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                                                                  DRAFT 9/25/72

                             PROPOSED OUTLINE FOR RMP DECISION PAPER

          I.  NARRATIVE DISCUSSION

              A.  Program Description:  Brief, summary touching upon:
                 ..-l.  Legislative and administrative history/evolution.

                                            s in terms of
                   2 . Current status of  REP

                       -a.  structure and process

                       b.  program activities

                       RMPS-RMP     s highlighting

                       a.  national review and funding process

                       b.. decentralization

               B.  Criticisms of Program:  Identification of major criticisms, their
                   bases/sotirces, and including when appropriate brief rejoinders to
                   set the record  straight."
                   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.g., HE74, HS) as to KT
                           role.  General agreement by all concerned that RMP needs to
                           be.tied to a larger national purpose, but none as to what
                           more spec fically that should be.
                   2.  Non-compliance with, non-respons-veness to national priorities,
                   3.  Major educational and training trust of RMP inappropriate, not
                       valid

                       a. Subsidization of continuing education for physicians
                           specifically

                       b. Turf issue vis-a-vis BHME generally,

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

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

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                   6.  Provider/medical school domination

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

                                                  ent---

                       b.  Goun/ei-1--@ha-s--too-much say-so

                   8.  Inadequate dem'onstration/documentation of substantive accomplish-
                       ments

                   9.  Categorical nature

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

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

                   2.  Provides a forum and mechanism for productive dialogue and
                       cooperative action between and among formerly disparate health
                       inte@ests and groups at.the local level.

                   3.  Supports and strengthens institutional reform in health arena.

                   4.  Strengthens local initiative and non-dependenc

                   5.  Bridges the services-education/@own-gown chasm

                   6.  Enhances local health planning, both its capacity and potential
                       pay-off*

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

                   8.  Provides a-good fulmim for increasing the leverage  of  limited
                       Federal health dollars.

                   9.  Flexibility,

               D.  Federal Needs:  Identification of those major, rather  specific Federal
                   health needs that RMP might reasonably be expected to  contribute to.

                   1.  Implementation of quality control/ass'urance mechanisms

                   2.  Mechanism(s) for conducting pilot experiments, demonstrations,
                                                       Th's '  1 d              -based
                       and reforms within the system,,   i  3-nc u es community
                       test beds for valid R&D efforts.

                   3.  Local implementation of CHP plans and priorities.


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

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

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

                 7.  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.

        III.  APPENDICES