNICATION 29700 500 3,660 4,567 19045 35,763 COMPUTERS 9t3OO 600 4 5) 15 t3.50 OTHER 100 1,700 1,614 11,083 27,3f)Z TOTAL 9tD4O 1,604 l8t2OC 17,640. 66,002 6.145 Zlt843 200*000 873,714 VI TRAINEE COSTS STIPENDS 81000 OTHER TOTAL stooo TOTAL DIRECT COST 37v360 359893 lO3v7C8 559626 1529264 39#325 389143 200,000 29080*008 INDIRECT COST 7v6ll 24,207 8,233 22,736 14#256 79552 460,480 TOTAL DIR IND 44,971 35,893 127,915 63PB59 175,DOO 53,581 45*695 2009000 2954ot488 II IN At M i 1) It. Al CtiPR f 1, I AS oF 1(1/31/71 PAGE: I RUN DATE ollit/T2 PROG YR 04 LEVEL F,JNOI@4G i)[1@ICT T(Il AL RLG iEGION camp CUMPL)NT- r4Y II I t 1: @, I,.% k a AI%AP U AYII.R 0 NO NAME NO 558.2',O 22r,,800 779tOCj 06 @NO CAROL cooo CORE ADM RES kVAL 196,800 06 NO CAROL Dooo DEVELOPMENTAL 74,r,'OO 19t3Oo 9393CO t)6 NO CAROL 001 EOUC RES Comm MED CAPE NEEDS 44,,400 T,BDO 52*200 CCU TRG DEV CONED MD N 06 NO CAROL 002 62,600 159200 779800 06 NO CAROL 003 OIAS MGT TO PRACT CONS CLINIC 16,000 4,230 2Ct2OU ,6 xEGISTRY REGIONWID NO CAROL 004 DEVELOP CA 23,600 6,800 3C,,.60 @6 NO CAROL 005 ME() LIBR XTN SLR 57,OGO -T2,300 69#300 06 NU CAROL C;()$ ED PHYS DENTISTS UNIV NC 42 S;)G 7,5DO 50, C; ')O ST Cp RESUS UNIT 06 NO CAROL 013 CLOSED CHE UL ED t,,LM MISS ASHV 7,100 300 7,4CO NO CAROL 014 HEART CGNS 015 COP.PR SIR PRG 1306MAN (,RAY. lrg,ooc 24,slc 133# 5,JO NO CAROL 3C,000 12'stoo 42,8 NO CAROL 017 REG CTITR GT:ST TF(OPHOOL NEOP 4 @16 16q,7c)o 53,600 2Z3#300 06 -t4C CAROL C19 TRG MD ASSYS DUKE U kURL MDS C6 NO CARGL. 023 PILOT STI)Y SCH CHLD PHNCASCAN 22,200 3,30C, 25,500 CONED 10@OS ALE)H AECRT EAST NC 5C-,Or@o 10,000 6C,CCO 06 NO CAROL 029 2 8 4(10 4,230 32,60r, 06 NO CAROL 030 RHEUM F PRG(, CHLURN 06 NO CAROL 031 CARDC PACEMAKER EDUC INFO PRG "6;jO 3,600 14,200 50 , G(7ic 20,000 7C., c co 06 NO CAROL 034 FAMILV N PPACTLTIONER 72,6%10 12 *3()O 841900 6 NC' CAROL R AtiE.IAIA RELATED FU 035 ADULT H ST 759')CO 250000 loo,occ 06 NU CAROL 036 CA PRG CUNED PKUF LAY 06 NO CAROL 037 Coop CONED PRG STWD 2(i,ooo 1,6@o ic9coo 1,503 111,5cc, C6 NO CAPOL 038 CA TLPH CONF MU$ U REG CTRS gErloN TOIALS 1,73l,guu 466,603 2,lq8,5GO NO OF CCMPON-E'ITS 22 out P'AQCH 14, 197 2 REGI@INAL k'EOICAL POOL;RA'4S SEPvicr DESK SOUT14 CENTRAL AREA RMP-OS-4-Pr.m,)Il REGIGN 06 NO CAROL BkIOGr.,T Pfklt)') LIS.'ING AWARD AS OF 12/31/71 RMP C04P FY ACT TYP TYP RMP COMP CompnN(,NT TITLE PUDGET PERIOD pi f] NO DATE ACT SUP SUP YP SUP YR FROM THPU 06 C')OO 71 11/71 4 2 n4 04 C-IRE 07/71 06/72 06 0000 71 11/71 "5 5 04 ot DEVELOP'I[NTAL L)7/71 06/72 )6 DOI 71 11/71 4 2 04 04 EOUCATINN AND PCSIARCH IN C(IMIAUNITY ?iEDICAL CARE 07/71 06/72 CJ6 i)02 71 1 1 / 7'1 4 2 f)4 04 CI)KONARY CARF TRAINING AND I)EVELnpMENT C@7/71 06/72. 6 71 11/71 2 04 f)4 rIAI3[.TIC AND Cl)kICATIO.'4AL SERVICES 07/71 06/72 003 CONSULTATION ')6 4 71 11/71 4 2 04 11) 4 CANCER PtrIS,rRy UTILIZATION Piii)GRAti 117/ 71 06/72 06 71 11/71 4 2 )4 C4 MT.'OICAL LI-IRARY FXTI'NSILIN srkvice 07/71 06/72 j6 008 71 11/71 --4- 2 fi4 04 CONTINUING EOLJCATION IN DENTISTRY 07/71 06/72 (j6 013 71 11/71 4 2 04 C4 CLCS[D CHRST CARD10PULMONARY RFSUSCITATION i,)7/71 06/72 )6 014 71 11/71 4 2 )4 04 litA;JT CA"C.LR ST@,@KL CO@;,LJLTt.Tlt)t*' AND ED:JCATION Li7/7l 06/72 )6 .11 5 -71 11/71 4 2 1)4 04 COMPi@Flif',t@SI'JC- ST;znKE PF,('CRAM 07/71 C6/72 IJ6 017 71 11/71 4 2 04 03 REGINNAL CENTEK FOR TROPtiD3LASTIC DISEASES 07171 06/72 36 71 11/71 4 2 u4 L)2 Pi4YSICIA'.'% A,SISTAliT TFAillINC. PPTICRAM 1 ',7/71 06/72 ;)2 2 71 11/71 '4 2 t)4 13 cocqi)i%,.@TrD r)NCI)L(ICY CIIEIJOTPCRAPY PRCGRAM ')T/71 t)6/7Z )6 023 71 11/71 4 2 04 03 lirAItT Sl',I@,:)S SC!tEF!4lNr. PRllr.RAP- 07/71 06/72 36 ",26 71 11/71 -4 I n4 01 N C [14PHYSEMA A4D LUNG DISEASE PROGRAM 07/71 06/72 16 129 71 11/71 '4 1 04 01 CONT ED roR PHY ALLIED 14,LTH PERSONNEL IN ENC OT/71 06/72 04 GI CIIMPRE.IIF.4rIVE R'IC()14ATIC FEVEP. PRFVENTINN PROGRAM 07/71 06/72 ,6 -13') 71 11/71 4 1 06 @)31 71 11/71 4' 1 04 )I COv.FIRFlir,4SIVC CARDIAC PACFt'.AKFR EDLICAIION PROGRAM 07/71 06/72 ut, 032 71 11/71 4 1 04 ut CARFER LADDER NURSINC. EDUCATION 07/71 06/72 @3(, 034 71. 11/71 4 1 04 01 FAMILY NURSE PRACTITIONER 07/71 06172 16 035 71. 11/71 -4 1 04 DI ADULT SCPFENING PROGRAM 07/71 06/72 .)6 036 71 11/71 4 1 n4 LI I CO','rEHrN%[Vr CANC@R PRr.C.PAM. 07/71 06/7Z '6 .11 7 71 11/71 4 1 Al 4 .11 C(;(ii,rt;ATIVr r'RrrWAM nF Cn.'4TINI)I.NG LI)UCATI(IN t) 7/ 71 ')6/72 1 6 ')3 8 71 11/71 4 1 ',I 4 I rFGIOPif%L TFLEPH(INF CA.4C[R CO@IFEKFNCE 07/71 06/72 'TOTAL (:rtI.PONENTS REGION 06 25 Region North Carolina Review Cycle PRINCIPAL PROBLEMS: The November 1970 Site Visit Team identified three chief weaknesses of the North Carolina program. These were subsequently reaffirmed by the April 1971 Review Committee and May 1971 Advisory Council. They were: 1. Gaps existing in the composition of the RAG - it was felt Blacks, Allied Health and Consumers were not properly represented. 2. Of the two governing bodies, the RAG and the Board of Directors, it was the 17 member Board that had final authority for program and operation ec s ons. 3. The Research and Evaluation Division of Core Staff which was centered in UNC was not instituting adequate evaluation practices. The site visitors believed a stronger evaluation section should be developed in the central core office. Other observations of the reviewers were: Nearly all health agencies were involved in NCRNP planning and/or operational activities with the exception of the Black Medica Association. Little enthusiasm could be mustered for support of the arge number of renewal projects. One exception was the Stroke Project. It was believed the Region must come to grips with phasing out new projects. OUTSTANDING ACCOMPLISHMENTS: During the past year NC/RNP has concentrated on strengthening the weakness identified (above) by the National Review Bodies at the time of their triennium submission. 1. They have improved the composition of the RAG by adding a Nutritionist and an X-ray Technician to the existing three Allied Health representatives. Public representation has been increased from 4 to 12 and Black representation has been increased to 9. To accommodate t ese new members the total RAG has been increased from 36 to 51. 2. The Region has reorganized its advisory bodies, disbanding the Board of Directors, and giving final authority for all activities and policy matters to the RAG. A 13 member Executive Committee, consisting of members of 7 designated institutions and associations and 5 other representatives elected by the RAG, manages affairs in the interims between quarterly meetings of the total RAG. 3. The Research and Evaluation Division of Core at UNC has been disbanded. Replacing it is the Division of Planning and Evaluation within Core which will be directly responsible to the Director. This Division will be staffed by a Director (newly hired) a biostatistician (TBA) and an evaluator (TBA). This Division will also be supported by a $30,000 budget item to enable subcontracting for data services with appro- riate agencies. Consideration has been given to involving the Black Medical Society "Old North State" which has approximately a membership of 200. However, the Black doctor currently on the RAG and other Black physicians informed the Director this is not really a viable organization and they feel its representation would not.be that relevant. This is believed to be particularly true since the State Medical Society now has integrated representation. Of twelve renewal project requests incorporated in the triennium submission the Region saw fit to support nine during the current year. The 05 Anniversary Application requests continuation of only two renewals, one the Stroke Project mentioned as an exception by the national reviewers (see above) and the second a Diabetic Education Project. Each request one additional year support. A third renewal the Cancer Registry is being incorporated at a much reduced level into another (non-renewal) project, Comprehensive Cancer Program. In summary, of the nine renewal projects, six are being supported from other sources, two are being continued one more year and one is being incorporated into another project. In one general statement, it is Staff's opinion that the Region should be commended on the accomplishments resulting from its effort to respond to weaknesses identified by the national review bodies a year ago. ISSUES REQUIRING ATTENTION OF REVIEWERS: While Staff in its review of this application was highly complimentary of the Region's achievements over the past year in correcting major deficienc es, it identified a number of issues which should be brought to the attention of the anniversary review bodies. 1. The goals and objectives, while having been moderately revised since the triennium review, like many Regions remain extremely broad and non-specific. It should be remembered,however,that they were developed by a subcommittee appointed by the old Board of Directors, right at the time the program was undergoing the stresses of organizational change. It should also be noted that RMPS reviewers have never before been critical of NCRMPs goals and objectives. Recently a Long-Range Planning committee was appointed by the RAG Chairman. One of its functions is to re-examine and refine the goals and objectives, relating them to specific time-frames and measurable,indicies. Staff believes the Region should be praised for recognizing the need to develop more sophisticated goals and objectives as the Region matures, and would recommend that encouragement be extended and RMPS assistance be offered as part of the forthcoming advice letter. 