[Congressional Record Volume 147, Number 53 (Wednesday, April 25, 2001)]
[Senate]
[Pages S3925-S3926]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mrs. LINCOLN (for herself and Mr. Reid):
  S. 775. A bill to amend title XVIII of the Social Security Act to 
permit expansion of medical residency training programs in geriatric 
medicine and to provide for reimbursement of care coordination and 
assessment services provided under the Medicare Program; to the 
Committee on Finance.
  Mrs. LINCOLN. Madam President, I rise today to introduce the 
Geriatric Care Act of 2001, a bill to increase the number of 
geriatricians in our country through training incentives and Medicare 
reimbursement for geriatric care.
  I am proud to be joined in this effort today by Senator Harry Reid of 
Nevada. Senator Reid has been a pioneer in seeking real commonsense 
solutions to the health care challenges facing our Nation's seniors. In 
fact, he has graciously allowed me to include in this bill components 
of a bill he introduced during the last Congress. Moreover, he has been 
an invaluable resource and ally to me as I have grappled with the 
solutions to these challenges we are seeking.
  Our country teeters on the brink of revolutionary demographic change 
as baby boomers begin to retire and Medicare begins to care for them. 
As a member of the Finance Committee and the Special Committee on 
Aging, I have a special interest in preparing health care providers and 
Medicare for the inevitable aging of America. By improving access to 
geriatric care, the Geriatric Care Act of 2001 takes an important first 
step in modernizing Medicare for the 21st century.
  The 76 million baby boomers are aging and in 30 years, 70 million 
Americans will be 65 years and older. They will soon represent one-
fifth of the U.S. population, the largest proportion of older persons 
in our Nation's history. Our Nation's health care system will face an 
unprecedented strain as our population grows older.
  Our Nation is simply ill-prepared for what lies ahead. Demand for 
quality care will increase, and we will need physicians who understand 
the complex health problems that aging inevitably brings. As seniors 
live longer, they face much greater risk of disease and disability. 
Conditions such as heart disease, cancer, stroke, diabetes, and 
Alzheimer's disease occur more frequently as people age. The complex 
problems associated with aging require a supply of physicians with 
special training in geriatrics.
  Geriatricians are physicians who are first board certified in family 
practice or internal medicine and then complete additional training in 
geriatrics. Geriatric medicine provides the most comprehensive health 
care for our most vulnerable seniors. Geriatrics promotes wellness and 
preventive care, helping to improve patients' overall quality of life 
by allowing them greater independence and preventing unnecessary and 
costly trips to the hospital or institutions.
  Geriatric physicians also have a heightened awareness of the effects 
of prescription drugs. Given our seniors' growing dependence on 
prescriptions, it is increasingly important that physicians know how, 
when, and in what dosage to prescribe medicines for seniors. 
Frequently, our older patients respond to medications in very different 
ways from younger patients. In fact, 35 percent of Americans 65 years 
and older experience adverse drug reactions each year.
  According to the National Center for Health Statistics, medication 
problems may be involved in as many as 17 percent of all 
hospitalizations of seniors each year. Care management provided by a 
geriatrician will not only provide better health care for our seniors, 
but it will also save costs to Medicare in the long term by eliminating 
the pressures on more costly medical care through hospitals and nursing 
homes. Quite clearly, geriatrics is a vital thread in the fabric of our 
health care system, especially in light of our looming demographic 
changes. Yet today there are fewer than 9,000 certified geriatricians 
in the United States. Of the approximately 98,000 medical residency and 
fellowship positions supported by Medicare in 1998, only 324 were in 
geriatric medicine and geriatric psychiatry. Only three medical schools 
in the country--the University of Arkansas for Medical Sciences in 
Little Rock being one of them--have a department of geriatrics. This is 
remarkable when we consider that of the 125 medical schools in our 
country, only 3 have areas of residency in geriatrics.

