[Congressional Record Volume 147, Number 70 (Monday, May 21, 2001)]
[Extensions of Remarks]
[Page E871]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]


     INTRODUCTION OF THE MEDICARE CRITICAL NEED GME PROTECTION ACT

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                        HON. FORTNEY PETE STARK

                             of california

                    in the house of representatives

                          Monday, May 21, 2001

  Mr. STARK. Mr. Speaker, I rise today along with several of my 
Congressional colleagues to introduce ``The Medicare Critical Need GME 
Protection Act of 2001.'' This legislation seeks to protect our nation 
against the growing depletion of health care professionals fully 
trained to treat costly and deadly illnesses.
  Under current law, the Medicare program provides reimbursement to 
hospitals for the direct costs of graduate medical education training. 
That reimbursement is designed to cover the direct training costs of 
residents in their initial residency training period. If a resident 
decides to proceed with further training in a specialty or 
subspecialty, however, a hospital's reimbursement is cut to half, 50 
percent, for that additional training.
  The rationale for this policy is strong. In general, we have an 
oversupply of specialty physicians in our country and a real need to 
increase the number of primary care providers. By reducing the 
reimbursement for specialty training, the Medicare program has promoted 
needed increases in primary care training rather than specialty 
positions.
  I agree with this policy. However, as is often the case, there are 
always exceptions to the rule. We do not want to hinder training of 
particular specialties or subspecialties if there is strong evidence 
that there is a serious shortage of those particular physicians. That 
is why I am introducing The Medicare Critical Need GME Protection Act.
  Child and adolescent psychiatry is a clear example of how certain 
subspecialties face critical professional shortages. The 2001 report of 
the Surgeon General's Conference on Children's Mental Health states 
that almost one in ten children suffer from mental illnesses severe 
enough to impair development, yet fewer than one in five get treatment. 
One huge barrier is the clear dearth of child and adolescent 
psychiatrists.
  Today there are roughly 7000 fully trained child and adolescent 
psychiatrists in the entire United States with only 300 additional 
psychiatrists completing specialty training each year. These numbers 
fall far short of what is needed to meet prevalence rates that identify 
nearly 15 million children and adolescents in need of mental health 
treatment. That means that many vulnerable young people will suffer 
needlessly, unable to access the help they desperately need.
  To provide another example of a current subspecialty facing serious 
professional shortages, we can look at nephrology. Between 1986-1995, 
the number of patients with End Stage Renal disease, ESRD, more than 
doubled, with over a quarter of a million people now on dialysis. Yet 
current data indicate that only 51.8 percent of today's nephrologists 
will still be in practice in the year 2010.
  Most primary care physicians are not trained to treat the complex 
multi-symptom medical problems typically seen in ESRD and are 
unfamiliar with specific medications and technology prescribed for such 
patients. The decreasing supply of nephrologists, coupled with an 
expanding population of renal patients, puts the health of our nation 
at risk.
  The Medicare Critical Need GME Protection Act provides a tool to help 
combat such shortages of qualified professionals. The bill would simply 
provide the Secretary of Health and Human Services with the flexibility 
to continue full funding for a specialty or subspecialty training 
program if there is evidence that the program has a current shortage, 
or faces an imminent shortage, or health care professionals to meet the 
needs of our health care system.
  The Secretary would grant this exception only for a limited number of 
years and would have complete control of the exception process. 
Programs would present evidence of the shortage and the Secretary could 
agree or disagree with the analysis. Nothing in this bill would require 
the Secretary to take any action whatsoever.
  The bill also includes protections for budget neutrality. If the 
Secretary approves a specialty or subspecialty training program for 
full funding under this bill, the Secretary must adjust direct GME 
payments to ensure that no additional funds are spent.
  Again, The Medical Critical Need GME Protection Act does nothing more 
than provide limited flexibility to the Secretary of Health and Human 
Services to ensure that we are training the health care professionals 
that meet our nation's needs.
  I encourage my colleagues to join me in support of this important 
legislation. By giving the Secretary the flexibility to allocate funds 
to attract and train professionals in certain `at risk' fields of 
medicine, we will significantly improve patient care and lower long-
term health care costs.

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