2. While the Region is making significant strides in its attempt to seat more minority representatives on the RAG and to hire more minorities to core staff positions, there has not to date been any significant effort made to include minority or underserved health interests as a major consideration of the North Carolina Program. In the past year, less than $100,000, of program funds, have been spent in underserved health related activities. This might be explained by the fact that NCRMP has concentrated basically on quality of care in categorical disease areas which consequently relates primarily to those consumers who have some means of meeting medical expenses, with little relationship to the health needs of the underserved. While Staff recognizes NCRMP has commitments for future years to certain ongoing program activities which emphasize quality health care, the myriad of accessibility and avail- ability problems faced by the underserved of N.C. combine with the priority RMPS places on these problem Areas would indicate a need for NCRMP to devote more attention to availability and accessibility. Consideration must be given to the fact that the Region's program was accepted last year by Council, without criticism of.the direction it was taking at that time. 3. Within Core is a Continuing Edutation Component which supports part-time Institutional Coordinators and their Staff at Duke, Bowman Gray, UNC and UNC/SPH at a total of $97,158 (d.c.). At the December '72 RAG meeting these positions came under close scrutiny and a sub-committee was assigned to make an assessment of the value of supporting these positions. It is speculated by the Deputy Director that this support will be cut 2/3 to 3/4 and the institutions have been notified of the possible cutback. The Director feels a need to institute Rradual phase-out in order to maintain these institutions cooperation. As a result of supporting these positions, the schools make available faculty consultants to NCRNP and its affiliates, free of charge. The subcommittee is also evaluating the entire RMP organization outlined in the application which was developed at the time the Board and RAG were in a state of transition. It has not as yet been officially adopted by the new RAG, although NCRNP is functioning basically along these lines. There is a disagreement among Staff as to whether the insti- tutional coordinator problem should influence the funding recommendation. One side argues that the Region has not .2 hese positions and reduced taken it upon itself to eliminate t Grants Manage @ t funding would help it make this decision (see gnize The other side argues the Region does reco attachment). d has taken positive steps in the form of a the problem an it, and given the Region's record of subcommittee to resolve MS directives we could expect N.C. with proper responding to p ed changes (without punitive advice from us would make the desir his should be funding action). Besides the aregument that t done on a phased basis is reasonable. Also the funds supporting iewed by the Region as an incentive these positions can be v in that as support is reduced , these funds become available for other activities. It should also be remembered that the national reviewers a year ago had no problem with this arrangement. 4. The fact that the four Institutional Coordinators being paid out of core funds also serve on the RAG and Executive Committee, and that one serves as Chairman raises a question of propriety. Staff does not see this as a legal question as the by-laws do not specifically provide for this type arrangement. While it is obvious the Region sees no problem with this arrangement, Staff agrees it is not one which insures against suspicion or criticism of conflict of interest, excessive medical school influence, and an ackward relationship between the Director and the Coordinator/RAG members who must play duel roles to each other. Staff would recommend the Region discontinue this --arrangement, and perhaps provide against such future arrangements by means of a provision in the by-laws. North Carolina RW prepared @iwilliam Reist Date: 4/3/72 a2 The goals and objectives presented in the Anniversary C)bjectives and -Priorities: Application were developed by a subcommittee appointed the old Board of Directors. They differ moderately from those of the triennium a year ago but remain like most regions, very broad and non-specific. The RAG, recognizing the need to update and refire them, has appointed a subcommittee which is in the process of developing new ones which will be measurable and relate to specific time-frames. The national reviewers, a year ago had found the goals and objectives to be satisfactory, however as the region matures, so should the entire program. Their simplicity would indicate they are well understood, here again the reviewers of a year ago saw no problem in this area. While short-term objectives and priorities have not been identified, plans are to include them in the new ones being developed. National priorities are to serve as the general guidelines. Related local needs are to be identified taking into account data and resources. While the current goals and objectives leave much to be desired, theregion should be comended for recognizing a weakness and taking remedial action prior to it being pointed out from an outside source. - - - - - - - - - - - - -- - - - - - - - - - - - @d Ar-tim: Staff would encourage and endorse NCRNP's action -and offer RMPS Staff assistance if the Region would so desire. Arcmplishmen-ts and Implementatiots. Core can be comended on the number and types of activities it nas engaged in and stimulated. Nbst activities have been unique to the particular problem and in most instances were not readily applicable to other problems or areas. Unique activities which could have national implications are the Stroke Program and,the Test and Evaluation Strategy for Improving Quality of@Nursing Care. Practically every project is desi2ned to,or has some component which,promotes new knowledge and techniques. The effect on moderating costs can be assumed, in that the more skilled health providers are,the more efficiently they operate. Quality of care as it relates to categorical diseases is probably the most outstanding a@ievement area, however it relates mostly to those who can cover medical care expensps. Certainly the major health provider groups and institutions in the state recognize NCRMP as a source of professional expertise assistance and information. ------------------------------------------------------------------ ------------- ----------- ended-Ar-tion: No Action Recomended William Reist Date: 4/3/72 o@ 12 renewal project.requests incorporated in the triennia Continued Support,: -he current submission, the Region saw fit to support 9 during t year. The 05 Amiversary Application requests support of only two renewals, one the Stroke Project was mentioned as an exception by the national reviewers a year ago although tfiey were generally critical the large number of renewals. The second is a Diabetic Education ect. Each request one additional year of proi support. The third.ren Cancer Registryis being incorporated at a much reduced level into anotrear (non-renewal) .project, CQm-prehensive Cancer Program. It should be noted that an overwhelming success of the'Stroke Program in and mortality influenced the decision of the Region reducing hospitalization to continue it for one more year. NC@ is now pursuing a policy of insuring other sources of support for the continuation of projects it funds. With few exceptions, outside sources have picked up continued support of projects. In those exceptions the projects were not worthy of continuation. Recomenclec' Act'on: The Region should be comended for its actiOn in teminating -renewed rojects. p 4. Wmority InteTests:NCWs _goals and objectives do not place any emphasis on 1w,rovijig iiea care to the underservea. Project activity tends to reflect no particular comitnent to serving the disadvantaged. O'L the total NCRMP budget less than $.loo.o@ has been spent in this service, all in feasibility or developme@ta'!'(foinponent activities. While some of the training programs might indirectly result in some atloyment benefits to the minorities, it is only a matter of coincidence. The Director has made an outstanding effort to include minorities on the RAG and is presently try@ng to recruit three Black professionals and three Black secretaries to Core Staff.. NCRMP does work closely with CHP and in some instances Model Cities. It might relate more closely with Indian Health, Appalachian Program and Migrant Health. --------------------- ------------------------------ e North Carolina to look more closely to Recomencled Action., Encourag the needs of the undersexed -.are these not infact some of the more important needs of the Region. Encourage th6 Region to balance quality- of care with accessibility and availability, particularly as it relates to the i in(I P--r-, erved. lbte: 4/3/72 North Carolinil PMaTed By,: William Reist bordinator: Dr. Patterson has served as Director since April 1970 (2 yrs.). Before 7e-was a practiciiig.surgeon in east North Carolina and did some cancer pMming as a member of Core staff. He is highly dedic'ated and.very conscientious. He works extremely hard on his job and is respected by ail members of Core staff. He can be credited for the new RAG organization and other major accomplishments over the last year, all of which apparently were very difficult tasks,(Particularly since Dr. Patterson is not an aggressive and bold individual, but rather a person who avoids confrontation and.respects individual opinion). He relys heavily on Mt. Ben Weaver, his Deputy.to@carry out many administrative and managerial details. Ben is highly competent, but does not always take advantage of other Core members knowledge and e!Kpertisp, to the extent that he might. Core members feel they are frequently excluded from.activities to which they could make a contribution, and that their ideas do not always get proper consideration. ded Action: Dr. Patterson feels a Management Assessment Visit ould be of great benefit and will be making a written request for one to be conducted early in the next calendar year. 6. Core Staff: Administrative Core Staff consists of 12 professional Staff, 11 of whom are full time, and 9.5 secretaries. Not included in this is a new Director of Planning and Evaluation coming aboard on May 1 and two subordinates,- a Bi6statistician and an Evaluator wl)ich are being recruited. Also a Nutritionist and three secretaries are being recruited. Core staff at uNc which has served as Research and Evaluation Division has been dissolved and is being replaced by .the e lanning and Evaluation Division which will be responsible directly to tRewDirector- Within Core is acontinuing education component which supports part-time institutional coordinators at Duke, Bowman Grey,,TJNC, LJNC/SPH- totaling $97,158 (d.c.). At the December 1971 RAG meeting, these positions came under close scrutiny and a sub- committee of the RAG was assigned to make an assessment of the value of continuing support for these positions. It-is speculated by the Director that this support will be cut by 2/3 to 3/4. The institutions h=llb%en notified of possible cutbacks and are'somewhat disturbed. As a result of supporting the coordinators, the schools make available other faculty consultants to NCRMP and its affiliates, free of charge-. The evaluation of the contribution of these people is done subjec@ tively. Some members of Core Staff 'are skeptical that dollar value to NCRMP is received, howev.er, most can see the overall continuing education effort of the Lmiversiti6s in North Carolina is enhanced. The Committee evaluating the Continuing Education c6mponent is also examining the current organization including t.],- rr.,@-litee.