Unanimous Consent Request -- S. 3656

Floor Speech

UNANIMOUS-CONSENT REQUEST--S. 3656 -- (Senate - November 19, 2008)

BREAK IN TRANSCRIPT

Mr. SCHUMER. Madam President, I introduced this bill in October in response to overwhelming concerns New York health care providers have about three devastating health regulations that the Bush administration is pushing.

My bill would put a 6-month delay on the Medicare Hospital Capital IME payment policy to teaching hospitals, a 6-month delay on the now-final Medicaid Outpatient Clinic regulation, and a 6-month delay on the Medicare Hospice rule--three regulations that affect the heart and soul of our health care system--the facilities and health providers that take care of all Americans, rich or poor, rural or urban.

Given the urgent challenges we face in our economic health, now is not the time to be cutting hospitals or clinics that serve our physical health. We should be making health care more effective and efficient--not slashing reimbursement and running these providers out of business.

The new Medicare Hospital Capital Indirect Medical Education, IME, payment policy is a disaster for teaching hospitals. It went into effect on October 1 and will be fully implemented in 2010.

This new policy runs counter to what works in American medicine. The Medicare program has long served the public good by funding the training of new doctors in our academic medical centers and teaching hospitals, using IME payments.

Across the Nation in large and small communities there is a shortage of physicians--from primary care to surgeons. We rely on our Nation's academic medical centers, 13 of which are in my State, and teaching hospitals to train new physicians.

The new policy eliminates critical funding that supports teaching.

The total cost of this new policy to New York's teaching hospitals would be $62 million when it is fully implemented in 2010. The total for all U.S. hospitals is $380 million.

Let me illustrate what these cuts mean to New York hospitals: Albany Medical Center Hospital, $1.2 million; Kaleida Health in Buffalo, $1.3 million, Montefiore Medical Center, $3.7 million; Strong Memorial Hospital, $1.6 million; Stony Brook University Hospital, $1.6 million; Bassett Hospital in Cooperstown, $426,000; and Coney Island Hospital, $565,722.

These facilities are the same ones in my State who provide the lion's share of uncompensated care to the uninsured.

One of the hardest hit hospitals in my State is Mt. Sinai Medical Center in Manhattan. They stand to lose $4.1 million by 2010.

This lost funding means Mt. Sinai Medical Center will be forced to take cost cutting steps:

First, delay completion of their inpatient electronic medical record rollout; second, they won't be able to expand their already crowded emergency room that provides over 100,000 patient visits a year; and third, they will scale back many free medical screenings and other programs for patients.

These are not the actions we want hospitals to take.

Hospitals need our help. The Medicare Payment Advisory Commission, MedPAC--which is a nonpartisan group--has said that in 2006, hospitals' Medicare margins nationwide were in the red at negative 4.8 percent.

In New York in 2006, rural hospitals were hit the hardest by low Medicare reimbursements with even lower margins of negative 8.2 percent.

After 7 consecutive years of overall negative margins, the hospitals in my State did little better than break even in 2006. It doesn't make sense to me that we would gut a source of training for high-paying jobs in this country at a time when we are bleeding jobs.

This is not just a New York issue. In July, 51 Senators signed a bipartisan letter to the Centers for Medicare and Medicaid Services, CMS, that opposed implementation of the capital IME. We need to pass my bill so that these cuts don't hurt all U.S. hospitals.

Now I want to speak briefly about the Medicaid Outpatient Clinic Regulation that my bill places a 6-month moratorium on.

For months I fought with CMS about this regulation. Unfortunately, they finalized it last week.

But, I am pleased that in the final version free-standing health clinics were saved from massive cuts. There were many clinics in New York that were saved from either closing their doors or saying no to their patients.

I want to talk about Ed, a 62-year-old Buffalo resident, who can only move his head due to his cerebral palsy. With the help of a free-standing clinic in Buffalo, called Aspire, Ed learned to operate his power wheelchair with his chin.

Even more amazing he can operate a computer using his chin. Ed spent 5 years mastering desktop publishing and then formed his own successful business.

If free-standing clinics were included in the final regulation, Ed could not attend Aspire of WNY's wheelchair clinic, where physical, occupational and speech therapists customize all sorts of things for him. Without that service, Aspire tells me that he would be completely immobile and not as independent.

Let me discuss another New Yorker that the Buffalo-based Aspire Clinic helped. In 1998, Aspire wanted a woman named Alice to have a colonoscopy. When she did, it was revealed that she had colon cancer. But luckily they found it in time and she had surgery to remove the cancer and now, 10 years later, she is doing fine.

Alice is just one of hundreds of individuals who receive primary medical care through these essential primary care clinics.

Enable, a Syracuse agency that serves children and adults with disabilities, told my office that they would have to stop providing physical and occupational therapy to more than 300 clients on Medicaid if the Rule had included freestanding clinics.

I wish CMS hadn't made this regulation final, but at least it isn't as bad as it could be. We will know the extent of pain that other clinics and hospital outpatient services may face on December 8, when the rule must be implemented.

Therefore, I hope that the Senate will pass the PATH Act. As we have heard, there are just too many terrible cuts underway in health care, and we need to be doing all we can right now to stop the bleeding.

I understand my colleague has objected. That is unfortunate. To wait another 3 months or 6 months at a time when our economy is in such dire shape will do severe damage to health care throughout the country. In my State of New York, for instance, the new Medicare Hospital Capital Indirect Medical Education payment policy is a disaster for teaching hospitals. It runs counter to what works in American medicine. It affects large and small communities. We have a desperate shortage of physicians, from primary care to surgeons. The country relies on academic medical centers. This clobbers them at a time when it should not have happened. Many of us believe this regulation was not within the purview of CMS to enact. They went ahead and did it. I would hope that maybe my colleague will reconsider. We will return to this issue when we come back in January, but some damage, unfortunately, will be done.

I understand why my colleague has objected. I regret it. There was no time to move in the Finance Committee because this regulation didn't take effect until very recently, having many bad affects. I will work hard and not rest until we overturn the regulation.

I yield the floor and suggest the absence of a quorum.

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