commission, consortium, council, or institute. The advantages and disadvantages of these options are discussed below.16

Federal Agency

There are several advantages to a federally based CPR development effort. In general, a federal initiative associated with an existing agency has implied authority and power, as well as lower start-up and operating costs than would be incurred for a newly created, freestanding organization. Moreover, congressional support is likely to be stronger if the CPR effort is closely linked to federal efforts that are already under way. In addition, staff would not need to spend time raising funds as would be necessary for a private sector effort.

A federal agency would have less independence than a private sector organization, however, and would face possible limitations from bureaucratic policies and procedures. Thus, greater potential for innovation might exist in the private sector. Another disadvantage to locating leadership for CPR development within the federal government is the potential for health care providers to see such efforts as too closely aligned with government and therefore open to excessive regulation and intrusiveness. Finally, such an approach must rely on receiving a mandate and funding, which could make start-up time for federal efforts longer than for a private organization.

Within DHHS, several agencies might be considered. First, the Office of the Assistant Secretary for Planning and Evaluation (ASPE) might be able to bridge the gaps among various agencies and programs in DHHS. It would be unlikely, however, to gather the resources and expertise required to mount an effort of the magnitude envisioned by this report.

AHCPR has functions quite consistent with the objectives of the leadership entity proposed by the committee, although these functions are not its primary responsibilities. Currently, AHCPR does not have the resources to undertake a CPR implementation project, but if such funding were forthcoming it could, over time, assume a more significant role. One drawback, however, is that such an effort might be seen as possibly undermining the agency's main mission—that is, support of health services, outcomes, and effectiveness research and the development of clinical practice guidelines.

HCFA has a substantial interest in the CPR for both operational and quality improvement reasons. Although HCFA would be a key beneficiary of widespread CPR implementation and hence likely to want to provide

16  

To address this issue fully, the committee organized a one-day workshop in September 1990 to evaluate the feasibility and desirability of alternative organizational models for a CPR organization; AHCPR provided separate funding for the meeting. Workshop participants included representatives of health care professionals, provider institutions, federal agencies, insurers, employers, and private foundations.



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