-qtnirtllrp ------------------ -------------------------- Recomended Action: Coimnend the RAG in its effort to examine the,continuing education component and 'internal organization. Point out that organizational planning should be'done in concert with establishing goals objectivesand priorities. epaTed By: Willinm Reist Date: 4/3/72 .jo Aclv-isory (;Toup: Reviewers of the Triennium Application one year ago 7. Regional deficient in consumer, allied health, Jay and Black - e=l ( representation. The RAG now has or will have in the near future twelve members Of the public at large, five allied health representatives and nine Blacks. The recommendation that the Board of Directors and the RAG be combined into one governing t. An Executive Committee meets on a monthly basis to aqt body has been carried ou Itings generally have a 6S- on business for the RAG which meets quarterly. RAG mee ecutive Committee, 70% turn out. out of -the five ele6t6d members to the 13 -member Ex , at uNC-none are Blacks .'i The RAG has one.,represents the public and is a professor orted only met twice in its new capacity as a @olicy-making body, however, it is TeP that it has demonstrated new st're@gth at- the last meeting by questioning the organization of Core staff. As a result it appointed a committee which is currently reconsidering NCRMP organization. lVhile Staff has offered the current organizational chart, there is some doubt that it will be accepted. Althouah the committee has met once it has not made known what in fact it is considering. --- - ------------------------------------ - - ----- ed Action: Comments relevant to the RAG and the related by-lawl are part of the attached Grants Management Branch report. Du serves strictly a,. antee Organization: the Core staff member who works closest to the grantee reports 8. G-r Duke has never tried to use its position as grantee to influence decisions being made by NCRMP. He reports that the only problem arises out of the attempt on his part and personnel at Duke to maintain books and records which comply with both Duke and RMPS regulations . He claims this at times strains personal relationships. He claims that Duke is not enthusiastic about serving as grantee and tends to be quite in@ ependent. It has recently dissolved, for no apparent reason, its relationships with another federal agency from which it was receiving indirect costs. ----------------- ---------------------------- ---------------------- ent Branch sees a problem in the relationship Recommended Action. Grants Managem between Duke University, the Grantee and the RAG. This problem is outlined in detail iik the attached Grants Manaizement. Branch Report attached to the Prog@am Analysis GuicLe. @IP: North Carolina Prepared By: William @eist @]Date: 4/ Most key health interests are represented on the RAG. Numerous other articipation- health institutions are involved, in that-they are active participants in ongoing projects.. llhile NCM has recently worked-closely with Migrant Health, and in fact is supporting one of its projects, there is.little evidence that rapport has been established, or cooperative efforts have-been made, with Indian Health Services or the Appalachia Program. History indicates that the program has been highly medical-school oriented and dominated.. The recent RAG related changes, appeared to be having a significant change in -the balance of power. This is exemplified by the RAG's new initiative in assessing the total program and in particular the institutional coordinator's role,. ------------------------------------------------------------------------------------------- -R6c6men'ded Action: (,iven the new emphasis North Carolin is placing on deliv a ery systems and the considerable number of migrants,Indians and rural poor in North Carolina, it may be beneficial for the Region to work more closely with the Appalachia Program, and Indian Health Services. Consideration might be given to including these groups on the RAG and subcommittees of,the RAG to which they might relate. 10.' Local Planning: North Carolina has not subregionalized and developed local planning groups as have many other regions. Rather, it has assisted and is-continuing to assist both with Core personnel and financial support the.development of health., Planning Councils in the seventeen multi-county planning regions designated by the governor. With this assistance available, planning, councils are now organized in the eight western planning regions-A handicap faced'by these planning organizations is the extreme difficulty in recruiting program directors. The -Region is assisting the planning councils in this area. Planning councils are developing in the other nine regions which are located in the east. The Region envisions its close working relationship with these organizations through the chief staff members(Fishel and Young) who have respon'sibility.for the continuing coordination of activities. These two people have almost daily contact with the planning regions. NCRMP policy-is now to involve local planning group@ in the initial stages of program proposals. ----------------------------------------------------------------------------------------- @mended Action: No Action Indicated Date: 4/ RW: North Carolina RMP PrL-2ared B So long as the Board of Directors existe 11. Assessment of Needs and Resources: needs were determined primarily-by this g and to some degree were based on institutional interests. Most programs,however, include some analysis of data. There-is continuing collection and updating of relative data particularly as it relates to heart, cancer and stroke, and attempts are being made to.relate@it-to new program goals in an effort to develop more specific objectives. This effort should be greatly enhanced by the new Director of Planning and.Evaluation scheduled to,join,NCR\lP. in June. The centralization of the Planning and Evaluation Division at Teer House, as opposed to previously being split with UNC, should also strengthen plann.ing efforts, as should the reorganization of this Division directly under Dr..Patterson. Hopefully, the new organization of the Planning and Evaluation Division and the new Staff will provide the needed back-up for the planning bodies in their effort to change program direction, including the establishment for the goals and objectives which are relevant to national priorities, but which have special significance to North Carolina. In addition it is hoped this division will provide the -expertise for defining measurable objectives related to specific time-frames. ------------------------------------------------------------------------------------------- P,e'comended Action: No action indicated, with perhaps the exception that the Region should be complimented'on its-reorganizational efforts related to the Planning and Evaluation Division and the hope on the part of RWS that this division will play a significant role in identifying the needs of the .Region based on valid data, and that the decisionmaking bodies w@ll use this data in the development of,their program. 12. Management: Core Staff is a relatively small group of individuals who demonstrate a e of team spirit. They respect each other and consequently take advantage of e'ac others knowledge and capabilities in the consideration of their own program interests. They have weekly staff meetings which are designed to coordinate.activities, however, much coordination is done on a one to one basis as need arises. Each member is responsible for monitoring projects and other activities. lqhile most have monthly contact with their related activities, formal evaluation reports are required-every six months. ..Final reports are required as are monthly fiscal reports. -------------------------------------------------------------------------------------- ,Recommended. Action: - - - No action indicated at this time. It should be noted that this aspect of the program will be covered in more detail in'the upcoming verification visit. Date: jj North Carolina: RUP Prel3ared BY: w ation Visit-it is Without the benefit of a Review Process VerifiC difficult to make any-valid assessment'of the evaluation process in North Carolina. In discussing the subject with @aff, they e is a need for incorporating more thorough evaluation techniques in developed and more stringent demands should be put ,projects as they are being on pvogress,reporting wh@ich-takes place twice a year. it is anticipated that der the new Director of Evaluatioii will have a significantly stronger position un the hew organization than the previous one. site visits of Technical Review Comittee's does take place when indicated. In one instance negative results in national program emphasis-has resulted in discontinuance of a project. --------------------------------------------------------------------------------- Fbdoimehcled'Action: None indicated at this time. Evaluation process as presented in the application is vague and should be clarified at the@time of -the April 27, 197: .Verifica:Clon visit. 