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DRAFT 9/25/72

PROPOSED OUTLINE FOR RMP DECISION PAPER

I. NARRATIVE DISCUSSION

A.

B.

Program Description: Brief, summary touching upon:
1. Legislative and administrative history/evolution.
2. Current status of RMPs in terms of

a. structure and process

b. program activities
3. RMPS-RMP nexus highlighting

a. national review and funding process

b. decentralization

Criticisms of Program: Identification of major criticisms, their
bases/sources, and including when appropriate brief rejoinders to

"set the record straight."

r

1. Lack of really any overall program strategy and direction,
specific mission, etc. .

a. Local laisse: faire/Brownian movement
b. No "agreement" at national level (e.gs, HEW, HS) as to RMP
role. General agreement by all concerned that RMP needs to

be tied to a larger national purpose, but. none as to what
more specifically that should be.

2... Non-compliance with, non-responsiveness. to. national priorities

3. Major educational and training trust of RMP inappropriate, not
- walid

a. Subsidization of continuing education for physicians
specifically

b. Turf issue vis-a-vis BHME generally

4. -Inordinate "overhead" cost of supporting RMPs (Program staffs,
and related activities) .

5. Involvement in planning, which is CHP's bag.
Cc.

8.

9.

2

Provider/medical school domination

Continued centralization of program administration and manage-
ment at Federal level.

a. Too little RO involvement

b. Council has too much say-so

Inadequate demonstration/documentation of substantive accomplish-
ments

Categorical nature

Program Strengths: Enumeration of the major strengths of RMP on
which there is general agreement, consensus.

1.

2.

Federal Needs: Identification of those major, rather specific Federal oe

Constitutes a functioning and acceptable link between the Federal
government and providers of care

Provides a forum and mechanism for productive dialogue and

cooperative action between and among formerly disparate health |

interests and groups at the local level.

Supports and strengthens institutional reform in health arena
Strengthens local initiative and non-dependency

Bridges the services-education/town-gown chasm

Enhances local health planning, both its capacity and potential
pay-off “

Increasingly problem-oriented (e.g., EMS, quality assurance).

Provides a good fulaum for increasing the leverage of limited
Federal health dollars.

Flexibility

health needs that RMP might reasonably be expected to contribute to.

1.

2.

Implementation of quality control/assurance mechanisms |

-Mechanism(s) for conducting pilot experiments, demonstrations,

and reforms within the system. This includes community-based

test beds for valid R&D efforts.

Local implementation of CHP plans and priorities.
It.

Itt.

4.

3

Promotion of/assistance to new Federal initiatives (e.g., HMO,
EMS, AHEC).

Vehicle for large-scale implementation of community-based
categorical control programs (e.g., hypertension, end-stage
renal disease)

Feedback loop from the service to the educational sector, those
institutions responsible for the production/training of health
manpower

Stimulation and support of greater sharing of resources and
services among health institutions aimed at moderating cost

increases.

ISSUES. AND OPTIONS

A. Issues Both of these are pretty well
laid out in the Berman and

B. - Options DuVal outlines.

APPENDICES