[Congressional Record Volume 149, Number 27 (Thursday, February 13, 2003)]
[Senate]
[Pages S2463-S2465]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mrs. LINCOLN (for herself, Mr. Reid, Ms. Snowe, Mr. Breaux, 
        Mr. Graham of Florida, Mr. Bingaman, Ms. Landrieu, Mrs. Murray, 
        Ms. Mikulski, Mr. Sarbanes, Mr. Reed, Mr. Kennedy, and Ms. 
        Collins):
  S. 387. A bill to amend title XVIII of the Social Security Act to 
extend the eligibility periods for geriatric graduate medical 
education, to permit the expansion of medical residency training 
programs in geriatric medicine, to provide for reimbursement of care 
coordination and assessment services

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provided under the medicare program, and for other purposes; to the 
Committee on Finance.
  Mrs. LINCOLN. Madam President, today I am pleased to introduce the 
Geriatric Care Act of 2003, 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 Senators Reid, Snowe, Breaux, Graham, Bingaman, 
Landrieu, Murray, Mikulski, Sarbanes, Reed, Kennedy, and Collins.
  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 2003 takes an important 
first step in modernizing Medicare for the 21st century.
  By the year 2030, 70 million Americans will be 65 and older. The 
elderly will soon represent one-fifth of the United States 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 risks 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 other institutions.
  Geriatricians 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 dosages to prescribe medicines for seniors. That's 
because frequently, older patients respond to medications in different 
ways than 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 annually.
  Care management provided by a geriatrician will not only provide 
better health care for our seniors, but will also save costs to 
Medicare in the long term by eliminating more costly medical care in 
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, UAMS, 
being one of them, has a Department of Geriatrics. This is incredible 
considering that all 125 medical schools in our country have 
departments of pediatrics.
  As if that weren't 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 barriers preventing physicians from entering 
geriatrics. These include insufficient Medicare reimbursements for the 
provision of geriatric care, inadequate training dollars, and too few 
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 almost 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 decision-making 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 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 for 
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.
  Finally, the Geriatric Care Act contains a new provision that ensures 
Graduate Medical Education payments for the second year of geriatric 
fellowship training. A one-year fellowship may be adequate for training 
clinical geriatricans but a two-year fellowship is essential for 
training academic geriatricans who will teach geriatrics to primary 
care and specialty physicians-in-training. Academic geriatricians are 
critical in preparing the next generation of doctors to care for our 
growing elderly population.
  My home State of Arkansas ranks sixth in the Nation in percentage of 
population 65 years 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.
  We are blessed in Arkansas to have the Donald W. Reynolds Department 
of Geriatrics and the Center on Aging at the University of Arkansas for 
Medical Sciences. It is my hope that the Geriatric Care Act will make 
it easier for our medical school and others across the country to train 
more physicians in geriatrics.
  As our parents, grandparents, friends, and loved ones cope with the 
challenges that aging brings, we must ensure that physicians skilled in 
caring for their special needs are there to help them. I ask my 
colleagues to join me in support of this effort to modernize Medicare 
to support crucial geriatric services for our Nation's seniors.
  I ask unanimous consent that following my statement there be a 
printed list of organizations that support the Geriatric Care Act of 
2003.
  There being no objection, the list was ordered to be printed in the 
Record, as follows:

        Organizations Supporting the Geriatric Care Act of 2003

       Alzheimer's Association.

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       American Association for Geriatric Psychiatry.
       American Association of Homes and Services for the Aging.
       American College of Physicians-American Society of Internal 
     Medicine.
       American Geriatrics Society.
       Association of Professors of Medicine.
       Association of Program Directors in Internal Medicine.
       Association of Subspecialty Professors.
       Catholic Health Association.
       International Longevity Center--USA.
       National Chronic Care Consortium.
       National Committee to Preserve Social Security and 
     Medicare.
       National Council on the Aging.
       National PACE Association.
       National Family Caregivers Association.
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