14. Program Pro-Dosal: Goals and objectives are vague and priorities have not been set in any meaningtu.L way. The RNP claims-this will be incorporated as the new goals.and objectives are developed. Two of these in.the past have related quite well to the goals and objectives, concentrating on Categorical Diseases, Continuing' Education,Manpower imd Rekionalization. The intended results of able of being quantified, however, this does not appear to activities are cap be done with any consistency. Progress report-s are-required twice annually but thei relevance is unknown at this time. Staff--claims attempts to rank.p@ojects against a -standard set of criteria has been rejected by the RAG. Each RAG member is individual criteria. ranks.projects according to h ------------ ----------------------------------------------------------------------------- Recom6nded Action: Given the relatively l'ittle information we have with regard --tcf this aspect of the North Carolina Program it is difficult to make a valid ass sment.. Clarification should be ma4e at the time of the es upcoming Verification Visit on April 27, 1972. Date: 4/3/72 William S. Reist North Carolina RMP, prepared By of Knowledge: Since a large number of NCM proj ects are 6ithef Dissem, inatiori educational in nature.or have educational components, they o in fict,.do disseminate knowledge to larae numbers of individuals in a la@ge number of facilities throughout the state -many involving the three major technical schools. Recently attempts are being made to involve more community schools. We can only assume better care to more people will result in some upgrading of the skills and kriowledge-of medical personnel. Most activities relate td more.serious problems of the categorical diseases, still others in health manpower relate more to the lack of allied health personnel. ---------------------------------------------------- -------- ------------------ 7------ Should @ommend the Region on its eEfort to de-emphasize categorical Recommended- Action . disease@. Encourage'the Region's awareness.of problems related to availability and accessibility of care in.the use of paramedical personnel -to make improvements in these problem areas 16. Utilization of Manpower and Facilities: The cancer, Stroke, and CPR projects all emphasize the need to-utilize or improve certain medical facilities,. so that they may serve an expanded role. As stated above, wIe can only assuneproductivity,of physicians is increased through education but it might be increasecy-more rapidly by concentrating more on delivery systems. Three projects are developing new allied health personnel.While manpow6r has been a goal of the region for some time, NCRMP is placing more emphasis on it.. 'Ihe Family Nurse Practitioner and the Nurse Associate projects should ha@e particular influence on the underserved.. ------------------------------------------------------------------- -------------------- Recommended Action: No action indicated. Date: pj,lp: North Carolina RMP Prepared By: Wilriam eist 4/3/72- Programs designed for the improvement of health care relative] Aftl7. Improvement of Care: lacking in NCPM. None of the current p-rojects.relate to improved primary mbulatory care delivery systems and, in particular, non' relate specifically to the poor, black,.and red minorities. Six activities related to improvement of care are.supported by developmental component funds. While the Region has the capability to make studies related to access and availability of care few, in fact, have been conducted. @st of those-which have been undertaken resulted in outside support for operations. One of the new goals being considered is health services delivery systems. As stated before, this is an area which staff would encourage greater emphasis. It should be remembered when considering this aspect of the program, that.NCRMP is somewhat @6mmitted to a categorical program related-to quality of care by the fact that this is-hoiv the original Triennium Application was designed'two years ago by the Board of Directors. --------------------------- -------------------------------------------------------- -Action: Conveyed to the Region, RMPS' endor ement and encou ement of Reconn. ended @ag- s greater emphasis,on availability and accessibility of care,- @ary @o the under-7 p served. 18. Short-term Payoff: We can only,assme activities being undertaken by NCRMP will have sitive-effects on accessibility, quality of care, and cost moderation, @ Po since the Region has not reached a s@age of sophistication by which it can evaluate progress in these areas. -The p'rograih is still highly geared to quality of care particularly in categorical diseases. Support in most instances can be withdrawn in three years or less. It should be notbd that th6,November 19-70.Site Visit Team did s.ight numerous' @p-roj.ect atcompli bments of the Region, although they did not relate specificall Y to criteria of accessibility, quality of care and cost moderation. Similar accomplishments, are sighted in'-the current application, most of which demonstrate significant achievements in training, expanding activities into other institutions, @development,.Publication, and distribution of -educational materials, mortality rates hospital stay rates, screening and follow-upand expanded use of paramedical personnel. ------------------------------------------------------------------------------------------- @ehded Action: Convey tothe Region our.hope-.that the new Planning and il-da-ri:cFn 'Divi7s@6n'will make an increased effort to access activities as they Late to availability of and access to services quality of care and moderation of costs. Date: '4/3/72 William Re ionalization, Re i?na-,,-zaT-loi iple provider gT s) and newly lanned activities serv.e Mult While most ongoing p -rvices are sharing of facilities has been a by-productstscarce resources and se ilabl'e but on a som&what unpyoportionate -rate between .6xamples of being made more readily ava d S@roke projectsa-re prime . The.Cancer-an the affluent and underserved Th re is no and. '.lity of resources and services e q.ua is involved have served improving both the q'uantity I-an and in which NCR4P -K- doubt that the many activities Lmderta efforts@of the heaath organizations to strengthen linkages and coordinate planning in many instances. within the Region. NC@ has served as a major catalyst - - - - - - - --- - - - - - - - - - - - - - - -- - --- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - No action indicated. 20. Otlier Funding: NC@ staff have worked on a number of activities which,once developed into al.$ have attracted OEO and MO funds for operational support. potential propos They have attempted to help other-pro@osals identify sources of support. -.Many. are co suPPOr of the Regiorl's activities ted with other funding sources and,iii turn, tend to c lement each Others efforts. OMP ------------------------------------------------------------- --------------------------- Recommended Action: the role it has played in identifying an The Region should be complemented on t of-activities which will serve to.improve the total soliciting outside suppor health care system in North.Carolina. ADDL,NDIR@I Ti) CAff)LF-iA r,7Ar-F- tAs an oversight ir, nr)r Staff Briefin@, on lqortit Ciroli@-ia, I neglect@-, to iwlude ttic f,,ict t@4,it t'iic observations !,,-adc, ivcre collectively agree(. uf*n @v Sti'Lf at its re,,riew oi-i Staff attending include,-': Gene Iiclson PlaiL-iii-W -.2iid Pyalu.,,tiort Di@,.Lsior. Teets Grants Itmst Bra,-.cii t T(Xl Griffith Regional Office Representative - Region TV Lee Van Winkle Soutii Cc.--,tral Operatiorz Prar-cli Bill Reist Soutli CentTal Operations 'Br;mich Joeme Parks @th Cejitral ErancJ) Gloria flicks Souti Central Operatio.,,is @i@rancii .5MTon Dt@ @th Cmtral Operatior-s il-r-,an&. Staff could not unani;wezly apTee on a rcca,.,rvndation. I%.to recc4incmtatimis %4ere therefore ma@ for SAPP consi-,ie-ratioii. 1. The Rej, m be anrove,li for the 05 operatioial ye-,ir ,it the r@tod level of $2,080,008, wILicli is I,:)wEr ti-ian tlic NAC level of $LI,194,400. pmved 2. The Region be app-roved at the rftluested level, but that fundin- @orizatio,.i for the Instittitional @rdinators/Contiyriing Education @nent of ('@re I)e withheld rLtil StAff 'was reviewer the RAG -r n@ations for t'iis cm.Wnent bi mUition to receiv:big a justi Fication for t'ic ne@i of tl)ese representatives to Core Staff. time c ts woul(-' =ost appropriately apT)ea-r on page -16 olr ycKtr North Carolina Briefiitp,, liocuntent. lllillian S. iZeist Ptitilic Ilealtl--l Aclvisor Soiith k',entr,-il @,eTations Brancii mii @,.i-;@cai rropr". Service SR:cmg Board File 303B/ -DOD/@, IEMORANDUM DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE PUBLIC HEALTH SERVICE HEALTH SERVICES AND MENTAL HEALTH ADMINISTRATION Acting Chief DATE: March 31, 1972 South Central Operations Branch Chief ,@OM Grants Management Branch jBjECT: Review of Continuation Application for North Carolina Regional Medical Program Grants Management Branch's concerns, as expressed in the Continuation review of the application submitted by the North Carolina RMP, have been accommodated by an in-depth review of existing documents. The results of this review are reflected in the enclosed material which is provided for attachment to the documents prepared by your staff for review by SARP. The organizational structure of the North Carolina RMP appears o be compatible with the advice given by the Operations Desk, as evidenced by the attached letter dated, March 13, 1971. Therefore, any constructive recommendations for change ought to be carefully phrased in the Advice Letter, to the RMP subsequent to SARP- Council action. Your attention is invited to the recommendations contained in the last paragraph of the GMB review concerning the funding of the Core component for Institutional Coordinators and Directors of Continuing Education. d T. Gardell Enclosure Grants Management Branch March 31, 1972 North Carolina RMP organizational Structure The North Carolina RMP is organized in a manner which places Duke University, the grantee, in jeodardy of audit exceptions for situations over which it has no control. The transfer of its responsibilities as grantee to the "Association" also Approaches sub-granting. . The By-laws of NCRMP recognize Duke University as the applicant organization and fiscal agent. The same By-laws almost immediately dispose of Duke with that one sentence of reaognitidn a'tid proceed to the