INN      RI
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                                                                     DRAFT 9/25/72

                              PROPOSED OUTLINE FOR @ DECISION PAPER



           I.  NARRATIVE DISCUSSION

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

                    2.  Current status of RNPs in terms of

                        a.  structure and process

                            program activities

                    3.  RIMPS-R'MP nexus highlighting

                        a.  national review and funding process


                        b.  decentralization

               B.  Ciitici6ms of Program:  Identification of major criticisms, their
                    bases/sources, and including when appropriate@biief rejoinders to
                  fiset 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 (eg.,    HEW HS)  as  to  RMP
                            role.  General agreement by all concerned that RMP needs to
                            be tied to a larger national purpos6,@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 RIIP@ina-Di)ropriate, not@
                        valid

                        a.  Subsidization of continuing education for physicians
                            specifically

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

                    4.  Inordinate overhead  cost  of  supporting  RMPs  (Program  staffg,
                        and related attivities)@,

                    5.  involvement in planning,  which is CHPis b@g.









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                    6.  Provider/medical school domination

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


                        a.  Too little RO involvement

                        b.  Council has too much say-so

                    8.  Inadequate demonstration/documentation of substantive accomplish-
                        ments


                    9.  Categorical nature

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

                        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
                        interests and groups at the local level.

                    3.  Supports and strengthens  institutional  reform  in  health  arena

                    4.  Strengthens local initiative and non-dependency

                    5i  Bridges the servides-education/town-gown chasm

                    6.  Enhances local health planning, both its capacity and potential
                        pay-off
                    7.  Increasingly  roblem-oriented  (e.g.,  EMS,  qualitv   assurance).
                                      p

                    8. @Provides a good fulenm for increasing the       erage  of  limited
                        Federal health dollars.


                    9.  F16xibility
               D.   Federal Needs:  Identification of those major,    i4thei 4pedific Federal
                    health needs that RMP might reasonably be 6xp66t4d to contribute to-

                    1.  implementation of quality contrdl/assurance@mechanisms

                    2.1 Mechanism(s) for conducting pilot experiments, demonstrations.
                        and reforms within the system.  This in6       s@ community b46  ed
                        test beds for valid R&D efforts.

                        Local implementation of CHP plans and priorities.








                                           3

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

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

                 6. Feedback loop from the service to the educational sector, those
                    institutions responsible for the prodtcdon/iraining of health
                    manpower

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


         II.@ ISSUES AND OPTIONS

             A.  Issues          Both of these are pretty well
                                 laid out in the Berman and
             B.  Options         DUVAI outlines.

        III.  APPENDICES