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Henry W.
Former Democrat CA 33
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    Children’s Hospital Gme Support Reauthorization Act of 2013

    by Former Representative Henry A. Waxman

    Posted on 2013-02-04

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    WAXMAN. Mr. Speaker, I rise today to support H.R. 297, the Children's Hospital GME Support Reauthorization Act of 2013.

    H.R. 297 reauthorizes the children's hospital graduate medical education--or CHGME--program at the program's current authorization level. This program provides ongoing and consistent financial support to hospitals such as Children's Hospital of Los Angeles for the training of doctors who want to specialize in pediatrics. Over the years, the CHGME program has been enormously successful in reversing the significant decline in the number of pediatrician trainees across the country. Indeed, today, children's hospitals nationwide that are supported by the program train 40% of all pediatricians and 43% of all pediatric specialists.

    Not surprisingly, the CHGME program has a decade-long history of bipartisan support. The program was first established in 1999 and has subsequently been reauthorized on two occasions. During the 112th Congress, the House passed legislation that would have reauthorized the CHGME program for another five years.

    I'm sure that Members of both sides of the aisle agree we want to make certain this important program remains in place, and we want to send a strong message about the importance of fully funding it.

    I want to commend the work of members of the Energy and Commerce Committee for advancing H.R. 297 to the floor today. I especially want to recognize and applaud the leadership of Ranking Member Pallone and Chairman Pitts on this bill. I know we are all hopeful the Senate will act quickly to enact H.R. 297, so we can send legislation to the President for his signature.

    I urge my colleagues to join me in supporting H.R. 297.

    Mr. GENE GREEN of Texas. Mr. Speaker, I strongly support the Children's Hospital Graduate Medical Education program and I am a cosponsor of H.R. 297. This successful program is the most important federal investment in the pediatric workforce and must be reauthorized. Failure to do so would be catastrophic to pediatric care in our country. Since this program began, it has allowed Children's Hospitals across the country, including Texas Children's Hospital in Houston, to increase training by 35%.

    I believe we must spend more on Graduate Medical Education entirely, but today we have the opportunity to extend the successful Children's Hospital program which, like other GME funds, is money well spent. Despite the successes of the program, there are still many pediatric specialties that are experiencing shortages. This bill will help address this and will continue to strengthen our pediatric workforce. I look forward to voting in favor of this bill and encourage my colleagues to do the same.

    Ms. EDDIE BERNICE JOHNSON of Texas. Mr. Speaker, I rise today in support of H.R. 297, the Children's Hospital GME Support Reauthorization Act of 2013. The Children's Hospital Graduate Medical Education Program not only provides a critical investment in the pediatric health workforce, but also helps improve children's access to health care.

    The Children's Hospital Graduate Medical Education Program was first authorized in 1999 and has achieved incredible success. The program has enabled children's hospitals to host teaching programs while maintaining high-quality clinical care. It currently supports 56 children's hospitals and is responsible for a significant increase in the number of physicians trained in children's hospitals.

    As the first registered nurse in Congress, I know firsthand that a well-trained primary care workforce is crucial to our health system. Only by ensuring the security of pediatric residency programs can we successfully work to promote the health of all Americans.

    Ms. JACKSON LEE of Texas. Mr. Speaker, I rise today in support of H.R. 297 the ``Children's Hospital Graduate Medical Education [[Page H321]] (GME) Support Reauthorization Act of 2013'' This legislation would authorize the appropriation of $110 million a year for 2013 through 2017, for payment toward the direct costs of graduate medical education in children's hospitals.

    As the Founder and Co-Chair of the Congressional Children's Caucus, I understand the important of this vital program. The Children's Hospital Graduate Medical Education Program (CHGME) trains 40 percent of our Nation's pediatricians and more than half of our Nation's pediatric subspecialists. Each year, over 5,000 residents take part in this program.