  As if that were not alarming enough, the number of geriatricians is 
expected to decline dramatically in the next several years. In fact, 
most of these doctors will retire just as the baby boomer generation 
becomes eligible for Medicare. We must reverse this trend and provide 
incentives to increase the number of geriatricians in our country.
  Unfortunately, there are two barriers preventing physicians from 
entering geriatrics: insufficient Medicare reimbursements for the 
provisions of geriatric care, and inadequate training dollars and 
positions for geriatricians. Many practicing geriatricians find it 
increasingly difficult to focus their practice exclusively on older 
patients because of insufficient Medicare reimbursement. Unlike most 
other medical specialties, geriatricians depend most entirely on 
Medicare revenues.
  A recent MedPAC report identified low Medicare reimbursement levels 
as a major stumbling block to recruiting new geriatricians. Currently 
the reimbursement rate for geriatricians is the same as it is for 
regular physicians, but the services geriatricians provide are 
fundamentally different. Physicians who assess younger patients simply 
don't have to invest the same time that geriatricians must invest 
assessing the complex needs of elderly patients. Moreover, chronic 
illness and multiple medications make medical decisionmaking more 
complex and time consuming. Additionally, planning for health care 
needs becomes more complicated as geriatricians seek to include both 
patients and caregivers in the process.
  We must modernize the Medicare fee schedule to acknowledge the 
importance of geriatric assessment and care coordination in providing 
health care for our seniors. Geriatric practices cannot flourish and 
these trends will not improve until we adjust the system to reflect the 
realities of senior health care.
  The Geriatric Care Act I am introducing today addresses these 
shortfalls. This bill provides Medicare coverage for the twin 
foundations of geriatric practice: geriatric assessment and care 
coordination. The bill authorizes Medicare to cover these essential 
services for seniors, thereby allowing geriatricians to manage 
medications effectively, to work with other health care providers as a 
team, and to provide necessary support for caregivers.
  The Geriatric Care Act also will remove the disincentive caused by 
the graduate medical education cap established by the 1997 Balanced 
Budget Act. As a result of this cap, many hospitals have eliminated or 
reduced their geriatric training programs. The Geriatric Care Act 
corrects this problem by allowing additional geriatric training slots 
in hospitals. By allowing hospitals to exceed the cap placed on their 
training slots, this bill will help increase the number of residents in 
geriatric training programs.
  My home State of Arkansas ranks sixth in the Nation in percentage of 
population 65 and older. In a decade, we will rank third. In many ways, 
our population in Arkansas is a snapshot of what the rest of the United 
States will look like in the near future.

  All of us today could share stories about the challenges faced by our 
parents, our grandparents, our families, our friends, our loved ones as 
they contend with the passing years. These are

[[Page S3926]]

the people who have raised us, who have loved us, who have worked for 
us, and who have fought for us. Now it is our turn to work for them, to 
fight for them, and this is where we must start.
  I ask my colleagues to join me in support of this legislation to 
modernize Medicare, to support crucial geriatric services for our 
Nation's growing population of seniors. I also urge my colleagues to 
recognize that this is only the beginning of what I hope will be a 
grand overhaul of the way we think about and deliver care to our 
Nation's elderly. There are many more things to discuss and to 
address--adult daycare, long-term care insurance, just to name a few. 
But it is essential that we begin soon, that we begin now in preparing 
those individuals we will need 10 years from now in order to be able to 
care for our aging population in this Nation.
  Madam President, I also want to submit three letters of support for 
this bill, along with a list of organizations that support this 
important legislation, and encourage all of my colleagues to recognize 
the unbelievable responsibility we have today to prepare for the 
seniors of tomorrow. I ask unanimous consent that the items I mentioned 
be printed in the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                                              The National Council


                                                 on the Aging,

                                   Washington, DC, April 24, 2001.
     Hon. Blanche L. Lincoln,
     Dirksen Senate Office Building,
     Washington, DC.
       Dear Senator Lincoln: On behalf of the National Council on 
     the Aging (NCOA)--the nation's first organization formed to 
     represent America's seniors and those who care for them--I 
     write to express our organization's support for the Geriatric 
     Care Act of 2001.
       A major shortcoming of the Medicare program is the grossly 
     inadequate, fragmented manner in which chronic care needs are 
     addressed. Some of the major problems include: specific 
     geriatric and chronic care needs are not clearly identified; 
     services are poorly coordinated, if at all; medications are 
     not managed properly, resulting in avoidable adverse 
     reactions; family caregivers are excluded from the care 
     planning process; transitions across settings are disjointed; 
     and follow-up care and access to consultation to promote 
     continuity are often unavailable. All of these serious 
     problems cry out for Medicare coverage of care coordination. 
     NCOA strongly supports your efforts to address these critical 
     shortcomings in the Medicare program.
       NCOA also supports efforts to increase the number of health 
     care providers who have geriatric training. Given the aging 
     of our population and the coming retirement of the baby 
     boomers, it is important to have physicians trained to care 
     for older patients who may be frail and suffer from multiple, 
     chronic conditions. We applaud your efforts to meet this 
     challenge by introducing legislation to allow for growth in 
     geriatric residency programs above the hospital-specific cap 
     established by the Balanced Budget Act of 1997.
       We applaud your leadership on behalf of our nation's most 
     frail, vulnerable citizens and stand ready to assist you in 
     working to enact the Geriatric Care Act of 2001 into law this 
     year.
           Sincerely,
                                                    Howard Bedlin,
     Vice President, Public Policy and Advocacy.
                                  ____

