Remarks to the National Association of Community Health Centers

Prepared Remarks of Elizabeth M. Duke, Ph.D.
Administrator, Health Resources and Services Administration

National Association of Community Health Centers
27th Annual Policy and Issues Forum
Washington, D.C. 
March 18, 2002

Good morning.  I am delighted to make my one of my first public speeches as HRSA Administrator to the members of the National Association of Community Health Centers. 

I am honored that Secretary Thompson affirmed his confidence in me by appointing me HRSA’s administrator earlier this month.  I took the position of acting administrator a year ago at his request, and I am very pleased with the changes we’ve implemented since then to streamline HRSA’s internal structure and improve administration of the programs we fund and oversee.

Two key programs affected by these changes – health centers and the National Health Service Corps – are, of course, of vital interest to you.  So I want to spend a little time here going over what we’ve done and why – and explaining how these changes fit in with the President’s design for HRSA’s future.

Last July we announced the transfer of the National Health Service Corps, the Division of Scholarship and Loan Repayment, and the Division of Shortage Designation from the Bureau of Primary Health Care to its sister entity within HRSA, the Bureau of Health Professions.  We made the change to improve internal efficiency and streamline duplicative operations, which are good reasons by themselves.  But we also made the change with an eye to the future.

Health centers and the National Health Service Corps are at the very heart of President Bush’s multi-year plan to expand access to health care for our nation’s neediest citizens.  To make his plan work, we need to make sure these programs are operating at peak performance.

Moving the Corps to the Bureau of Health Professions makes sense because it puts within a single bureau the entire spectrum of HRSA’s recruitment, training, loan, scholarship and placement programs for health professionals.  Consolidating responsibility for health professions programs in one HRSA bureau increases the coordination needed to ensure that the right number of health care professionals serve in the right places.

And by streamlining operations at the Bureau of Primary Health Care, we’ll be better able to focus staff and resources on the President’s push to expand the health center system.  The expansion of access points and services that began last year will be a top priority for HRSA for many years, and it will be a visible task of paramount importance to the overall health of the American people.

Let no one doubt President Bush’s commitment to strengthen and expand the health center network.  In a March 22, 2001, speech in Portland, Maine, he called health centers “incredibly important programs … that make an enormous difference for the indigent and the poor.”

The Secretary and I are committed to ensuring that these incredibly important programs make the difference that the President envisions.

BPHC’s leadership in building and maintaining the health center network is widely respected.   Now, with the restructuring, BPHC officials have turned their full attention toward making this unprecedented multi-year expansion a success.

Passage of the FY 2002 budget has put the President’s plan in motion.  Health centers received an increase of $175 million in 2002, to a total of more than $1.34 billion.  These additional funds represent a down payment on the President’s five-year plan to create new or expanded health center sites in 1,200 communities and increase the number of patients served annually to more than 16 million.

The President’s proposed budget for 2003 would raise health center funding total to $1.5 billion, a $114 million increase.  We hope to work closely with all of you to see that this expansion occurs in an orderly and organized manner.  People often think that more money solves all problems, but we all know differently.  We must all work together and work smart to make sure that, as the system grows, the reputation for quality, dedication, and service to the community that health centers currently enjoy is in no way diminished.

Let me just note here a challenge to the system that Bill Hobson and I are paying close attention to -- the federal tort claims issue.  This is a problem of self-insurance which covers over 4,000 physicians and over 19,000 other health care providers.  Over the years, claims are beginning to outstrip appropriated funds.  We have an increase to $15 million in 2002 and a proposed increase to $25 million in 2003.

You are no doubt aware that President Bush also has big plans for the National Health Service Corps.

The Corps’ FY 2002 budget contained an increase of about $20 million, to a total of $145 million.  The President’s 2003 budget proposal would give the Corps an increase of another $45 million to a total of just over $191 million.  The added funds would provide scholarships or loan assistance to about 1,800 professionals practicing in underserved areas -- an increase of more than 500 participants over the current fiscal year.

The NHSC expansion is linked to the health centers’ growth.  Since a large percentage of Corps clinicians are assigned to health centers, if one part of the system expands, so must the other. 

The President also has announced a reform initiative designed to improve the Corps’ service to America’s neediest communities.  The initiative will examine several issues, including the ratio of scholarships to loan repayments, and will consider amending the Health Professional Shortage Area definition to include non-physician providers and visa providers practicing in communities.  These efforts will enable the NHSC to more accurately define shortage areas and target placements to areas of greatest need.