Association and RAG. All duties and responsibilities for both the program and administrative management of NCRMP are assigned to the RAG. The Association appears to function more as the Board of Directors in'an incorporated RMP, but it in fact has no such legal foundation. The RAG can be controlled by a very small number of people. Provision is made in the By-laws for more than 60 members of the RAG and there is a good balance. However, aquorum is only 25 .,nd 2/3 of those present and voting where a quorum is present shall be an act of the total RAG. This then means that 17, or fewer, can act for more than 60 peop'-e. A similar situation is even more diL irbing in the case of the RAG Executive Committee because ot the inherent power of an executive committee. The NCRMP Executive Committee is composed of 13 members with 7 constituting a quorum. Again, 2/3 of th-se ?r-sent and voting act for the entire committee which in ti-n speaks for the total RAG beLween meetings. Therefore, 4 or fewer me@ :a of the powerful Executive Committee can act for the total RAG. Changes in the orgA--ii-;ational structure, 'Trantee involvement, and the By-laws are necessary. Apparently Duke University is willing for the Association to assume Dukes responsibilities as grantee. Since there is no indication of trauma.resUltilLg from a change, the Association should become legally incorporated and be made the grantee for NCRMP. The By-laws should be rewritten to clearly assign program responsibilities to the RAG and administrative responsibilities t the grantee. The By-laws should also be changed to require a quorum of the RAG and Executive Committee to be one inor6 thnn 50% of the total membership. .Ala,,, the wording should, be changed to r-quire that a majority vote of those pre,sept at a quorum@be necessary for the vote to represent an act of the tota.L body. This would cause the words "and voting" t:o be removed from that ortion of the By-laws s eaking to the number of votes required p p at RAG or Executive Committee meetings. Included in the budget request for Core is.$97,158 for Institutional Coordinators and Directors of Continuing Education. The program has supported this service thru the three medical centers and are of two types: (a) a physician in each institution serves in a liaison role to the program on a part-time basis of 25% time and effort. (b) the program has supported approximately 10% of the salaries of the Director of Continuing Education in each of the three medical centers. These physicians work closely with Core Staff Director of Continuing Education in planning and conducting NCRMP supported educational activities throughout the State. Because of the decline in importance of continuing education, the RAG has designated one of its committees to study the situation and possibly reduce the funding requirements, if they determine that this activity should be reduced. These activities have been supported in the past. In reviewing financial data obtained from the region, a total of $132,328 is being requested to support these activities ($97,158 D.C. and $35,170 I.C.). Institutional Coordinator and Continuing Educatio A copy of the n Component budget is attached. It does not indicate in which capacity the individuals serve, clerical, Institutional Coordinator or Director of Continuing Education. Although one individual may serve in two capacities, the total time and effort should not exceed 35%. However, the budget requests for Dr. Emery Miller (Bowman Gray) and Dean Fred Mayes (University of North Carolina) exceed that figure. There are 6 professionals listed which average 36% effort. Since there are four Institutional Coordinators at 25% and 4 Continuing Education Coordinators from the three medical centers, (according to the application) at 10%, the maximum % of effort would average 17.5%, so the salaries claimed are somewhat out of line with that stated in the application of the individuals listed. The followind individuals receive compensation from the Institutional Coordinator and Continuing Education Component and are also members o.f the RAG and the Executive Committee of RAG; 1. Dr. E. Harvey Estes, Chairman, Dept. of Community Health Sciences, Duke Medical Center, also Chairman of RAG and Executive Committee 2. Dr. Robert Smith, Professor and Chairman, Dept. of Family Medicine, UNC., School of Medicine, also Vice Chairman of RAG and member of Executive Committee 3. Dr. Emery.C. Miller, Associate Dean for Continuing Education, Bowman Gray School of Medicine 4. Dr. W. Fred Mayes, Dean, Schoo'@ of Public H ealth, UNC. There are thirteen members on the Exe cutive Committee of RAG and four are paid from Core funds, including the Chairman and Vice-Chairman of the RAG. Because of their Core-related activities and their responsi- bilities as members of Core, it is indeed hard not to assume that some of-the activities for which the individuals are being compensated are for RAG-related activities, particularly in light of the rather large percentages of effort charged to the grant. Furthermore, there may be a conflict of loyalties resulting which would infringe upon their abilities to perform in their capacities as members of RAG and Core. It is recommended that staff withhold funding authorization for the institutional Coordinators/Continuing Education component of Cote until they have reviewed the RAG recommen dations for the Continuing Education component in addition to receiving a justification for the need of these representatives to the Core staff. We further re- commend that no member of RAG (excluding the Executive Director of the RKP) receive any compensation from the program other than for travel expenses for RAG meetings. The final recommendation is that the Chairman of RAG (currently an employee of the grantee institution and a member of Core staff) should not be permitted to serve as a ,voting member of the RAG. Efforts should be made to replace the present Chairman at the next election of RAG officers with an individual not employed by the grantee (Duke University). or and Continuing Education Component Institutional Coordinat FY 1973 Approx. Fringe Name of Salary Benefit Duke UNC 71,4c/SPR BG -Effort Harvey Estes, Jr&p X*De -36 $13,320 $1,065 $14t985 .len'Bivins 50 @@351 419 3,770 27 5,600 .625 5,.625 lliam DeMaria, MOD. 668 bert Sinith, M.D. 15 4,575 59.243 ncv Vernon 20 1,400 204 1, 604- .7,950 11161 Glenn Pickard, MOD. 30 9,111, Glenn "Zilson 15 4,725 690 '5$415 @an Fred ',Mayes 50 13,542 1,977 ,dia Holley' 10 1,818 265 2,083.- terv I-lill.er, M.D. 60 17,000 1,700 $181,700 @llv Rae McCartney ioo 500 5.500 $2lp373 $173,§02 .$24,200 Tota'u Salaries $77,681 $9,874 $24;380 627 431 500 Travel & Other 45 8 Totals $24,,425 $30,,OOO $18,033 $24,700 Total Direct Costs $97,158 Indirect costs, $32 677 Total $129,835 FY 1977 --)st UNITED STATES GOVERNMENT DEPARTMENT OF HEALTH, EDUCATION, AND WELFAR' emorandum REGION IV - ATL..ANT.A Mr. William Reist TO South Central Desk DATE- March 20, 1972 Regional Medical Programs, Rockville REFF,R TO: FROM Regional Health Director, Region IV, Atlanta SUBJECR: North Carolina Regional Medical Program Continuation Application I have reviewed the North Carolina RMP Continuation Application and have requested reviews from other programs represented in the Atlanta Regional Office. I want to give you a summary of the comments that were made: Grants Management stated that they do not have the guidelines against liable costsj etc., and that it would be hard to come up with specific suggestions since they are unfamiliar with Regional Medical Program ServicesIpolicies. This has been discussed with Mr. Gardell who has promised to send updated information regarding Grants Management policy for Regional Medical Programs. office of Comprehensive Health Planning stated that "this is a very impressive, agressive and bold application. It is well coordinated, clear and concise. The justification for additional funds seems realistic in terms of program activities and there is an interlocking membership between Rt4P and CHP. Although the applicant states that this application has been reviewed by all appropriate health planning agencies and without any adverse comments$ the application is void without these comments. It would have been of interest to this reviewer to have seen these comments in order to analyze how CHP views the activities of RN]?. It is the recommendation that this application be approved with the additional funds requested." Health Maintenance Organization program states "In addition to a somewhat unique and abbreviated format, the writer was impressed with the attitude of the North Carolina @ regarding new and current trends in health, with particular emphasis on alternate health care systems and Health Maintenance Organizations. Although one might readily say that their activities have been somewhat limited in regard to HMO development to date, this could be expanded considerably through one of the following methods: (1) utilization of both a formal and informal reporting system through the Regional DUCTION PROGRAM Mr. William Reist, RMP, 3/20/72 Representative concerning HMO potentials as well as developing activities in North Carolina, (2) that a conscientious effort be made to involve North Carolina @ officials early in the planning sphere of any HMO activities, and (3) to further consider possible funding potentials for RMP and HMO development; this would also relate to programs that would be concerned with future HMO potential, such as Family Health Centers, Neighborhood Health Centers and indeed any type of prepaid or fee-for- service delivery system with specific population groups in mind. Again, I would.reiterate that the North Carolina RMP proposal is brief and concise yet covers the,realistic elements of a very diversified program in the health field." Community Health Service program states "At the present time there are four county migrant health projects receiving federal grant funds from HSMRA to provide services to migrant and seasonal agricultural workers in North Carolina. In addition to those four projects the State Board of Health receives some HSMHA funds to provide health services to the migrants located in areas of the State other than within the four