79R7766 CME-D
By: West, Royce, et al. S.C.R. No. 27
CONCURRENT RESOLUTION
WHEREAS, Two major phases comprise the American system of
medical education -- medical school, consisting of classroom and
clinical training, and the several years of graduate medical
education completed during a student's residency, typically in an
accredited medical education program at a teaching hospital or
academic health center; and
WHEREAS, Significant funding for this postgraduate training
is provided through Medicare's graduate medical education (GME)
program, whereby the federal government reimburses teaching
hospitals and certain other facilities for a portion of the costs
associated with operating health education programs; and
WHEREAS, Medicare's funding includes two categories of
reimbursement payments, direct graduate medical education payments
(DME) and indirect graduate medical education payments (IME); DME
payments cover the costs of resident stipends, salaries for
supervising faculty positions, and administrative expenses
associated with the residency program; IME payments cover the
increased operating expenses resulting from training residents,
such as greater technological needs, longer patient stays, and the
ordering of a greater number of tests; and
WHEREAS, The amount of Medicare's reimbursement to a teaching
hospital is partially determined by the number of full-time
equivalent residents enrolled in the facility's GME program;
however, in 1997, the federal Balanced Budget Act (BBA)
considerably reduced the amount of federal support for graduate
medical education programs by limiting the number of full-time
equivalent residents that hospitals can use in calculating DME and
IME payments and by scheduling an estimated 29 percent further
reduction in IME payments over a five-year period; and
WHEREAS, The rates of Centers for Medicare and Medicaid
Services payments for DME and IME in Texas are already
significantly lower than those in many comparable states, largely
based on historical differences, and the potential consequences of
these caps and the resulting reductions in federal GME
reimbursement are severe; teaching hospitals and the training they
provide to physicians and other health professionals are a critical
component of the American health care system -- these facilities
are the vanguard of medical research and technology and provide a
broader range of care to an increasingly diverse and sicker patient
population than general hospitals; and
WHEREAS, In addition, teaching hospitals are a traditional
fixture of the health care "safety net," serving uninsured and
underinsured patients; the importance of this service to Texans is
evident in light of United States Census Bureau reports indicating
that nearly 25 percent of the state's population is not covered by
health insurance; and
WHEREAS, More specifically, the resident caps threaten the
future availability of health care professionals and with the
population of the nation aging, the demand for doctors and other
health care professionals is increasing; in fact, a 2003 study
commissioned by the United States Department of Health and Human
Services Bureau of Health Professions at the National Center for
Health Workforce Analysis forecasts a greater need for physicians
and nurses by 2020 if current health care consumption and physician
productivity remain constant; and
WHEREAS, Furthermore, the study found that the health care
workforce is also aging and will retire just as their services are
most needed and that the proportion of the population age 18 to 30
is declining, impeding efforts to recruit an adequate number of new
health care workers; and
WHEREAS, Congress has acknowledged the deleterious effects
of the BBA caps and made bipartisan efforts to diminish its effect
on graduate medical education programs: the Medicare, Medicaid,
and State Children's Health Insurance Program (SCHIP) Balanced
Budget Refinement Act of 1999 froze IME payments for one year and
the Medicare Prescription Drug, Improvement and Modernization Act
of 2003 increased IME payments slightly for federal fiscal years
2004 and 2005; and
WHEREAS, Nevertheless, these measures offered only brief and
minor reprieves to the dramatic reductions in IME reimbursement
payments and did not directly address the issue of federal caps in
resident training positions though, clearly, the caps and the
decreased commitment to IME funding continue to endanger the entire
system of medical education in the United States; now, therefore,
be it
RESOLVED, That the 79th Legislature of the State of Texas
hereby respectfully encourage the Congress of the United States to
eliminate current caps on funded Medicare resident training
positions and related limits on costs per resident used to
determine Medicare graduate medical education reimbursement
payments and to reexamine the DME and IME reimbursement rates for
graduate medical education in Texas; and, be it further
RESOLVED, That the Texas secretary of state forward official
copies of this resolution to the president of the United States, to
the speaker of the house of representatives and the president of the
senate of the United States Congress, and to all the members of the
Texas delegation to the congress with the request that this
resolution be officially entered in the Congressional Record as a
memorial to the Congress of the United States of America.