Within our broadly diverse and dynamic nation, there are, of course, differences of opinion on the best way to expand access to health care.  The option that President Bush and Secretary Thompson have chosen is to focus on programs that we know work well and make them the base of a strategy to gradually and persistently expand access to care.

• What works?  Health centers and the National Health Service Corps work. So increases are provided for both of these vital resources.

• What works to expand health care to children?  SCHIP – the State Children’s Health Insurance Program.  So President Bush wants to make sure $3.2 billion in unspent money remains available to states.  And Secretary Thompson has created a model waiver program that lets states try innovative ways to extend SCHIP coverage to children.
  
• What works to help people leave welfare and join the workforce?  Continuing their Medicaid coverage works.  So the President is asking for another $350 million in Medicaid benefits next year to pay for child care and health care programs for families making the transition.

These are elements of a multi-front strategy that makes targeted investments in time-tested programs and infrastructure, improves organization and operations, and increases flexibility at the state and local level to respond to state and local problems.

It is a strategy that honors you and the hard work you do.  Congratulations.  You should feel proud.  You deserve to be proud.

On Wednesday, Secretary Thompson will be here to speak with you.  He is putting tremendous emphasis throughout the department to make sure all the separate parts of HHS understand what he means when he says “One agency, one department, one America.”  It’s a mantra for him.  Broken down, it means that we all have to stop seeing ourselves as single actors, as separate entities one from another.

It means telling people that they have to work together as never before to coordinate and collaborate, to make sure the American people get the most from the hard-earned tax dollars they trust us to spend.  It’s the foundation for the changes within HRSA that I’ve just discussed.

It’s also the reason why we’re meeting with HHS colleagues from the Center for Disease Control and Prevention to discuss bioterrorism issues.  And it’s why we at HRSA are talking with our peers at the Center for Medicare and Medicaid Services on Medicaid issues that impact health centers and, specifically, on the prospective payment system issue.

Within HRSA, it’s why we are stressing the need for all of our grantees to work together, to be aware of service connections, to establish inter-agency linkages.

Our telehealth program, for example, is a vital and growing part of our efforts to unite us within “One HRSA.”  The Secretary and I intend to ensure that the medical consultations and distance-learning that use telehealth technology are not just discrete innovative grant programs – which will continue -- but become a core element of all of HRSA services.  We want to exploit this amazing video and computer technology to ensure that the best health care is available even in the most remote and difficult sites.

HRSA’s Office for the Advancement of Telehealth -- called OAT for short -- was part of  last year’s streamlining and consolidation.  We move OAT from my office – the Administrator’s office -- to the HIV/AIDS Bureau to improve the office’s ability to manage grants, since HAB has an established mechanism to award and manage grants. 

The change also puts OAT under leadership that is as passionate as Secretary Thompson and I are about enhancing the quality of care through the use of telehealth technology.  HAB’s management team and I share a passion for the use of technology to build capacity and increase quality in all care settings.

Under my leadership, technology will be a priority in everything we do – and we’re going to use it to improve the quality of services HRSA supports.  Quality is another topic you’ll hear me emphasize again and again.

In this vein, I congratulate the 255 health centers who have received JCAHO (Joint Commission on Accreditation of Healthcare Organizations) accreditation, and I laud those of you who have been part of health center collaboratives to fight diabetes, cardiovascular disease, asthma, HIV/AIDS and depression.

By pulling together to change the way centers deliver care; by helping patients set personal goals to manage and improve their conditions; and by reaching out to local organizations for in-kind support, you put quality at the core of everything you do.

Already notable improvements in patients’ outcomes have been verified because of the collaboratives.  By implementing more appropriate counseling and treatment methods through the diabetes collaborative, for example, patients are now better able to monitor and control their blood sugar levels.  Results have been impressive: participating health centers helped diabetic patients reduce blood sugar levels by 1 percent.  A 1 percent reduction significantly cuts the risk of death, stroke, and cataract eye surgery.  Patients at health centers in the South, the region hit hardest by diabetes, reduced their blood sugar levels by 1.5 percent. 

This and other impressive health outcomes achieved by patients at health centers reflect a wonderful paradox – that is, that some of our nation’s poorest citizens get some of the nation’s best primary and preventive care.

They also reveal a national tragedy in that too little of that care is available to meet demand.

President Bush’s vision for health centers -- if ratified by Congress later this year and in years to come -- will go a long way toward expanding the paradox and diminishing the tragedy.