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MEETING SCHEDULE COUNCIL OF TEACHING HOSPITALS ADMINISTRATIVE BOARD

March 22-23, 1978 Washington Hilton Hotel Washington, D.C.

permission Wednesday, March 22 without 6:30 P.M. COTH Administrative Board Meeting Edison Room

7:30 P.M. Cocktails Farragut Room

reproduced 8:30 P.M. Dinner Edison Room

be

to

Not Thursday, March 23 •

AAMC the 9:00 A.M. COTH Administrative Board Dupont Room of Business Meeting (Coffee and Danish)

1:00 P.M. Joint COTH/COD/CAS/OSR Conservatory Room collections Administrative Board Luncheon

the 3:00 P.M. Executive Council Map Room from Business Meeting

Document

Suite 200/One Dupont Circle, N.W./Washington, D.C. 20036/(202)466-5100 Document from the collections of the AAMC Not to be reproduced without permission • VIII. XII. VII. III. XI. IX. VI. IV. II. X. V. I. AAHC State School Programs CAS Program: HEW Election AICPA AHA C. COTH Report Membership A. B. Consideration Call Handicapped Resolution Multi Sinai Eligibility Application Detroit, Report Statement Executive to Exposure Rate Admissions on Order in of -Institutional Request COTH Hospital Review on Provisional Allied Michigan Membership of on on Salary Survey Spring Draft for Regulations Minutes Accreditation LCGME to Health of Council Continuing Sponsor Washington Meeting Detroit 9:00 Administrative Systems Institutional Dues March of and AGENDA a.m. Dupont a Plans and Teaching Seminar COTH of Medical 23, Hilton - Terminations Educational 1:00 Room Membership 1978 Members Board Hotel Hospitals p.m. Executive Executive Executive Executive (Separate Dr. Page Page Page Page Council Council Page Council Council Page Page Page Page Page Pagel Page Bentley Attachment) 46 34 52 23 22 50 24 59 30 25 14 Agenda Agenda Agenda Agenda -2-

XIII. AAMC Recommendations on FY 79 Appropriations Executive -Council Agenda for VA Department of Medicine & Surgery Programs Page 49

XIV. Emergency Meeting on Medical Manpower Executive Council Agenda Legislation Page 51

XV. Withholding of Services by Physicians Executive Council Agenda Page 53

XVI. AAMC Statement on Involvement with Foreign Executive Council Agenda Medical Schools Page 57

XVII. Industry-Sponsored Research and Consultation: Executive Council Agenda Responsibilities of the Institution and Page 62 the Individual permission XVIII. AAMC Biomedical and Behavioral Research Executive Council Agenda Policy Page 77

without XIX. Discharge in Bankruptcy of Student Loans Executive Council Agenda Page 109 Information Item

reproduced be XX. Tentative to List of Participants In June Page 75 MAP Program

Not

XXI. New Business

AAMC the XXII. Adjournment

of

collections a

the

from

Document

• Document from the collections of the AAMC Not to be reproduced without permission • S PRESENT: Elliott Stuart STAFF: James James John Joseph John Mitchell ABSENT: Armand Stanley Lawrence William Robert Robert Richard John James Jerome Gail GUEST: Malcom Martin David David Robert A. Gross W. Reinertsen, I. L. D. D. M. Egelston C. E. Checker G. R. Randall M. Marylander M. D. Colloton C. T. R. Hudson, Ensign Bentley, Everhart, A. T. Thompson, Petersdorf, Isaacs Heyssel, Dolezal Toomey Knapp, Cooper, Robinson, Roberts Nelson Rabkin, Hill Secretary M.D. Ph.D. Ph.D. M.D. Chairman M.D., M.D., M.D. AHA Association M.D. COTH,Administrative Chairman Representative Immediate Washington January of -Elect Past MINUTES American Chairman 19, Hilton 1978 Board Medical Hotel Meeting Colleges Document from the collections of the AAMC Not to be reproduced without permission I. of of Following Advisory debate Cost Cost make Cooper Consideration were on pages observation atives AMA, that described described Board expenditures he some state were Trevor board account atives. and ing times Bancroft Deans; Call members summarized was were boards a and Manager, growth letter the the encouraged both to it then 2 of or and for Containment Containment some The For Mr. unanimously to held Mr. 63 level representatives of contribute and of to meeting and Executive 4 stay Thomas, of and in the were the when Order: and Panel Everhart the minutes Everhart that the representatives a purposes Mr. the the & Room recommendations on Alex the a their the simultaneously the schedules. 64) staff presenting the meeting COTH committees brief AAMC's through should introduced FAH). of page Everhart not the AAMC. benefit Division of them three AAMC of emergency would of that Charles McMahon, format which functions the Program recommendation. of Board meeting percentage approved. to Council; Minutes: the 67 of asked the summary, called key of be to including organizations institution the the the he These He ultimately of debate would- of Washington AHA included for told the stay of are the He as Fentress, and would personnel the pointed that the who November Administrative momentum or the of program followed the explained are Medical observations they (the Advisory from Executive 9 the within aforementioned the Dr. then through outpatient the staff. Executive increases the would representatives he new from Dr. see COTH meeting COTH four AAMC screened Knapp regarding out the Board would reach be are National members, Hilton goals. of that Knapp not the 7, and Services convey sponsoring He the by and Panel incorporated Organization that the that Board He appearing Executive 1977 the calculated. Council suggested reported like John Association. normally the members a to the Council in Council that setting also Board comment would joint Joint Hotel. the COTH voluntary order there on Steering the Dr. the the concerns COTH meetings, state Mr. issue to Sherman at all welcomed extent Voluntary are which the Knapp AAMC total then screening luncheon. that meeting see Everhart Luncheon the has on that Council Agenda Administrative seen of should were at the on level the He into from was of Executive the voluntary four Dr. --and Academic 9:00 AHA. position be Committee program is and in their then felt to Administrative revenue Student four Board he at including --that put Martin passed committees. Knapp of a Administrative not the the the for Cost summarize which the had representatives of then A.M. process letter briefly welcomed on that COTH, commitment He administrative form meetings Council be governing the purposes told meetings by Societies; to the the Council program Containment. summarized also and Egelston, Represent- in briefly on along taken hospitals Board another endors- meeting boards from represent- of however, the agendas the as Voluntary the named new of to Board -- into of Dr. meetinodli Agenda (MEIA, events the • • ler Document from the collections of the AAMC Not to be reproduced without permission • first comply Committee of program list to the the example, easy each even created society a be responded a planned any screen, screens. would right of program, personal issues to that general teaching Thompson it Hill if and expressed National that expenditures subject Justice board Texas affected. three submit forthrightly Congressmen appear leadership most provider Congressional if task. of would Mr. At Dr. thought teaching Mr. review action direction with with and and is for the of that their this agreement could Everhart Dr. because and felt disparate reservations Steering but Everhart hospitals Knapp's Department states It that small that skepticism be anti trustees their Justice investor the Mr! this which of or Knapp if the would was point that should was budgets published This that be hospitals of -competitive. it became they other the 10% screens. bits Marylander and support that there program not numbers point philosophically well the did members for there was reaction Committee. it then is organizations noted be a the should -owned Department of 15 at significant, also wanted of question sign clear regarding could party the state not the would sufficient. his strong about aware taken. point them a are Board invited about which information the was should -off that provided to given express Thus, appointed. understand state part grant understanding representatives. expressed some how to more be may fell hospital have the be particular that voluntary program support had inpatient for there would it was In potentially Mr. exempts that institution implemented hospitals not national general committees still obvious coercion potential an than to outside for working other to the but AAMC discussed the and raised Marylander Each look unconditional announce be bothered and are say association, adopted that how believed of it concerns. special bring program Dr. compare cost supported a reviewed concern. words, discussion. vs. over public institution that the represented the that self-serving organization program the the would that together. by Bentley it effectiveness harmful would signed at control but outpatient suit committee program, Dr. the Dr. the screen state by it 500 was they consideration. thought is fell the them it suggested take relations no the which Heyssel had There this on in Bentley his be being hospitals hospitals state approval. was Mr. pointed the a lcoal were to more committees outside against proposal its an the established it National the commitment would been Mr. understanding Everhart pointing a program, and teaching efforts. that state would at seemed revenues requested, anti-trust would hospital step supporting than own form level? genuine of as Mr. Randall the explained problems. proposed take out then the that the in to the the that medical not of Everhart, in Dr. that. of Steering mean state to He that the would out how overall expressed but a hospitals to established screen be the program the and Mr. through publicity. did be associations felt felt Dr. efforts stand be the sense, but State that a it asked that the those made that the an level that He be As first Knapp not was would an if a Mr. Everhart suggested that this agenda item be tabled until Mr. • Robinson arrived since he could provide specifics about the program and respond to questions. Shortly thereafter, Mr. Robinson arrived and was requested to discuss the progress of the program and respond to some of the questions that had been raised. Mr. Robinson reported that progress on the cost containment program couldn't go much further at this point until some sort of anti-trust clearance was obtained because of the anti-trust implications that exist at all levels. Each of the three organizations have selected counsel to assist with this matter. These legal representatives have tried to obtain a "business letter" from the Justice Department which in essence recognizes that even though anti-trust implications exist, the program is being conducted satisfactorily. Even if such a clearance should be obtained, Mr. Robinson explained that other organizations could still permission bring suit.

He reported that the Steering Committee without has generally agreed upon the 15-point program and that efforts are being made at the state level to create committees that will carry out the program. There is some confusion and reluctance at the state level concerning this process. Significantly, however, no state reproduced hospital association has refused -- either undertaking the effort or be seriously considering doing so. to Other national organizations representing hospitals have given a generalized assent. Mr. Robinson described the AHA Advisory Panel

Not on Voluntary Cost Containment which had had substantial input to the 15-point document of the Steering Committee. He emphasized that states could not • be expected to act as the national associations have and

AAMC therefore the program must be tailored to acommodate such variables.

the

of Summarily, Mr. Robinson explained, the whole focus of the program is to restrain costs in total health care, beginning initially with the emphasis on hospitals. There are risks involved with this program for the industry and the three sponsoring associations, such as the

collections potential loss of viability and embarrassment, as well as a possible the acceleration in the legislative process and diminished congressional consideration in the future. The obvious reward would be successful

from demonstration that this activity can be conducted at the state level on a voluntary basis. He hoped the COTH Board would pass a resolution giving its whole-hearted support to the program.

Document Mr. Robinson indicated that there seemed to be an increased concentration by hospitals on cost containment over the past several months and momentum has built. Based on general national guidelines each state would assess its own needs. He emphasized that the program seeks to reduce the nationwide average rate of increase by at least two percent below the previous fiscal year. Dr. Heyssel asked what would happen to hospitals that declined to participate in the program? Mr. Robinson suggested that they might possibly publicize the non-participants or only the participants in a manner that would make those not involved conspicuous. He pointed out, however, that the AHA's anti-trust lawyers have concerns about both so they have yet to address the topic of penalties. Dr. • Heyssel noted that traditionally where voluntary programs have failed, the states have established state rate review commissions, as with Document from the collections of the AAMC Not to be reproduced without permission • • • to a regard other. pointed Health about lated for did to the faction. they sent consequences. support state should supported rate recognizes voluntary voluntary program, possibility, punitive public and acceptable and and Mr. McMahon now into legislation stated would was Therefore, budget introduced hospitals was Robinson major those whom have feels -setting. program the would Robinson not leading the state Congress. to Dr. Dr. When were Mr. level. into the approve Subcommittee, to be review. that utilities. out effort it and Alex states with most believe Mr. Everhart of Knapp Thompson rate reported in yet program, by responding it voluntary asked effect transmitted strategy be are budget legislation. to should and that he that Dave he to the the has which Randall -setting looking the expressed stated would McMahon popular stated yet send the in believes should reported so would Mr. Mr. this when. Some about that cost event some New Mr. failed Jay Hitt's Administrative review, support a concluded moved. guidelines wondered be that would for make a either Robinson Robinson He very program York that asked the and Roberts for Constantine, letter to closely has sent. become board containment Congress success model. programs to now questioned the He that the concerns the the a and legislatively, that the mandate reactionary realization whether the consideration it never from The hospital stated but for direct be time whether -5- if Administrative members voluntary the AHA federal felt the believed voicing and Mr. that questioned said was question made at in AHA the is and Mr. full Mr. the would liked frame under voluntary has (as Consumer late Board expected spenders. were Robinson that uncertain state support in that that the challenge Congressional showed will Marylander whether in chief Robinson association states a again strong drafted a previously government any mandated position that jump that taking 15 for the support way January program the letter Dr. then this and have rate -point at there the staffer concerns, potential. should Price felt they on that expressed "mandatory state program the no has the Heyssel's that the Board support since as from Dr. could would to enthusiasm would three review a one the pointed of from state would on program should be which been cost to program national that the would wait people come Index discussed) rate a Heyssel the staffs be one-third on in legislation Rep. the hospital wants which check make not fails. be legislative -and and Dr. unconditionally AHA very programs. given containment -setting concerns it the terms rate concern would be -voluntary" about make views out issue when changes. Rostenkowski. be have would -writing Cooper -see that should be would were House punitive any for one to Senate believed promising. level supported, the review for that for of to one industry then be Mr. of suggestions were and of the should warned it that skeptical attitude be for of as introduce concept case action mandated. be federal a to the and California Robinson models state way Mr. Finance much should with be voluntary effort machine He perfectly discussed strong similar legislation, Delegates program Alex that state if strongly as the states of or trans- be or if but regard on the He more the this be the it with Document from the collections of the AAMC Not to be reproduced without permission IV. . in Eligibility 1975, current continuing points ACTION: to board objective important meeting Alex with be on for them Delegates concerns position this meantime would would be Administrative of program iates. chains. resolution networks hospitals will the the sent the made all the As the Mr. It aware McMahon issue With not Mr. Mr. members be be agenda in rate program individual COTH required of to was to Board will State Robinson previously at late enough of the He be Roberts Everhart program, the containment It pages all approved McMahon, be of issue the would regard are membership the of the the to be for of decided the dealing academic stated membership recommended the was expressing staff not identifies felt AAMC letter rate the to members put place organized increase Council. COTH Committees. current and Board Continuing 62-64 that act time next by moved, voluntary arrive to be reminded added Association's on hospitals. President explained constitutents as the of this legislative could that COTH membership, that discussed. and particular the with what to it meeting. since the seemed health eligibility; committees. of well increase to AAMC's motion criteria. other seconded, in the was should AAMC since at question differently he those Board to the a concentrate be agenda the makes the COTH as program the letter it a would final an approve Dr. to guided center/teaching that of Executive position. approval over organizational to positions Alex and wasn't Board Mr. and teaching in unreasonable Gross be specifics. Mr. be it emphasis Membership: the It Heyssel position requesting for the and of support the and point hospital a should the divided. Toomey work, 7,000 the AAMC Mr. to was Marylander McMahon by AHA, the major the state nowadays that state by National certain on staff carried make of Board and preliminary Everhart Council also Executive hospitals letter recommendations and felt that Mr. developing on next individual but who prior be the its stressed amending -level agenda perhaps vs. expenditures the their was the had concerns measurement felt sent could Robinson Mr. rather hospitals Preliminary sponsors would it that program meeting how with support Product. that federal asked Agenda from spread to still particular conducted suggested was Everhart voluntary input item from that soon that Council this their decide an the that voluntary findings be the materials the hospitals Dr. the whether be and felt supporting in amendment of and of asked of for a John the rate proposed and do Executive was and the concerted Cooper conveyed overall and appearing Several to negotiation letter March. the the Report percentage also on suggested that that a not action a House that their needs cost compare making Cooper such review program survey as to objective. Spring a March hospital voluntary voluntary on because meet firm the once presented to this forward should there could an of debate In this of affil- in to Council effort Alex on to the of that the Document from the collections of the AAMC Not to be reproduced without permission • • V. VI. interest followed. it it in in ACTION: Spring issues issues good decided good the ship should Toomey Thompson a visualized planned attended appointed ACTION: in thought the Discussion meeting meetings COTH held was where preliminary any had larger a be a order had general Chief established action applied for opportunity less time central and Mr. Mr. Distinguished Dr. decided the

felt relating that be a Regional the to and when of opened only Everhart audience. to meaningful a as Marylander was Knapp Executive formal to forward representative. It It AAMC the meeting held names of period this eliminate be foster the agreement agenda for the carried would an report in location. consider was was a Possible to by deferred VA and final Distinguished reported annual favor of to this meetings, membership. as agenda criteria, corresponding locale, for moved, have the moved, Hospital of provided is to warrant personal Service teaching could a what be Gerhard Officer out He agenda, stated CEOs the eight the matter CEO national held. report of that an event such treated felt Spring was until format this Mr. that seconded, seconded, Executive regional rather annual and the be -Fayetteville indicating to coverage he Several that a Hartman, a the an Members years. on Ensign interaction for meaningful at addressed that Dr. hospitals. will possibly Service get meeting, meeting spring Mr. the proposed the year overview meeting COTH membership as COTH it the most discussion. than he spring Heyssel Everhart there together VA an March be meetings should and and and members believed at In Council success would Membership Ph.D. member meeting important information Hospital available. a and that Membership. one 1975 important this then which would that that carried carried meeting for central of and are Administrative moved The among be recommended take. in felt other the and those and felt on kind a of the topical hospitals judge as corresponding obvious in the should would be COTH. substantial He in this the share issue, Sidney that the COTH history Meeting to to favor of that when business Administrative of person issues, that explained meetings meeting General Fayetteville, institution item the recommend recommend the be basis attendees. meeting. one. given be a Since nominations question, and concerns. now future regardless of that this spring rather aimed Lewine and entire of held. Board or of discussion the environment, should and would where the it membership. had past number that it that the would only insufficient that approval meeting of meeting than was be met be member- Dr. current be He been CEO's should it Board COTH be Mr. N.C. for sent such There be he accepted. of of be at the held held all to a a if be of Document from the collections of the AAMC Not to be reproduced without permission IX. VIII. VII. enthusiasm "...for OSR independent indicated try be responsibilities. of process in need shape, staffing seven approve LCGME, together education have Committee successful. by agenda ACTION: Board Everhart ACTION: Student location, agreement a ACTION: short two the the the to Resolution to With the Dr. Dr. Dr. to members

possibilities: do and LCGME, recommendation item. LCME, COD of be the and time Representation Heyssel for ten initial as Cooper suggested Knapp regard it that in It on Council a It at time, that with It be Spring Chairman. would reviewed would accreditation there at staff LCGME oversee the student incrementally the their The Future the recommended and years was period was was making He the generally on the the May cautioned accrediting informed program, be be isn't LCGME to major LCCME. informed moved, responsibility present explained moved, meeting moved, for only Graduate request Agenda. It LCME when respective conditions would that determined needed one every Staffing the as in it the on is

either (independent problem any under on a which the difficult had aspect actions seconded, seconded, seconded, voiced a felt has page The etc., the time. be non to that this LCGME three the of the committee from reason Medical with that medical lengthened body -voting a accept to Option problem Board the to totally that specialties. Board 32 good set LCME there by May, of is prior their the the be and of years. to CCME accomplish of for OSR a financial why to the and out and and Education revised. there the set that the month the committee first Board then schools of #4..." the briefly observer be would separate residency is relates to which enthusiasm first revolutionize AMA carried on carried carried the the the residency invitation appointed specific Executive Dr. the this the proceed should page to to financial step be accreditation AMA). standards had this rate requirements, Heyssel appeared The of parent March hold make There Directory to resolution participant a appointed costs that that 29 that being the training reconsidered lot LCGME the be for effort, arrangements residency with review of the to the Dr. Council meeting. of would a organization background this the of COTH the agreed support and LCGME the determine the to to for move meeting. the other meeting Cooper has work Executive by process gain be identify programs committees issue Executive meeting. had and would period appear graduate in LCME for Dr. Agenda been which the in that programs involved, issues. and this been accordance There that made an for successful. good Cooper independent for be to the COTH hold marginally from or to the for staffing was to staffing to issue. tabled tabled appoint much Council which medical this a was Mr. which a read put the change • 4Il Document from the collections of the AAMC Not to be reproduced without permission • S XI. X. XII. ACTION: American the CMSS. Cooper's of Ethical ACTION: that that the component change Report The Residency recommendation. version ACTION: Settings discussion medical Cooper which to sent sponsored that the CCME report, ACS the Dr. Dr. Dr. the Mr. to has

in of Dr. by public Practices Letter was data. each centers, Heyssel letter formed College Thompson Everhart LCGME document Thompson Physician It bodies It It 5, page American Staff LCGME the staffing. Review be be been Executive Agenda). under be bution Congressman and Cooper ensued submitted and recommended recommended 1977 was was recommended dean was Committee directed health. is long would However, 73 for Option (as a that was of of moved, moved, Committees. of moved, summarized where felt of to followed elaborated provided letter committee was Governing asking explained College Surgeons' it Physicians" its in developing the Distribution, Council remove be the it to weak, Rogers that support appeared #4 the research Dr. on CCME, a consideration seconded, seconded seconded he was Executive to to the be if to of good Physician of outcome the Knapp by believed on Privately the the recommend a presented ask that they time with approve Agenda). on the CCME raising Letter He Surgeons staffing with a place of specialty background a on power (as this the motion background in report report. and inadequate indicated to this understood and had "The bringing on and the page Council of public further recommended Association the put to point. four December Distribution carried carried data of independent carried and item Sponsored that by problem exception recommending Specialty to of this start Report 32 the the and response After information or or approve questions of of the the Agenda). that dealt research that data delay LCGME that that geographic CMSS report policies publicly and that the this 12. matter Committee of existed to many on Research a of the and and with press Executive the the the the memorandum staffing representative would the respond issue. (as page in Dr. the that may behind about drafts thrust -funded Geographic interpretation overseeing Executive Executive for up on proposed Committee a for Executive presented Thompson for LCME, letter distribution be 35 not on the through in this this the for to The of all us. deleterious the of Future Council improve a Academic December had university final the and subject role the of thrust item. Dr. the sent felt Council on Limited Distri- Council the the Council on to been the LCGME of to the of Dr. and encotiraging them to raise Congressman Rogers' 4 questions in the appropriate setting at their own institutions and then relay the • results to the AAMC. A draft position paper on this issue should be available by the March meeting.

