[Congressional Record Volume 148, Number 52 (Wednesday, May 1, 2002)]
[Senate]
[Pages S3588-S3589]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                           TEACHING HOSPITALS

  Mr. TORRICELLI. Mr. President, earlier this morning, Senators 
Corzine, Clinton, Schumer, and Durbin were all here to join with me in 
making a common case. I hope they will be joining me during the course 
of the day, if they are able to return. If not, I would like to deliver 
what I believe is a common concern.
  This morning Senators heard from my colleagues about the pressing 
problems of financing education in America in a difficult budget 
environment. I share in that concern.
  I rise with a matter of equal importance for each of our States and 
all of our communities; that is, the rising pressure on medical care in 
America as a result of our difficult budget circumstances.
  In the next few months the Senate Finance Committee and then the 
Senate itself is going to be debating the question of how to fund 
different components of American health care in this difficult 
budgetary environment. That debate will affect doctors and their 
ability to maintain their practices and the integrity of their 
profession; home health care providers and their ability to provide 
service to those who are often locked in their own homes and need 
desperately to have care; nursing homes, in many cases not simply the 
quality of their care but whether hundreds of nursing homes around the 
country continue to operate at all; and teaching hospitals. It is 
teaching hospitals this morning that I want to address in detail 
because in some ways their plight is the most perilous and the issue 
most immediate.
  Since 1983, this Congress has recognized the unique role of teaching 
hospitals in the delivery of American health care. They have a 
particular contribution to make, providing technology dealing with 
difficult cases and providing the doctors themselves for each of our 
States and all of our hospitals. In recognition of these unique costs, 
the Congress created the Medicare indirect medical education funding, 
IME. For more than these 20 years, there was an adjustment for the 
1,100 teaching hospitals around the country; that is, they were given a 
6.5-percent additional payment for Medicare to fund their unique 
contributions, recognizing that all hospitals and all communities 
benefited by these few flagship hospitals in the Nation, these 1,100 
institutions that made unique contributions. This 6.5-percent payment 
was maintained in good years and bad years, years of deficits and 
surpluses, because we recognized that without them the medical system 
in the country simply could not be maintained at its current quality. 
That is until now.
  On October 1 the 6.5-percent payment for 1,100 teaching hospitals 
will be reduced to a 5.5-percent additional payment. It is important 
that Members of the Senate understand the consequences. The first is to 
medical technology. All hospitals in America are important, but all do 
not make an equal contribution. The 1,100 teaching hospitals in America 
are the source of almost every major medical breakthrough in the 
country: drug-coated stents which prop open clogged arteries and 
prevent scar tissue from closing up the artery again--teaching 
hospitals; implanted cardio defibrillators, such as the one used by 
Vice President Cheney, to keep heart rhythm regular--teaching 
hospitals; EKGs or heart-lung machines, open heart surgery, and 
angioplasties--teaching hospitals.
  Indeed, if you were to go through every major medical advance of our 
generation, they would come back to the best minds and the best 
facilities and the best medical departments --in teaching hospitals. 
That is what is in jeopardy.

  Certainly, as it is the leadership of technology in the medical 
profession, so, too, it is with the most important delivery of 
services. The chart on my left shows the difference in the burden being 
carried by these relatively few hospitals. Crisis prevention services 
are delivered by 11 percent of other hospitals; teaching hospitals, 52 
percent. Teaching hospitals, 91 percent of them deal with AIDS service 
deliveries, 24 percent of other hospitals; geriatric services, 75 
percent of teaching hospitals are in geriatric cases, 35 percent of 
other hospitals; substance abuse, 47 percent compared to 14; nutrition 
programs, 84 percent of teaching hospitals deal with nutrition 
programs, 58 percent of other hospitals.
  This extraordinary concentration of the development of technology, 
and dealing with the most difficult and most pressing of the Nation's 
medical problems, is the basis--the reason why we have additionally 
provided 6.5 percent. This addition to Medicare is something on which 
we have never before compromised in recognition of the higher costs and 
societal contributions.
  I recognize in the Senate there is a belief that these teaching 
hospitals are simply a matter for northern New Jersey or Manhattan, 
Boston, Chicago, Los Angeles, or Miami--a few urban centers servicing a 
small part of the population. That could not be further from the truth.
  Last year, teaching hospitals around the Nation admitted 15 million 
people and provided care to 41 million Americans in emergency rooms. 
These teaching hospitals may have elite talent and give important care 
with advanced

