Remarks to the National Association of Public Hospitals and Health Systems

U.S. Department of Health & Human Services
Health Resources and Services Administration
HRSA Press Office: (301) 443-3376
http://newsroom.hrsa.gov

by HRSA Administrator Mary K. Wakefield

March 9, 2010
Washington, D.C.

Thank you, Chris (NAPH executive director Christine Burch), for that kind introduction.

In preparing for these remarks, we did a quick scan of the NAPH Web site. There I saw a lot of phrases that could be lifted straight from HRSA's own Web pages:

“a long tradition of quality and service to the community”;
“delivering care to America's growing number of working uninsured families”;
“employees that reflect the diversity of their communities and emphasize the delivery of culturally competent care.”

And finally, this wonderful, simply stated phrase that describes your work:

American safety net hospitals and health systems stand for quality of care, access for all, and service to the community.

I'd be hard-pressed to find a better, more succinct description of what we're aiming for through HRSA's own work – the work we do and support through our health centers, our Ryan White HIV/AIDS program, and many of our other agency efforts.

What that says to me is that we are natural partners. We treat many of the same people, in the same communities. We are committed to the same values of service and quality and access for all.

Where we work together now, we should, I think, look for opportunities to expand. Where we don't work together, we should determine whether we're missing opportunities to advance both your mission and ours. It's really a shared mission.

What I'd like to do today is start by telling you a bit more about HRSA, about our programs that you may not be familiar with. Then I'd like to tell you where we're headed under President Obama's leadership. And by doing that, I think we'll see where some of our natural points of interest and collaboration already are and where they can be.

First, a bit about what we do at HRSA with our $7.2 billion annual budget. Those funds were supplemented last year in unprecedented fashion by the influx of an additional $2.5 billion under the American Reinvestment and Recovery Act, which President Obama signed just over a year ago.

Many of you know all about the health center network that we support because, as HRSA grantees, you operate health centers. Our 1,100 health center grantees provide quality primary care to close to 20 million medically underserved people at 7,500 sites in urban and rural areas across the nation.

You also know about the 340B Drug Pricing Program, which gives safety-net providers access to discounted pharmaceuticals and which, I'm told, all of your member organizations participate in.

Still others know about our administration of the Ryan White HIV/AIDS Program, whose grantees provide some of the best care for low-income and uninsured people living with HIV/AIDS that can be found anywhere in the world. You know because you are the end users of Ryan White funds that HRSA passes through your state or city governments. More than half a million people living with HIV/AIDS in the United States receive care every year thanks to the Ryan White program.

In addition to those core programs, we also fund:

the Maternal and Child Health Bureau, which leads the federal government's efforts to improve the health of mothers and their children. Every year, its block grant funds to states provide health services that reach six out of 10 women who give birth in the U.S.
Additionally, our Bureau of Health Professions staff provide resources to help train the next generation of the health care workforce and, through the National Health Service Corps, we place them where they're needed most. I'll talk more about the NHSC in a few minutes.
And we have a range of other programs that include overseeing Poison Control Centers, Federal Organ Procurement and Donation efforts, the National Vaccine Injury Compensation Program, and the Office of Rural Health.

That's a brief summary of our portfolio. Now I'd like to talk about HRSA's role in the future, even as efforts to move on health care reform continue to push forward, with the aim of expanding access to care to all Americans, bringing down the ever-rising cost curve on health care expenses, and ending the practices of insurance companies that limit people's access to health care coverage when they need it most or deny it to them because of pre-existing conditions.

But for us at HRSA, for the programs we administer and the grantees who are our partners, these two points speak loudest to us:

First, the president wants to expand access to primary care. Few in America know better than the people in this room that regular access to primary care holds the promise of a healthier nation, with fewer people progressing to chronic illnesses, and fewer of them using expensive emergency room care. If we expand access to health homes and to health promotion and disease prevention activities, we can reduce the number of Americans with chronic disease more effectively and manage the care needs of people who do present with them.
Second, the President wants to make sure we have more trained health professionals, especially nurses and primary care physicians and others in high demand. Increasing access to appropriate care has implications for the numbers of nurses, dentists, doctors and others to provide it.

You can see these priorities of Congress and President Obama in the investments made over the past year through the Recovery Act and in the President's proposed budget for 2011.