Dr. Heyssel felt the Administrative Board should come out very strongly on this as a moral issue and moved to support the proposed recommendation.

ACTION: It was moved, seconded, and carried that the Executive Council be recommended to ask the AAMC staff to draft a position on the issues raised by Mr. Rogers' letter, taking into consideration the discussions at this meeting and the replies received from the medical school deans, permission and to present the draft position paper to the Administra- tive Board and to the Executive Council at their March meetings (as set forth on page 57 of the Executive without Council Agenda).

XIII. Recommendations of the AMA Commission on the Cost of Medical Care reproduced Mr. Everhart reviewed the item and proposed that the Board not take be any action on this document. There was general agreement that the board to was comfortable with not taking a position at this point.

Not XIV. • Report of the AAMC Officer's Retreat • AAMC Mr. Everhart explained that the Retreat is attended by the Chairmen and Chairmen-Elect of the AAMC Councils the and the Executive Staff of the AAMC. He suggested of that the board read the report since it expressed the priorities of the Association and might enable the board to be more responsive to the issues.

collections He indicated that a fair amount of time at the Retreat was spent on ethical issues in medicine - pages the 6 & 7 of Report. There were also discussions about the roles of the Association, teaching institutions from and medical- schools in educating the public about health -- should the roles be expanded? Mr. Ensign wondered if it would be appropriate for the AAMC to recognize outstanding efforts in this area by outside organizations. Mr. Everhart said that the Association's emphasis was Document on determining where those programs are and on the promotion of those efforts by its constituent members. Mr. Ensign thought that it might be possible to formally commend NBC for its TV special on health care, but Dr. Knapp indicated that there might be some unwillingness on the part of the AAMC to do so because of the varying ways certain medical school programs were portrayed. Mr. Hill suggested that perhaps some sort of inventory could be done on what is being done to educate the public about health care and noted that much public health information is disregarded by the public anyway. Mr. Toomey agreed with Mr. Hill and believed that the medical school should not have to teach the public about health except in those areas where public health is an important part of the medical school. He pointed out that there are other • organizations for doing this. Mr. Everhart suggested that medical centers and educators in this country need to be more involved in the Document from the collections of the AAMC Not to be reproduced without permission S XVIII. XVII. XV. XVI. peer AAMC to wiser Regulatory and action get Bob those entangled. somewhat, Classification would Executive and in Mr. Board surveys Reversal because according ACTION: that should responsibility. appropriately important, education should and alerted Mr. agreed the March, familiar -grouping. Everhart inviting some Derzon, that Toomey Comments Dr. Dr. Mr. Dr. if refine if included meeting.

Board. was spend be that there and consumer that Everhart the Bentley Knapp of visibility. Knapp medical but to did Salary It from the than be of Process deemed but believed Cardwell in said it Board the their suggested with his was recommended time this the on was not were public a of in Some thought reported his public an not should It function listing, the presented discussions that moved, and Mr. education public schools necessary good. the this COTH stated address on institutional is did was response. several letter necessarily members Schools Report Decision JCAH more about Marylander an listing, Mr. final health be report generally possibly not Members that INFORMATION to seconded, issue than that Dr. of to should expressed distribute Marylander the reversing Surveys important try an issues the health is -- of of it results of advise the Heyssel with education they he and Dr. explanation central at to that to the this by requesting the was board Public a sending AHA. thought setting not thought agreed Duke responsibility be push said Thompson in Non Mr. is and have AMA board significant ITEMS staff to will was the should issues be advocated it felt thought -routine on which recognized issue Derzon University Dr. carried Health the Special that this at saddled been merely the by and advisory the -- this require felt the to that their and this Heyssel Executive the advised HCFA be a at request listing too he directly. progress spend and board a this responsibility COTH, have description Service that available that this by felt Committee board it an letter that time, with reaction did hard as of that attention. opinion Hospital the informational needed was time moved this was that this time. the an not the response it to HCFA not it. Council that as to although Association, staff Points should be done important well-informed all was Dr. on Executive AAMC-wide, AAMC responsibility "the" it listing for want date that on to to provided Administrator He the of issues COTH might well Knapp purposefully should the the be the was particularly. expressed The as to to this on the method staff educating refined being item. done. rating. it. get sent members should these objective. March more board be said other Council staff item Duke it be for about to No XIX. Additional Information Items .

COTH Nominating Committee--Mr. Everhart explained that the • composition of the Nominating Committee of COTH is made up of the Immediate Past Chairman as Chairman, the Chairman and one other representative at large. Dan Capps had agreed to serve as the at large representative.

Other Committee Nominations--Irv Wilmot has been appointed to the Flexner Award Committee and Dr. Spencer Foreman appointed to the Task Force on Graduate Medical Education (replacing Dr. Heyssel who resigned from the Task Force).

MAP Program--Mr. Everhart informed the board that COTH is sponsoring a third Management Advancement Seminar to be held June permission 9-14, 1978 in Florida. The invitations to that session have been sent and Mr. Everhart urged anyone who has not participated to do so.

without

Cost Containment Attitudes of Other AAMC Councils--Dr. Bentley reported on the meetings of the CAS and COD Boards where he had reported on cost containment. He said that the CAS reproduced supported all of the recommendations. They weren't enthusiastic be about a voluntary program, to but don't have any alternative to suggest. The COD would not take a position and are waiting for the COTH Board to provide Not some guidance to them on how to vote on the recommendations. COD feels that the voluntary program accepts two concepts with which they don't agree. The first being that the gap between GNP and any

AAMC hospital cost index needs to be closed. Secondly they object to. the reducing capital expenditures on a formula approach.

of

collections • NEW BUSINESS

the Martin Egelston reported that the AHA Committee on Medical Education from had addressed some issues which may be of interest:

1. Reacted to the Essentials of Graduate Medical Education

Document 2. Women in Medicine

3. Foreign Medical Graduates

4. Request for Critical Care as a new specialty

5. Second Opinion Surgery

6. Guidelines for affiliation of community hospitals and medical schools. • Document from the collections of the AAMC Not to be reproduced without permission • • XX. Adjournment the on setting Coordinator service developing country. The Mr. and up meeting Toomey staffs for for Mr. cooperative its Development announced was Everhart both selection adjourned in Chicago arrangements that commended of of at Multi he Mr. 12:45 and has -Hospital the Toomey Greensboro. accepted between P.M. AHA to for Systems direct hospitals a the new He creation position the will and throughout effort. is be now of working as this AHA ASSOCIATION OF AMERICAN MEDICAL COLLEGES COUNCIL OF TEACHING HOSPITALS

Application for Membership

to the INSTRUCTIONS: Type all copies, retain the Pink copy for your files and return two copies Association of American Medical Colleges, Council of Teaching Hospitals, One Dupont Circle, N.W., Washington, D.C., 20036. PLEASE ENCLOSE A COPY OF THE HOSPITAL'S AFFILIATION AGREEMENT WITH THE APPLICATION.

MEMBERSHIP CRITERIA:

the following criteria: Eligibility for membership in the Council of Teaching Hospitals is determined by

with a school of medicine (a) The hospital has a documented institutional affiliation agreement for the purpose of significantly participating in medical education;

AND

active residencies in at least (b) The hospital sponsors or significantly participates in approved, Surgery, Obstetrics- four recognized specialties including two of the following: Medicine,

permission permission Gynecology, Pediatrics and Psychiatry.

operated for educational, Membership in the Council is limited to not-for-profit (IRS-501C3) institutions,

scientific or charitable purposes and publically-owned institutions. without without

I. MEMBERSHIP INFORMATION SINAI HOSPITAL OF DETROIT

reproduced reproduced HOSPITAL NAME be be 6767 W. Outer Drive Detroit to to Kam CITY

Not Not Michigan .48235 493-5010 TELEPHONE NUMBER STATE ZIP CODE Julien Priver, M.D.

AAMC AAMC Chief Executive Officer NAME

the the Executive Vice President

of of TITLE

Date hospital was established: January 15, 1953

collections collections APPROVED FIRST POST-GRADUATE YEAR 1 F.T.E. 1 the the F.T.E. Date of Initial Total Positions 1 Total Positions , Approval by CME Total F.T.E. Filled by U.S. 2 And Canadian Grads Filled by FMG's from from TYPE of AMA** Positions Offered

Flexible (rotating) 6/19/54* 0 0 n

Categorical 24 15 6 Document Document 1 Categorical* 6 2

and/or with appropriate AMA Internship ** Council on Medical Education of the American Medical Association and Residency Review Commission. If hospital participates in combined 1. Full-time equivalent positions at applicant institution only. to applicant institution. programs indicate only F.T.E. positions and individuals assigned

and Residencies. (Flexible-graduate 2. Type as defined by the AMA Directory of Approved Internships Categorical-graduate program pre- program acceptable to two or more hospital program directors; dominately under supervision of single program directpr; Categorical*-graduate program under supervision of single program director but content is flexible.)

*At the time of initial approval by CNE of AMA we had 11 rotating internships. • APPROVED RESIDENCIES 1 F.T.E. 1 Date of Initial Total Positions F.T.E. Approval by CME Total F.T.E. 1* Filled by U.S. Total Positions TYPE of AMA** Positions Offered And Canadian Grads Filled by FMC's

Medicine 2/28/55 45 31 14

Surgery 6/6/55 16 5 8

Ob-Gyn 7/26/54 13 11 2 Anesthesia 4/19/56 9 8 1

Psychiatry 4/25/62 18 7 8 Ophthalmol. 6/8/60 6 5 0

Pathology 3/22/55 2 0 1 Radiol. DX 6/17/55 6 0 6 Radiation Thr. 6/17/55 2 0 1 *Includes PG/1 positions permission permission II. PROGRAM DESCRIPTION

To supplement the information above and to assist the COTH Administrative Board in evaluating whether or not the it is requested that you briefly and succinctly describe the extent without without institution fulfills the membership criteria, of the hospital's participation in or sponsorship of educational activities with specifici reference to the following questions.

A. Extent of activity for undergraduate medical education students (e.g., number of clerkships offered;

number of students participating; proportion of medical staff time committed to medical students). reproduced reproduced be be B. Presence of full-time salaried chiefs' of service and/or Director of Medical Education (e.g., depart- to to ments which have salaried chiefs; hospital chiefs holding joint appointments at medical school).

Not Not C. Dimension of hospital's financial support of medical education costs and nature of financial agreement with medical school (e.g., dollars devoted to house staff salaries and fringe benefits; the percentage of the hospital's budget these dollars represent; hospital's contribution to cost of supervising faculty;

portion of service chiefs' costs paid by the hospital).

AAMC AAMC

medical school's involvement in and reliance upon hospital's education program the the D. Degree of affiliated

(e.g., medical school faculty participation in hospital activities such as in-service education, of of conferences or medical staff committees).

The above are not meant to be minimum standards or requirements, but reflect the belief that COTH membership indicates a significant commitment and consideration of the items above. The hospital's organized medical

education program should be described clearly with specific reference given to unique characteristids and to collections collections

the institution's medical education objectives. the the

III. LETTER OF RECOMMENDATION from from

A letter of recommendation from the dean of the affiliated medical school should be included outlining the

importance of the teaching hospital in the school's educational program. Document Document

Name and Address of Affiliated School of Medicine: Wayne State Univeraity School of Medicine 540 East Canfield Avenue, Detroit, MI 48201

Name of Dean: Robert D. Coye, M.D.

Information Submitted by: 411 Mrs. Norma G. Silver Associate Administrator NAME T OF PERSO MAITTING DATA

ATE OF HOSPITAL CHIEF EXECUTIVE Sydney C. Peimer Senior Vice President/Medical Affairs -15- WAYNE STATE UNIVERSITY

SCHOOL OF MEDICINE GORDON H. SCOTT HALL OF BASIC MEDICAL SCIENCES 540 EAST CANFIELD AVENUE DETROIT, MICHIGAN 48201

3, 1978 OFFICE OF THE DEAN February

Mr. David L. Everhart President Council of Teaching Hospitals American Association of Medical Colleges Northwestern Memorial Hospital Chicago, Illinois 60611

Dear Mr. Everhart: Hospital of Detroit This is in support of the application of Sinai of the AAMC. for membership in the Council of Teaching Hospitals medical school with Sinai Hospital is a major affiliate of this program having educa- undergraduates in three of the four years of our physical diagnosis, required tional experiences at Sinai. These include and psychiatry and third year clerkships in gynecology/obstetrics number of Sinai Hospital numerous electives in the fourth year. A affiliate faculty with based physicians are members of our full-time faculty with many all rights and responsibilities of the full-time faculty. additional Sinai faculty members of our voluntary relationship with In addition we have enjoyed'a very effective linkages with: the Medical respect to developing further' and closer and medical school School. We have regular meetings.of.th&hoSpital programs and possibilities administration and.review'both Present joint appointment was recently for future ventures. Out of onesuch.ieview.an of Anesthesiology as Chairman made which designated the Sinai Chief Medicine. of the Department at the'SchoOl of Sinai Hospital of Detroit There is no question in my mind that and research goals of the is completely dedicated to the educational consideration for membership Medical School and fully merits favorable in COTH. Sincerely,

Robert D. Coye, Dean \ -7

RDC:lel

-16- Sinai Hospital of Detroit

• COUNCIL OF TEACHING HOSPITALS - APPLICATION FOR MEMBERSHIP

ATTACHMENT A.

Wayne State University's second, third, and fourth-year students rotate at Sinai Hospital of Detroit as follows:

2nd year - 32 (physical diagnosis)

3rd year - 48 OB/Gyn

76 Psychiatry permission 4th year (includes electives) without 120 Medicine

26 Gynecology reproduced 12 Psychiatry be to 3 Radiology Not In addition, Sinai offers a Summer Fellowship in all programs to • first and second-year students. Approximately 60 students will AAMC receLie a combined 330 weeks of training. the of collections the from Document

• Sinai Hospital of Detroit

COUNCIL OF TEACHING HOSPITALS - APPLICATION FOR MEMBERSHIP

ATTACHMENT B - DEPARTMENT CHAIRMEN/WAYNE STATE UNIVERSITY APPOINTMENTS

Arnold R. Axelrod, M.D., Professor Chairman Department of Medicine - Sinai

Hugh Beckman, M.D., Clinical Associate Professor Chairman Department of Ophthalmology - Sinai

Eli Brown, M.D.., Professor and Chairman, Department of Anesthesiology Chairman Department of Anesthesiology - Sinai permission Milton H. Goldrath, M.D., Assistant Professor Chairman, Department of Obstetrics/Gynecology - Sinai without Sidney D. Kobernick, M.D., Ph.D., Clinical Associate Professor Chairman, Department of Pathology - Sinai

Harold Perry, M.D., Clinical Associate Professor reproduced Section Chief, Department of Radiation Therapy - Sinai be to Norman Rosenzweig, M.D., Professor Not Chairman, Department of Psychiatry - Sinai

Saul Sakwa, M.D., Clinical Assistant Professor AAMC Chairman, Department of Surgery - Sinai the of Maurice Tatelman, M.D., Professor Chairman, Department of Radiology - Sinai collections the from Document

• Sinai Hospital of Detroit

411 COUNCIL OF TEACHING HOSPITALS - APPLICATION FOR MEMBERSHIP

ATTACHMENT C - DIMENSION OF HOSPITAL'S FINANCIAL SUPPORT OF MEDICAL EDUCATION COSTS*

1. Dollars devoted to House Staff salaries and fringe benefits - $2,393,363.00.

2. Percentage of hospital budget - 6.7%

3. Hospital's contribution to cost of supervising faculty - $838,359.00 permission *Based on approved 1977/1978 budget without reproduced be to Not • AAMC the of collections the from Document

• Sinai Hospital of Detroit

COUNCIL OF TEACHING HOSPITALS - APPLICATION FOR MEMBERSHIP • ATTACHMENT D - FACULTY APPOINTMENTS OF SINAI MEDICAL STAFF

Professors 33

Associate Professors 15

Clinical Professors 15

Clinical associate Professors. .. . 37

Assistant Professors 16

permission Clinical Assistant Professors • • 95

without Adjunct Professor 1

Adjunct Assistant Professors • • • 2

reproduced Instructor 6

be to Clinical Instructors 82

Not Adjunct Instructor 1 •

AAMC 303

the

of

collections

the

from

Document

• ,.;•ty 1970

AFFILIATION AGREEMENT

Hospital of Detroit is a duly WHEREAS, tho Board of Trustees Of Sinai

of the State of Michigan, herein- established hospital in accordance with the laws after referred to as "Hospital; and

State University is a public WHEREAS, tlie Board1 of Governors of Wayne

VIII, Section 5, of the Constitution body corporate, organized pursuant to Article

to as "University"; and of the Slate of Michigan, hereinafter referred

are dedicated to furthering the • WHEItEAS, the University and the Hospital

and service to patients; and goals of health care education, research, • • units or division co- • WHEREAS, it is desirable that various colleges, • . these mutual objectives; operate in their endeavors toward

agree as follows: NOW TliEREFORE, the parties

be established which shall have as its 1. That a standing committee

study of the various relationships, and coordinate function the continued over-all

Hospital and the University. • joint programs between the

.shall consist of three Members on a policy-making . That said Committee

appoieted r!:,.• •resident and the Director of the Hospital. level from each institution, • • adequate it is devmed necessary in order to assure If, in the judgment of either party,

comn:ittec. It may appoint atklitional , representation of its Concerns on the

equal voice in the parties that each shall have an However, it is understood between

committee actionn. • . • 2

• 3: The committc shall make recommendations to the Board of Trustees

of the Hospital and to the President of the University regarding joint staff and

• faculty appointments, and appropriate rank, but such recommendations are to be

within the framework of the bylaws of the Hospital and the policies of the Univer-

permission permission sity. A report of all committee activities shall be presented periodically, and at

without without least once a year, to the governing boards of the respective institutions.

No action shall be taken which:would deprive the Hospital of its rights

reproduced reproduced • be be

as a corporation, commit it to action contrary:to its charter or bylaws; impose

to to Not Not an unreasonable demand upon said hospital duo to University rules.eoncerning •

AAMC AAMC tenure and retirement, or which would jeopardize the rights and privileges of

the the of of those members of the Hospital staff who do not take part in teaching and research

•••

and who arc not concerned with this agreement.

collections collections the the

4. That when salaries are the joint obligation of the two institutions, from from

insti- the amount of recompense shall be determined by concerted action of the two . •

Document Document and tutions and that neither will alter its agreed-upon share without the knowledge

upon written consent of the Other; and that changes in salary will be implemented only

agreement between the two institutions. • •

7 Document from the collections of the AAMC Not to be reproduced without permission . • fessorial teaching, or facilities; use to committees the costs sourcc not pense without Hospital the departments; knowledge pay of may other, any these 7. 6. of 5. the additional shall standing research income, person and be .knowledge That, That That. of facilities, access apportioned and not that the research this all wherever rendering remuneration pay and College. consent (Hospital, this and faculty to agreement and additional will including and shall service, by consent projects of be possible, every appointees service the be the University, eligible • done to respective shall compensation the administrative Hospital. reasonable of a supported to full-time University the in without for . not of the the University, • professorial or appointment limit Hospital, institutions pursuit- combined), allocation use by appointee to the and costs; outside of a right of University the their provided, and their to rank, provided to of Hospital of sources will of administrative that respective specific costs the the mutual regardless be thc full-time Hospital however, Hospital that or accorded will carrying University joint fees objectives amounts physical accord, for projects without to appointee and of that pro- provisiOn recann_ the .other shall and• each the. of • ..

4

for institutional overhead expense; and to projects in which separate and individual

agreements are made between the University and the -Hospital, .according to the

terms of those agreements.

This agreement is subject to revision from-time to time, as agreed upon

peithission peithission by the two institutions, and may be extended by mutual agreement to include •

without without departments of the University and the Hospital. Either party may termi- specific •

nate this agreement by giving the other party written notice of its desire to termi- reproduced reproduced

be be nate at a date not less than six months 'after the date Of such notice.. Unless this

to to Not Not . 'agreement is terminated in .the manner set forth above, this agreement shall be

AAMC AAMC :deemed to be renewed from year to year.

the the of of IN WITNESS WHEREOF the parties hereto have on the day and year first

above written set their hands and seals.

collections collections

the the from from BOARD OF TRUSTEESBOARD'OF GOVERNORS SINAI HOSPITAL OF DETROIT WAYNE STA F UIMERSITY <77--- C.---r!

Document Document c--- • By By ,..;- ' . .. . s: ..." . Witnessed By: Witnessed By: '

.• /. 1.1.A.7174-ty", •::7-Fea.•• 74..,._ • • j

; COTH Members Who Have Not Paid Their Annual Dues

For the Year 1976-77:

1. Los Angeles County - USC (Paid for FY 77-78) 2. Harlem Hospital, New York 3. Mayaguez Medical Center, Puerto Rico (Also owe for FY 75-76)

For the Year 1977-78:

1. Veterans Administration Wadsworth Hospital, Los Angeles 2. Cedars of Lebanon Hospital, Miami 3. Schwab Rehabilitation Hospital, Chicago 4. Veterans Administration Lakeside Hospital, Chicago

permission 5. Veterans Administration Hospital, Biloxi 6. Veterans Administration Hospital, Albany 7. Bronx Municipal Hospital without 8. Harlem Hospital, New York 9. Jewish Hospital and Medical Center, New York 10. North Central Bronx Hospital 11. Veterans Administration Hospital, Northport, New York reproduced 12. New York Medical College - Flower and Fifth Avenue Hospitals be 13. Hubbard Hospital of the Meharry Medical College, Nashville to 14. University Hospital, Seattle

Not 15. Mayaguez Medical Center, Puerto Rico • 16. San Juan City Hospital AAMC the of collections the from Document

• Document from the collections of the AAMC Not to be reproduced without permission 12/67 10/68 . 6/70 6/30/70 8 6/69 6/69 6/69 6/69 6/69 6/67 6/69 6/69 6/69 6/69 7 6/69 / / 6 6 9 8 - - - Buffalo, Buffalo Fort Brooke St. Scott Temple, St. Stockton, San El Baltimore, William U.T. The Milwaukee Lexington, Lafayette Bethlehem, Knoxville, Travis Oakland, Milwaukee, Lafayette, Baptist, Detroit David Children's Reading, Highland National Paso, Joseph Joaquin Luke's Reading Sam Memorial & HOSPITALS Grant General Air General Texas Beaumont White Memorial Houston, New Texas Pennsylvania Cal. General Institute Nashville Psychiatric California Charity Tennessee Maryland Pennsylvania Hospital Hospital La. Wisconsin Hospital Kentucky Force General Hospital USHFH York Research Memorial Hospital Hospital WHICH General Base, Hospital Texas Hospital of Hospital of HAVE Hospital Mental Center Hospital Cal. Birmingham Hospital DROPPED Health & Hospital FROM COTH MEMBERSHIP • -2-

6/70 - Carney Hospital Boston, Mass.

6/70 - The Charles T. Miller Hospital St. Paul, Minne.

6/70 - Crouse Irving Memorial Hospital Syracuse, New York

6/70 Fitzsimons General Hospital Denver, Colorado

6/70 - Harrisburg Polyclinic Hospital Harrisburg, Pennsylvania

Hospital permission permission 6/70 - Lincoln Bronx, New York

without without 6/70 - Maimonides Medical Center Brooklyn, New York

6/70 Mount Carmel Medical Center

reproduced reproduced Columbus, Ohio be be to to 6/70 Providence Hospital D.C.

Not Not Washington,

III 6/70 Queens Hospital Center AAMC AAMC

Jamaica, New York the the

of of 6/70 St. Agnes Hospital Baltimore, Maryland

6/70 St. Clare's Hospital & Hlth. Center

collections collections New York, New York the the 6/70 - St. Mary's Hospital

from from Minneapolis, Minne.

6/70 St. Vincent's Hospital

Jacksonville, Fla. Document Document 6/70 Univ. of Miami School of Medicine National Children's Cardiac Hospital Miami, Florida

6/71 - The Jamaica Hospital Jamaica, New York

6/30/71 - Jersey City Medical Center • Jersey City, New Jersey -3-

6/30/71 - Pontiac General Hospital , Pontiac, Michigan

6/71 Sisters of Charity Hospital Buffalo, New York

6/71 U.S. Public Health Service Hospital New Orleans, Louisiana

6/71 U.S. Public Health Service Hospital San Francisco, California

5/16/72 - Fairview General Hospital Cleveland, Ohio permission 6/73 Milwaukee Children's Hospital Milwaukee, Wisconsin without

6/73 St. Joseph Infirmary Louisville, Kentucky reproduced be

to 6/74 - Bayfront Medical Center, Inc. St. Petersburg, Florida Not 6/74 - Good Samaritan Hospital, Inc. Baltimore, Maryland AAMC the of 3/75 University of Texas M.D. Anderson Hospital and Tumor Institute Houston, Texas collections 4/75 University Hospital, State University of the New York at Stony Brook Stony Brook, New York from 6/30/75 - Allentown Hospital Association Allentown, Pennsylvania Document 6/30/75 - Fairview Hospital Minneapolis, Minnesota

6/75 Massachusetts Mental Health Hospital Boston, Massachusetts

5/76 St. Francis Hospital Evanston, Illinois 6/30/76 - Baptist Medical Center of Oklahoma Oklahoma City, Oklahoma

6/30/76 - Church Home and Hospital Baltimore, Maryland -4-

3/77 Greater Baltimore Medical Center Baltimore, Maryland

4/77 - Fordham, New York (CLOSED)

4/77 - Morrisania, New York

5/27/77 - The Children's Hospital of Buffalo Buffalo, New York

6/1/77 - Mount Carmel Mercy Hospital Detroit, Michigan

6/30/77 - Philadelphia General Hospital (CLOSED) Philadelphia, Pennsylvania permission 6/77 Presbyterian Hospital Center Albuquerque, New Mexico without

2/78 - Methodist Hospital Houston, Texas reproduced be to Not • AAMC the of collections the from Document

• Document from the collections of the AAMC Not to be reproduced without permission These March RESPONSES 153 132 53 68 16 32 13, tabulations

1978. TO Total Total Total Total Total and Total As Veterans COTH Their Bring Number Number Number Number Number Number reflect SPRING Administration Hospital's One of of of of of of Additional MEETING data Responses Individuals Individuals Individuals Individuals Institutional received Only INITIAL Hospitals Staff Representative from Planning Planning Planning Not at Responses INVITATION Member Individuals COTH Planning Who Offices to to to Plan Attend Attend Attend to at to Attend as Attend of • INDIVIDUALS PLANNING TO ATTEND COTH SPRING MEETING

William E. Hassan, Jr., Ph.D. *Charles Ashley, M.D. Peter Bent Brigham Hospital, Boston Mary Imogene Bassett Hospital 411 Cooperstown, NY *David Weiner Childrens Hospital Medical *Paul W. Hanson Center, Boston The Genessee Hospital, Rochester, NY

*Mitchell T. Rabkin, M.D. John B. Stevens Beth Israel Hospital, Boston Highland Hospital, Rochester, NY

Doyle R. Liles Allan C. Anderson VA Hospital, Newington, CT. Strong Memorial Hospital, Rochester, NY

C. Thomas Smith *Lad F. Grapski Yale-New Haven Hospital Allegheny General Hospital, Pittsburgh

permission *Clarence W. Bushnell Irwin Goldberg Bridgeport Montefiore without Hospital, CT Hospital Association of Western Pennsylvania, Pittsburgh M. Michael, Jr. VA Hospital, East Orange, NJ C.R. Youngquist

reproduced Magee - Womens Hospital, Pittsburgh

be *John D. Phillips to St. Barnabas Medical Center Henry Hood Livingston, NJ Geisinger Medical Center, Danville, PA

Not *Robert L. Evans, M.D. *Francis J. Sweeney, Jr., M.D. • Cooper Medical Center, Camden, NJ Thomas Jefferson University Hospital AAMC the Donald S. Broas Gerald Katz of Hospital for Special Surgery, NY St. Christopher Hospital for Children, Philadelphia David A. Reed Lenox Hill Hospital, *Raymond S. Alexander collections NY Albert Einstein Medical Center, Phila. the *David D. Thompson, M.D. New York Hospital Philip S. Birnbaum

from George Washington Univ. Hospital Seymour Cohen Bronx-Lebanon Hospital Center A.A. Gavazzi

Document VA Hospital, D.C. Lloyd V. Sturm VA Hospital, Bronx Robert M. Heyssel, M.D. The Johns Hopkins Hospital Robert K. Match, M.D. Long Island Jewish - Hillside Spencer Foreman, M.D. Medical Center Sinai Hospital of Baltimore

Harold Light Charles D. Jenkins Kings County Hospital Center, NY The Union Memorial Hospital, Baltimore

Charles H. Meyer Dennis Barry • Brookdale Hospital Medical Center, NY North Carolina Memorial Hospital

*Planning to bring one additional individual to the meeting. -31- Individuals attending (cont.) -2-

Richard H. Peck *George Cartmill Duke University Hospital Harper Grace Hospitals, Detroit

P.K. Whiteside *William J. Downer, Jr. VA Hospital, Decatur, GA Blodgett Memorial Medical Center Grand Rapids Malcom Randall VA Hospital, Gainesville *Marvin F. Neely, Jr. Milwaukee Cty Medical Center John E. Ives Shands Teaching Hospital *Gordon M. Derzon University of Wisconsin Hospitals Fred J. Cowell Jackson Memorial Hospital John H. Westerman Univ. of Minnesota Hospitals & Clinics Alvin Goldberg permission Mt. Sinai Med. Center John F. Imirie, Jr. of Greater Miami Foster G. McGaw Hospital of Loyola without Robert P. Blair William Jeffries VA Hospital, Birmingham VA - Lakeside Hospital, Chicago

J.E. Stibbards William Hejna, M.D. reproduced The Children's Hospital, Rush Medical Center be Birmingham to Earl Frederick

Not Russell B. Wimmer Childrens Memorial Hospital, Chicago VA Hospital, Louisville Gerald Mungerson • AAMC John R. Rowan Illinois Masonic Medical Center, Chicago

the VA Hospital, Lexington of *Robert E. Frank *Charles B. Warner (Tentatively) Barnes Hospital, St. Louis Univ. Hospitals of Cleveland *Linn B. Perkins collections *Allen E. Howland St. Louis Childrens Hospital

the Akron General Medical Center *David A. Gee from *Thomas A. Saladin Jewish Hospital of St. Louis Good Samaritan Hospital Cincinnati Robert Haith, Jr. VA Hospital, Kansas City Document *Lonnie M. Wright, Ph.D. Children's Hospital Medical J.L. Kurzejeski Center, Cincinnati H.S. Truman Memorial VA Hospital Columbia, MO Jack A.L. Hahn Methodist Hospital of Indiana Sheldon Krizelman University of Kansas Medical Center Michael R. Swhwartz St. Joseph Mercy Hospital T.P. Mullon Pontiac, MI VA Hospital, Omaha • *Planning to bring one additional individual to the meeting.

-32- Individuals attending (cont.) -3-

*Robert J. Baker Gary Mecklenburg (Undecided) Univ. of Nebraska Hospital & Clinic Stanford Univ. Hospital

*James M. Ensign James Heidenreich Creighton Omaha Regional Orthopaedic Hospital, Los Angeles Health Care Corp Roy S. Rambeck *L.R. Jordon Univ. of Washington Hospitals, Seattle Ochsner Foundation Hospital W.G. Hitchings James E. Crank VA Center, Dayton Univ. Hospital, Little Rock Ira Clark Bruce M. Perry Kings County Hospital Center University Hospital & Clinics

permission Oklahoma City *Barry Bowers Maryland General Hospital, Baltimore *C. Wayne Hawkins without VA Hospital, Dallas *G. Bruce McFadden Univ. of Maryland Hospitals, Baltimore *William F. Smith Hermann Hospital, Houston Thomas Beckett reproduced Hahnemann Medical College and be Jose R. Coronado Hospital of Pennsylvania to Audie L. Murphy Memorial

Not VA Hospital, San Antonio Barry M. Spero Mount Sinai Hospital of Cleveland James H. Henderson

AAMC Presbyterian Medical Center, Denver Wayne E. Sarius (Tentative) VA Hospital, Syracuse the

of James A. Cunningham VA Hospital, Denver Plato A. Marinakos Mercy Catholic Medical Center, Philadelphia John Reinertsen collections University of Utah Hospital William I. Jenkins William N. Wishard Memorial Hospital the Daniel W. Capps Indianapolis from University Hospital, Tucson Thomas A. Gigliotti Stuart Marylander VA Hospital, Pittsburgh Cedars-Sinai Medical Center

Document Robert E. Mack *John D. Ruffcorn Hutzel Hospital, Detroit Loma Linda Univ. Medical Center Donald F. Brayton Robert W. White Kern Medical Center, Bakersfield Univ. of California, Irvine Med. Ctr. *J. Robert Buchanan, M.D. William B. Kerr Michael Reese Hospital and Medical Center Univ. of California Hospitals and Clinics, San Francisco *David L. Steffy • Ohio State University Hospitals *Planning to bring one additional individual to the meeting. INDIVIDUALS NOT PLANNING TO ATTEND THE COTH SPRING MEETING

David Barrett Joseph J. Mason The Memorial Hospital, Worcester VA Hospital, Philadelphia

Lawrence Hill H. Robert Cathcart New England Medical Center Pennsylvania Hospital, Philadelphia Hospital, Boston Stanley W. Elwell Charles A. Sanders, M.D. Episcopal Hospital, Philadelphia Massachusetts General Hospital Carl L. Mosher LaUrens Maclure Presbyterian Univ. PA Medical Center New England Deaconess Hospital Boston David C. Schmauss Albert Einstein Medical Center, Northern permission James M. Malloy , Philadelphia Univ. of Connecticut Health Center Paul A. Scholfield without John K. Springer Graduate Hospital, Philadelphia Hartford Hospital Richard M. Loughery Felix M. Pilla Washington Hospital Center, D.C. reproduced Monmouth Medical Center be Long Branch, NJ Mortimer B. Lipsett, M.D. to NIH, Bethesda

Not Alvin Conday Catholic Medical Center, R.J. Lipin, M.D. Jamaica, NY VA Hospital, Baltimore •

AAMC

the Donald Eisenberg Don L. Arnwine of Nassau County Medical Center Charleston Area Medical Center East Meadow, NY J.W. Pinkston, Jr. Paul Philipps Grady Memorial Hospital, Atlanta collections VA Hospital, Albany, NY

the Dr. Wadley R. Glenn Lyle W. Byers Crawford W. Long Memorial Hospital from Eye and Ear Hospital of Pittsburgh Atlanta

Harold W. Luebs Paul Hofmann Childrens Hospital of Pittsburgh Emory Univeristy Hospital

Document William E. Corley John B. Byrd Milton S. Hershey Medical Center VA Hospital, Memphis

Milton H. Appleyard Sheeler B. Lipes Harrisburg Hospital, PA City of Memphis Hospital

Carl I. Bergkvist Harold Margulis Bryn Mawr Hospital, PA Louisville General Hospital • Individuals NOT attending -2-

Gerald W. Wagner William K, Anderson Jewish Hospital, Louisville VA Wadsworth Hospital Center Los Angeles Judge T. Calton Albert B. Chandler Medical Center Neal D. Asay Lexington Riverside General Hospital, CA

E.J. Conklin, M.D. J. Rock Tonkel Wayne County General Hospital Childrens Hospital of San Francisco Eloise, MI John R. Simmons, M.D. Robert H. Gregg, M.D. Gorgas Hospital, Ancon, Canal Zone Childrens Hospital of Michigan, Detroit Edward M. Stein University Hospital, Seattle William R. Merchant, M.D. permission Memorial Veterans Hospital Daniel L. Stickler Madison, WI Presbyterian University Hospital without Bernard J. Lachner Edward C. Andrews Jr., M.D. Evanston Hospital Maine Medical Center, Portland Marvin C. Miles reproduced MacNeal Memorial Hospital Assoc. be Berwyn, IL to

Not J.L. Buckingham Touro Infirmary, New Orleans

AAMC Elliott C. Roberts

the Charity Hospital of LA at New Orleans of Louis M. Frazier, Jr. VA Hospital, Shreveport

collections David H. Hitt

the Baylor University Medical Center Dallas from Newell E. France Texas Childrens Hospital, Houston

Document Donald G. Shropshire Tucson Medical Center Baldwin G. Lamson, M.D. UCLA Hospital and Clinics

Donald C. Carner Memorial Hospital Medical Center Long Beach • Document from the collections of the AAMC Not to be reproduced without permission Childrens Earl Doyle Veterans Blodgett William Cooper Robert David Charles New Mary Mitchell Beth Hospital Hospital Hospital Medical York Frederick Imogene Israel R. Thompson Medical L. J. Allen Administration Liles Memorial Hospital Rabkin Memorial Evans Center Downer, , Hospital Bassett Ashley Center Jr. SUGGESTED Possibility Outpatients Possibility How Full-time to to to Utilization The on Allocations. Teaching Potential Major Ambulatory The and in Hospitals Relationships This Propietary Possible Health Federal Medicare Legislation Update Hospital Going Share Program the Establish Assuring Cost Impact Role TOPICS Fast-growing Teaching With Teaching Planning on vs. on of Program Effective Section Exemption and Clinician for Which Federal of Management Care This Hospitals: of of in of a State the Quality re: FOR and What Cost-effective the of Utilization a Operating Incentive CAT Hospitals - Hospital Hospital Form Act and COTH Teaching "forced Components Update Medical 223 Uniform National Sector Cost Control are the Units of in - of Who Core SPRING Decision and Hospitals Impact a Care Control What's Data Else Teaching a Compensation - Chief Colleges retirement" of Setting Justification of Coding of Units Larger "One Innovative Health in Evaluation the MEETING Basis Base. on Rural Reimbursement is - Happening Affiliation Executive Legislation Class" from of Teaching Business Getting Where of Implications Setting, Planning and Among Hospitals Clinical Considered Episodes Pending for Approaches Their Are Service is of at Clobbered? Institutions Officer Hospitals the Productive We If Guidelines Resource With Roosevelt Campuses Non of as so, of to Essential -Owned Care • -2-

Voluntary Cost Containment Sheldon,Krizelman 0 University of Kansas Shared Services

Henry Hood Marketing Geisinger Med. Ctr. Multi-Institutional Systems

Philip Birnbaum "Cost Containment" and the Teaching Hospital GW University Hospital Health Planning, HSA Focus, and Medical Education and Research permission Allen Anderson Rationalizing the Adaptation of the Teaching Hospital Strong Memorial Hospital to Restricted Reimbursement without The Teaching Hospital and the Local HSA.

reproduced C.R. Youngquist How to Convince Medical School Faculty That They

be Magee-Womens Hospital Have an Obligation to Take Cost Containment Seriously to How are Medical Schools and Teaching Hospitals Not Getting Research Funded for Their Faculty as Federal Funds Dry Up. AAMC the Ira Clark Long Range Planning and Operational Adjustments of Kings County Indicated in Anticipation of the Future Non-availability Hospital Ctr of FMGs

collections Methods by Which Collaboration Between Dean's and Hospital Directors Can Be Enhanced and Conflict the Reduced., e.g. Particularly Where Chairmen Are Shared. from David A. Gee Strategies for Coping With Cost Containment Activities Jewish Hospital on Teaching Hospitals of St. Louis

Document Organization of Ambulatory Primary Care That Will Meet the Medical Education Requirements But Which will be Financially Reasible.

Clarence Bushnell Special Relationships of Teaching Hospitals to Bridgeport Hospital Planning and Cost Control Agenices --HSAs etc.

Will There be Further Development of a National Policy (and program) Controlling Choice of Specialty by Way of Further Controlling or Regulating Residency Programs TOPICS (Continued) -3-

G. Bruce McFadden Governance Structure and/or Issues of University of Maryland the University, Academic Health Centers Hospitals The Financing of Graduate Medical Education Source and Control. The Numbers Game in Graduate Medical Education

Section 227 Operation in October 1978 Lad F. Grapski Allegheny General Hospital Voluntary Cost Containment's Effects on Teaching Programs and Hospital Care

Lonnie M. Wright Implications of Cost Containment for Teaching Children's Hospital Hospitals Cincinnati permission Irwin Goldberg Governance of Academic Science Centers Including Montefiore Hospital the Relationship of Non without -University owned Teaching Hospitals to Medical Schools

The Joint Commission on Accreditation of Hospitals

reproduced Requirements and Their Impact on Teaching Hospitals be to Garald Katz Regionalization and the Academic Medical Center Not St. Christophers Hospital Organizing the Academic Medical Center in an Era of Cost Constraint AAMC the of Malcom Randall Improving Effectiveness in Hospital Operation VA Gainesville Development of Hospital Employees and Physicians as a Cohesive Team collections the Gerald Mungerson A Session on the Effects of Changing Mix in from Illinois Masonic Med. Ctr. Students, i.e., more females, more minorities less F.M.G.s -- What are the soothsayers saying re: Future Composition of Medical Staffs and

Document how That Will Effect Medical Programming

John Westerman An Analysis of Teaching Hospital Mission Patterns U of Minne Hospitals and Acceptance by Various HSA's - Including Description & Clinics of Outreach Efforts

Accountability Systems -- of Teaching Hospital Board -- of Teaching Hospital Manage- ment for Research Grants With Patient Care Funds • TOPICS (Continued) -4-

C. Wayne Hawkins •Cost Containment VA - Dallas Impact of Health Planning Guidelines & P.L. 93-641 on Teaching Hospitals

Marvin Neely JCAH and Ther "So Called" Teaching Hospital Survey Milwaukee Cty. Teams - How and Where are They Trained

Discussion of the Voluntary Cost Containment Program and the Effects upon GME Programs

Russell B. Wimmer COTH Involvement in Health Systems Agency Activities.

permission VA - Louisville

without John F. Imirie Cost Effectiveness as it Relates to Teaching Hospitals Foster G. McGaw Hosp. The Separation of Education from HEW will have What Effect? reproduced be John Ives Governance to Shands Teaching Hosp. Regulations Not

AAMC Dennis Barry Impact of Hospital Cost Controls on the Educational N.C. Memorial Hosp. Programs of Teaching Hospitals the of Realistic Financing of Outpatient Services

collections Harold Light Who Should Control Graduate Medical Education -- Long, Island Coll. Hosp. The Teaching Hospital or the Medical School the from William F. Smith Teaching Costs in Hospitals - Who Will Pay in the Hermann Hospital Future?

Document Relationships with Medical Schools - Where Primary Hospital is not Owned by Medical School

John Byrd Greater Support of HSA's Role in Cost Containment VA - Memphis of Expensive Equipment and Control of Available Beds (CAN'T ATTEND DUE of Different Category in Assigned Area. TO PRIOR COMMITMENTS) VA Deans Committee Responsibilities and Limitations in Univeristy/VA Hospital Affiliations -5-

A.A. Gavazzi Role in Schools of Health Care Administration VA - D.C. by COTH. Program Approval, etc.

J.L. Kurzejeski HSAs Role Truman Memorial VA • National Health Insurance

Fred J. Cowell Accountability of Chiefs of Services Jackson Memorial Hosp. Effective Organizational Structures

Barry Bowers Effect of P.L. 94-484 on Residency Programs in U.S. Maryland General Hosp. What is the Posture of the Federal Government on Funding Residency Programs in the Future as Regards permission Rate Setting Through Medicare and Medicaid.

without James C. Heidenreich Roles of Universities and Hospitals in Coordination Orthopaedic Hospital of Joint Programs (How is it Done With Pros and Cons)

reproduced Private Practices for University Faculty Within be the Teaching Hospital and the Ramifications for the to Hospital

Not

William Hassan, Jr., Ph.D. Group Practice Arrangements Within the Hospital Peter Bent Brigham Hosp. •

AAMC

the

of Raymond Alexander Effect of Cost Control Programs on Houst Staff Albert Einstein Trianing - Current and Future Outlook.

collections The "real" facts on Salary and Practice Arrangements with Full-time and Part-time Physicians

the

from John D. Ruffcorn How Can we Get Government to Recognize on a Timely Loma Linda Univ. Basis that Teaching Hospitals Have Heavier Operating Costs than Comparably Sized Community Hospitals

Document

Robert White Integrated Planning in the Teaching Hospital -- How UC, Irvine to Achieve

Implications of Federal HMO push on Teaching Hospitals

Dan Capps The Relationship of COTH to the AAMC in light of U of Arizona the emergence of the Association of Academic Health Centers • COTH Comparative data gathering and reporting -6--

Richard Peck The impact of State Rate Review/Setting Duke University Hosp on University Teaching Hospitals

Charles Jenkins The Union Memorial Hosp. Future of Free Standing Residency Programs

Major Town/Gown Conflicts and How Best to Resolve

Role of CEO vis a vis Organized Medical Staff in Relation to Residency Programs

Linn Perkins National Health Policy Directions St. Louis Childrens Retaining University Hospitals Ability to Pioneer permission New Technology, Determine Efficacy and Cost/Benefits New Technology in an Anti-Technology and Cost-Constraint Environment without

Robert Frank Teaching Hospitals' role in National Health Barnes Hospital reproduced Teaching Hospitals in the CAP approach to Cost Control be to Not 0 Paul Hanson Status of Medical Education in the COTH Group of Hospitals The Genessee Hospital AAMC Relationship of COTH Hospitals as Affiliates of Medical the Schools -- Have They Changed With Present Fiscal and of Regulatory Circumstances

Lloyd V. Sturm Report on HMOs Effectiveness as Health Care Delivery collections Hospital Director Modes the Progress Report on HSAs Across the Nation from

M. Michael, Jr. Is there anyway to show or predict a dropoff or VA Hospital restriction of number of residents entering specialities Document East Orange, N.J. the next five years? We all have to do some considerable replanning to take care of our patients ratio physician staff wise if this is going to occur to any degree.

Alvin Goldberg The Future of Self Standing Programs (Not Controlled Mt. Sinai Med. Center of By A University) Greater Miami Beach Political Understanding of Continuation of Educational Costs as Part of Reimbursement -7-

Jack A. Hahn Status of Reimbursement in Affiliated Hospitals Methodist Hospital for Teaching Faculty of Indiana Teaching ambulatory care - move from traditional OPD Approach •

Roy S. Rambeck Case Mix Determination in Teaching Hospitals; Univ. of Washington Need, Technology, Data Source, et al.

Cost Containment Ideas

Bruce Perry Organization and Reimbursement for Ambulatory Univ. Hospital & Clinics Services Strategy for Improving Ambulatory Oklahoma City Reimbursement Since COTH Hospitals Operate Majority of Ambulatory Care Programs

permission HSA Encounters - Problem Progresses; Problem Impact

without James Crank Placement of Medical School Graduate for House Staff Univ. Hospital Training Little Rock reproduced Financing of Intensive Care - Perinatal, etc.

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to

Not T.P. Mullon The Relationships of Teaching Hospitals and P.L. 93-641 VA Hospital, Omaha •

AAMC the John Reinertsen It is my understanding that the Commission on of Univ. of Utah Hospital Public General Hospitals will publish their report by mid-April. It would seem timely therefore to have as a topic the review of this report by Dr. Russell Neilsen or Arthur E. Hess.

collections

the Gordon Derzon Role of the Medical Staff of State University Hospitals from U of Wisconsin Hosp. in Approaches to Cost Containment. What Has Been Done; What Approaches Have Been Utilized?

Document David Weiner Marketing Opportunities And Strategies for the Childrens Hosp., Boston Teaching Hospital

Physician Practice Plans - Alternative Organizational Arrangements and Their Implications for Future Reimbursement of Teaching Hospital Based Physicians

Robert J. Baker Long Range Teaching Hospital Financial Stability Under U of Nebraska Hospital Federally Mandated Revenue Ceilings. and Clinics Impact of Revenue Ceilings on University Hospital • Financial Control (Governance by U Regents and Legislature) -8-

L.R. Jordan Financing of Graduate Medical Education in a Hostile Ochsner Foundation Hosp. Environment

Thomas A. Saladin In the Halls of Congress How Strong is the Push to Good Samaritan Hospital Control Medical Education Dollars?

Will the Number of Medical School Graduates Decline in the Near Future or Will It Continue to Increase

Gary Mecklenburg The Increasing Difficulties and Costs Associated Stanford U Hospital With JCAH Compliance - The Need to Continue Evaluation of the Accreditation Process

The Relationship of the Teaching Hospital to HMOs permission

without Robert M. Heyssel, M.D. Cost Containment in Hospitals The Johns Hopkins Hospital Multiple Hospital Consortions & Teaching Hospitals reproduced

be William Hitchings Sharing of CAT Scanners and other Sophisticated to VA Hospital, Dayton Tertiary Care Equipment

Not Strengthening Affiliations AAMC Wayne E. Sarius A discussion concerning the apparent disagreement the VA Hospital, Syracuse between Residency Review Boards of specialties and of sub-specialties and the LCGME Board and what strategy should teaching hospitals use to help alleviate these differences so we can avoid their consequences. collections I would like to hear a discussion on strategies that the teaching hospitals should tse with their affiliated medical schools to come to some reasonable agreement of lead time from schools need to adjust their residency assignments in the teaching hospital and, if necessary, reduce the number of residents needed in the teaching hospital. Document

Thomas Beckett Legislative Developments: Hahnemann Medical College a. National Health Insurance and Hospital of PA b. Cost Containment c. Health Planning

William I. Jenkins Cost Containment via Prospective Rate Setting in William N. Wishard Teaching Hospitals Memorial Hospital Practice Plans-Salaries for Full-Time Physicians

-43- Thomas A. Gigliotti Planning of the expanding clinical requirements of VA Hospital, Pittsburgh educational programs in line with cost containment and restricted resources. • The inter-institutional planning between medical school and hospital to assure the need to meet the objective of both institutions in the areas of patient care, education and research.

Donald F. Brayton Statement from the Commission on Public-General Hospitals Kern Medical Center Bakersfield, CA Status of the Long-Ribicoff-Talmadge Catastrophic Health Insurance and Medical Assistance Reform Proposal

permission Edward M. Stein Rate regulation and teaching hospitals - how have University Hospital, the agencies affected these organizations. What does Seattle (WILL NOT the future hold? without ATTEND) Evergency medical services - What is the academic relationship in a teaching hospital?

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• Document from the collections of the AAMC Not to be reproduced without permission AO 110 Presbyterian Carl Presbyterian Daniel John City Hartford Wheeler Washington Richard Grady Milton William Tucson J.W. Mt. Donald Don Charleston Harrisburg Milton Baylor Barry Long Donald Memorial David Medical Medical Cleveland Sinai Arnwine Mosher Springer of Pinkston Beach, Memorial M. Hitt L. S. Shropshire Medical Appleyard C. Univ. Memphis Loughery Lipes Corley Hospital Spero Hospital Stickler Hershey Hosp. Carner Hospital Center Hospital Area Center CA U U Hosp. Hospital Center Hosp. of Center My Thanks: for meeting. the Conflicting Regrets, institutions group. conducted beneficial. attending, Sorry. Already I I compelling I WILL Will Unless Sorry, Unfortunately, like believe may regrets day these Plan NOT have the Subsequent but with Membership Committeed. Major but I ATTEND I dates. the by to —4c— - regret a idea but reasons this think Meetings I am and the no conflict in most Conflict have will I already outside but - Future year we Applachian am your having meeting COMMENTS effective is to a discuss already not committed However, I major restricted that participate. idea years. in have committed speakers. know a information Dates. conflict. will conflict: "burning is Teaching have conflicting meetings until for idea "Booked" good prevent to commitments to May mid is and about another issues" Hospital -April are good. suggests 3 this will me and dates. 20 those from 4 year. of be more EXECUTIVE SALARY SURVEY

At the September, 1977 Board meeting, the executive salary survey was reviewed. The Board recommended that questions concerning the usefulness and confidentiality of the executive salary survey be added to this year's questionnaire.

permission

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RECOMMENDATION: Based upon the survey results it is recommended that the Executive Salary Survey be continued on an annual basis and that the results continue to be distributed to COTH members only.

• Document from the collections of the AAMC Not to be reproduced without permission • State Other, Municipal AGGREGATE Church Hospital AGGREGATE Major Limited University None Hospital dissent to of Question the • Desired Desired distributing interested municipal Nearly Nonprofit Ownership from this Affiliation 25: -Owned Distribution Distribution three "I hospital parties. unidentifiable the -fourths - - prefer view distributed generally report of of was directors COTH Restricted COTH Restricted that 68% 67% 43% 80% 84% 74% 76% 77% 74% 36% COTH of COTH only among (34) (3) Members (20) (91) (21) (8) (149) future (21) (100) (149) Members distributed the and 1977-78 1977-78 Executive Executive only to municipal members that preferred To To COTH survey to findings COTH members Salary To General To Salary General to preferred that hospitals. results Interested Interested interested members 57% 23% 24% 64% 32% 26% 33% 16% 20% 26% be Survey Survey the be Distribution Distribution (4) (11) (10) (28) (14) (10) (53) (4) (25) (53) continued. that remain report Persons Report Persons Report Nearly persons." the individually be current made two-thirds The 100% 100 100 100% 100 Total 100 100% 100 100% 100 Total available major practice of Document from the collections of the AAMC Not to be reproduced without permission Other, AGGREGATE State Church Ownership Municipal Q. of Hospital use hospitals 26 the of Overall, - Nonprofit the report. Please COTH Usage reported report, Executive 38 of indicate Grouped percent Executive 60 a higher rate percent Salary the by Considerable of 49% 40% 44% 38% 34% various Salary the use, 1977-78 Survey made (74) (10) (10) (14) (40) members of if limited types Report any, usage report. reported of your than By use, Limited 60% 60% 63% 51% 56% hospital Membership, hospital did (5) (15) (76) (119) (13) and that other 2 ownership, they percent makes None 0% 0% 0% 2% 3% hospitals. made (4) (4) of made more the considerable 100% 100% 100% 100% Total 100% no state use • • • Document from the collections of the AAMC Not to be reproduced without permission • • • State Church Other, Municipal AGGREGATE Ownership Hospital year state the reminader Q. 27 survey. was More Frequency - hospital Nonprofit Salary conducted? From the reported than On your preferred Survey three members of the hospital's Executive that -fourths basis 'Annually 83% 72% 77% 73% 77% report, frequency wanted they (157) (19) (55) (18) (25) of Salary their of preferred present the 1977-78 how the for Biennially survey often 22% 26% 21% 17% 24% common Survey membership the use (44) (26) (5) (6) (7) alternate should to survey. of ownership, Desired remain the the believed 0% 0% 4% 1% 2% Other COTH years Nearly By (4) (3) (0) (0) (1) on survey relatively Membership, Executive an for that Total 100% 100% 100% 100% 100% annual all be conducting of once the more basis. per Document from the collections of the AAMC Not to be reproduced without permission jointly for and a the Rush be Rush plan third held -Presbyterian -Presbyterian teaching meeting the The to sponsor seminar sponsor and hold attached AHA that will a hospitals seminar Multi for originally this -St. -St. the be agenda Request -Institutional sponsored the seminar. Council Luke's Luke's on in program. represents the to multiple came of Sponsor Medical Medical role by from Teaching the -unit It Systems of a a American is Center. Center. Dr. the brief Seminar management recommended James Hospitals academic Program: committee The A Hospital Campbell, request program formally systems. health that discussion Association was the President science will serve made The COTH definitely at of impetus center as Board of and a • • . Irt7,1r '4i126A.tit9k 6Pa. AMERICAN HOSPITAL ASSOCIATION 840 NORTH LAKE SHORE DRIVE CHICAGO, ILLINOIS 60611 TELEPHONE 312-645-9400

AGENDA

TASK FORCE TO PLAN TEACHING HOSPITAL SEMINAR

permission Room 2042, O'Hare-Hilton, Chicago March 9, 1978

without Beginning 8:00 a.m., CDT

1 WELCOME AND INTRODUCTIONS

reproduced

be to 2 ROLE OF THE TEACHING HOSPITAL

Not A. Is there a need and a desire to establish a role for the academic • health science center and teaching hospitals in the Multi-Institutional AAMC Systems program.

the of B. If it is the opinion of the group that there is an appropriate role, how can it be defined and what items should be covered. collections 3 INDIVIDUALS TO BE INVITED

the from 4 DATES, TIME AND LOCATION FOR SEMINAR

ADJOURNMENT Document 5

• AICPA Exposure Draft

On the following pages appears the Exposure Draft issued by the Subcommittee on Health Care Matters of the American Institute of Certi- fied Public Accountants entitled "Proposed Statement of Position on Modification of Reporting Practices Relating to Hospital Related Organizations and Funds Held in Trust By Others." The staff of the Department of Teaching Hospitals will be drafting a response and a full discussion of this document would be most helpful to the staff. In addition, it is recommended that each Board member submit comments to the AICPA. permission without reproduced be to Not • AAMC the of collections the from Document EXPOSURE DRAFT

PROPOSED STATEMENT OF POSITION ON MODIFICATION OF REPORTING PRACTICES RELATING TO HOSPITAL RELATED ORGANIZATIONS AND FUNDS HELD IN TRUST BY OTHERS „ • FEBRUARY 10,1978

Issued by the Subcommittee on Health Care Matters of the 8 American Institute of Certified Public Accountants For Comment From Persons Interested in Accounting and Reporting

Comments should be received by June 15, 1978, and addressed to 0-1-402 Robert C. Mullins, Manager, Federal Government Relations Division, File No. • AICPA, 1620 Eye Street, N.W., Washington, D.C. 20006 Document from the collections of the AAMC Not to be reproduced without permission An (other refer Persons February Reporting at Directors State. representatives To other document this ested in Organizations The The of A in Concerned the This Other of on of donfidential problems .

Tentative Practice dealing Council; exposure the Certified the the Trust subcommittee subcommittee Al subject exposure Public - to Society interested CPA in than issues American AICPA Who PA 10, n states and improving by Practices and Library With . discussion

with Have statisLical Offices draft Set. Others Technical . Public 1978 not Disclosure concepts will basis) nnd draft considered Committee Not Regulatory,-Supervisory,..or

of the specifically of Institute Requested later parties believes recommends Chapter of Uovered in be

the accompanies accounting Accounting PrincipleS of Relating has problems Accountants will a welcomed, New similar of Committee health thnn CPA proposed . data Chairmen; of been - this for and beome Y-)rk Presidents, that or by Firms; Copies: Financial

that June Certified described. their foster and to that Existing prepared , subject care and to

City and this this and statement Hospital Chairmen; part those 15, related those . Members

it Organizations reporting written industry, comment.. after American exposure letter. the 1211 will does Activities; or 1978. contained by AI('PA Public in reviewing Avenue

the interchange Accordingly, and Jum: explanatory the Related be not this of comments Written available Positive standards. industry publ ol Institute Reporting draft certified Subcommittee position 22, apply he Accountants exposure - in Americas, ic and Organizations 1978. an comments presents record of to should of . it Audit material commenting recommendations for.public entitled AICPA Certified New Practices hospitals, public ideas is draft. York,

to on of Guides. brAng be a on discussion New among Health help tire accountants, Public submitted submitted workable the and Modification York on for distributed American inspection focus it -exposure this those•inter— Funds Although 10036 Accountants Care - deals Nonprofit regnrding (212) approach draft

attention to draft on Held Matters Institute 575-6200

arrive and a with that at draft of to entitled also Document from the collections of the AAMC Not to be reproduced without permission • • /1J June and Sincerely, In notify Subcommittee will to Albert exact Federal Joseph addition attend should -1 14, hold -4? location Robert A. F. Government -t 1978. a should Cardone, Moraglio, submit - to public

on C. .accepting Persons of /9' Health contact Mullins written the hearing Chairman RelationsDivision Director hearings or Care as Mr. written or outlines on early Matters Mullins the will comments as eXpol;uru by be at possible, June made (202) wishing for 8, draft at 872-8190 con!;ideration, 1978'. a but to later in not make Selection V:ashington, for later date, presentations this and than the of information. D.C., subcommittee the persons June time should on 1, expecting 1978, and . PROPOSED STATEMENT OF POSITION ON MODIFICATION OF REPORTING PRACTICES RELATING TO HOSPITAL RELATED ORGANIZATIONS AND FUNDS HELD IN TRUST BY OTHERS

INTRODUCTION, pavors and others. ()tilers share this increasingly important and the concerns about the potential comple\ area. Furthermore, since 1. There is increasing interest ill, effects On reinibiirsements but be- funds held in trust for the benefit and - 111 apparent trend toward the lieve that those concerns should be of hospitals by independent organi- creation of, separate organizations, (ll'illt NVitil 111(1(TWII(Irlith. Of :IC- zations are similar ill many respects frequently referred to as founda- eonsideratimis and that to resmirees held by hospital related tions, to raise ;Ind hold certain funds accounting and reporting should be I rganizations and to eildowment other restricted funds held permission permission for hospitals. determim•d xyithout tel to and those potential effects. by hospitals, the subcommittee be- .2. One of the basic.... reasons usu- lieves it is necessary to reconsider ally cited for establishing those sey hinds ludd hi without without financial reporting .for ;trate organizations is to broaden THE PROBLEM trust by others for the benefit of the base of Philanthropic 'support The A [CPA's ilaypital A11(1it hospitals. in the community while at the same Giti(//' presently calls for combined time. distributing the horden financial reporting for related or- reproduced reproduced and APPROACHES TO THE PROBLEM

board or trustee rc;sponsibility ganizations if "significant resources be be effort among more . III operations of a hospital . are 7. One approach to the problem to to reasons appear .Nlore. recently, the handled by such organizations mid would be to coffin me that xvhiell is to iiisoi- Not Not the desire to center around they . . . aro tinder the control of presently set forth in the guide with against the . late contributed hinds (or common control with) hospi- the primary focus 001 contnil, and and potential rego- effects of actual tals. . . I lowever, the guide does II erely to expand it by. defining by and, ill par- AAMC AAMC lation government not give any guidance about or ex- or giviiig guidance about what ticular, against use by third-party constitutes •"control" and -hospital the the planation of what constitutes "con- payors . to underwrite their pro- resoitrces." of of trrIl" or "hospital resources." As a die re- grains. Nfany hospitals fear cionseiplence, a variety of reporting turn of constraints similar to the S. A second approach is' dmseAl practices are being folloxyed ill Economic Stabilization Program iv- on the rationale that the t•neolirage- :identical or similar cireunistanc(ss. menu aml development of philan- quirement to prove "severe finan- II'- collections collections ellhe financial statements of some cial hardship" in order tO he per- thropy is a fonction separate and hated organizatioils are combined distinct from the operation of a the the mitted to raise prices, whic..11 caused ssith -those of hospitals, \vhile the enter- some facilities to use contributed hospital as a .self-sustaining II nancial statements of others ill environment from from operations. Mal- prise in the current funds to support cireimistanc•es are not. Tile also seen as of health insurance and third-party practice claims are related facts. and circumstances are to hos- payors. Under this approach, it threats to funds contrilmted sometimes disclosed and sometimes pitals.. Organizers of separate flind- might be argued that there is such not. ill functions Document Document raising entities hope that exposiire a •distinct differc.lice that it is not necessary Or apprOpli- of those funds to 501(11 threats may 5. Com..erils aro expressed that tO CO11111010 111111116',11 5th tell Cli Is I)(' avoided or lessened hy the Ilse 11e55' organizations are being ere- of the two entities or to disclose dic of such organizations. _ated and eisting organizations ;ire related facts and circumstances. Al- being modified in a maimer de- argiied that 3. Some believe that the finan- signed to oyershadoSy the Substance teritati \•ely, it might he combination is not necessary, cial statements of such separate or- III the relationship and tti avoid the 551111e the cireninstances•Ill ganizations should not be coin,. re(ptireinents for combined finan- disclosure of the R•lationship is appropriate. bined with those of hospitals be- cial statements. cause they believe that combining l'ilder this alternative, reference too them wonld limit the effectiveness G. iii them' eirenuistanceS, the SI:11011111a on Stall(lardti of the organizatibus and tlic...rebv sulicommit(ee 1)e11es•i-s that the • 110. 6, lielated l'arty Trrui vartions subject contributed funds to the llospitol Audit (:riiilr (SAS (I). might provide wieri l iatc• feared exvropriation by third-park tomlifird to give more guidance in guidance. -5t- 6 EXPOSURE DRAI'T

0. A third itpinotti•li, (111551111111 11111(15 IL) 11111'1; 1"1111 1 or believing (hat die Hinds are to ii.i:esented in this ii alt. is basel III (II' per11111111'111 III 11.1111.11' «Well 111111.4 lIt' 115t•11 I > I IF or the benefit (il the a comprehensive. concept ()I hosp1. 1 11c 1115t1 11111111111 111 1 11111611.11. 1:111.14•1: hospital. III resources, its !Jelin( (I iipit'rit- 1111' '111110.11111110 ler.1 1111111.t111111,-11111111 1 1 ,,111.11 sc1l111;t1,. orgatiiiation IN graph 12. Linder this api)roach, II Ill'1(1 111 (Fl15[ 1.1\ 11111e1N- 551111111 111' 1 1111 111. (.n1111111 of or 1111111.r 111111- hospital resources (its (1(.•fili(.'tl) - aectirdet1 the treatment—in- 11(1111 ‘vith the hospital, the ist, they should Itc rellected hr clusion in the hospital's linaileial 1.51, 11 (1111t11.'` N111/11111 he C111111)11101 115 ili/SpiLlIS MACH/C.11k 11V statements—as entliA\ men( 11111(15 IL SilIglu' unlit , recognizing onlv combination or other\\•ise (see parit- 11(.111 11V 1111' .11051111111. c\[(quid thinor r('strictiims. graph 1:1),, of the lorins How; imposed 1),.. the separate o.r- of organization lhat ti tic t.).inization should be treated as the THE SUBCOMMITTEE'S and regardless of 11(.01(1 \ ;tient 01 hoard desigilu tions. to them CONCLUSIONS the hitspital controls the lithe' or- .\s defined in Statement 101 Ain lit- ganizatiolus. This approach places 12.. Based 1111 the subeittinnittee's hr.), St.indarth, no. 0, 1?cltil(•il control in 0 sceondarv role, as it tentative conclusions, the .stu tions 11(111N(rctiun5, -C.(1111.1'(11 determinant of the method and ex- (if the //ctspii(//. .1/1//it Guide that 1111SSCSS11111. ili11•1 tlic tent of conthinalion and not as it enrrtaillv deal \kith -()ther hi'I,iti 'ii 1)(1 (1) (hive( ill' determinant of ‘Ylicther th.c finan- ()rganizations- ( pages I I and 12) llic cial statements should be combined. and \vith -11111115 1 in Trust bv Ill a specified party 55 lit.ilter permission ()fliers- (paige 1.1 ), should be (It - 11110itt,11 o‘viletslu i t, his' (•11111 1.00, lIF 10. This third approach allects leted and replaced \kith the hillo\v- lither‘vise.- Among the factors 'con- rtportin,g of hospital resources han- nig te\t: sidered tit 1)c evidence cil control of without dl(d 1)5. organizations (hit are.not 1111 ort.2.,anizittion. ltv a hospital ;Ire controlled. 1 11111t.r this ap1uro.m..11, 110' ui till) killmvii114; RELATED ORGANIZATIONS thost• hospital resources 551111(1 ill' AND FUNDS HELD IN TRUST 'I'll.' 1lllSItiIi"s 1)11:11*(1 ;IS It 11111(1 111 BY OTHERS ill other ht)spital represen(a- reproduced (111;1116;11 .\ II tives. or 1)11(11, constitute tt ma- be COlaribAllialS IV- Ii' ;Ili (.)1'1,1%111j- iolitY III. the (itht.r orgitiliza- to 11;111(11C(1 r)V SIIV11 ;1 Z11111111 S('l)ill'atr 1.1'11111 the hospital SI/WITS Hion's board. organization \you'd be re- are consitleret1 to 1):‘ resources of

Not pmv(r (1) ported as additions to the restrict- the hospital if, ill substance, their The hospital hits the i1111)10111. reappoint, or 11111(1k:1' ed fund balance in the combined use or I'S1.(111.1;t1 distribution is lint- 1111111.11 111(111- financial statements pending dis- . lied to the 1111spital by the I /1*.t4;111.1%;1- II 11111i111'11V Ill 1111'

AAMC 1111114' (11'1,411111Z:1111111. trilmtion to the hospital. Thetim- i(111S (•11;IVICI. 1/V all/T. 111C;IIIS, 1)(•I'S.14 the ing' iii distribritions and any other I N 1111111I'll II/ SI11)1),),.1 11):11'11 in('tul)ers representing of restrictions on distributions im- cins,dv n.. the iIIlN1hlI II IRIVC T11111111111 111' posed the separate hit,d the 11051,1u.1.111. resources, 1•1•1.11 voli111 rights, such as (ion 51,01)1d be recognized ill addi- I f sig,nificititt, should Ile 1(1)1 it I'll I `I't" tion I(/ ;HIS' (11111111'•iniposcd restric- the at•ernal basis in the hospital's If such a scp.ara(c c)rgitnization is collections tions. treatment reelitrilizes finant•ii11 statements. The manner of III t under Olt: control of lit' nutlet. (hit a separate organization that reportint!, 511(1111(1 1)1) (1t7teriiiitied 11 the 'common control 551t1) the hospitai, 110I 11;IS the light (if all relevant attendant tilt.I.,„„1111,1111111,sI 1101k I 1)(. ,0,1111. iii I 0,Sjlj(II lstances. ()verriding con- from (Wel' WV 1:Se circu11 treitliii,i; lii il the separate or:!ani- and provides iiir hill .sideratitm should be to reileet the resources .zittion's assets, and fund closure of those resources in the sul)stitm:e and not [newly the 1111111 1).(1.i1hees ;Is resources oi. the hospi- hospital's financial statements. Ill the relationship 1),•kverli the tal in it .separate restricted fund in

Document lt(tspitill and tht. separate ()rgaiii- the combinetl linitm•iitl statements. I A sighificatit colisciiticitce Ill .zation. (luring the period this approach is that. funds held in Activity refh•(•tc(1 115 c111111gres in the re- trust bv others for the benefit of a A. Organizations Functioning sirieied fund balance. 1s Hinds are hospital 55.111111I also be included In for Cl Sinrile Hos.pitol distributed iir liecolitt. (list! ilitohle 1111SHIarS to the hospital. they, shonld Ix, rt•- 1 linvit\ er, these funds are held II. the Imrpfisi. or film- e(triled 1)\- the hospital, recognizing 51,1115 and trust agreements lion i ih :t scpar:or organization is Ill I.\ hlaial donor or separate or- Nit up 1)v donors, and the terms ill tI handle significant n•sonrces restrictitms.° distribution of incortH' 1111(1 111 111C.1- a single llii,Nillt III, its financial state- 11.1.tle1V. SOIlll• 111;15' 11011(•'.'1• ments should be combined 1.vith t11:lt 11111(',.S 1.11(.' 111/S1111:11 is entitled those of the hospital. All e\ample )1•.11iloilioie. dio/11.1 n•(,), to distribution of ptinciptil ‘vithin is a sepiti.ate organization that solic- 11,11.„ ilwy 1,111' reasonable length of time, the ItInds its contributions in the hospital's

(Ill not meet the definition 01 -hos name or in such a xvitv that the 1.,1.1111 di-.1)iti...1.111,111 1.. Ow pita] resonrees.- I lin.veSer, II Oil en- cot itrilintool have a II 'II basis .1 -.pl•Hril •111.•..1111•111 EXPOSURE DRAflr 7

Organizations Functioning to Ike bY entities other thin: the refli•cicil as clialigi.s lit for More Than One Other hospital, or to support \Airs the rei,tric•tc(1 .1s Organization managed 1)\• oilicr\\•ise closet\ hinds are rclate\I to 5.1.1411 ciiiitics, should Iii ilistrihntahlr lo the hospital, tli(ic If a separate organization han- inchided as It si should he recorded tile dles significant resources: of a hos- hindIi thecimil \Mud financial state- ;WV \ (1()IMI. tiE pital as \yell it.s significant resources ments ot the liosi>ital, reflecting It sci);11';11c restrietimr.. for entities other than the hospital or trust relationship, such 1:,\.ini1Iles iii -such separate ift.gani- and is under the control id or undi•r iIN "liimls held ill trust lift others.- zatimis 'arc a hank as It trustee, it common control \vith the hospital. If such a separate organization is university il the Imspilal IS 'iLli('r its financiid sUcimaas should he not 'miler the control isf iii nutter part of (iii • samc corporation or IS combined \vith those of tlic ii'' 51 11 common c•olitrol \vith the hospital. rclatc(1. anti a foundation (fund- - as if thcv were a single entitv. Rec- ()Hie those assets, Iii hilt is, ni.1 orpnization) that solicits ognition should he given in the liiiiii 1 /alimer5 or the:111 1 iii 'Ill iii ('ontriluitions lift the luici)ilal 1111(1 combination only -to este) mil donor 11111 (II iirintiaesi iii tlicin compris- restrictions: Those resources han- in:_; resources of the hospital should dled h\- the sepatate organization 1)e inchulial in the hospital's 1:3. The follm\•ing flow chart (11'- thc Ilse. or. cvelitnill distrilmtion iii statements. The inimmits should piCtS Ill,' IVI)t)11111:1, (I1 110N1 111:11 re- \vhich is restricted hv esteinal do- 1)e-reported in 1 scparate restricted S(1111'Ci'S 11C1(1 Its separate org,anizit- nor;. or is limited hs other means Activity (liirint.r, the periid lions as descrilied ill this draft. permission him"

Reporting of Hospital Resources Held by Separate Organizations without S jOltt It'll ii 4 No hold by.ii reproduced be Viis to Not handles iiesimices fur single I hispit.il AAMC

the Yr!, of

'H's collections the from

C111111-(11 iii i' 1111111 lii

' (111,11',11 Document

(iiiiilitiit;is

i•\

!hat di, ol !,4- 10: I 1.0•1•i1.1) ‘,11 .1 11,111'1.1:1': .111.1111LE iii,ty I m. .111( ilUIllils 1:‘,111 1,111 ;Li! •ii. iii.iL• ilii• II) • (1•,!10.,111,,1)% II,, • 1.••: iii t)siL,,cii,i ui Ow ,r Lit,•ti tio. Li, it, iii ,1.1k • Document from the collections of the AAMC Not to be reproduced without permission • S of discussion, state was January next Budgets approved meeting At rate 29, the for review 1978. the January in by Health the attached March. be American Board placed Care For "Guidelines State meeting Institutions" on purposes Hospital the Rate it agenda Review for of was Association providing State suggested should for -Level full be a Board that discussion helpful. framework Review of the Trustees and issue This for at Approval the document of on Document from the collections of the AAMC Not to be reproduced without permission I. Introduction the of institutions economy exacerbated have of of The of buted regulation For product for funds effect mental services. a The purchase and accessible care a and determination dition. rational further the health expenditures health trend services, hospital many other access. distribution will accorded for to public financing GUIDELINES a for and extensive years, moderation The decisions. of require services facilities, effort care regulatory to system as :BUDGETS for by health spending industry as The American that there high all. and described the and the society well and, of in Approved industry and FOR private compatible for "demand-pull" inefficient is services growing priority are of federal this has As care In as in FOR availability mechanisms, STATE currently manpower, recognizes Hospital an regulating largely the a January in been in for a addition HEALTH increasing have result, direction.' by collective has sectors -LEVEL increases financial sections general to budget. presents government. Board a and increased done insulated 29, Association method making massive employed. CARE and insurance the inflationary to expenditures comprehensive such of REVIEW responses 1978 this of and II percentage these research It INSTITUTIONS services. problems in effort, a many high of Trustees as the infusion major and to is expenditures already retrospective from These AND utilization -quality increased reasons the III now coverage advocates government to APPROVAL problem is programs for increases the while the of pressures extent evident of remedies Both of by attempting the impact these for many health priority supporting government expenditures and maintaining have for for review a that in to the OF gross that payment health system in in govern- guidelines of improve the health particular are contri- escalation care the to consumers order their the of national and further nation's of planning care develop cost health effects care quality accre- to payment as Review/ 2

This proposed system of payment regulation is supported by the 111 American Hospital Association for the following reasons: 1. The proposed system is deemed the best method of moving to a prospective payment mechanism that apportions the payments equitably among all purchasers of services. The inadequacies of retrospective cost reimbursement have rapidly become more unsatisfactory to providers and payers alike.

2. Appropriate financing is essential to maintaining health care institutions' ability to continue to deliver high quality services to their communities. The public support necessary to obtain financing for institutions at an appropriate level on a sustained basis depends upon public understanding of the

reasons for cost increases related to new technology, improve- permission permission ments in quality, inflation, and volume fluctuations. Because of this need, effective methods must be developed to inform

without without the public of the nature of hospital costs and to assure the public about the efficiency and effectivenesss of these institu- tions' expenditures and management.

reproduced reproduced 3. The making of decisions on health service priorities and be be financing must be by a system that is publicly accountable to to and that balances the interests of consumers as well as third-

payers and providers. Not Not party

4. The distribution of finite funds requires a highly flexible system must consider AAMC AAMC of the regulatory system. The processes

the following:

the the of of . the broad spectrum of local needs and circumstances • the full variety of organizational and service configura- tions properly found in institutions collections collections • the needs of all types of institutions from the small

rural hospital to the large regional medical center the the

from from From year to year, the payment regulatory system must allow for payments as required not only for institutions that are adding expensive, complex services in response to planning decisions or incurring con- tinual shifts in patient mix, volume, or scope of services, but also Document Document for institutions that are relatively stable in their operation or that are reducing their level of services.

5. The payment regulatory system must be capable of integrating its decisions precisely with the decisions of other regulatory systems operating at the state and local level, such as planning, utili- zation review, or quality assurance controls, so that each regu- latory system performs its intended purposes well and facilitates or complements the activities of each of the other regulatory systems.

6. The payment regulatory system must be capable of identifying and impacting upon expenses in health care institutions that are considered excessive. This should be accomplished by Review/ 3

prospectively denying recognition and payment of such expenses by promoting cost avoidance, and by stimulating sound manage- ment through appropriate incentives.

T. It is important to recognize that a health care delivery system must be consonant with the needs and desires of the community that is served. So, too, must all forms of regulation be con- sonant with the needs and desires of the community. In developing and implementing mechanisms that regulate the accessibility and utilization of health care institutions, the federal government has enacted P.L. 93-641 and P.L. 92-603 on the principle that administration and regulation at the state level is the most appropriate method to ensure community involvement. This prin- ciple has equal application to the mechanism for regulating health care expenditures, since the community's needs and desires relate permission directly to the level of health care institution expenditures. There- fore, the states, through appropriate public policy mechanisms, should have the responsibility to make decisions concerning the without level of expenditures necessary to ensure that the ends and desires it has determined for its institutionE are met. A state-level regulatory mechanism provides greater access to the community and its institutions, and thus an awaremess of local issues that may reproduced impact upon them. These factors can then be considered in any be determinations made. to

Not Sections II and III of these guidelines are founded on the conviction that a federally mandated, state-administered or state-sanctioned prospective payment regulatory system, based on certain principles 111 AAMC and characteristics described herein, has advantages over all other

the systems for accomplishing the above purposes. These guidelines would of be implemented through federal legislation requiring government-regulated health care payment programs to recognize the payment decisions made by entities established at the state level. The federal legislation would also have to provide for the degree of national consistency among the collections state entities that would allow their role to be continued under any the universal health insurance program. Thus, the federal legislation would be establishing another basic element in preparation for universal health from insurance, compatible with the already established planning and Professional Standards Review Organization networks.

Several states now utilize some type of regulation of hospital payments. Document Most of these programs have not applied to all payers, and many use regulatory techniques that do not comply with the principles described herein. It is important, therefore, to distinguish between their very limited effectiveness and the greater potential for the system proposed in these guidelines.

As early as 1970, the probability of expanded payment regulation for health care was recognized by the American Hospital Association, and it initiated studies of other regulated industries in an effort to benefit from their experience. It established the Advisory Panel on Public Utility Regulation whose recommendations became the basis for the Guidelines for Review and Approval of Rates for Health Care Institutions and Services by a State Authority that were approved in 1972. Review/ 4

In 1976, the Association established its Advisory Panel on the Regulation of Hospital Payment; its report is an addendum to the report of the Spe- cial Committee on Regulatory Process. The advisory panel's findings were generally consonant with the earlier reports but emphasized the import- ance of integrating the payment regulation with planning and other regu- lations and avoiding the establishment of incentives for excessive utilization of patient services.

A succession of events has contributed to the growing support among health care institutions for federal legislation that places the respon- sibility and authority for administering payment regulation at the state level. One such event was the Economic Stabilization Program and the distortions in hospital economics it created. The latest impetus has been the introduction of federal legislative cost contain- ment proposals. These proposals seek to regulate hospital expenditures

permission with no recognition of the potential impact on the quality and avail- ability of health care services or of the economic viability of institutions whose purpose is to serve patients. without

II. The Guidelines: Purpose and Concept reproduced The basic objective of the guidelines delineated below is to promote be the development of state-level regulation of hospital payments under to which each institution would be paid its full financial requirements

Not through a prospective payment mechanism that apportions the payments equitably among all the purchasers of its services. The realization of this objective will require that government and other payers accept

AAMC nationally determined standards for the regulatory process. Flexi-

the bility must be built in to allow the state entity to use discretion in of making decisions that will accommodate local considerations and provide management incentives.

In response to this need, the American Hospital Association proposes collections the following guidelines: the A. Each institution will establish its budget in accordance with the from principle set forth in the American Hospital Association's Statement on the Financial Requirements of Health Care Institutions and Services and related interpretations. Document B. The budgets will be submitted to an entity established as described in section III-C of these guidelines for reviewing and approving the budgets, using procedures and standards that are equitable to providers, payers, and consumers.

C. The review will be focused upon the institution's demonstrated financial requirements and projected volume at the departmental level. The approval will be of the budgeted gross and net revenue related to those financial requirements and volume. The charge schedule will then be required to be related to its approved aggregate gross and net revenue requirements. Individual charges will be subjected to challenge only on the basis of their being discriminatory among classes of payers. Review/ 5

D. Charges will apply to all purchasers of services.

E. The approved revenue budget will apply for the following fiscal year, although the process will include an acceptable method for considering emergency adjustments of the budgets during the fiscal year. •

F. The entity will receive fiscal year-end reports of the operating results of each institution. Its procedures will provide for retrospective evaluation of those results and prospective handling of substantial gains or losses due to major volume changes for the amounts projected.

G. Appropriate appeal mechanisms, including the right to direct judicial review, will be established to protect the rights of all parties.

III.. Guidelines for Federal Delegation permission

A. The purpose of the state regulatory process to be included in federal legislation is to approve budgets that promote quality and availability without of service based on the health care institution's full financial requirements.* The regulatory proces7 must take into account the institution's community and regional role and its responsibilities

reproduced as defined by the planning and other regulatory programs. be

to The process will cause those financial requirements to be allocated among all purchasers through equitable charge schedules. In any Not federal program of payment regulation that delegates a significant role to the states, the size of federal expenditures for health care 0 services and the achievement of the national goals of such a regulatory AAMC program will require that provisions be made for federal oversight of the the program. Therefore, to allow for effective delegation, certain of criteria must be used to ensure the achievement of the desired goals and outcomes as well as equity among the programs conducted in the various states. collections B. Under its authority, each state will be required to submit a plan the and provide reports to the Secretary of Health, Education, and Welfare, Federal approval of from showing that it meets the established criteria. those plans and reports will constitute federal delegation of the budget review and approval entity.

Document 1. Budget review and approval will extend to all health care institutions that customarily charge for their services. For health care institutions participating in a comprehensive prepaid health insurance program on a capitation basis of payment, the entity will review and approve the rate of payment for contracted institutional services under the capitation program and ensure that the institution's charge schedules are equitable for all purchasers, including those not participating in the capitation program.

*As defined in the American Hospital Association's Statement on the Financial • Requirements of Health Care Institutions and Services. Review/ 6

2. After a public hearing process it will promulgate and adopt 410 standards for uniform reporting. 3. After a public hearing process, it will develop equitable criteria and methods for the review and approval of budgets including cost performance measurements and comparative evaluations that are equitably defined and uniformly applied.

4. The individual needs and peculiarities of health care institutions require it to recognize the individuality of the institutions it regulates, therefore, precluding the use of standardized payment formulae uniformly applied to all in- stitutions. It will review and approve institutions' budgets in- dividually, based on their respective demonstrated financial requirements. The review will be on the institution's revenue permission total as opposed to line items. The approval decisions will be such that institutions rendering needed health care services and

without operating efficiently and effectively will have their financial requirements met and their financial solvency preserved on a current basis.

reproduced 5. Its decisions should provide for financial incentives to

be institutions to encourage them to manage efficiently, and its to decisions will encourage experimentation and innovation in institutional and financial management. Not • 6. Its decisions will support the purposes of planning and other facilitate the voluntary dis- AAMC regulatory controls. It will continuance of unneeded services and facilities by recognizing the the costs associated with phasing them out as a financial of requirement for the institution, and it will approve the budgets accordingly.

collections Its decisions will not encourage excessive volume of services and facilities by rewarding the increased use of services. the It will use "per patient day" and "per case" costs only as

from a screen for selecting institutions for closer review, not as a unit for direct regulation.

8. It will monitor the decisions of other state regulatory Document agencies and legislative bodies and will inform them of the economic impact of their decisions on the operation of health care institutions.

9. It must be accountable to the public, the health care industry, and the state and federal governments. Public accountability requires it to operate in full public view. Further, public accountability requires it to certify to the public as to the reasonableness of the budgets established by the health care institutions, therefore requiring it to explain to the public the nature of institutional costs, the reasons for those costs, and the reasons for differences in costs among comparable institutions. In order to perform this function it must require the public disclosure of health care institutions' financial condition, including balance sheets detailing Review/ 7

assets, liabilities, and net worth as well as detailed statements of income and expense.

10. It is accountable to the public for assuring the solvency of institutions that operate efficiently and effectively and are deemed necessary by the appropriate planning agency.

U. It is accountable to the state and federal government to periodically document its activities by presenting financial data concerning the regulated industry.

12. Its budget approval decisions must be made on the weight of the evidence in the record. In any budget review and approval proceeding, it is the health care institution's responsibility to justify its budget. Potentially aggrieved parties may appeal alleged arbitrary and capticious decisions to the permission courts. The courts must adjudicate based upon the weight of theievidence in the record. without C. Organization and Financing

In each state the budget approval entity may be organized in one avoid conflict of interest reproduced of the following ways, but in order to not engage in administer- be and promote objectivity, the entity must

to ing health service programs or purchase institutional health services for either itself, its subscribers, or the state or federal Not government.

1. It may be organized as a full-time independent commission, AAMC composed of three to five highly qualified, well-compensated the commissioners appointed by the governor to serve for rela- of tively long, staggered terns. Recommendations for commissioners shall be solicited from providers as well as other interested parties. The commissioners should be chosen with a view commission broad-gauged, collections toward their ability to bring to the effective, and impartial policy direction. During their terns the of appointment, commission members should not be permitted business, profession, vocation, public from to engage in any other elective office or employment, or in any activity that would result in a conflict of interest with their duties as commissioner. Document 2. It may be organized as an independent commission, composed of five to nine highly qualified compensated or uncompensated commissioners, appointed on a part-time basis by the governor to serve for relatively long, staggered terms. Recommendations for commissioners shall be solicited from providers, as well ' as other interested parties. They should bring to the commission broad-gauged, effective, and impartial policy direction, which may include a balanced representation from various interests.

3. It may be organized as a nongovernmental entity operating under a contract with the state and under sanction of. state laws. Such • an entity would have to be nominated or approved by two-thirds Review/ 8

of the providers and the majority of major third-party payers subject to its decisions. The entity's actions would have to be generally authorized by state legislation so that its actions will be at least quasi-governmental or its decisions would have to be specifically approved by a government entity so that its decisions will be governmental in their effect. States should have wide latitude in the format for such entities, but they should follow procedures and principles that fulfill all of the requirements listed in these guidelines.

Regardless of the manner in which it is organized, the entity must have a professional, well-qualified staff of adequate size. The staff will conduct ongoing activities, including gathering and analyzing financial data and providing recommendations on

budget approval requests. permission permission

The entity's financing will be through assessments levied by

the state legislature on an equitable basis against health without without care institutions. Assessments so levied must be used only for financing the direct and related expenses of the budget review and approval process. The financing, especially during the

start-up period, may be augmented.by grants from other sources. reproduced reproduced

The cost of any assessment against the health care institution be be

to to will be includable in its financial requirements.

Not Not D. Relationship with the Planning Process

The plan submitted by each state applying for federal delegation AAMC AAMC of the budget approval responsibility will include a protocol the the for the integration of payment regulation with other regulatory of of mechanisms within the state.

Decisions of the budget approval entity must be reached with assurance that the health care institution's facilities

collections collections the are adequate and acceptable and do not unnecessarily duplicate the the other facilities and services within the community. Decisions

related to the approved level of payments will be made in from from accordance with the established planning process and will finance the necessary provisions •for changes in services and

facilities in the region to achieve more effectiveness. Document Document The entity's decisions should promote long-term efficiency and effective use of resources by facilitating voluntary discontinu- ation of unneeded services and facilities as approved by the planning process.

In addition, the protocol for the integration of planning regulation with budget review and approval will provide that:

1. The criteria used by the Health Systems Agency and the certificate-of-need agency in the review of the financial feasibility of applications will be jointly developed by the budget approval entity and the certificate-of-need agency. Review/ 9

2. On all applications for certificate-of-need agency approval, that agency will receive and consider financial analyses and economic impact studies provided by the budget approval entity.

3. The certificate-of-need agency's approval of a certificate- of-need application will be binding upon the budget approval entity to recognize the financial requirements associated with the service or facility.

E. The Budget. Review and Approval Process

1. Grandfathering

At the time of the establishment of the entity and promul- gation of its administrative regulations, the charges of all permission health care institutions then currently offered would be deemed reasonable, adequate, and proper; they will thus be

without constructively approved by the entity.

2. Budget Approval Process

reproduced Proposed budgets and charges, together with data for their

be justification, will be submitted by the health care institu- to tion within a specified period of notice prior to the beginning of the budget year. The institution could make Not a request more than 90 days in advance of the proposed effec- tive date, but the notice should not be required to be •

AAMC longer than 90 days. During this notice period, the entity will perform the necessary approval process and reach the propriety of the application. In the of a decision on the event that a decision is not announced by the 90th day . following such application, the application will be deemed approved and may then be implemented by the

collections institution. the Where emergency situations arise under which changes might

from be needed to maintain the institution's ability to serve the community, the entity may reduce the specified notice period. This will be done under circumstances clearly defined in its regulations and after a prompt review of

Document the institution's reasons for requesting emergency consideration.

In order to simplify the budget review and approval process, the entity will be authorized to permit changes in charges by the health care institution to be filed and implemented without the necessity for the formal hearing process in certain predefined situations, which are likely to be repetitive (such as allowances for routine inflation adjustments). The waiving of the advance notice require- ments and the hearing process should apply to routine requests for changes in institutional health care charges when such changes are consistent with the approved • budgeted gross and net revenue. Review/ 10

Al]. institutional costs associated with the budget review and approval process will be considered appropriate ele- ments of financial requirements.

3. Public Hearing Process

When budget applications are filed, the budget approval entity will cause public notices of the application to be given as specified in the entities regulations. The notice will specify a deadline for filing written comment. In the event of protest, a formal public hearing on the merits of any substantial application may be ordered by the entity. In any case where the application is being contested, the affected parties will have the right to present related evidence and arguments. The entity will prepare an

permission official record, including testimony and exhibits, in each contested case and will follow appropriate rules of procedure for notice and hearing. without All evidence, including record. and documents in the possession of the agency of w1- .ch it desires to avail itself, will be offered and made a part of the record in case, and reproduced no other factual information or evidence will be considered be in the determination of the case. Documentary evidence to could be received in the form of copies or excerpts or

Not could be incorporated by reference.

Whenever in a contested case the majority of the members of

AAMC the entity who are to render a final decision have not heard

the the evidence, the decision will not be made until a proposal of for a decision, including findings of fact and conclusions of law, has been served upon the parties. In addition, an opportunity must be afforded to each party adversely affected to file exceptions and present arguments to a majority of the collections members who are to render the decision. the Every decision and order rendered by the entity that is from adverse to a party in a contested case will have to be in writing or stated in the record and be accompanied by findings of fact and conclusion of the law. The findings of fact will consist of a concise statement of the con- Document clusions upon each contested issue of fact. A copy of the decision or order and the accompanying findings and conclusions will be delivered or mailed promptly to each party of record.

Any party aggrieved by a final decision in a contested case will be entitled to judicial review. In order to expedite its early determination'a matter under judicial review shall be given priority on the court dockets as a case of public interest. Any legal fees incurred by the institution in the budget review and approval process, as well as the ap- peals process, are justified elements of an institution's financial requirements. The entity, by regulation, shall provide for interim budgets and charge schedules to be used by the institution while the decision on its application is under judicial review. Review/ 11

IV. Implementation

A. In the legislation establishing the budget approval entity, there must be provisions for the implementation of the proposal with ample opportunity for the development of sound standards for reporting, criteria and methods for establishing the budget approval procedures, and implementation of the budget approval process. It is vital that deadlines be set as to how long the states have to initiate the entity and have the program become operational. Rather than setting different time spans for each stage of implementation, it is recommended that it be required that the program be enacted by law at the first legislative session subsequent to enactment and be implemented by submission of the plan for federal approval within one year after enactment. This allows flexibility for states permission in which the timing of the legislature's meetings does not coincide with a specified time period for setting up the entity. without

The full implementation of the budget approval process should be approached with due consideration of the importance of developing a sound process as well as meeting the urgency of the timing. reproduced In order to achieve this, the need to educate health care be budgeting process must be to institutions about budgets and the met. While provisions for education are not the duty of the Not budget approval entity, it is imperative that all involved be aware of the need. This would then allow for the state hos- pital associations or some other body to fulfill the educational • AAMC role. the of collections the from Document Attachment A • DEFINITIONS Full Financial Reauirements

Full financial requirements, as differentiated from accounting costs, are defined as those resources that are not only necessary to meet current operating needs, but also sufficient to permit replacement of the physical plant when appropriate and to allow for changing community health and patient needs, education and research needs, and all other needs necessary to the institutional provision of health care services that must be recognized and supported by all purchasers of care.

Health Care Institution permission The defini4ion of "health care institution" as contained in the American Hospital Association's Classification of Health Care without Institutions is: Establishment with permanent facilities and with medical services for patients, including inpatient care institutions, outpatient care institutions with organized medical staffs, and home care institutions. reproduced be to Independent Commission Not An independent commission is defined as a entity, established by law, • whose sole purpose is the review and approval of budgets for health AAMC care institutions. It shall not be a subsidiary of any other agency

the or entity. of

Major Third-Party Payers collections Major third-party payers are organized groups or governmental programs the that usually pay hospitals directly for the hospital services provided to group members or program beneficiaries. from

Oversight Document The review of the implementation of a program, on a periodic basis, with specific attention to the regulations being promulgated and their consistancy with, the enabling legislation.

Parties

Parties are payers, providers, and consumers who have a direct or indirect interest in the activities and pronouncements of the budget approval entity. Attachment A/2

Public Hearing for hay member of the public as well A public hearing is an open forum interrated in the budget review and as all other parties involved cr shoula be governed by the state's approval process. Such hearings Administrative Procedures Act.

'Volume Changes of tIltu dcc=ent, are defined as Volume changes, for the purpose tted s.s well as changes in changes in the number of patients racterns. case mix, intensity, and utilization

wa••• ••••=m, ••••mm dmin••••

• s ...UN", 1111111A111 7inr. Tr\,, lore g • •s, 0 Ii Knows II

• • irj'• .ATTACHMENT B ,• .** AMERICAN FINANCIAL REQUIREMENTS OF HEALTH CARE HOSPITAL AND SERVICES

INSTITUTIONS 11,einntswAti ASSOCIATION

as those resources that are Financial requirements, as differentiatedfrom accounting costs, are defined to permit replacement of the not only necessary to meet current operating needs, but also sufficient health and patient needs, physical plant when appropriate and to allow for- changing community provision of health care education and research needs, and all other needs necessary to the institutional of care. services that must be recognized and supported by all purchasers

needs, there is a corollary IAIZMIZONAINIAI Ifan institution ensures that its role and mission is consonant with community essence, the community Must that the institution he assured that its financial requirements are met. In the components within the health provide the proper financing of its health care delivery system. and and management of that system. tare system must accept the responsibility for proper planning To provide this encouragement, it Philanthropy should be encouraged as an important source offunding. paid by the patient or a third should not be used as reimbursement for services that could otherwise be party. Health Care Institutions and This revision of the 1969 Statement on the Financial Requirements of by emphasizing that all purchasers Services reaffirms and updates the position taken in that document ofinstitutions providing ofhealth care must recognize and sharefully in the totalfinancial requirements adequate reserves as a capital care. It further recognizes the established concept of the need for of the American Hospital requirement. This statement was approved by the House of Delegates Association in August 1977.

these financial requirements will enable the institu- Introduction Meeting tions to maintain and improve current programs and facilities profes- The delivery of health services requires a vast array of and to initiate new programs and facilities consistent with and ed- sional services, institutions, allied health organizations community needs and advances in medical science. ucational programs, research activities, and community health Health care institutions differ in size, scope, and types of projects. A high-quality health care delivery system is depen- ownership and services, and therefore their operating and dent upon the commitment of sufficient resources and their ef- capital requirements differ. However, all elements of financial fective management. The system must ensure that necessary and must be reflected in the payments to health care services are provided to the public in an effective, efficient, requirements to provide adequately for demonstrated financial economic manner. Coordination of the components of the institutions The elements of financial requirements are described health care delivery system and self-discipline of all partici- needs. below. pants within the system are necessary to meet this end. Three and self-dis- interrelated functions whereby such coordination Current operating requirements cipline can be achieved are effective planning, effective utiliza- requirements include the following costs: • tion, and effective management. These functions share the ul- Current operating the highest standards of qual- timate purpose of maintaining I. Patient care ity in the delivery of health care. These costs include, but are not limited to, salaries and has and should continue to The health care delivery system wages, employee benefits, purchased services, interest ex- must meet total finan- have multiple sources of financing that pense, supplies, insurance, maintenance, minor building of financing should recognize cial requirements. These sources modification, leases, applicable taxes, depreciation, and the must be financed at a level that that health care institutions monetary value assigned to services provided by members of the community, including un- supports the health objectives of religious orders and other organized religious groups. compensated care costs as defined herein. The health care delivery system and its financing should he sufficiently flexible 2. Patients who do not pay needs of the community change and as new to change as the It must be recognized that a portion of the total financial technologies are developed so that the total and effective requirements will not- be met by certain patients who: financial requirements can continue to be met. a. Fait to fully meet their incurred obligation for services financial requirements Elements of rendered, Institutional financial stability requires that there be a realistic b. Are relieved wholly or in part of their responsibilities appraisal of the two major financial components:(1) current because of their inability to pay for services rendered. operating requirements and (2) operating margin.

- North Lake Shore Drive. hicago. Illinois 60611. (3 1977 by the American Hospital Association. 840 Printed in the U.S.A. All rights reserved. Catalog no. $031. 20M-12/77-5953. ATTACHMENT 13/?

Therefore, these unrecovered financial requirements plant and equipment to ensure compliance with chang- plan- must be included as a current operating requirement for ing regulatory standards andeodes and to finance those who pay. ned and approved renovation projects. equipment 3. Education b. Replacement of plant and Where financial needs for educational programs having ap- Because of deterioration and obsolescence, assets must propriate approval have not been met through tuition, be replaced and modernized based on community needs scholarships, grants, or other sources, all purchasers of care for health care services. Funds that reflect the changes in must assume their appropriate share of the financial re- general price levels must be available for the replace- quirements to meet these needs. ment and modernization of plant and equipment. 4. Research C. Expansion Appropriate health care services and patient-related clinical Sufficient funds must be available for the acquisition of research programs are an element of the total financial re- additional property, plant, and equipment when conso- quirements of an institution. The cost of these programs nant with community needs. from endowment income, gifts, should be met primarily d. New technology grants, or other sources. Advances in medical science and advances in the tech- Operating margin often require addi- permission permission nology of delivering health services expenditures. Sufficient financial resources must In order to meet the total financial requirements of an institu- tional for continued additional investment in the tion, a margin of net patient care revenues in excess of current be available consonant with without without of and equipment, operating requirements must be maintained. This difference improvement plant that health care institutions can will provide necessary funds for working capital requirements, community needs, so with changes in the health care delivery sys- capital requirements, and return on equity. keep pace tem. I. Working capital requirements reproduced reproduced 3. Return on equity

be be Financial stability is dependent on having sufficient cash to Investor-owned institutions should receive a reasonable to to meet current fiscal obligations as they come due. return on their owners' equity.

Not Not 2. Capital requirements Responsibilities of purchasers for Health care institutions are expected to meet demands

resulting from such factors as population shifts, discon- meeting financial requirements AAMC AAMC tinuance of other existing services, and changes in the Each institution's total financial requirements should be ap- the the public's demand for types of services delivered. In order to portioned among all purchasers of care in accordance with of of be in a position to respond to such changing community each purchaser's use of the institution and measurable.impact needs, health care institutions must anticipate and include on the operations of the institution. Any apportionment that such capital needs in their financial requirements. There permits a purchaser to assume a lesser responsibility is not ap- must be assurances that adequate resources will be avail- propriate and does not alter the total financial requirements of collections collections able to finance recognized necessary changes. the health care institution. Rather, it requires other pur- chasers to make up the deficiency. the the The capital requirements of a health care institution must its governing authority in the be evaluated and approved by Responsibilities of providers from from context of the institution's role and mission in the com- munity's health care delivery system. Coordination among Health care institutions have an obligation to disclose to the the health care institution's governing authority, adminis- public evidence that their funds arc being effectively utilized in tration. and medical staff and the cooperation among accordance with their stated purpose of operation. Institutions but Document Document health organizations and the appropriate areawide health also have a responsibility not only to purchasers of care planning agency are essential to this evaluation. also to their community to provide effective management. An institution's goals and the methods that it uses to acheive those a. Major renovations and repairs goals should be consonant with community planning and the Funds must be provided for necessary major repairs of resources in that community.

-74-

2 Document from the collections of the AAMC Not to be reproduced without permission gip Amk 6. 2. 4. 5. 3. 1.

Senior W. One P. Hospital Assistant Barry Boston, Washington, Toledo, The James John Medical Atlanta, Administrator Administrator Assn. 1364 Danville, William Dept. David 827 Geisinger Executive Cincinnati, 75 Maryland F. Baltimore, University Hospital 3200 Veterans O. Hospital East Administrator Administrative Daniel Kenneth Crawford Linden Dupont Clifton H. Vine Bentley, W. Box of Bowers of Vice OH Betjemann College Newton MA E. General American Teaching Director Benfer GA Administration Director 6190 PA Barker Medical Street Director Vice Ackerman Circle, Hospital Avenue MD Claypool 02118 43614 of President DC OH W. Road, 30322 -President, 17821 Street 21201 Ph.D. Emory 20036 of 45220 Long Hospital Hospitals Medical Director Center Ohio N.E. N.W., Memorial University & MANAGEMENT Hospital Hospital Suite Colleges 200 LIST Palm ADVANCEMENT La June OF Coquille Beach, Phase 9-14, PARTICIPANTS -75- Florida I 1978 14. 12. PROGRAM 10. 11. 13. Club 9. 8. Superintendent Seattle, 2305 622 2201 4435 President The Omaha, President, Jackson James Hospital East 1405 500 William Donald Creighton The Jerome Hershey, Hospital Nassau New Executive Felix Miami, Ann Veterans Director 1611 University Jeptha Fred SEMINAR Health the Presbyterian Arbor, West York, University Milton South Hempstead Meadow, Beacon J. N.W. East M. E. W. H. NE City R. County FL Cowell Memorial E. 168th WA PA Ensign Administration Demartini, Director Administrator Omaha Ann Director Dolezal Care NY Eisenberg 12th Dalston, 68108 Public Hospital S. Tenth MI Corley 33136 of Avenue 98108 NY 17033 Street Medical 10032 Hershey Street 48104 Turnpike Corporation New Avenue Drive Regional Street Hospital Hospital 11554 Health South Ph.D. York M.D. Center Medical Hospital Trust in Center Document from the collections of the AAMC Not to be reproduced without permission 15. Phase 20. 17. 16. 18. 22. 19. 21. Sixth San William President Cooper The Robert Pittsburgh, Executive 1600 Camden, Thomas Jefferson John Executive 3459 Mt. Senior Irwin William President Hospital Albany, Albany Administrator Charlottesville, University Emory 1753 Paul Atlanta, 1364 Chicago, Rush John New Hospital 1360 Maywood, Foster I, of Medical Executive Loyola Scotland June Zion -Presbyterian Montefiore Francisco, Western Fifth Divisadero West Hofman F. South Clifton F. Goldberg and University L. Evans, Medical Medical L. Vice C. H. Harlan, NJ NY F. Imirie 9-14, Hospital Director IL GA Director IL Stevens Director Director Park Hawkins, & Congress McGaw University of -President Avenue Gurtner Hejna, Center First 08103 PA 12208 Director Pennsylvania 60612 Avenue 60153 Officer Road, 30322 and Virginia Hospital 1978 Center Avenue CA Center Street 15213 Jr. Hospital -St. M.D. Hospital VA Avenue Streets and M.D. Chief 94120 Jr., Parkway N.E. 22901 of Medical Hospital Luke's Medical Association M.D. Chicago of Center Center -2- 24. 29. 27. 26. 25. 28. 23. 30. Shands President, San San Philadelphia, Hospital Executive 225 Sheldon S. William William William Box 1161 Third Nashville, 3400 Mark Administrator Administrator 1516 L. William Director 1001 Riverside John Gainesville, New Edgar Executive Executive 3535 Indianapolis, Vanderbilt Director Columbus, University University University of and of Medical Center R. Orleans, Diego, West Francisco, 767, S. Spruce - West E. Olentangy Jefferson Pennsylvania O. Avenue the Jordan 21st Teaching Clinics B. Levitan Ives Kreykes N. I. of of of Mansfield Dickinson J. OH Tenth Director Director Methodist Alton Director of of Ochsner of TN Wishard CA Jenkins University Center Kerr King Street Hospital Avenue, Hillis Hospitals the LA & FL 43214 PA California, California IN Florida 92103 Parnassus Highway CA River 37221 Street Ochsner Hospital University 70121 32610 19104 46202 94143 Street Foundation Miller Memorial South La Hospital & Road Hospital & Coquille Clinics Medical Clinics Hospitals & San Health Clinics Hospital Hospital Diego Club Foundatior • • Document from the collections of the AAMC Not to be reproduced without permission • 0 Phase 32. 34. 35. 33. 36.

2500 8700 Hospital Stuart William 5201 Executive Los Jackson, Georgetown Administrator Washington, Charles Cedars 3800 Administrator 2215 Dallas, University C. Peter Mt. Vice Dallas California Ruth Executive Mt. Chicago, Minneapolis, I, of J. June Angeles, Sinai Sinai Beverly North President Harry M. Park Reservoir -Sinai Sammond Price Chicago Marylander County T. M. TX Rothstein 9-14, Director MS IL Vice Hospital Avenue Hospital Director State Hospital O'Brien, Hines Newell University at DC 75235 60608 Boulevard CA 39216 Medical MN -President Hospital -Executive 15th 1978 Road, 20007 90048 Street 55404 Boulevard Street Medical Jr. Center N.W. Hospital District Director Center -3- -77- 40. 41. 37. 42. 39. 38. St. 410 St. 640 Sixth 80 John Hurley Hartford Ohio William Director 428 The Richard Hartford, Flint, Executive Executive Lavand Director David Columbus, Executive Executive North Manhasset, Dennis New 300 Seymour Medical Paul West Paul, Jackson West Roosevelt York, Community State K. Avenue & L. Shore Medical MI M. F. Springer -Ramsey Towle C. Steffy 59th Tenth Hospital Syverson OH Buckley Director CT NY MN Director Vice Vice Street Schripsema 48502 Center University NY Street University 06115 43210 Street 55101 -President -President 10019 Hospital Drive Begole Avenue Center 11030 Hospital La Streets Hospitals Hospital Coquille and Club V/1 71 (-71 C7 r-7, 7-AL ELIGIBILITY FOR CONTINUING COTH MEMBERSHIP • Page Background 1

Membership Criteria 1

Findings 2

Conclusion 3

Table 1 -- COTH Members Not Responding to 1978 4 Directory/Membership Questionnaire

Table 2 -- Present COTH Members Who Returned a 5 Questionnaire But Who Have Not Sent permission a Copy of Their Affiliation Agreement

without Table 3 -- Present COTH Members Submitting a 6 Letter Indicating Hospital Is Unaffiliated

reproduced Table 4 -- Present COTH Members Submitting a 7

be Letter From Dean of "Affiliated" Medical to School in Lieu of Signed Affiliation Agreement Not Table 5 -- Present COTH Members With Unsigned 8 • Affiliation Agreements AAMC the Table 6 -- Present COTH Members With Affiliations • • . . 9 of Only At Departmental Level

Table 7 -- Present COTH Members With Three or Fewer . . 10 Approved Residency Programs collections the Table 8 -- Present COTH Members With Less Than Two . . . . 11 of the Required Residency Programs from Document

• Document from the collections of the AAMC Not to be reproduced without permission • • • "membership Corresponding Council 1977 they Background its members In There report Membership cant Teaching have school and recommending and at appTIOWT medicine, cipation psychiatry. 1975 least recommendation, corresponding publicly will undertaken be institution are reviews accredited and the advised who

four residency Hospital the the medical in medical are to the the the medical school's the two be surgery, Criteria COTH criteria Assembly may -owned medical bed determined membership Other availability filled, affiliated number significance presence significance Membership, categories approved, current that a not size, Administrative to education; graduates; education. study membership. membership

by involvement obstetrics considerations hospitals programs Eligibility fulfill the have education of . approved their the and of the .

membership internship COTH on of from active medical . of a Liaison full-time the for and of of proportion eligibility the the be

documented COTH required must Administrative -gynecology, the is which the the proportion communicated the the

activities activity in eligibility basis Both residency for Board limited school membership: Committee dean be them; hospital's hospital's establishment Council criteria evaluated and sponsor, chiefs Continuing membership in criteria. of (in recommended affi3iation of residency for the of and and these to

which the are: full-time programs. of of pediatrics, undergraduate

and to continued of following on not the Board or in financing educational Teaching affiliated service all criteria."

teaching -for-profit Medical present are COTH summarizes categories significantly determining degree of positions

and adopted present agreement filled a equivalents) Membership

At membership new specialty or the COTH Hospitals. family Education of support least hospital medical clerkships; a programs membership

the by AAMC the staff Department -- hospitals require director in members.

a

with foreign two IRS participate practice, hospital's relation medical position

for Executive areas: findings after membership and school. which a

501(C)(3) of to In the medical of category, and a the making This staff November appli- letter that or internal

that parti- on in, -- Document from the collections of the AAMC Not to be reproduced without permission • • • (e.g., and to work that corresponding In Non-profit Findings eligibility, Table questionnaire these twenty-two hospital of affiliation Table Approved the to In the tion Table up membership Copies Table the school. Table Five Table related ments. approved 7 have than two and the make reviewing letter. present provide psychiatric LCGME LCGME related of the agreement; current department 2 2 4 hospitals, 3 6 8 7 case consortia, of the exceptions

lists is lists have medical lists shows are specialty membership Residencies, Copies residencies residency Directory, to the and members a hospitals, a questionnaires, of specialized status school eligible the copy it determine list been COTH membership. eighteen used letters six two six specialty governmental institutions should however, of level schools. all preliminary foundations, of sent current of members members hospitals to hospital to who of the describing programs but

of the their twelve for in the 5% obtain the i.e., are agreements do be affiliation a hospitals letters objectives having which the hospitals follow-up of description none corresponding requirement noted not hospital included COTH The who have affiliation a meets hospital the the present that required and -- findings the letter fulfill are of fiVe the lack federations) affiliation members are unsigned the "Green that, total Table that necessary these sponsor between the listed hospital's -- of as status. letter in members included institutional COTH COTH indicating and of specialties. of membership such from the membership, membership in returned shown Appendices 8 agreement. Book." hospitals submitting membership. the affiliation lists four Administrative medical spite in members or hospital hospital. requesting agreements as the criteria are not Table All in procedure as participate relationship children's, residency three staff of Attachment the the the enclosures shown eligible of criteria education criteria. submitting, has B affiliation 1, several -N. have a services questionnaire The latest the hospital Members information. agreements letter hospitals may survey a responded in are and not copy table hospitals Board programs Table in for increase rehabilitation, follow-up eligible within A criteria LCGME with O organizations yet from -T. and listed three of of reproduces, is teaching also with agreements is 5. having membership

returned their to unaffiliated. the with school Directory the authorized the provided shown but or lists Some the that their in for used medical letters, Dean fewer their frame- failed affilia- fewer Tables number depart- of follow- in from the the by but

of of Document from the collections of the AAMC Not to be reproduced without permission • • S Conclusion Executive Based Hospital Board be taken on recommend the with membership Council, actions respect to the it requirements. of is to AAMC a recommended current previous Executive COTH COTH that members Council Administrative the what not present fulfilling actions, COTH Board Administrative if and present any, AAMC should Teaching Document from the collections of the AAMC Not to be reproduced without permission 411 10. 11. 13. 12. 18. 15. 17. 16. 14. 19. 21. 20. 22. Table 6. 1. 4. 8. 2. 5. 3. 7. Date The Cedars Cook Mt. Martland Cumberland Wayne City Bronx Charlotte Newark North New Mayaguez Highland Hospital Eye San University Memorial Wilford Prepared: 1 -- Queens Sinai York and Juan County of County Lebanon Central COTH of Questionnaire Beth Memphis Ear Hall, Medical of Hospital, Hospital Municipal Hospital, Hospital Lebanon, Hospital, Memorial Hospital, Hospital, District Members Hospital, Israel the Hospital 3/13/78 Psychiatric Hospital Bronx U.S.A.F. University of Hospital, College, of of Florida Hospital, New Hospital, Puerto Hospital, Minnesota Not Hospital, Hospital, Hawaii Rochester, of New Rhode Illinois Jersey Center, Medical Responding Pittsburg, Hospital, York Flower Tennessee Rico Island New Puerto North Pennsylvania Puerto New New Center, New Jersey & York to Michigan Fifth Carolina Pennsylvania York York Rico Rico 1978 Texas Avenue Directory/Membership Hospital • Document from the collections of the AAMC Not to be reproduced without permission 411 10. 12. 11. 13. 15. 14. 16. 18. 17. 2. 4. 6. 1. 8. 3. 5. Institution 9. 7. Table 1 Date • cated graduate the Hospitals have programs Mount Veterans Little Mount Saint Abbott Saint Boston Methodist Hospital, Butterworth Jewish Kings Harlem Akron Western Western Latter-day Women Prepared: hospital 2 been Jersey Illinois that -- only. affiliation Zion -Northwestern Sinai Michael's County Present Barnabas General & Not identified have Company Hospital Hospital, Hospital the Psychiatric Pennsylvania Infants Administration is sent Hospital, Saints 3/13/78 been hospital Hospital Hospital, used Hospital COTH Hospital, of Medical a for Hospital, of Hospital identified Copy New as to indicates Mary Hospital, Members Brooklyn, Memorial Women, Brooklyn, Hospital, a a is San of York Hospital, Grand Center, of limited limited Hospital, Center, a Chicago, Hospital, Akron, Francisco, Their of major City New Massachusetts as a Who Rapids, Salt Rhode Hospital, New hospital Jersey Pittsburgh New New a extent affiliate Livingston, Ohio Pittsburgh Affiliation Returned unit major Evergreen Illinois York Lake Washington, York York Island California Michigan in in affiliate City, used Minnesota the a the when Questionnaire Park, school's New Agreement by Utah school's a D.C. the medical when school teaching a teaching "Green Limited Major Major Major Unaffiliated Unaffiliated Major Limited Major Major Major Unaffiliated Major Limited Major Major Limited Limited medical school Affiliate But for and Affiliate Affiliate Affiliate Affiliate Affiliate Affiliate Affiliate Affiliate Affiliate Who Book" graduate program. Affiliate Affiliate Affiliate Affiliate Affiliate program. has school Limited Have indicated Status training has Hospitals A 1 indi- that Table 3 -- Present COTH Members Submitting a Letter Indicating Hospital Is Unaffiliated

It 1 Institution Book" Status See Attachment

1. St. Joseph's Hospital and Medical Center, Arizona Major Affiliate

2. Mercy Hospital and Medical Center, California Major Affiliate

3. Gorgas Hospital, Canal Zone Unaffiliated

permission permission 4. Touro Infirmary, Louisiana Major Affiliate

5. National Institute of Health, without without Maryland Limited Affiliate

6. Prince George's General Hospital

and Medical Center, Maryland Unaffiliated reproduced reproduced be be 7. The Catholic Medical Center of to to Brooklyn and Queens, Inc., New

Not Not York Unaffiliated • 8. St. Vincent's Medical Center of

AAMC AAMC Richmond, New York Unaffiliated the the of of 9. Wilson Memorial Hospital, New York Limited Affiliate

10. Cleveland Clinic, Ohio Limited Affiliate collections collections

the the 11. Mercy Hospital, Pennsylvania Limited Affiliate

from from 12. St. Francis General Hospital, Pennsylvania Limited Affiliate

13. Baptist Memorial Hospital, Document Document Tennessee Major Affiliate

1Hospitals have been identified as a major affiliate when a medical school has indicated that the hospital is a major unit in the school's teaching program. Hospitals have been identified as a limited affiliate when a medical school has indicated that the hospital is used to a limited extent in the school's teaching program. A graduate affiliation indicates a hospital used by the school for graduate training programs only. 411 Date Prepared: 3/13/78 Document from the collections of the AAMC Not to be reproduced without permission • • Table 1. 4. 6. 2. Institution 3. 5. 1 Date indicated school Hospitals teaching Hospitals has Maricopa Arizona Massachusetts Lutheran Berkshire Brooklyn Hospital, Emanuel York Beckley indicated Prepared: 4 -- for program. Present Medical that have have Appalachian Hospital, graduate County Medical Hospital, Medical West that the 3/13/78 been been School COTH Virginia General the A hospital Center, identified identified training Center, Oregon graduate New Members Regional hospital In York Hospital, Lieu New is programs affiliation Submitting as as a is of major a a used Signed major affiliate limited only. "Green Graduate Major Limited Graduate Limited Limited Limited unit Affiliate AffiTiate to a indicates Affiliation a Letter affiliate in Affiliate limited Book" and and Affiliate Affiliate the Affiliate Affiliate Graduate Graduate From schools' Status when a extent when hospital Agreement Dean a

1 medical a teaching in of See medical the used "Affiliated" Attachment 0 school's school by school program. the has Document from the collections of the AAMC Not to be reproduced without permission • Table 1. 4. 2. 3. 5. Institution 1 Date Hospitals indicated teaching school Hospitals has Memorial Massachusetts Monmouth St. Texas Beach, Iowa Prepared: indicated 5 -- Elizabeth's for Methodist Children's program. Present California that have have graduate Medical Hospital that the 3/13/78 been been COTH Medical Hospital the A hospital Center, Hospital, identified identified training Medical graduate Members hospital Center, of New is Center programs Texas affiliation With Boston, as as a Jersey is major Iowa a a used Unsigned of major limited only. Long unit to affiliate indicates a

affiliate in Affiliation limited the "Green Major Major Limited Major Limited school's Affiliate Affiliate when a extent when hospital Agreements and Affiliate Affiliate a Book" and Affiliate medical a in teaching Limited medical Graduate the used Status school's school by school program. the has Document from the collections of the AAMC Not to be reproduced without permission II! Table 1. 2. Institution 1 Date school Hospitals Hospitals indicated teaching has Providence Hamot indicated Prepared: 6 -- for Medical program. Present Level that have have graduate Hospital, that the been 3/13/78 been Center, COTH the A hospital identified identified training graduate Members hospital Southfield, Erie, is programs affiliation Pennsylvania With as as a is major a a used Affiliations Michigan major limited only. unit to affiliate indicates a affiliate in limited the Only "Green Graduate Limited school's when a Affiliation extent At when hospital Departmental a Book" and medical a Affiliate teaching in medical Graduate the used Status school school's by school program. 1 the has -10-

Table 7 -- Present COTH Members With Three or Fewer Approved Residency 410 Programs

Institution

1. Norwalk Hospital, Connecticut - Internal Medicine, Pathology

2. Little Company of Mary Hospital, Illinois' - Pathology, Radiology, Surgery

3. Abbott-Northwestern Memorial Hospital, Minnesota - Internal Medicine, Pathology, Surgery

4. Veterans Administration Hospital, Dayton, Ohio - Internal Medicine, Surgery, Urology

5. Saint Thomas Hospital, Nashville, Tennessee - Internal Medicine, Surgery, Thoracic Surgery

6. Beckley Appalachian Regional Health Care, West Virginia - Internal Medicine, Pathology, Surgery

'Would have four approved programs if Flexible First Year accepted as a , III residency program. Date Prepared: 3/13/78

8

• -11-

Table 8 -- Present COTH Members With Less Than Two of the Required Residency Programs

Institution

1. Norwalk Hospital, Connecticut - Internal Medicine

2. Little Company of Mary Hospital, Illinois - Surgery

3. NIH Clinical Center, Bethesda, Maryland - Psychiatry

permission permission Date Prepared: 3/13/78

without without

reproduced reproduced

be be to to

Not Not •

AAMC AAMC

the the

of of

collections collections

the the

from from Document Document

• Attachment A -12-

Residencies by Medical School Affiliation and Bed Caoacity • Table 1:3 cla:,sifies programs by lied capacity and medical teaching programs at the -C"Ilospital: school affiliation. It must be mphasized that affiliation with .1. A contractual arrangement ( with or without financial a medical school is not a reqffirement for approval of graduate commitment) for assistance in the organization and supervi- training programs: prograins aree vaam.m..I t on the basis of sion of the graduate program in the hospital designated for their quality and their conformance with the requirements graduate training. stated in the "Essentials of Approved Residencies." The designation of graduate affiliation should mit be used Information concerning the affiliation of medical schools if the hospital is used for undergraduate clerkship teaching. with hospitals offering residency programs is obtaitwel from if the faculty participation is as tenuous as an occasional the office of the dean of the medical school; it is not solicited lecture or consultation visit, or if the hospital's residents nor usually accepted on the basis of ;i statement from the attend medical school teaching conferences only as visitors. institution, because of the variety of affiliation arranguments Of the hospitals designated as having an affiliation, the possible. and because of the necessity of using the information "combined hospital" category represented 117 of the total provided from an official source. The indication of affiliation number of hospitals offering residencies. and this group had With a medical school for an individual hospital as shown in 297 of the approved programs. offered 407 of the residency the "Consolidated List of Hospitals" which follows these positions. and recruited 417 of the total candidates appointed. reports in each issue of the 13ireciory. llospitals may be listed They obtained 45% of the U. S. and Canadian graduates and

permission as having a major affiliatirn with a medical school, be. affiliated 29% of the foreign graduates. The previous year this category to a limited extent, or h affiliated only for graduate medical represented 147 of the total number of hospitals, offered 407 education. Thi• classification designated by the dean of a med- of the residencies; obtained 447 of the U. S. and Canadian ical school is icurptcd. hut each school, is provided with a graduates, and 2:5% of the available foreign graduates. There- without definition of the expected use of these terms. When a hospital fore, although thr number of hospitals involved has de- has been designated as having ;1 major affiliation. it is expected creased, their success in recruiting candidates has increased. that it plays a major role in the clinical clerkship program of The next largest group among the affiliated hospitals was the medical sehool, with students serving regularly on in- the group with 500 or more beds, which comprised 21% of patimit services limier the direct supervision of members of the hospitals offering residencies. This group offered :327 reproduced the no•dical school faculty. It is expected that hospitals listed of the total positions. reennted 12% of the available residents. Canadian graduates be as hying major teaching hospitals ‘vonlil provide clerkships in including :317 of the available U. S. and twit or more of the r11:110r services of and 357 of the available foreign graduate's. Their record for to iuternal medicine, general surgery, pediatrics, and obstetrics, but the list might also in- 1973 was similar. The group of affiliated hospitals with :300 total number of hospitals Not clude hospitals responsible for most of the teaching ill a single to 499 beds comprised 19% of the specialty. such as psychiatry, chest diseases, or pediatrics. participating in residencies, offered 19% of the programs and A hospital used for teaching to a limited extent might 147 of the total positions. They recruited 14% of the available provide clerkship experience irregularly, on an elective basis, candidates, obtaining IV of the available' U. S. and Canadian

AAMC in limited specialties, or only in the outpatient service, hut .graduates and 16% of the available foreign graduates. Their such expericner shin 11(1 still he related to curricular assign- record also was similar to that of 1973. the ments arid should be under the supervision of faculty mem- In the group of non-affiliated hospitaLs, the largest group of bers. Hospitals may be indicated as having an affiliation for was that of less than 200 beds. This group, which comprised graduate training even though they do not participate in the 117 of the hospitals offering programs, offered 31; of the pro- Program of a medical school. The designation of grams, with 21- of the total positions offered. They recruited graduate affiliation may be 'ismd for hospitals not already 1% of the availahle candidates, filling their positions with less designated as having a major or limited affiliation and in cases than 17 of the ;wadable U. S. and Canadian graduates and collections in which one or more of the following arrangements is in with 27 of the foreign graduates. This group had die lowest elh•ct: percentage of positions filled. 79%, but also had the lowest the I. House staff selected by officials of a specific. medical percentage, among the non-affiliated hospitals of foreign grad- school clepartment or by .1 joint committee of the hospital uates recruited. The non-affiliated hospitals, however, re- from teaching staff and the medical school faculty; cruited only 7% of the total candidates available, appointing 2. Some degree of actual exchange of resklents between the only 4% of tire available U. S. and Canadian graduates and I ospital designated with a graduate type of affiliation, and 14% of the foreign graduates. In 1973 they had recruited 9% the principal medical school teaching hospital; of the availalile candidate's. and had appointed 57 of the avail- :3. Regularly scheduled participation of medical school able U. S. ;cod Canadian graduates, .;inci 167 of the available Document faculty ( other than the hospital's own attending staff) and graduates of foreign medical schools. The total member of residents ;ippointed in the non-affiliated hospitals was 451 less than in 197:3. or ;x decrease of about 111.

SOURCE: LCGME Directory of Accredited Residencies, 1975-76 • Attachment B 00C' -13-

Si JOSEPH'S December 15, 1977 HOSPITAL AND MEDICAL CENTER

Post Office Box 2071 Phoenix, Arizona 85001 277-6611 (Area 602) James D. Bentley, Ph.D. Assistant Director Department of Teaching Hospitals Association of American Medical Colleges One Dupont Circle, NV permission Washington, D.C. 20036 without

Dear Dr. Bentley:

reproduced This is in reply to your letter of November 30, 1977, regarding be our affiliation with the University of Arizona. to St. Joseph's Hospital and Medical Center tigeannaitiffainNii Not , . However, individual departments - Internal Medicine, Pediatrics, Neurology, and Family Practice - have departmental AAMC Neurological Surgery agreements for undergraduate medical education. the of The undergraduate training offered in these departments is listed in the University of Arizona's catalogue of available senior rotations. collections If you wish copies of the individual departmental agreements, please the let us know, and we will be happy to forward them. from Sincerely yours,

Document 4 64-ev). °6v• Jo eph C. White, Jr., M.D. Director of Medical Education

JCW/fmg

Founded and operated by the Sisters of Mercy 3+S-- Attachment C -14- RCY HOSPITAL AND fIEDICAL CENTEI

SERVING THE COMMUNITY SINCE 1890

4077 FIFTH AVENUE I SAN DIEGO. CALIFORNIA 921')3 p!-iCCIE (714) 294-3111

January 3, 1978

James D. Bentley, Ph. D.

Assistant Director permission permission Council of Teaching Hospitals Assoc. of American Medical Colleges without without One Dupont Circle, N. W. Washington, D. C. 20036

Dr. Bentley:

reproduced reproduced Dear be be to to This letter is in response to your request for a copy of our agree- of California, San Diego Medical School. Not Not ment with the University _

IfflemillualialWAMMIR The only documentation that I can think of at AAMC AAMC this time is a listing of residencies in the green book which includes

the the Pediatrics, Orthopedics and Surgery. of of

If there is some other way we can meet your request, please let me

know. collections collections

Sincerely, the the from from cx-

Document Document Edward G. Hertfel er Administrator

EGH/mg

Almighty God. we humbly ask the help of Thy mercy on behalf of Thy servants who are sick, that being restored to health they may .;ive,- thanks to nee. 33(.. Attachment D -15-

CANAL ZONE GOVERNMENT CANAL ZONE

IN REPLY REFER TO:

• Gorgas Hospital Box "0" Balboa Heights, Canal Zone December 5, 1977

permission James D. Bentley, PH.D. Assistant Director Department of Teaching Hospitals without Council of Teaching Hospitals Association of American Medical Colleges One Dupont Circle, N.W. Washington, D.C. 20036 reproduced be

to Dear Dr. Bentley:

Not We have received your letter requesting copy of the hospital's present medical school affiliation agreement.

