[Congressional Record Volume 158, Number 71 (Thursday, May 17, 2012)]
[Senate]
[Pages S3286-S3287]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. REED (for himself and Mr. Kyl):
  S. 3201. A bill to reform graduate medical education payments, and 
for other purposes; to the Committee on Finance.
  Mr. REED. Mr. President, today I introduce the Graduate Medical 
Education, GME, Reform Act, along with my colleague Senator Kyl. This 
legislation is a continuation of my longstanding efforts to support our 
future health care workforce and improve patient care.
  While there are a variety of initiatives to support the education and 
training of physicians, none are more substantial than the GME funding 
provided by Medicare. This program either directly or indirectly 
supports every single physician trained in this country. No other 
Federal or State program can claim this credit.
  Unfortunately, the size of the program has led some to propose its 
funding be cut and redirected toward deficit reduction. The President's 
Fiscal Commission, the Domenici-Rivlin plan, and even some Members of 
Congress have made this recommendation. Reducing GME funding by the 
levels specified in these proposals could be devastating to training 
programs.
  These proposals stem from an assertion by the congressionally 
authorized Medicare Payment Advisory Commission, MedPAC, that teaching 
hospitals are overpaid for the education and training they currently 
provide residents, and that GME funding should be better used to align 
residency training with key improvements in our health care delivery 
system. However, the Fiscal Commission and the Rivlin-Domenici plan 
ignored the latter aspect of MedPAC's recommendation. MedPAC did not 
recommend removing GME funding from the system. Instead, MedPAC 
suggested Congress should make teaching hospitals more accountable for 
the GME funding they currently receive. In MedPAC's proposal, all GME 
funding would stay in the system to help support and improve medical 
education and training.
  The legislation we are introducing today aligns closely with MedPAC's 
proposal for greater accountability by teaching hospitals and enhanced 
effectiveness in the use of GME funding, but with some key changes. One 
such change would enable hospitals to compete for additional GME 
funding in order to provide a greater incentive for teaching hospitals 
to improve their programs.
  Teaching hospitals incur higher costs than other hospitals. They 
invest in the newest technologies and employ the physician supervisors 
most qualified to train our future doctors. Moreover, as a result of 
the new health care reform law, many of these hospitals, physician 
supervisors, and residents will treat an influx of patients beginning 
in 2014. GME funding is critical to building and sustaining our health 
care infrastructure and future health care workforce.
  It is critical that GME funding remain intact, but that doesn't mean 
we shouldn't use this opportunity to encourage these programs to do 
more to better train residents in: primary care delivery, a variety of 
settings and systems, care coordination, and how to work in inter-
professional and multi-disciplinary teams. The new oversight provided 
for in the GME Reform Act would help to break down the silos in 
medicine and ensure that physicians work together to provide patients 
with comprehensive health care.
  In addition, the legislation would enhance GME payment transparency, 
which we hope will help prove to the skeptics that this funding serves 
a critical purpose.
  I am particularly pleased that the Association of American Medical 
Colleges has expressed support for legislation. While the organization 
would prefer this legislation be included as part of an overall effort 
to increase the number of residents trained each year, which I also 
support, I believe we must begin a dialogue about a sensible and 
thoughtful approach to improving GME accountability and transparency. I 
hope my colleagues will take careful look at our legislation, and I 
look forward to working with them on this important issue.
  Mr. KYL. Mr. President, the Federal Government now pays for more than 
half of all health care costs in this country, and that number is 
likely to grow with the rapidly aging U.S. population. Indeed, Medicare 
will face a nearly \1/3\ enrollment increase in the coming decade. We 
have promised health care benefits to these seniors; to keep that 
promise, we must ensure there are enough physicians to treat them. 
Unfortunately, the medical workforce is shrinking: estimates show that 
we may experience a shortage of up to 159,000 physicians by 2025.
  In light of these sobering statistics, the government has a strong 
interest in doing more to encourage the training of physicians who can 
deliver quality care to our Nation's seniors. Even if we continue 
funding medical education at current levels, we will soon face a severe 
crisis in access to medical care. Cutting this medical education 
funding would be counter-intuitive at best; dangerous at worst. In 
recent years, however, there have been several proposals to do just 
that.
  It is true that there is a lack of transparency and accountability 
around this funding--mainly because we do not require hospitals to 
report on how money is spent, and because we have not set workforce 
goals for hospitals to meet. But that does not necessarily mean that 
the money is spent poorly, or that it is an area ripe for funding 
reductions.
  Rather than simply slash funding, we should work to remedy this lack 
of

[[Page S3287]]

transparency and encourage hospitals to meet certain quality metrics. 
The Graduate Medical Education Reform Act offers one promising avenue 
to do so. Under this bill, if a teaching hospital produces quality 
residents as measured by certain consensus-based metrics, it can get up 
to a 3 percent increase in indirect medical education funding. 
Conversely, a hospital that fails to meet the metrics can be penalized 
by up to 3 percent.
  This is one common-sense approach that maintains overall current 
funding levels while encouraging quality teaching programs. I urge my 
colleagues to join Senator Reed and me in supporting this measure.
                                 ______