inte
April 1969

: OTHER POSSIBLE LEGISLATIVE ISSUES

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There are a number of other possible legislative issues which, of
perhaps lesser import or not quite so pressing, also warrant mention

and some consideration.

Authorization for New Construction

This issue, which was considered to be of major importance during the
early days of the program and was treated accordingly in the “Report on RMP
to the President and the Congress," now appears to be dead. There is
little or no indication from the Regions that the need for or desirability
of such authority is critical or great. Current efforts by the Administra~

tion to reduce inflation and the anticipated budget pressures would seem to

make any efforts in this direction quixotic.

Cost Sharing or Matching

“There presently are no formal RMP cost sharing or matching require-
ments for either planning or operational activities except for renovation
(90% Federai - 10% local). The Regulations state that when approving pro-
“jects, the potential utilization of nonfederal resources in carrying out
program activities must be taken into account, but to date this has not
been a major practical consideration. Some Regions have adopted proce-
dures regarding the gradual phasing out of projects or the transference of
their support to community resources, but no specific policy in this regard

has yet been adopted and applied nationally.
Don

“One of the strengths of RMP has been the ability to full-fund

program activities without having to worry about obtaining continued
local support. However, some persons have argued that if matching money
were required, it would bring increased local involvement to the program.
Given the current financial status of most medical schools, cost sharing
potentially might increase the outreach of the program by forcing RMP to
look to the community for financial support. In addition, cost sharing
also would multiply the impact of the available RMP funds. The basis for
cost sharing or matching in a progran dealing with and composed of multiple
institutions and organizations would pose substantial administrative prob-
lems, hovever.

One very practical consideration is that a program with an authori-
zation level (or appropriations) of even $2~300 million might well elicit
Congresstonal pressures for local matching, even though that same program

at a $65-120 million level had not.

Regionalization

An increased emphasis on regional cooperative arrangements or region~
alization of health resources and services, could raise questions with
respect to the present prohibition against interference with ". . . the
patterns, or methods of financing, of patient care or professional practice,

or with the administration of hospitals". Strict interpretation of this

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provision in the Act could limit severely the opportunities for Regional
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Medical Programs to contribute to the regionalization of health resources
and services. However, to date this prohibition has not appeared to have
caused any major difficulties; and in all probability any attempt to change

ox to clarify it would raise more problems than it would solve.

Broader Involvement in the Program

Although medical schools and centers, community hospitals, practicing
physicians, and by extension, medical societies, make up the primary con-
stituency of RMP, the mix and relative influence of these groups varies
considerably among Regions. Community hospital interests in particular,
have been concerned about their limited involvement in the RMP decision-
making and planning processes and operational projects. There has also
been implied criticism from certain Congressmen about RMP funds not getting
beyond the medical school (or "dean's office").

Perhaps some consideration needs to be given to means by which broader
participation by community hospitals and other provider groups, as well as
community and consumer interests might be insured. Cost sharing, redefi-
nition of the function of Regional Advisory Groups, and increased cooper-
ation with both state and areawide CHP efforts have been suggested as
possible ways to accomplish this purpose. The recent AHA position with
respect to hospital planning and financial requirements may provide an
impetus and opportunity for greater RHP support ef individual hospital
planning efforts and cooperation and collaboration with CHP areawide plan-

ning agencies.
 

Care Capacity

The present explicit emphasis of RMP is on improving the quality of
care -- "To afford to the medical profession and the medical institutions
of the Nation... the opportunity of making available to their patients
the latest advances in the diagnosis and treatment of these diseases."
Consideration perhaps should be given to including within the program's
broad purposes an explicit reference to increasing or improving the
capacity of the professions and hospitals for providing care through

regionalization.