[Congressional Record Volume 146, Number 97 (Monday, July 24, 2000)]
[Extensions of Remarks]
[Page E1306]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




   ON THE INTRODUCTION OF THE GERIATRIC WORKFORCE RELIEF ACT OF 2000

                                 ______
                                 

                            HON. GENE GREEN

                                of texas

                    in the house of representatives

                         Monday, July 24, 2000

  Mr. GREEN of Texas. Mr. Speaker, the complex health problems of aging 
require specially-trained physicians in order to adequately care for 
frail older persons. Geriatrics is the medical specialty that promotes 
wellness and preventive care; these specialists are first board 
certified in family practice, internal medicine or psychiatry and then 
complete additional years of fellowship training in geriatrics. With an 
emphasis on care management and coordination, geriatricians help 
patients maintain functional independence, thus improving their overall 
quality of life. An emphasis on coordination also limits unnecessary 
and costly hospitalization or institutionalization.
  Despite the increasing number of Americans over age 65, there are 
fewer than 9,000 geriatricians in the United States today. In Texas, 
there are only about 225 geriatricians--and we are one of the top ten 
states nationally. Texas has four geriatric training programs; Baylor 
College of medicine in Houston, the University of Texas at San Antoino, 
the University of Texas Medical Branch at Galveston (where, I am proud 
to say, my daughter is a third-year student) and the University of 
Texas Southwestern.
  The Baylor program, in my Congressional District, has been operating 
for over 15 years. It trains six fellows now and is unable to increase 
this number because of a Congressionally-mandated Graduate Medical 
Education (GME) cap. I am told that there are plenty of applicants 
interested in geriatrics who are being turned away because our Medicare 
program will not allow them to be funded.
  Why is there a cap on the number of new geriatricians? The Balanced 
Budget Act of 1997 established a hospital-specific cap based upon the 
number of residents in the hospital in the most recent cost reporting 
period ending on or before December 31, 1996. Under the cap, the number 
of residents for direct graduate medical education payment purposes is 
based upon a three-year rolling average, except for Fiscal Year 1998, 
when a two-year average was used.
  The implementation of this cap has adversely impacted geriatric 
programs in Houston and elsewhere. As geriatrics is a relatively new 
specialty, the cap has resulted in either the elimination or reduction 
of geriatric programs. Because a lower number of geriatric residents 
existed prior to December 31, 1996, these programs are under-
represented in the cap baseline. Thus, new geriatric training programs 
are severely limited and existing training programs tend not to 
increase funding, or even decrease funding, for geriatric slots.
  There is a well-documented shortage of geriatricians nationwide. Of 
the approximately 98,000 medical residency and fellowship positions 
supported by Medicare in 1998, only 324 were in geriatric medicine and 
geriatric psychiatry.
  At the same time, the number of physicians needed to provide medical 
care for older persons has been estimated to be 2.5 to three time 
higher in 2030 compared to the mid-1980s, according to the federal 
Health Resources and Services Administration.
  Unfortunately, the pace of training is not meeting this need. The 
actual number of certified geriatricians has declined, as approximately 
50% of those who certified in 1988 did not recertify in 1998. This has 
occurred just as the baby boomers have started reaching the age of 
Medicare eligibility.
  To correct this problem, I am introducing the Geriatric Workforce 
Relief Act of 2000 today to allow an increase in the number of person 
studying geriatrics at our medical schools. In order to be fiscally 
responsible, my legislation does not completely lift the cap. Instead, 
it allows hospitals to increase the cap by 30%. This will allow for a 
few more students at most programs. My legislation defines approved 
geriatric residency programs as those approved by the Accreditation 
Council of Graduate Medical Education.
  My legislation, which will also be introduced in the Senate today by 
Senator Reid, is modeled upon a similar provisions that was enacted 
last year for rural hospitals. It is a sensible and reasonable proposal 
and one that allows us to meet the needs of Medicare patients. I 
encourage my colleagues to support it.

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