[Congressional Record (Bound Edition), Volume 145 (1999), Part 6]
[Extensions of Remarks]
[Pages 7990-7991]
[From the U.S. Government Publishing Office, www.gpo.gov]




             THE MEDICARE CRITICAL NEED GME PROTECTION ACT

                                 ______
                                 

                        HON. FORTNEY PETE STARK

                             of california

                    in the house of representatives

                        Thursday, April 29, 1999

  Mr. STARK. Mr. Speaker, I rise today to introduce ``The Medicare 
Critical Need GME Protection Act of 1999.'' This important legislation 
seeks to protect our nation against the depletion of health care 
professionals that are trained to appropriately 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. However, if a 
resident decides to proceed with further training in a specialty or 
subspecialty, 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 
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.
  To provide an example of a current subspecialty facing serious 
shortages of professionals, we can look at nephrology. Between 1986 and 
1995, the number of patients with

[[Page 7991]]

End Stage Renal Disease (ESRD) has more than doubled. At present, more 
than 40 million Americans die from kidney failure or its complications 
each year. In 1998, the estimated cost to treat ESRD exceeded $12 
billion. However, current data indicates 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 seem in ESRD and are 
unfamiliar with particular 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, of physicians to meet the needs of our 
health care system. The Secretary would grant this exception only for a 
limited number of years. The Secretary would have complete control of 
the exception process. Programs would present evidence of the shortage 
and she 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 Medicare 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 would 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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