                                     American Association of Homes


                                   and Services for the Aging,

                                   Washington, DC, April 18, 2001.
     Hon. Blanche L. Lincoln,
     Dirksen Senate Office Building,
     Washington, DC.
       Dear Senator Lincoln: I understand that you are introducing 
     legislation to provide incentives for the training of 
     geriatricians and to require Medicare reimbursement for 
     geriatric assessments and care management for beneficiaries 
     with complex care needs. The American Association of Homes 
     and Services for the Aging (AAHSA) strongly supports your 
     proposal, which would help to alleviate the serious shortage 
     of physicians trained to meet the special needs of older 
     people.
       AAHSA is a national non-profit organization representing 
     more than 5,600 not-for-profit nursing homes, continuing care 
     retirement communities, assisted living and senior housing 
     facilities, and community service organizations. More than 
     half of AAHSA's members are religiously sponsored and all 
     have a mission to provide quality care to those in need. 
     Every day AAHSA members serve over one million older persons 
     across the country.
       Residents of long-term care facilities rely on physician 
     services more than the general population does. The severity 
     of older people's medical conditions compounded by multiple 
     co-morbidities demand more time per visit than younger or 
     healthier people need. Many of these seniors would benefit 
     from the services of a geriatrician, who is trained in the 
     special medical needs of older people. Unfortunately, few 
     physicians elect to specialize in this field. In addition, 
     the Medicare Part B fee schedule does not recognize the 
     specialty services of geriatricians and the time and effort 
     they spend providing medical care of this older, more 
     vulnerable population. Nursing facilities have a difficult 
     time finding physicians, let alone geriatric specialists, to 
     serve residents. Geriatric clinic practices find it difficult 
     to provide the level of service this population requires and 
     deserves for the payment that they receive through the 
     Medicare fee schedule.
       Your legislation would do much to address these issues, and 
     AAHSA is anxious to work with you toward its passage. Please 
     feel free to contact Will Bruno, our Director of 
     Congressional Affairs.
           Sincerely,
                                   William L. Minnix, Jr., D. Min.
     President and CEO.
                                  ____

                                              American Association


                                     for Geriatric Psychiatry,

                                     Bethesda, MD, April 24, 2001.
     Hon. Blanche L. Lincoln,
     U.S. Senate,
     Washington, DC.
       Dear Senator Lincoln: On behalf of the American Association 
     for Geriatric Psychiatry (AAGP), I would like to take this 
     opportunity to thank you for your introduction of the 
     ``Geriatric Care Act of 2001.''
       Although geriatric psychiatry is a relatively small medical 
     specialty, it is one for which demand is growing rapidly as 
     the population ages and the ``baby boom'' generation nears 
     retirement. Arbitrary, budget-driven limits on Medicare 
     payment for graduate medical education, such as caps on the 
     aggregate number of residents and interns at a teaching 
     hospital, could discourage the expansion of training programs 
     in geriatric psychiatry and other fields that are extremely 
     relevant to the Medicare population. Your bill would help to 
     increase the number of physicians with the specialized 
     geriatric training that is needed to serve the growing number 
     of elderly persons in this country.
       In addition, we support the provision of your bill, which 
     would provide Medicare reimbursement for assessment and care 
     coordination. This will help to provide those Medicare 
     beneficiaries with severe physical and mental disorders with 
     the access to the appropriate and coordinated care that they 
     deserve.
       AAGP commends you for your commitment to ensuring that 
     America's senior citizens have adequate access to effective 
     health care, and we look forward to working with you on the 
     ``Geriatric Care Act of 2001.''
           Sincerely,
                                              Stephen Bartels, MD,
     President.
                                  ____


              Supporters of the Geriatric Care Act of 2001

       American Association for Geriatric Psychiatrists.
       Alzheimer's Association.
       Alliance for Aging Research.
       American Geriatrics Society.
       National Chronic Care Consortium.
       National Council on Aging.
       National Committee to Preserve Social Security and 
     Medicare.
       American Association for Homes and Services for the Aging.
       International Longevity Center.
                                 ______