    We are all aware that we must continue to support the development and training of all medical professionals. Me must do more to ensure that we have enough qualified medical professional choosing to specialize in key fields in order to address the growth in both our baby boomers and child populations. I believe this legislation is a step in the right direction.

    In the early 90's, we witnessed a thirteen percent decrease in the amount of qualified graduate medical students entering into pediatrics. Upon the enactment of the Children's Hospital Graduate Medical Education program we saw a significant increase in the amount of qualified medical school graduates choosing to enter into pediatrics, their numbers increased by 35 percent.

    In 1999, Children's Hospital Graduate Medical Education, CHGME, was enacted as part of the Healthcare Research and Quality Act to provide freestanding children's hospitals with discretionary federal support for direct and indirect expenses associated with operating medical residency training programs. Since few children's hospitals receive Medicare funds, the program is designed to correct the exclusion of pediatric training in the Medicare Graduate Medical Education, GME, program.

    Under the Children's Hospital Graduate Medical Education Program, direct medical education funding is designed to cover costs associated with stipends for residents, salaries, salaries for faculty, overhead and other costs of running a training program. The CHGME also provides indirect medical education funds that are designed to assist in expenditures such as reduced productivity of staff training residents and the processing of additional diagnostic tests those residents may order.

    Graduate Medical Education, GME, begins upon graduation from medical school and passed the examination needed to obtain general board certification. GME in a specialty field (residency) and further specializations in a specific clinical field (fellowship) are generally provided in hospital settings with additional clinical experiences in non-hospital site. This can take between three and seven years to complete, depending on the medical, dental or podiatric specialty track chosen.

    Freestanding children's hospitals receiving Federal GME funds have increased the number of residents and fellows that they are training since 2000: The number of residents and fellows claimed for Federal support for the 2000 Federal fiscal year (FY) was about 4,263.

    In the latest Government Performance Results Acts, GPRA, report for Federal FY 2009, the hospitals described training 5,631 pediatricians, pediatric subspecialists, and other physicians in the clinical care of children within the U.S.

    Of the 5,631 resident FTEs being trained, about 48 percent were in general pediatrics, 24 percent were in pediatric subspecialties, and 28 percent were non-pediatric residents.

    In FY 2009, 56 children's hospitals located in 30 states and Puerto Rico had nearly half a million inpatient discharges. Children's hospitals vary in size and service mix. The number of available beds at these hospitals varies from 30 to 456.

    These freestanding children's hospitals provide services ranging from outpatient ambulatory care to inpatient critical care.

    TEXAS In Texas, excluding military and Veterans Affairs programs, there are currently 5,902 resident physicians in Texas training in 468 accredited graduate medical education (GME) programs.

    It is likely that many of these resident physicians will join the ranks of the 39,872 licensed physicians currently practicing in Texas.

    These practicing and resident physicians, together with 656 resident physicians training in Texas military and Veterans Affairs hospitals, provide health care to Texas 22,016,911 people.

    Texas ranks 40th nationally in the number of physicians per 100,000 civilian population and faces serious challenges in attracting physicians to locate and practice in rural, remote, and urban underserved areas.

    With Texas' population increasing at both age ends of the population spectrum, the ratio of 158 direct patient care physicians per 100,000 population ratio will likely not improve unless policy changes are implemented to encourage expansion of the Texas physician workforce and foster greater distribution of physicians across the state. As Texas continues to grow in general, pediatric and our aging population we will more physicians--and more specialized physicians--to care for our citizens.

    With 25 percent of Texas total population uninsured and 22 percent of its children uninsured, Texas has the highest number of uninsured individuals in the country. Which is one of the many reasons I supported the Affordable Health Care Act.

    The majority of under-insured Texans receive health care through the our network of locally tax-funded and privately funded teaching hospitals and clinics.

    Uninsured Texans play an important role in graduate medical education; they are one of the groups of patients that residents care for and treat, while honing their medical skills and expertise.