AAMC Gorgas Hospital is operated by the U.S. Government in the the Canal Zone and .. ,,.—wolgOmMOSOOPRIAMObl

of _ ianitiontak NINIIIIIIMINCIMMOVIStag. We, therefore, cannot provide this document for your Directory.

Sincerely yours, collections the (1 ( 0 c) 14 from Richard T. Travis, M.D. Assistant Director/Medical Activities Document t9c‘ Attachment E -16- rrou-no INTFIERIVIATIV • ESTABLISHED 1854 1401 FOUCHER STREET • (504) 897-8244 • NEW ORLEANS, LOUISIANA 70115 office of the EXECUTIVE DIRECTOR December 12, 1977

Richard M. Knapp, Ph.D. Director, Department of Teaching Hospitals Association of American Medical Colleges One Dupont Circle, NW Suite 200 Washington, D.C. 20036

Dear Dr. Knapp:

permission This letter will serve to document the relationship between Touro Infirmary and Tulane University School of Medicine as regards post-graduate teaching programs conducted by Tulane at Touro. without

For many years, Touro has been one of the principal institutions utilized by Tulane for residency training. There has never been, however, a written affiliation agreement. Both institutions recognize reproduced that such agreements should be committed to writing. The Dean of the be School of Medicine and the Executive Director of Touro have pledged to themselves to preparation of a written affiliation agreement which will

Not be presented to the Boards of the two institutions for approval. In the meantime, this letter is intended to outline the scope of our affiliation • for presentation to the Council of Teaching Hospitals. AAMC

the Touro and Tulane are affiliated in the following departments: of Department/Division Number of Residents Assigned to Touro

Medicine 18 collections Surgery 1 the Orthopedics 3 Urology 2 from Ophthalmology 2 Plastic Surgery 1

In addition, ten fourth-year medical students are assigned to Touro at Document any one time by Tulane.

I hope that this letter will be sufficient evidence that Touro and Tulane are indeed closely affiliated for purposes of medical education. It is anticipated that a formal written affiliation agreement will be developed within the first quarter of 1978.

Sincerely '

idmes T. Hamlin‘III, M.D. . L. B ckingh Dean, School of medicine Executive Direc Tulane University

JLB:cl ' 912-- Attachment F -17-

DEPARTMENT OF HEALTH, EDUCATION. AND WELFARE PUBLIC HEALTH SERVICE NATIONAL INSTITUTES OF HEALTH BETH ESDA. MARYLAND 20014 August 25, 1977 Our Reference: CC-ASD-PVC

Richard M. Knapp, Ph. D. Director Department of Teaching Hospitals Association of American Medical Colleges One Dupont Circle, N. W.

Washington, D. C. 20036 permission permission Dear Dr. Knapp: without without A completed 1977 questionnaire for the Directory of Educational Programs and Services, giving data for the Clinical Center of the National Institutes of Health is enclosed. As I'm sure you know, the Clinical Center is an unusual "teaching hospital". It is not reproduced reproduced possible to give a fair description of the educational activities be be which go on here, in a format designed with most teaching hospitals

to to in mind. Not Not To begin, we don't have a formal affiliation agreement with a medical school. The affiliated Foundation for Advanced Education in the

AAMC AAMC Sciences offers many evening courses for physicians, and the NIH-FAES Medical Education.

the the is accredited by the AMA Council on of of We offer nine clinical elective courses for medical students, open to 3rd and 4th year students in all U.S. medical schools, which are accepted as creditable towards the M.D. degree. About 120 students take these collections collections electives each year. Thus in a sense we are affiliated with all the Nation's

the the schools.

from from The Associate program of the NIH offers advanced post-graduate training in virtually all fields of clinical and pre-clinical bio-medical research. These two-or three-year appointments (both clinical and non -clinical) are accepted by about 200 physicians every year. Only a Document Document few Associateships qualify as approved "free-standing" residency programs--namely Blood Banking and Clinical and Anatomical Pathology. More limited residency credit may accrue to the Clinical Associateships in Neurology, Psychiatry, Dermatology, and Nuclear Medicine. (I have listed these under Section IV as "PA", although these programs are not affiliated with any particular school or other hospital. -18-

2 • Dr. Richard M. Kanpp, Ph.D. - page

By and large the Clinical Associateships are much more analogous to sub-specialty Fellowship programs in most teaching hospitals, 1977 creditable toward sub-specialty certification. As of July 15, there were 190 Clinical Associates on duty here. for Three catalogs, which give information on the FAES, electives somehow students, and the Associate program are enclosed. If it were your directory, possible to include the information about the Associate in as I have summarized it above, we would appreciate it. Sincerely,

P. V. Cardon, M.D. Associate Director The Clinical Center

Enclosures

• Attachment G d13 -19- CHEVERLY • MARYLAND •20785 PRINCE GEORGE'S 301-341-3300 OGENERAL HOSPITAL

and RALEIGH CLINE Executive Vice President MEDICAL CENTER

November 16, 1977

permission permission without without

Richard M. Knapp, Ph.D. Council of Teaching Hospitals 200 reproduced reproduced One DuPont Circle, Suite

be be Washington, D. C. 20036 to to

Dear Mr. Knapp: Not Not

The Board of Directors of Prince George's General Hospital and Medical Center AAMC AAMC

has moved to negotiate a Medical School Affiliation Agreement with The University the the of of of Maryland. The hospital has not yet completed negotiations with the

University of Maryland. When the negotiations are completed, a copy of our collections collections

Medical School Affiliation Agreement will be sent to your office. the the

Sincerely, from from

c / /\

Document Document Raleigh Cline Chief Executive Officer he collections of the AAMC Not to be r roduced without p THE Yo7- CATHOLIC HOSPITAL SAINT JOHN'S MEDICAL James Assistant Association Washington, Department 111111•11110111411.111MIMIMIIMEISMINMPEMMir. Dear Council One please Programs. OF reported, IS/th THE QUEENS Dupont Dr. Bentley: In HOLY D. be of response HOSPITAL CENTER Bentley, FAMILY Director advised it Teaching of Circle, of D.C. does Teaching American OF • 20036 to • Ph.D. that maintain N.W. BROOKLYN Hospitals your QUEENS SAINT 88-25 ZIONIZIVINIMMIIIMMIUMINNIMPIMNIIIIIW Hospitals Medical CHARLES correspondence 153 HOSPITAL Departmental ST. AND ORTHOPEDIC JAMAICA, Colleges CENTER QUEENS, Sincerely, Administration Director Irwin (212) AFFILIATION HOSPITAL of Free N.Y. 657-6800 Shapiro November 11432 December INC. Standing of However, • Hospital • MARY 30, 7, SAINT Attachment Residency IMMACULATE 1977 1977, as MARY'S HOSPITAL H HOSPITAL Attachment I

• st. ncent's me ca centen oc nichmono

JOHN J. De PIERRO Executive Vice President

January 12, 1978

permission permission James D. Bentley, Ph.D. Assistant Director

without without Department of Teaching Hospitals Council of Teaching Hospitals Association of American Medical Colleges One DuPont Circle, N.W.

reproduced reproduced Washington, D.C. 20036 be be

to to Dear Dr. Bentley:

Not Not In response to your letter of Decebber 28, 1977 requesting • a copy of our institution's affiliation agreement, please

be advised that at the present time St. Vincent's does not AAMC AAMC

have a formal agreement with a medical school. the the of of For your information, at the present time we have depart- mental affiliations in Medicine, Surgery and Ob/Gyn with

Downstate Medical Center. collections collections We are expecting a letter shortly from the Medical School the the regarding our application and as soon as we receive word

we will transmit this information to you. from from

Sincerely, Document Document

ULLA) J. ierro tive ice President

/lsa •

355 BARD AVENUE • STATEN ISLAND, N. V. 10310 • 390-1207 ) Attachment J

WILSON MEMORIAL Ho SPITAL

DEPARTMENT 33-57 HARRISON STREET OF domisoN CITY, N.Y.13790 MEDICAL EDUCATION TELEPHONE 607-773-6391

December 13, 1977 peithission peithission

PH.D. without without James D. Bentley, Assistant Director Department of Teaching Hospitals Council of Teaching Hospitals Colleges reproduced reproduced Association of American Medical

be be One DuPont Circle, N.W.

to to Washington, D. C. 20036 Not Not

Dear Doctor Bentley: AAMC AAMC In response to your letter of November 30th regarding our the the affiliation agreement with the Upstate Medical Center of of of Syracuse, New York, please be advised that the Upstate Medical Center to our knowledge has not formalized any

affiliation agreement with its major teaching hospitals. collections collections We are currently setting up representative committees to the the formally discuss these matters in view of Wilson Memorial

Hospital's extended involvement with the Binghamton Clinical from from Campus of the Upstate Medical Center.

I will be pleased to provide you any other additional

Document Document information if you so wish.

Sincerely,

r, -‹ ti--( Eugene M. Wyso, M.D. Director of Medical Education

cc:Mr. Stith Mr. Rozzi

• EMW:bcd Attachment K

CLEVELAND CLINIC

THE CLINIC CENTER •9500 EUCLID AVENUE, CLEVELAND, OHIO 44106, U.S.A.• 216/444 • 5694• CABLE: CLEVCLINIC CLV.

EDUCATION DIVISION William M. Michener, M.D. Director December 19, 1977

James D. Bentley, Ph.D. Assistant Director permission permission Department of Teaching Hospitals Association of American Medical Colleges N.W. without without One Dupont Circle, Washington, D.C. 20036

Dear Dr. Bentley: reproduced reproduced November 30, 1977, indicating "a copy of the be be In answer to your letter of

to to hospital-medinal school affiliation agreement hAs not yet been received" I am writing to inform you that the Cleveland Clinic Education Foundation Not Not does not have any formal written teaching agreements whether they be affiliation or association agreements. No such written agreements have ever existed in the history of the Cleveland Clinic Foundation and its AAMC AAMC Educational Foundation. Graduate and other education programs in this

the the Institution have always fallen under the "free-standing" designation. of of I believe you are probably aware of the Cleveland Clinic Foundation's efforts in education but so that these may be documented for the purposes of the Council of Teaching Hospitals I would like to elaborate a few of collections collections these. The Cleveland Clinic Foundation at the present time has a full- the the time staff of 270 physicians practicing in the Cleveland Clinic and in the Cleveland Clinic Hospital, a hospital of 1000 beds. At the present from from time there are 437 medical doctors taking graduate education in all 27 training programs. All programs at the present time are approved as well. During the past year, 374 fourth year students from 70 different medical in many different programs within the Institution. Document Document schools took electives The Department of Pediatrics participates in the required clerkship for third years students at Case Western Reserve University Medical School. This Department is affiliated for the purposes of teaching pediatrics. Approximately 20 percent of the Case Western Reserve School of Medicine class takes their required pediatric experience in this Institution. Clinical faculty appoiniments are held by 35 to 40 Cleveland Clinic staff and there are many cooperative conferences between the various teaching program.

I hope this information satisfies the criteria for memebership in the Council of Teaching Hospitals. If any any further information is needed, -24- Two TO: James D. Bentley, Ph.D. Page December 19, 1977 •

please contact me, and I will be happy to provide information or answer any questions you might have.

Sincerely yours,

William M. Michener, M.D. Director of Education

WMM:ec

• 111 Attachment L

Mercy-

Pride & Locust Streets Pittsburgh, Pennsylvania 15219 Telephone (412) 232- 7500 December 8, 1977

James D. Bentley, PH.D.

permission Assistant Director Dept. of Teaching Hospitals Association of American without Medical Colleges One Dupont Circle, N.W. Washington, D.C. 20036

reproduced Dear Mr. Bentley: be to Per your phone conversation with my secretary regarding advised Not your correspondence of November 30th, please be that v1.3", -4•=7

AAMC :imoginiallgt with the University of Pittsburgh Medical ! School. the of If we can be of further assistance, please do not hesi- tate to call upon us.

collections Sincerely, the 4.uis cza.A. from ' Sister M. Ferdinand Clark .Executive Director

Document SMF/ js

• Attachment M -26-

ST. FRANCIS GENERAL HOSPITAL

• 45th STREET (off PENN AVENUE) PITTSBURGH, PENNSYLVANIA 15201 (412) 622-4343 December 22, 1977

James D. Bentley, Ph.D. Assistant Director Department of Teaching Hospitals Council of Teaching Hospitals

permission permission One DuPont Circle, N. W. Washington, D. C. 10036

without without Dear Doctor Bentley: This is in reply to your letter of November 30, 1977 in

which you request a copy of our hospital's medical school affiliation reproduced reproduced

agreement. be to to Although we provide clinical facility for several areas of at the University of Pittsburgh School of Medicine, Not Not the teaching program including a prominent portion of its orthopaedic residency, we do not

411 have a specific affiliation agreement which can be documented. AAMC AAMC

Sincerely,

the the of of

Sister M. Sylvia Schuler Director

collections collections Executive

the the from from

Document Document SMS:cmp

PHYSICAL MEDICINE AND REHABILITATION MEDICINE AND SURGERY COMMUNITY MENTAL HEALTH CENTER Attachment N 29/

BAPTIST MEMORIAL HOSPITAL • 899 MADISON AVENUE MEMPHIS, TENNESSEE 38146

FRANK S. GRONER, PRESIDENT December 19, 1977

ROBERT F. SCATES SENIOR VICE PRESIDENT

Mr. James D. Bentley, Ph. D. Assistant Director permission Department of Teaching Hospitals Association of American Medical Colleges

without One Dupont Circle, N. W. Washington, D. C. 20036

Dear Dr. Bentley: reproduced be We acknowledge your letter of November 30, 1977 on the subject of the to hospital-medical school affiliation agreement. At this time, we do not Not have an over-all agreement that is current though we do have a number of medical school relationships. AAMC

the We trust that this letter will explain the fact that we have not previously of sent you the material which you requested.

Sincerely, collections

G''6`21 the Robert F. Scates

from Senior Vice President

RFS/mlo Document

• Attachment 0 -28- THE UNIVERSITY OF ARIZONA ARIZONA MEDICAL CENTER TUCSON, ARIZONA 85724 AuG 7q77 VICE ?RESIDENT HE_ALTH SCIENCES ::411 r.:17 ,r.D

August 29, 1977

M=. A. Markey, Director Maricopa County General Hospital

9601 East Roosevelt permission permission Phoenix, Arizona 85008

without without Dear Mr. Harkey:

I have received your letter of August 24 which addresses the subject of affiliation agreements between our respective institutions. We because reproduced reproduced do not have a single, master agreement between our institutions teach— be be the master agreement used by the University for its many clinical to to ing affiliations was apparently unacceptable to you when an effort was

made a few years ago to execute such an agreement. If your group now Not Not wishes to reapproach the question of a master agreement we would be glad

to tri t with you. AAMC AAMC

th meantime, our respective institutions are operating through an the the

agreement with the Phoenix Hospitals Associate Pediatric Program and, of of in addition, the Departments of Internal Medicine, Obstetrics and Gynecology, and Surgery at our College of Medicine are rotating students through the respective teaching services at your hospital in the absence

collections collections of a written agreement. the the Those of us at the University of Arizona Health Sciences Center have in your hospital. We hope from from appreciated the opportunity to have students that your medical staff will continue to be interested in perpetuating that arrangement.

Document Document Very sincerely yours,

.' Merlin K. DuVal, M.D.

• 12— Attachment P MA 0 UNIVERSITY OF MASSACHUSETTS . AMHERST • BOSTON • WORCESTER s 1863'

CHANCELLOR, UNIVERSITY OF MASSACHUSETTS AT WORCESTER DEAN OF THE MEDICAL SCHOOL 55 LAKE AVENUE NORTH WORCESTER, MASSACHUSETTS 01605

permission November 2, 1976

without Gerald L.. Haidake M.D.

Pittsfield General Unit

reproduced 725 North Street be Pittsfield, MA 01201

to Dear Dr. Haidak:

Not

This letter is to verify the major affiliation between

AAMC the Berkshire Medical Center and the University of Massachusetts Medical School.

the

of Sincerely,

74

collections

the Roger/A. Bulger, M.4. from Chan llor/Dean

MS/mg

Document Enclosures ti Attachment Q 'STATE UN1V.ERSITY OF NEW YORK

Office of the Vice President • DOWNSTATE MEDICAL CENTER for Hospital Affairs May 23, 1977

Vincent Tricomi, M.D.,F.A.C.S. Director of Medical Affairs The Brooklyn Hospital 121 DeKalb Avenue Brooklyn, New York 11201

Re: Major Affiliation with the permission permission State University of New York,

Downstate Medical Center. without without Dear Dr. Tricomi:

This is to certify that The Brooklyn Hospital enjoys a Major (M) reproduced reproduced University of New York, Downstate Medical be be affiliation with the State to to Center and is so listed with the Council on Medical Education of the Association. Not Not Medical

• American

AAMC AAMC the the

of of ery truly yours, collections collections . the the Julius E. Stolfi, M./ Vice President for /liospital Affairs

from from Associate Dean of Clinical Affairs Document Document pcsavED

MAY 23 1971

OFFICE OF EXECUTIVE DIRECTOR

MAILING ADDRESS: 450 CLARKSON AVENUE, BROOKLYN, NEW YORK 11203 / PHONE: (212) 270-1000 Attachment R -31- STATE UNIVERSITY OF NEW YORK

Office of the Vice President • DOWNSTATE MEDICAL CENTER for Hospital Affairs

June 25, 1975

Mr. George Adams rzeSident Lutheran Medical Center 4520 Fourth Avenue Brooklyn, N. Y. 11220

• Re: Change in Affiliation Status permission to "G" Directly without Dear George:

I am pleased to notify you that your request for a change in affiliation status

reproduced and the data submitted have been reviewed and approved. be to Lutheran Medical Center will henceforth be listed as a "G" affiliation directly

Not with our school and no longer by way of Maimonides Hospital. The latter has been duely notified through Dr. George Degenshein, Associate Dean. He

voiced no objection. • AAMC the The Council on Medical Education of the AMA will be instructed to list your of hospital as indicated above.

Congratulations and best wishes for continued success in'your efforts to up- collections grade all phases of patient care and educational programs in your fine hospi- the tal. from Cor lly yours, Document ius E. Stolfi, M Vice President fo I-109p ital Affairs Associate Dean of Clinical Affairs JES:pl cc: Calvin H. Plimpton, M.D. Dean Leonard Laster, M.D. George Degenshein, M.D. Gabriel Cucolo, M.D. NHOF riTAJZ. Attachment S

OFFICE OF THE DEAN-32- SCHOOL OF MEDICINE

Area Code 503 225-8220

Portland, Oregon 97201 UNIVERSITY OF OREGON HEALTH SCIENCES CENTER

August 12, 1977

Hugo Uhland, M.D. Director of Medical Education permission Emanuel Hospital 2801 N. Gantenbein Street Portland, Oregon

without

Dear Doctor Uhland:

The purpose of this letter is to respond reproduced to your telephonic request for some written statement regarding be the affiliation for educational programs between Emanuel to Hospital and the School of Medicine. I do not know what written documents there might be scattered Not through the files of the two Institutions but I do not have hand any at all. at However, in connection with preparing for the Health an application Manpower Capitation Award, we have AAMC had to review, according to the definitions in the application form, what actual the or implied affiliations we have with community hospitals.

of With respect to Emanuel Hospital, my current understanding that in Pediatrics, is Obstetrics/Gynecology, Orthopedics Urology and in residents are appointed by Program collections Directors at the School of Medicine with or without concurrence of counter parts at Emanuel the and that house officers rotate to Emanuel being paid while by your Institution. there

from According to the newly introduced definition in the Capitation Questionnaire, the programs in Family Practice, Medicine, and Surgery at Emanuel Flexible

Document Hospital also qualify as affiliated because of the existence of volunteer faculty appointments to having instructional individuals responsibility in those programs. I regard the whole matter of the appointment basis for volunteer faculty, titles, privileges and obligations as a piece of rather disorderly, housekeeping. In addition, our affiliation agreements

• 1 ,7r--7--; • I •J

Dr. Hugo Uhland Page 2 . August 12, 1977

need to be formalized with all of the hospitals with whom we cooperate. During the next six months or .so, members of the faculty and I will be working on these matters to try to put them into a more systematic framework. Undoubtedly there will be consultation with individuals in the various hospitals in order to exchange view points. I hope that you will be involved and help us to sort things out.

If this letter does not serve your purpose, please do let me know and I will try to do something more appropriate.

Sincerely, permission

without V6/ LUZ__ Lert Stone, M.D. Dean, School of Medicine

reproduced RSS:mk be to Not • AAMC the of collections the from Document

• 3..77 Attachment T -34-

MARSHALL UNIVERSITY OFFICE OF THE VICE PRESIDENT FOR HEALTH SCIENCES AND DEAN OF THE SCHOOL OF MEDICINE HUNTINGTON, WEST VIRGINIA 25701 September 16, 1977

Guy Hollifield, M.D. Appalachian Regional Hospital permission 304 Stanaford Road Beckley, WEst Virginia 25801 without Dear Guy:

Although the formal Affiliation Agreement between the Beckley

reproduced Appalachian Regional Hospital and the School of Medicine has not

be been signed by all parties, the BARH is an affiliate of the to Marshall University School of Medicine.

Not Many of the attending staff of BARH have faculty appointments in the School of Medicine. The residency programs are Marshall • affiliated and the Program AAMC Directors are School of Medicine faculty. Beckley area faculty members have been active participants in the several of our School Committees. of

• It is my intention to formalize our affiliation with a signed agreement in the near future. collections Sincerely, the from

Robert W. Coon,.M.D. Vice President and Dean Document RWC/db