project counties. The limited categorical funds do not allow for providing adequate health care services to the migrants and the added problems of lack of accessi- bility and residence requirements to participate in state programs further magnify the problem. Education and income levels and language barriers, in some cases, tend to isolate the migrants from necessary health services. The developmental component of the North Carolina Regional Medical Program contains a category in the amount of $35,000 to provide health care ser- vices in conjunction with the State Board of Health to migrant farm workers in North Carolina. When combined with the migrant health categorical funds of the North Carolina State Health Department project, this will allow an extension of health care services to migrants outside the four county project areas where the needs are probably the greatest. In addition to the migrant health categorical funds, the funding of projects involving emergency health care services and providing health services to the rural underserved areas of North Carolina will have a significant impact on the migrants' health care needs. The North Carolina Regional Medical Program has apparently recognized and is responding to the health needs of this particular segment of the population which is in a difficult position in obtaining health care. Migrants in other states are in the same status in regard to health care needs, and the problem recognition and efforts of other Regional Medical Programs would influence the services made available and have a positive impact on the migrants' health status." Y-S Mr. William Reist, REP, 3/20/72 Division of Emergency Health Service states "In general, the references made in this plan to emergency medical services are peripheral. They seem to overlook the total EMS system approach. I am unable to find reference to the State Comprehensive Emergency Medical Services Systems Plan and how EMS activities of R4P are coordinated within the scope of this plan." In summary, I was impressed with the organization of the material, the conciseness, and I was very happy with the application. I have not received comments from Health Manpower, and @ternal and Child Health Service. When they are available, I will forw on to you. Emil E. Palmquist, M.D. BY: Theoda H. Grif'fl'th Public Health Advisor, RMP -Y fo THE ASSOCIATION FOR THE NORTH CAROLINA REGIONAL MEDICAL PROGRAM Executive Office 4019 North Roxboro Road, P.'O. Box 8248, Durham, N.-C. 27704 919 - 477-0461 F. M. Simmons Patterson, M. D. Executive Director March 29, 1972 Mr. William Reist Operational Branch Regional Medical Programs Service ParklaNqn Bu4-lding 5600 Fishers Lane Rockville, Maryland 20852 Dear Bill: In an effort to keep you and the Regional Medical Programs Service Staff abreast of new developments concerning the North Carolina Regional Medical Program, ,-he progress that is being made, I would like to emphasize the following: and (1) As you know, whereas in the past the North Carolina Regional ',,Iedical th a Board of Directors and an Advisory Council, we now have only Program had bo one goverpiii- body, the Re-i6nal Advisory Group. At the last L.Leeting of the ? b Regional Advisory Group on March 15, 1972, the Membership of this body, on the recommendations of the Nominating Committee, was revised so that we now have an increased number of Allied Health representatives and Ifinority representatives. I am happy to state that at the present time that in rel.ation to the total Membership of 51, 18% are Nlinority members. I am enclosing a copy of the Regional Advisory Group Membership on which the Minority members are specifically designated. (2) On November 18, 1971, we received a document from the Regional Medical Programs Service stating the specific requirements that should be covered by the Articles of Association or Bylaws of a Regional Advisory Group. lqe have met several times with our attorney, Mr. Charles Dameron, of Greensboro, North Carolinai and have amended the Articleb of Association with the unanimous approval of the Regional Advisory Group, so that at the present time we feel our Articles of Association satisfactorily encompass the requirements listed. For your edification, I am enclosing a copy of the Articles of Association in its recently amended form. (3) At present there are three vacancies on our Professional Staff. I have made a sincere effort to recruit Minority members for these positions. Tomorrow, I am intervie@qing a Minority member for a position on our Planning and Evaluat4.on Division, and feel that this individual will sign an agreement to join our Staff ,terview. -.i- 'I)osit at this ir. For the two atlic ions we have c(-jnticLc-d Minority individt,-.@'s that I will interview in tli(! next wc,el( oi- so. T fc!t-I t-li;it I will I-,c. In two @lli 'I(Itlitioll!i I() ()tlr '; t ;i f 1'. q7 Mr. William Reist Page Two If I am unsuccessful in this endeavor, I will further pursue my efforts in this direction. (4) In regard to the matter of the Institutional Coordinators and Directors of Continuing Education that you have discussed with me several times, an Ad Hoc Committee was appointed by Dr. Harvey Estes, Chairman of the Regional Advisory Group, to study this matter in depth. The first Meeting of this Committee was held yesterday and much progress was made. Another Meeting will be held in several weeks, and hopefully, a wise and just decision can be made concerning this matter. (5) A Long Range Planning Committee of the Regional Advisory Group has been appointed and its recommendations concerning the goals and objectives in keeping with the new emphases and directions of the Regional Medical Program have been adopted unanimously by the Regional Advisory Group. (6) Subconunittees of the Reg4-onal Advisory Group are being appointed so that the Regional Advisory Group Members can be more int.imately involved in the operation of the North Carolina Regional Medical Program. As developments arise concerning our Program, I will continue to keep you informed. With kind personal regards, I am Very truly yours.j,-, @.f. P2tterscn, @!.D. Executive Director FMSP:mh dc: Dr. Harold Margulies Mr. Lee R. VanWinkle Enclosures REGIONAL ADVISORY CROUP of the NORTH CAROLINA REGIONAL MEDICAL PROGRAM CHAIRMAN: E. Harvey Estes., Jr., M.D. VICE-CRAIR!.IAN: Robert Smith, M.D. SECRETARY: Joseph G. Gordon, II.D. Medical Society of the State of North Carolina Charles W. St yron, M.D., President Medical Society of the State of North Carolina 615 St. Mary's Street Raleigh, North Carolina 27605 Phone: 919-832-6307 John Glasson, M.D., President-Elect Medical Society of the State of North Carolina 306 Soi,th Gregson Street Durham, North Carolina 27701 Phone: 919-688-1059 resEtntatives-at-Large from the Medical Sncietv of the State of North Carolina Edgar T. Beddingfield, Jr., M.D. .*John R. Chambliss, M.D. Wilson Clinic Boice-14illis Clinic 1704 South Tarboro Street 100 Nash Medical Arts @iall Wilson, North Carcilina 27893 Rocky Mount, North Caroll.na 27801 Phone: 919-237-2151 Phone: 919-443-884". represents Eastern North Carolina represents Eastern ',worth Carolina 'Joseph C. Gordon, M.D. George W. Paschal, Jr., M.D. Kate B. Reynolds Memorial Hospital 1110 Wake Forest Road 1101 East Seventh Street Raleiv-h, North Carr-'l.-'@-- '-)7(-04 Winston-Salem, North Carolina 27101 Phone: 919-832-3431 Phone: 9i9-@24-26:3i represents Central ',\orth Carolina represents Central North Carolina *Julian S. Albergotti, Jr., M.D. Louis deS. Shaffner, M.D. 4101 Central Avenue Bowman Gray School of Medicine Charlotte, North Carolina 2820 Wake Forest University Phone: 704-537-0020 Winston-Salem, North Carolina 27103 represents Western North Carolina Phone: 919-727-4502 represents Western North Carolina Chief E-.@ecutive Officer. Duke University School of Medicine William G. Anlyan, ii.D. Dr. Anylan's designee: Vice-1.1r@.s-.'der,t for Ilealth tLf- 'Lairs *E. Harvey Estes, Jr., M.D., Chairman Duke University Department of Community Health S,'-n( Durham, North Carolina 27710 Box 2914, Duke Medical Center Phone: 9101-684-3438 Durhain, North Carolina 27710 P]IOII)C: 919--684-531+ Cc)rmlttee School of Medicine @icf @cutive officer, Bowman 11(@tads, M.D. Dr. Meads' designee: ,,.,,;ident for Medical Affairs *Emery C. Miller, II.D. Vice-) Bowm;lil ii-ay School of Medicine Boiman Gray School-of Medicine Wake University Wake Forest University Winstt'l$ !;alem, North Carolina 27103 Winston-Salem, North Carolina 27103 Phone. 919-727-4301 Phone: 919-727-4683 Chief-.I,@(?cutive Officer, Univ hool of Medicine Christ4liolier C. Fordham, III, M.D. Dr. Fordham's designee: Dean *Robert Smith, i@I.D. Univel-@.@lLy of North Carolina School of Medicine I ,f Medicine Department of Family Medicine Schoo Chapel North Carolina 27514 Wing D - 3rd Floor Phone: 919-966-1116 Old Nurses' Dorm'itory Universit of North Carolina y Chapel Hill, North Carolina 27514 Phone: 919-966-5152 Chief l@,i, cutive Officer, University of North Carolina School of Public Health W. Frc,t Mayes, M.D., Dean Dr. Mayes' designee: School i,f Public Health *Mr. Charles L. Harper A&ivcr,@ity of North Carolina Associate Dean en,,,, liall School of Public Health lwapel 'lill, Nortli Carolina 27514 University of North Carolina Phone: 919-966-1113 Rosenau Hall Chapel Hill, North Carolina 27514 Phone: 919-966-111 reE,,,tiiatives of the N rth Carolina Hospital Association Mr. Jo,,@,@tili James *Mr. Robert R. Martin AdMini,,.I&aLor Administrator !@,L :7,Dspital y Goldsl,@@lt,, North Carolina 27530 Laurinbtirg, North Carolina 28352 Phone: 1)19-723-2211 Phone: 919-276-2121 represents Eastern North Carolina 14t. Eai-I Bullard Mr. Don C. Morgan Admini.,iirator Administrator P,owan @iitiorial Hospital C. J. Harris Community Hospital Salisbti,V, North Carolina 28144 Sylva, North Carolina 28779 Phone: Y04-636-3311 Phone: 704-586-2151 er tial North Carolina represents Western North-Carolina repr ,oiil-s Cen Direct(", North Carolina State Boara of Health @.acob M.D., Director Dr. Koomen's designee: rth (',(rjl.ina State Board of Health W. Burns Jones, M.D. 5 Nolli, McDowell Street Assistant State Health Director post Box 2091 North (,arolina State Board of Health 0 i$vrtil Carolina 2Y602 Post Office Box 2091 Raleigli, North Carolina 27602 Iortli Caroli.nii Scl,001 of Dciitistry Chief E% -or, Universitv Of ,:cct,,t ive Of Jam@s I,. Ila%,iden, D.l@. Dean Dr. Baw(Ic@ii's designee: School of.Dentistry Ben D. Barker, D.D.S. Associate Dean for Acad mic Affairs University of North ro 1 ina e Chapel Hill, North C,---.