[[Page S3589]]

technology, but it is not for a select few; they are facilities used by 
all Americans in every State wherever you live.
  I cannot overstate that in my region of the country or in my State it 
will not be a particular problem. It will be. But that burden is shared 
by all States. Because of this, when we confronted the issue of two 
previous Medicare give-back bills to compensate for the balanced budget 
amendment, Congress in 2000 and 2001 maintained the 6.5-percent IME 
adjustment. As I have noted to my colleagues, that expires on October 
1. Automatically, it will return to a 5.5-percent adjustment. This is a 
28-percent reduction in funding at teaching hospitals. The consequences 
are that over 5 years, $5.6 billion will not go for medical 
breakthroughs in AIDS, cancer, or heart disease; $5.6 billion is not 
available to teach and train the next generation of America's doctors; 
and $5.6 billion is not available to deal with the most difficult 
medical problems in the country.
  This chart illustrates the degree of loss. Mr. President, 1,116 
teaching hospitals in America will lose next year $784 million and, 
over 5 years, $4.2 billion.
  In my State of New Jersey, this is as acute as anyplace in the 
country. In some ways, it is more so. Next year, New Jersey's teaching 
hospitals will lose $31 million. This is a State where 60 percent of 
our hospitals are now losing money. Those that are making money on 
average are making less than a 1 percent return on capital.
  Over 5 years, New Jersey's teaching hospitals will lose $166 million. 
This does not just mean a reduction in services. It does not mean just 
a reduction in quality of care. It means that many will close.

  I recognize the perception is that this is our problem, or New 
York's, or California's, or Illinois'. Allow me to share with my 
colleagues this information, lest you think this is our problem alone. 
We may have more teaching hospitals than anyplace in the country, but 
this is your problem, too. Arizona will lose $40 million; Arkansas, $13 
million; Florida, $98 million; Massachusetts, $248 million; Maine, $15 
million; New Mexico, $7 million; North Dakota, $3.7 million; and 
Oklahoma, $30 million. My colleagues, we are in this together.
  The infrastructure that has created the greatest medical care in the 
world has been strained. Now it will be broken. Doctors will not be 
trained. These medical breakthroughs do not occur by chance. It has 
taken generations over a century to build these institutions and 
generations of building teaching staff and trained professionals to 
give us the greatest medical profession in the world.
  It may be that this is concentrated in a dozen States. But the great 
medical centers of New York, Chicago, Massachusetts, New Jersey, 
Florida, and California are sending doctors to every State in the 
Nation. There is not one State in this country that will not this year 
or next year have had a doctor trained at a teaching hospital in New 
Jersey, or several from New York, or several from Boston, or Chicago, 
or Los Angeles. They go to Montana and the Dakotas. They go to New 
Mexico. They go to the Great Plains. They go to the Deep South. But 
most of them are trained in our urban centers.
  Their ability to continue to train is now at its end. I don't know 
how the medical profession continues on its current basis. Doctors are 
closing offices for insurance reasons. Because Medicare payments are no 
longer adequate to meet the cost of service, offices are closing. 
Doctors move instead to practice at other hospitals. Now we are going 
to reduce reimbursements to hospitals. Some of those will close.
  We have known for a long time that the current quality of medical 
care in America and the extent of service through different levels of 
income and class cannot be maintained. We have postponed it.
  The inability of this Congress and the country to have a national 
system of health care delivery with privately or nationally based 
insurance has strained every degree of health care delivery. We have 
done our business to maintain it. We have even been able to maintain 
these hospitals by maintaining the IME system. Now that is at its end.
  There is introduced in the Senate the American Hospital Preservation 
Act which would maintain the current IME adjustment at 6.5 percent. I 
am a cosponsor. Its major provisions will be before the Senate Finance 
Committee when we consider how to deal with the medical crisis in 
America.
  I cannot more strongly urge my colleagues to follow the leadership of 
this legislation and consider seriously the consequences of allowing 
expiration of IME adjustment, what it will mean to these hospitals, 
what it will mean to the medical care profession, and what it will mean 
to every one of your communities and every one of your States when the 
local doctor who went away to the big city to become trained no longer 
comes home with his or her training and special skills and ability to 
save lives. The spigot is closed. Everybody is on their own. The 
teaching hospital just closed.
  That, my colleagues, is no longer on the horizon. It is no longer 
speculation. That is exactly what we are faced with--the real 
consequences of losing our leadership in these technological 
breakthroughs and providing these very specially trained people.
  I know earlier in the day Senator Schumer, Senator Clinton, Senator 
Corzine, and Senator Durbin were to be here to share in these remarks. 
Regrettably, they were delayed because our colleagues were speaking, 
understandably and justifiably, on other issues. I know that on other 
days they will come to the Chamber to speak about these same concerns. 
Each of them would like to be identified with this case. We will come 
back to fight this on other days. This is not going away. We are not 
going to be silent.
  I yield the floor.
  The PRESIDING OFFICER (Mr. Nelson of Nebraska). The Senator from 
Michigan.
  Ms. STABENOW. Mr. President, I ask unanimous consent to speak for up 
to 10 minutes in morning business.
  The PRESIDING OFFICER. Without objection, it is so ordered.

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