    Graduate medical education is just one piece, albeit an important piece, of the complex health-care delivery system. While ensuring the viability of the safety-net hospitals and clinics in Texas is important to the future of Texas, solving all of the problems associated with ensuring that viability is beyond the scope of this. The medical school/hospital partnerships responsible for training many of the next generation of Texas physicians are stressed financially. Especially Children's Hospitals.

    The GME and The CHGME programs both train resident physicians while providing essential health-care services to those who might not otherwise receive access to care.

    Currently, Five children's hospitals in Texas benefit from the CHGME program: Texas Children's Hospital (Houston), Children's Medical Center of Dallas, Driscoll Children's Hospital (Corpus Christi), Dell Children's Hospital (Austin) and Cook Children's Hospital (Fort Worth). Last year alone, more than $23 million in CHGME funds was allocated to Texas.

    I can say that Texas Children's is the largest pediatric hospital in the nation, providing medical care in more than 40 pediatric subspecialties. It also has the largest pediatric cancer and hematology research and treatment center in the country As an internationally recognized children's hospital it is the primary pediatric training site for Baylor College of Medicine, which has one of the largest pediatric residency programs in the country.

    Baylor College of Medicine, operates the nation's first Children's Nutrition Research Center, a U.S. Department of Agriculture facility that conducts research on the nutritional needs of pregnant and nursing women and their children.

    Since opening its doors in 1954, Texas Children's Integrated Delivery System has cared for more than one million children from every corner of the world and has more than 2 million patient encounters a year.

    Together with Baylor, Texas Children's participates in approximately 400 research projects annually and received $59 million in research funding in 2003. Current projects include testing of medications to improve the quality of life for patients with HIV infection and AIDS; diagnostic methods based on DNA analysis for cystic fibrosis, muscular dystrophy, and other genetic disorders; development of treatments through human gene therapy; and other basic and applied research studies.

    I must also mention the Lyndon Baine Johnson General Hospital operated by the Harris County Hospital District, it is the second primary teaching facility or the University of Texas at Houston. They have been dedicated to serving the people of Houston for over two decades. Those who are fortunate enough to receive their training under the CHGME program may very well one day be treating children who arrive at this hospital.

    We must remember who these soon to be specialists will serve . . . our nation's children. Children like Audrina, who was born in October of last year. Little Audrina was born with her heart outside of her body. After six hours of surgery, baby Audrina is going home. Supporting funding for programs like the CHGME supports the training of specialists who will one day save the lives of countless children.

    FAST FACTS--CHILDREN'S HOSPITAL GRADUATE MEDICAL EDUCATION (CHGME) The Children's Hospital Graduate Medical Education, CHGME, Payment Program currently supports 56 children's hospitals in 30 States.

    Train about a third of the Nation's pediatricians.

    Trains about 50 percent of pediatric sub-specialists.

    The CHGME Payment Program has provided more than 2 billion dollars to eligible freestanding children's hospitals since its inception.

    Fifty-Six U.S. hospitals participate in the program, which enables them to: Provide GME to graduates of medical schools.

    Enhance research capabilities.

    [[Page H322]] Care for vulnerable and underserved children.

    A hospital is eligible to apply for CHGME Payment Program funding if it: Participates in an approved Graduate Medical Education (GME) program.

    Has a Medicare Provider Agreement.

    Is excluded from the Medicare Inpatient Prospective Payment System, IPPS, under section 1886(d)(1)(B)(iii) of the Social Security Act, and its accompanying regulations.

    Operates as a ``freestanding'' children's teaching hospital.

    The SPEAKER pro tempore. The question is on the motion offered by the gentleman from Pennsylvania (Mr. Pitts) that the House suspend the rules and pass the bill, H.R. 297.

    The question was taken.

    The SPEAKER pro tempore. In the opinion of the Chair, two-thirds being in the affirmative, the ayes have it.

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