Graduate Medical Education Reform Act of 2012

Mr. President, I rise today to introduce S. 3196 and S. 3197. This legislation will strengthen the resources and support that we provide to women entrepreneurs, and to strengthen oversight of the SBA's technical assistance programs. The SBA's Entrepreneurial Development programs are a vital source of training and management support for entrepreneurs, and I am pleased to work with Chair Landrieu to improve these programs and ensure that the taxpayer dollars that support them are being utilized in the most efficient and effective way possible.

The Women's Small Business Ownership Act of 2012 builds upon our commitment to providing assistance to women entrepreneurs, whose firms have grown at ice the rate of other firms. The SBA's Women's Business Center, WBC, program provides critical assistance to economically or socially disadvantaged entrepreneurs, especially women. The bill I am introducing today with Chair Landrieu holds funding for the WBC program at current levels for the next three years, in recognition that now is not the time to grow Federal programs, including proven ones like the SBA's technical assistance efforts.

Our bill also makes necessary improvements to the WBC program, such as establishing a process and criteria that the SBA must follow in administering grants under this program, and expanding eligible entities that can host Women's Business Centers to include local economic development organizations and community colleges. It also improves the transparency of project funds to ensure that WBC hosts are not comingling their grant funds with those for separate purposes and initiatives.

To further strengthen growth in women-owned businesses, we are also introducing the National Women's High-Growth Business Bipartisan Task Force Act of 2012. This legislation would repeal the National Women's Business Council and replace it with a Women's High-Growth Business Bipartisan Task Force charged with developing and promoting initiatives, policies, and programs designed to encourage the formation of startups and high-growth small business concerns owned by women.

Under current law, the Council receives funding to employ an executive director and four additional employees, who may receive a maximum pay rate of GS 15. However, most other advisory committees across the government and SBA operate without staff, and under this bill we will save taxpayers nearly $1 million by transitioning the current Council into a Task Force, similar to the Interagency Veteran's Task Force at the SBA, which was established in 2008.

Additionally, this legislation places an emphasis on high-growth small businesses owned and controlled by women. Recently, the Kauffman Foundation, based in Kansas City, MO, researched the effects of startups as part of the American economy. These reports demonstrate the necessity of new and young start-ups to act as mechanisms for reviving the American economy; particularly those of high-growth entrepreneurs. In this rapidly growing area of high-growth firms, which often incorporate intellectual property endeavors, this bill ensures that women's small business concerns are being addressed, with an emphasis on achieving and maximizing high-growth potential.

Finally, I am pleased to join Chair Landrieu in introducing the Strengthening Resources for America's Entrepreneurs Act. This legislation aims to improve oversight and coordination among the SBA's existing entrepreneurial development, ED, programs, including the Women's Business Centers, WBC, the Small Business Development Centers, SBDC, and the Service Corps of Retired Executives, SCORE, by setting performance measures, reducing duplication, and increasing partnerships with local entrepreneurial training providers to make them more effective and responsive to the needs of small businesses.

Importantly, this legislation makes several changes to the SBA's entrepreneurial development programs at no cost to taxpayers. The bill instructs the SBA to develop a plan outlining how to use ED initiatives to create new jobs over the next 2 years, improves cross-program coordination to maximize use of program resources, establishes a consistent data collection process for all of its technical assistance programs, and ensures that someone is available to assist small businesses at all SBA district offices. By requiring the SBA to collect data will provide important insights into the strengths of the ED programs and highlight where there is room for improvement.

Now, more than ever, we in Congress must do everything within our power to help small businesses drive our Nation's economic recovery, and the SBA programs we are reauthorizing today are critical elements of that support. In the coming weeks, I look forward to working with the Chair and my colleagues on both sides of the aisle to move these bills through the full Senate.

Mr. President, I ask unanimous consent that the text of the bill be printed in the Record.

Mr. President, I ask unanimous consent that the text of the bill be printed in the Record.

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. 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. 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

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.

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

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.