-olina 27514 School of Dentistry Phone: 919-966-1161 'University of North Carolina Chapel Hill, North Carolina 27514 Phone: 919-966-1161 Chief Executive Offi@er, North Carolina Medical Care Commission Mr. Ira 0. Wilkerson North Carolina @ledic-,t'- Care Commission Post office Box 25459 Raleigh, North Carolina 27611 Phone: 919-829-7461 Director, North Carolina State Boardo of Social Services Mr. Clifton M. Craig, Commissioner Mr. Craig's alternate: State of North Carolina Mr. Emmett Sellers, Director Department of Social Services Medical Services Division Post Office Box 2599 State of North Carolina Raleigh, North Carolina 27602 Dgpartment of Social Services Phone: 919-829-3055 Post Office Box 2599 Raleigh, North Carolina 27602 Phone: 919-829-4550 Chi f Executive Officer, North Carolina State Nurses' Association *Eloise R. Lewis, Ph.D. (designee) Professor and Dean School of Nursina t, ,,I--,itv of North Carolina at Green@boro Univ Greciisb:)ro, North Carolina 27412 Phono: 919-379-5177 Chief Executive Officer. Office of Comprehensive Health Planning Mr. I.'ln,2r M. Johnson Post Office Box 1351 Raleigh, North Carolina 27602 Phone: 919-829-4139 rc,r,o,itativ of Comprehensive Health PlanninR "b" A5zenci.es Mr. Co-orge @t. Stockbridge 1975 ExceLitive Secretary "laiiLiitig Council for Central North Carolina Home St,.,.urity Building 505 Chapel Hill Street Post off-ice Bo--< 61. north C-qroli,,-t 2770'-) Plioiit@: 919- 682- 3640 lir,a e Veterans Administration- system of Nortli Caro Ilospitizl Director Veterans Adm'nistration Hospital 508 Fulton Street Durham, North Carolina 27705 Phone: 919-286-4934 Representatives of Public-at-Large East:_ *Mr. Charles James 1973 *Mr. John Taylor 1973 Director Darden Funeral Home Cho noke Development Association Wilson, North Carolina 27893 a Phone: 919-237-2169 104 Third Street Murfreesboro, North Carolina 27855 Phone: 919-398-4131 'Mrs. Marjorie B. Debnam 1975 *Mr. 0. T. Faison 1974 - Post Office Box 728 1615 East Davie Street New Bern, North Carolina 28560 Raleigh, North Carolina 27610 Phone: 919-637-5632 Phone: 919-834-4602 a J)avid G. Warren 1974 'Mr. Walter T. Johnson, Jr. 1975 institute of Government Attorney-at-Law Southeastern Building Knapp Dii'Ldiiig North Carolina 102 North Elm Street University of Chapel Hill, North Carolina 27514 Greensboro, North Carolina 27401 Phone: 919-933-1304 Phone: 919-274-8463 "Mrs. William J. Kennedy, III 1975 Harvey L. Smith, Ph.D. 1975 102 East MAsondale Avenue Social Research Division r-- r i'L a I 'L Phone: 919-682-7645 University of North Carolina Chapel Hill, North Carolina 27514 Phone: 919-933-2007 estern,- Carl D. Killian, Ph.D. 1974 Mr. John B. Rogers, Jr. 1973 Box 2672 Post Office Box 337 Cullowbee, North Carolina 28723 Davidson, North Carolina 28036 Phone: 704-293-9611 Phone: 704-892-0564 Mrs. Evalyn trdndeJ, M.P.H.- 1975 Mr. Donnell VanNoppen 19 160 Cotintrv Club Road Box 337 @heville, .North Carolina 28804 Morganton, North Carolina 28655 Wone: 704-253-8424 Phone: 704-437-5261 *Members of Executive Co:nmittee Ot:licr Thati l@',edi-ccil Scllo,)ls 1974 Mr. E. 11. l@173 *],?dwin 1-1. Monroe, M.D. Vice-Presi.,dent for Health Affairs Vice-president Dept. of Community Colleges School of Allied Health and Social Professions N. C Post Office Box 2772 State Board of Education Building East Carolina University Raleigh, North Carolina 27602 Greenville, North Carolina 27834 Phone: 919-829-7051 Phone: 919-758-6310 ollr. George T. Thorne 1973 "llr. Earl Murphy 1975 Controller Assistant Dean North Carolina Central University Craven Technical Institute Durham, North Carolina 27707 Post Office Box 885 Phone: 919-682-2171 Nei4 Bern, North Carolina 28560 Representative of a Philanthropic Orpanization *Mr. James R. Felts, Jr. 1974 The Duke Endowment 1500 North Carolina National Bank Building Charlotte, North Carolina 28202 Phone: 704-376-0291 ies Mr. W. James Logan 1974 William A. Robie, M.D. 197?-.I- Executive Director 5437 Thayer Drive North Carolina Heart Association, Inc4 Raleigh, North Carolina 27609 No. 1 Ile-art Circle Phone: Chapel Hill, North Carolina 27514 represents N. C. Chapter of American Phone: 919-968-4453 Cancer Society represents N. C. Heart Association Eloise P. Hathcock 1975 *T. Reginald Harr-is, M.D. 1974 615 St. Mary's Street 8OoO @lor@,'i D-@',@alb S,:r@eL Raleigh, North Carolina 27605 Shell)v, ':North C.-ir-lira 2SIc)n Phone: 919-832-6307 Phone : 704-482-1482 represents N. C. Diabetes Association represents T.B. and Respiratory Assoc Clark R. Cahow, Ph.D. 1975 Duke University Registrar 114 Allen Building Duke University Durham, North Carolina 27706 Phone: 919-684-3146 represents United Health Services Representatives of Other Health Providers Including 3rd Party Carriers & Government @encies Mr. W. J. Smith 1975 Miss Sally Far'riiid 1975 Executive Secretary Physical Therapy Section North Cl-:roli-na Pliarmicetiticil- Association N. C. State Board of licaitli Ro>: 1 53 Po s t -u f f ic c i@) x @z, o'-@, i Chapel I ill,- ',orLli Carolina 27514 Ralei.gli, North Cirolina 27602 Phone: 919-967-2237 Phone: 919-829-@J131 -- - -. @,l r, T)I,,,cionl I'l@,@rinv rd Party Carriers Mr. George Hider 197'3 Edwin S. Preston, Ph.D. 197-' Pilot Life Insurance Company 2711 Anderson Dri-%,e Post Office Box 20727 Raleigh, North Carolina 27608 Greensboro, North Carolina 27420 Phone: 919-782-1@478 Phone: 919-299-4720 represents 1\1. C. Health Council represents N. C. Health Insurance Council Mr. Ken G. Beeston 1974 N. C. Blue Cross and Blue Shield, Inc. Durham-Cliapel Hill Boulevard Durham, North Carolina 27707 Phone: 919-688-5521 represents N. C. Blue Cross & Blue Shield, Inc. Executive Director, North Carolina Regional @ledical ram *F. M. Simmons Patterson, M.D. (non-voting) Executive-Director North Carolina Regional Medical Program 4019 North Roxboro Road Durham, North Carolina 27704 Phonei. 919@477-0461 *Memb6rs of Executive Committee 'Members of Minority Groups "-M-EMORANDUM DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE PTIBLIC HEALTH SERVICE HEALTH SERVICES AND MENTAL HEALTH ADMINISTRATION Acting Director DATE: April 18., 1972 Division of Operations & Development FROM Director Regional Medical Programs Service SUBJECT: Action on April 10-11 Staff Armiversary Review Panel Recomendation Concerning the North Carolina Regional Niedical Program Application. Accepted @l. (Ddte) Rejected @te) Modifications Region: North Carolina RMP Peview (,),cle: une T'ype of Application:Amiversary within riennium Ratiniz: 324 REC ATIONS FROM SARP Review Comittee Site Visit Council RECO ATIONS: The Reizion be approved for the 05 operational year at the requested level of $2,080.,008, pending'additional information and@satisfactory review of the $200,000 request for conmmity-'based edumtio@ programs. The Region be advised.,Of n*,weakaesses identified by SARP (see below) and that Staff follow up with careful study, advice, and assistance. I UE: SARP was presented with two divergent recomendations by Staff who conducted a preliminary review of the North Carolina a-D-Olication. The recomeMations were: I'he Region be approved At the requested level"of $2,080,008. The Region be approved at the requested level, but that funding authorization for Institutional Coordinators/ Continuing Education Component of Core be withheld until Staff has reviewed the RAG recomendations for this component in addition to receiving a justification for the need of these representatives on Core Staff. The members of SARP, with minor exceptions, agreed NCRNP must be viewed with a high degree of credibility and reliability, and therefore, can be entnisted to strengthen its weaker areas (dee below) with encouragement and advice from FMS. It was not felt restriction or reduced funding, which might@'be interpreted as punitive action, would serve any@meaningf-ul. -Durpose. This rationale was based on the fact that the Region has done a connendable job in responding to, and resolving all of the problems identified by the national review bodies a year ago. Pag6 2 - Critique North Carolina RMP The composition of the RAG has improved by increasing allied health, public and black representation. The advisory and decision-making bodies have been reorganized, disbanding the Board of Directors, giving final authority for all activities and policy matters to the RAG. The Resear and Evaluation Division has been centralized in Program Staff and is directly responsible to the Directors. With few exceptionsrenewal projects are being terminated at the end of the current year. Staffing plans include the hiring of minorities, three professional and three secretarial. While the reviewers were compl entary of the Region's progress, they did identify areas of needed strength, and/or correction. it@was believed these weakness-es could be corrected with proper assistance from RWS Staff. The goals and objectives while having been moderately revised, since the triennium review; like many Regions remain broad and non-specific. The Region recognizes this weakness and is taking corrective measures. While the program is de-emphasizing categorical and continuing education activities, there is a need for it to accelerate change toward direct impact on improved care,, particularly to the underserved. The role of and need for the Institutional Coordinator/ Continuing Bducation Component of Program Staff is highly questionable, particularly in view of the apparent changing program direction. The Region shares this skepticism and has designated a comittee which is studying the matter. The fact that the four Institutional Coordinators are paid as part-time program staff wh3,, of the RAG and Executive Committee both from the standpoint of conflict of interest anct dual relationships to the Director. The relationship of the grantee to the RAG as presented in the By-laws is inappropriate. The By-laws should be rewritten to clearly assign program responsibilities to the RAG and administrative responsibilities to the grantee. RNPS/SCOB Bill Reist 4/18/72 -AM211cation Component and Financial Summary Anniver3iry_ COZIPONENT CURREIIT YEAR YEAP, RECOMIIEM YRTS AWARD COU',,'CIL @UND I N .04 OPER. RECOIOMNDED 'REQUEST SARP YEAR LEVEL REV. COM. 558,193 643,940 CORE (73 O- Sub-Contracts OoL OPER, ACTIV. 