As I said earlier, the Recovery Act invested $2.5 billion in HRSA programs. The funds were split three ways:

First, we received $2 billion to expand, improve and renovate the health center system. With those additional $2 billion – a figure equal to the annual health center budget – our grantees served some 1.5 million new patients last year while adding 125 new health centers to the network.
Second, we received $200 million to counter health workforce shortages by expanding training and educational opportunities. This investment reflects President Obama's commitment to attract and retain more nurses, physicians, and other health care professionals. Colleges and universities competing for these funds will use them to pay for scholarships, loans and loan repayments that will train 14,000 clinicians over the next few years. Of the $80 million awarded to date, about half has gone to students, health professionals and faculty from minority and disadvantaged backgrounds.

This, I think, is an enormous step in the right direction, as workforce diversity is one of the biggest challenges we will be facing over the next decade. And we know from long experience that students from disadvantaged backgrounds are precisely the ones most likely to pursue practice in underserved communities.
Third, we received $300 million in Recovery money to add thousands of new clinicians to the ranks of the National Health Service Corps. The NHSC repays up to $50,000 in student loans for advance practice nurses, doctors, dentists and others who serve a minimum of two years in areas with too few health professionals – or $150,000 for a five-year commitment.

The Recovery Act is generating unprecedented growth in the Corps, and our field strength is rapidly closing in on 5,000 practitioners, hundreds more than we had just two years ago. That total includes more than 1,400 PAs and advanced-practice nurses; almost 1,700 physicians and over 1,000 mental and behavioral health professionals.

The 2011 budget proposal that the President announced last month continues his emphasis on primary care and health professions.

The proposal includes an additional $290 million for health centers (to a total of more than $2.45 billion) over the 2009 level to keep up the increased pitch of activity initiated by the Recovery Act. If agreed to by Congress, the additional funds also will create 25 new health centers across the country and will expand health centers' ability to provide behavioral health care.

Additionally, the 2011 proposal continues the huge increase over the past year for the Nurse Loan Repayment and Scholarship program. The President again asks for $94 million, an increase of more than 150 percent over the FY 2009 total of $37 million. This infusion of funds supports hundreds of additional contracts for nurses in critical-shortage facilities.

The President also continues his increases for the Nurse Faculty Loan Program. The 2011 request asks for $25 million for the program, a jump of more than 100 percent over the 2009 total of 12 million.

And the President's request sustains his expansion of the NHSC. There he asks for $169 million in 2011, an increase of $34 million over the 2009 appropriation.

That's where HRSA is headed under President Obama's leadership.

Now the question that all of us need to ask and try to answer is: How can we pool our resources and integrate our efforts to make the biggest difference for the largest number of people?

One of the first things we can do is look at the hospital and health systems that already are involved with HRSA as health center grantees and see if those existing relationships can serve as models for expansion. We need to ask Denver Health, Cook County, San Francisco General Hospital, Boston Medical Centers and the many other NAPH members that operate HRSA-funded health center sites what works well and should be promoted as a base to expand collaborative efforts. And, conversely, whether there are problems we need to fix that hinder a closer level of cooperation.

As I said earlier, our grantees and your organizations treat many of the same people, in the same communities. We are committed to the same values of service, quality, access. We are natural partners.

I know that the NAPH has strongly supported the establishment of Community-Based Collaborative Care Networks that are included in the House and Senate health care reform bills.

These networks would stimulate greater integration of services among safety-net providers in a manner similar to what already occurs in the cities I just mentioned, where the delivery of primary care by health centers is integrated into your overall operations.

Obviously, any idea that encourages greater integration of resources and more seamless care for patients is one that HRSA supports. But we don't need to wait for the bills to pass. We can begin today to work more closely together, and I look forward to talking with you and your leadership about how to proceed.

You may know that some of our health centers are involved in working with hospitals, health systems and other partners on grants that CMS distributed in 2008 to 20 State Medicaid agencies to reduce the use of emergency departments for non-urgent reasons. And staff in our Bureau of Primary Health Care are in early discussions with the American College of Emergency Physicians on the development of a model plan to strengthen collaboration between emergency rooms and health centers.

Let me just wrap up by urging all of us to take full advantage of the emerging opportunities for greater collaboration.

I know there are other areas of interaction between HRSA and public hospitals and we should include those as well. For example, all of you participate in the 340B drug pricing program that HRSA administers. If you have ideas on how our oversight of that program can be improved, let me know. I know you support expansion of 340B authority to include inpatient drugs. Should that be approved as part of health care reform we will, of course, work with you and other stakeholders to implement it.

And let me thank the NAPH member hospitals that are participating in the HRSA-sponsored Patient Safety and Clinical Pharmacy Services Collaborative. The collaborative pulls together some 300 organizations into multi-professional teams that work to improve medication use and boost health outcomes for patients with chronic diseases.

So let me say thanks to the following NAPH members for joining us in this effort: