ON THE INTRODUCTION OF THE GERIATRIC WORKFORCE RELIEF ACT OF 2000 -- HON. GENE GREEN (Extensions of Remarks - July 24, 2000)

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HON. GENE GREEN OF TEXAS IN THE HOUSE OF REPRESENTATIVES Monday, July 24, 2000

Mr. GREEN of Texas. Mr. Speaker, the complex health problems of aging require specially-trained physicians in order to adequately care for frail older persons. Geriatrics is the medical specialty that promotes wellness and preventive care; these specialists are first board certified in family practice, internal medicine or psychiatry and then complete additional years of fellowship training in geriatrics. With an emphasis on care management and coordination, geriatricians help patients maintain functional independence, thus improving their overall quality of life. An emphasis on coordination also limits unnecessary and costly hospitalization or institutionalization.

Despite the increasing number of Americans over age 65, there are fewer than 9,000 geriatricians in the United States today. In Texas, there are only about 225 geriatricians--and we are one of the top ten states nationally. Texas has four geriatric training programs; Baylor College of medicine in Houston, the University of Texas at San Antoino, the University of Texas Medical Branch at Galveston (where, I am proud to say, my daughter is a third-year student) and the University of Texas Southwestern.

The Baylor program, in my Congressional District, has been operating for over 15 years. It trains six fellows now and is unable to increase this number because of a Congressionally-mandated Graduate Medical Education (GME) cap. I am told that there are plenty of applicants interested in geriatrics who are being turned away because our Medicare program will not allow them to be funded.

Why is there a cap on the number of new geriatricians? The Balanced Budget Act of 1997 established a hospital-specific cap based upon the number of residents in the hospital in the most recent cost reporting period ending on or before December 31, 1996. Under the cap, the number of residents for direct graduate medical education payment purposes is based upon a three-year rolling average, except for Fiscal Year 1998, when a two-year average was used.

The implementation of this cap has adversely impacted geriatric programs in Houston and elsewhere. As geriatrics is a relatively new specialty, the cap has resulted in either the elimination or reduction of geriatric programs. Because a lower number of geriatric residents existed prior to December 31, 1996, these programs are under-represented in the cap baseline. Thus, new geriatric training programs are severely limited and existing training programs tend not to increase funding, or even decrease funding, for geriatric slots.

There is a well-documented shortage of geriatricians nationwide. Of the approximately 98,000 medical residency and fellowship positions supported by Medicare in 1998, only 324 were in geriatric medicine and geriatric psychiatry.

At the same time, the number of physicians needed to provide medical care for older persons has been estimated to be 2.5 to three time higher in 2030 compared to the mid-1980s, according to the federal Health Resources and Services Administration.

Unfortunately, the pace of training is not meeting this need. The actual number of certified geriatricians has declined, as approximately 50% of those who certified in 1988 did not recertify in 1998. This has occurred just as the baby boomers have started reaching the age of Medicare eligibility.

To correct this problem, I am introducing the Geriatric Workforce Relief Act of 2000 today to allow an increase in the number of person studying geriatrics at our medical schools. In order to be fiscally responsible, my legislation does not completely lift the cap. Instead, it allows hospitals to increase the cap by 30%. This will allow for a few more students at most programs. My legislation defines approved geriatric residency programs as those approved by the Accreditation Council of Graduate Medical Education.

My legislation, which will also be introduced in the Senate today by Senator REID, is modeled upon a similar provisions that was enacted last year for rural hospitals. It is a sensible and reasonable proposal and one that allows us to meet the needs of Medicare patients. I encourage my colleagues to support it.
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