1,152,129 1,248,175 1,248,175 DEVET,. COMP. 168,605 187,893 y EARMARKS: KIDITEY #28 (145,400)__ 145,400 AHEC #41 (200,000) 200,000 R14PS ii@.,FcT I-8Z8,227 ft non Ana 2.080@008 94. RELUESTED 3,875,118 COUNCIL APPROVED LEVEL 2,194,400 NON-P,14PS and 1009000 34,691 INCOME REGION North Carolina June 197 REVIEW CYCLE The 04 year is b@ing exte.nAi4 to 9./1. and the, region will receive $365,733 for th@,,two-month extension resultih' ina direct-cost 9 award of $2-,244,660 -for 14 months. s at i s f actery. 4T-Ia" **P iclin2,.additionAl-.-informat-ion an Of-@tl* $ZOO-t@000 Tequest f6r com=ity-based educational p@og-rams. 4 18/72. SCOBIRMPS Re2ion NORTHEAST OHIO RMP Review Cycle June 1972 Type of Application Anniv. Prior to Triennial Rating 132.S Recommendations From SARP Review Committee Site Visit Council Recommendatio'ns: 1. The approval of a one year period of support (September 1, 1972 through August 31, 1973) of the Program at a funding level of $600,000 direct cost. 2. That the NEORNLP would, during the 02 year of support., develop and submit an application more consonant with the priorities of the Region justifying the continuation of this program or face the alternative of a merger with the other Ohio Program or termination of funding. 3. 'That the present operational projects be phased out and that the funds be utilized to support planning and feasibility studies indicated by the program's data base. @4. That attention be given to the recruitment of a Deputy Coordinator and Program Directors in evaluation and communication. S. That the NEORMP give considerable attention to the delineation of the relationship and responsibility between the Board of Trustees, Fxecutive Committee., and the RAG. That all technical assistance recommended by SARP be provided to the Program. Critique: Committee members were very concerned over the fact that NEORMP had decided to remain separate from the merger of the Ohios and it was the feeling of some of the members that all funds should immediately be withdrawn from t program. The Committee Agreed with SARP that there was little apparent relationship between regional goals and the operational activities presently supported by the Region and also, that Program staff needs additional development. ortheast Ohio IW -2- Th6"Comittee expressed concerns in basically the same areas as did staff and SARP reviewers. Also, Comittee members considered the fact t at NEORNP hadbeen without a full-time Coordinator for 17 of the just 19 months of operational status and were in agreement with the types of assistance recomended by SARP. Committee felt that the NEOW had been anything but satisfactory up to the present time and that a year of planning was needed. Comittee indicated that their action was not intended to be vindictive, punitive, or anything of that nature, but felt that a strong directive was in order. uomponenu ana ti.nanciat bummaiy ONENT CURPEITT @'FAR YFAR RECOMI'tEliDED YRIS AWARD COUTICYLL FUNDING OPER. RECO'LViElIDED 'REQUEST "W YF,AR LEVEL REV. COM. 481 CORE 424 637 796 8ub Contracts 55,000 OPER, ACTIV. 208,763 193,501 114P. yes DEVELO Cb or No EARMARKS.# Klirb viRECT 690,187 .803,696. 831,297 600,000 '75 REQUESTED 1.1232,0 COUNCIL 78 6,187 APPROVEB LEVEL NON-Rl4PS and TL'COME Does not include 24 month extension for 01- year of $2,376,158 REGION Northeast Ohio M@y/June 1972,.REVIEW CYC' 01 Al 01 A2 Cor 67i Core., .865,918 e @8-26. -Proiects 359,,284. -Projects -473,1-30 Direct Cost-1,037,110 -Direct 'Cost 1,339,204& SCOB/RMPS ay 24, 1-972. TABLE OF CONTENTS NORTHEASTERN OHIO REGIONAL MEDICAL PROGRAixi ANNIVERSARY APPLICATION Staff Briefing Document Pace Page Regional Map 2 Geography and Demography 3 Component and Financial Summary 4 MIS Printouts 5 Problems, Accomplishments, Issues 14 RN? Review Criteria 15 STAFF BRIEFING DOCUMENT OPERATIONS Eastern Mid7Cor RM 00064 South Centr'! /-7 western NEORMP BRANCH - BRANCH yp2 APPLICATION NA LAST RATING Tel. No. 3-1740 Room 10 2" 197 DATE BRANCH CHIEF Lee t. Van Win le TRIENNIAL ist IV YEAR SARP BRANCH STAFF V@tnie D-Ashby 2nd ANNIV YEAR REV. COM. RO REP.- ice C THER LI OTHER Last Mgt. Assmlt Visit 19" Chairman AS'f S@@V4 2/5-6 1970 Chairman- ilin T- Whirp, M 'n haii@-.,%nls Name and T e of Visit) a f %7isits, Last 12 mc (Dates, C yp Ashbv 3/30"31/72 Staff Assist-a-nep i6h Occurred in the Region Affe,,-ing the RNP Since Its Last Review 97 T"-,e employment of Dr. Donald Glover as Coordinator on January 1, 1972. 2 Rj'.l 00064 NORTiE;'6TERN 0310 Enco,npasses 12 counties in northeast Ohio centered around Cleveland. Population ( 1970 Census) Total; 4,115,000; 86% urban o,ier 3.5 iiillion) Land area; 5,784 square miles; densit@ 710 per sq. nile Major metropolitan areas: Akron, Cleveland, Lorain and Youngstown-Warren Cleveland - 38% Negro Cleveland S,'ISA#. Per Capita income - 3,705 .9 Congressional I)Istricts Part of i@ 18 OLEDO at N @G OPAI"4 WOOD ELYRIA* WEN*, 5 SENECA yoi FINDLAY ""COCK AS.L VAN W(RI *,A-POT CANT @OAAANSFIE 0 MASSILLO] ARION 0. STEUBEN ,on cos@ION CUC*@SEY ..O.so, Maus IIA R TTEI,, @MIDDLETOWN .,PRE' *"S I'O,tTs.k@OUT) RM OU064 3 Northeastern Ohio R,',IP Facilities and Resources 1969/70 Enrollilent Graduates Medical Schools Case Western Reserve Univ. Cleveland 362 92 :,try 287 60 Dental : Case Western Res* Univos School of Denti Prof* Nursing Schools: 21 - 6 at colleges and Universities Practical Nursing schools - 6@ Allied Health Schools,, cytotechnold- - 7 Medical Technology - 16 Radiologic Technol.- 18 Ph sital Therapy - 1 (Case West. Reserve) Non Federa1 No. of Beds General 65 16,545 Osteopathic 10 reported in planning application) Veterans Administration:- 1 -780 beds -InclIudea for Cleveland SMSA 32 hogp. 9229 beds ( about total reported for all 12 counties.) Personal Care Homes levelaod SMSA: Beds are qomes Nursing C Personal Care Homes 19 1345 'with Nursing care p yst6ians - Cleveland SMSA ( 1970) Total non-Federai ( practicing and not practiting)- 4,148 Total Active - 3626 Gen. Practice 375 Med. Spec. 621 Surg. Spec. 724 Other Inactive 150 m rsos ( Prof.)- Cleveland ST.LSA 1966) Active - 6305 Inactive - 2838, P,,'IPS DOD March 1972 4 Co mponent and Financial Summary Anniversa ry Application COMPONENT CURPIENT YEAR YEAR RECOMMENDED YRIS AWARD COUNCIL FUNDING first 12 months SARP 01 OPER. RECOMMENDED 'REQUEST YEAR LEVEL REV. COM. 481,424 637,796 CORE Sub-Contracts 55,000 208,763 193,501 OPER. EVEL. C Yes or No EARMARKS: KIDNEY IR'MPS DIRECT 690.187 831,297 REQUESTED 1,232,075 COUNCIL 786,187 APPRO NON-RNPS and NONE Does not include 24 Month extension for 01 yr. of $2,376,158-. REGION Northeast Ohio 01 Al @--.-Ol A2 - y/June 1972,.REVIEW CYCLE Core 677,826 Core 865,918 54 -284 Projects 3 I.:i" Projects 473,130 Direct Cost Jo 7,1 0 Direct.Cost 1,339,048 -,@,72 PrGinN N5 CHI(, 9RF-AKC@JT CF REQUFST QY flmr'64 (,6/72 2 rpnGRAm PFQfnf) OMPS-CSti-JTrGR2 2) (4 )rNTtFTrATICN CF Cr'vFrNEN'T I Cf!@NT. WlTfJTNI CCNT. REYNNOI ADOO . N-T I NFWV NCT CtJOQr%'T I CIJDP ENt I APPP. PFRICrl APPP. PEPIR)CI PQE\JfntjSLY I EIDEVirL;SLY rjlRP(-.T INDIPFCT TRTAL OF SUPPI)QT CF SUPPCOT FUNCEP I APPRCVFD COSTS COSTS coc?F ]__-@.37. 7q6 $ 21.L A 'I@ ibi @p I I HNSPITAL LTPQ'APY Cf'tN'SLLTI .-I N, @,E r - - - - - - - ------------- l@ @rCU NU;ZSF TOAft\T@G - --------- - - - - - - 13 STPEP CTLTURF PRCGRAM 7 STQCKF OEHAPILITATICN OEI IIZ A Ti S76,11 7 -------- - 7 6 TCIAL $F?1#21;? %831 2q7 $51, 1 I!i 98 41 5 MARCH 23,1972 REGIONAL MEDICAL PROGRAMS SERVICE PAGE 1 SUMMARY BLOGET CATEGORIES BY COMPONENT RMPS-OSK-JTOC.M2 REGION 64 NE CHID REQUEST MAY/JUNE 1972 REVIEW CYCLE COMPONENT COMPONENT COMPONENT COMPONENT COMPONENT REGIO!i NO COOO NO 001 NO 002 NO 003 NO 007 TOTALS I PERSONTL SERVICES WAGES 3359522 26@920 4 79 226 75,000 20,034 5O4w7O2- SALARIES. EMPLOYEE OFNEFITS 52,876 3,365 5,668 39IZ5 1#042 66,076 TO TAL 438,398 30,285 52,894 289125 2lwO76 570977B 11 PATIENT CARE IN-PATIENT OUT-PATIENT TOTAL III EQUIPMEf4T BT)ILT-IN )O,OVABLE 109000 Soo 169899 70TAL 6*399 109000 500 169 899.- IV CRINSTRUCTION NEW M AJ AL I C R EN TOTAL V OTHER COti@ULTANTS 16#628 29200 18,829 SUPPLIES l2v597 250 59750 24o371 550 43,513 DMST TRAVEL 850 3#500 lo,750 25, 94 5 191845 FPC.N TRAVEL SPACE 30tooo TOO -.309 70',) RENT PENT OTHER 6,300 6,300 MIN AI.T C PEN 28,772 Pt)[ILICArIONS 2Ov272 500 89000 .55,000. CR)NTRICTUAL 55,-On COM,-iUttICATION 199857 200 2tOOO .22 G 5 I., COMPUTERS 129500 -,@12# 500- OTHER 19t250 24ip3TI 243 9 620 TOTAL 1929999 2t5OO 40500 VI TRAINEE COSTS STI PT tiDS OTHER TOTAL 8319297 TOTAL DIRECT COST 637,796 32,785 629144 52IP496 26PO76 51,118 INDIRECT COST 319890 6PO57 69347 61824 - - 269076 SSZ9415 TOTAL DIR F. IND 6699686 389842 889491 59t320 MARCH 08.1972 REGIONAL MEDICAL PPOG$KAMS SFRVICE DESK S(IUTH CENTRAL AREA LIST OF COMPONENTS REQUESTED Ft)R NEXT SUPP(IRT YEAR AMP-OSM-PEMot)l REGION 64 NE OHIO CL RMP-SUPP-YR 02 REQUEST MAY/JUN 1972 REVIFW CYCLE COMPONENT COMPONENT NEXT DIRECT COST EST DATE OF NUMBER TITLE SUPPORT YFAR NEXT PERIOD TERMINATION CODO CORE 02 637t796 001 HOSPITAL LIBRARY CONSULTING SERVFCE 02 32t7B5 06/73 002 CCU NURSE TRAINING 02 829144 06/73 003 STFIEP CULTURE PROGRAM 02 521,496 06/73 007 STAOKE REHABILITATION DEMONSTRATION 02 26,076 06/73 TOTAL REGION 64 COMPONENTS S. $3lr297 MARC@I l')91972 PFR.I(INAL MFNICAL PROGRAMS SFFTVTCF SU4MAPY RUDGET,F%Y TYPE nF SUPPORT r PERTI)N 64 @'E I)Hlf) RMP SUPP. YR 02 REQVFST-MAY/JUNE. @1972 REVIEW CYCLE ')ESK SOUT14 CENTRAL RMPS-OSU-JTOGRB RMPS Rmps RMPS RMPS TR)TAL C 0 M P 0 N E N T Co.MpnNENT DIRECT INDIttFCT TG;AL' nIPECT DIRECT r)IRFCT No. TITLE SUPPORT YEAR IST YR IST YR l@i YR-- 2ND YR 3RD YR ALL 3 YRS COIITINUATIO@4 WITtilN APPRNVEO PERIOD OF SUPPORT COAN CORE 02 6379796 31,890 669,686 637,796 I') I HOSPITAL LIBRARY CONSULTI 02 32,785 6,057 38,842 32t785 Nrl SERVICE 'DZ CCU F.'URSE TRAINING 02 8ztl44 6,347 813,491 §2,144 nO3 SRPFP CULTURE PROGRAM 02 52,4q6@ 6,824 599320 52,496 ')t)7 STNOKE REHABILITATICN DEM 02 @6,n76,. 26,n76 Z6o376 ONSTFTATI ON CONT. WITHIN SUB-TOTAL 8310297 519118 8829415 8319297 QFGT(Ilq TOTATS-.