June 22, 2005
Washington, D.C.

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It is wonderful to be here with all of you today for this second meeting of HRSA’s Primary Health Care grantees.  I’m told that close to 1,900 people are attending the conference, representing health center and other primary health care grantees from every corner of the nation.
 
I’m sure you will use this wonderful opportunity to develop new friendships, discuss issues of common concern, and share best practices with the other grantees you meet.
 
I trust, too, that many of you will take advantage of the conference to meet with HRSA staff who are here in great numbers.  I know that many of you have scheduled appointments with your program officers; I commend you for that.  I know that Michelle Snyder, HRSA’s associate administrator for primary health care, and I have crowded our schedules with meetings, and we plan to talk with as many of you as is possible in the next few days.  If you’re not on my schedule but would like to talk to me, please call my office when you return home and we’ll try to set up a conference call later this summer.
 
Health center grantees are, of course, the largest bloc by far of HRSA’s Primary Health Care grantees.  You get the most money and the most attention – and that is as it should be.  After all, how many other Federally supported health care networks serve more than 13 million people each year and are the focus of a Presidential expansion initiative?
 
But in case you didn’t know, HRSA has three other important programs that receive Primary Health Care grants, and I’d like to tell you about them here.  They are our:
 

• Black Lung program grantees, 15 of them in 12 states, who provide primary health care, outreach, counseling, pulmonary rehabilitation and other services to current and former coal miners;
  
  
• Native Hawaiian grantees, who provide primary health care services to Native Hawaiians on their distant islands; and
  
  
• and our Radiation Exposure Screening and Education Program grantees.  They provide outreach, screening and referral services to individuals exposed to radiation from nuclear tests.  Currently we have 6 RESEP grantees in four states: Arizona, Colorado, New Mexico and Utah.

Compared to health centers, budgets for these programs are limited, their reach restricted to certain parts of the country.  But their patients need just as much help – more in some cases – as patients who are helped at health centers.
 
Many grantees from these three programs already coordinate care with local health centers.  6 of the 15 Black Lung grantees operate out of health centers.   
 
But we can probably all pull together even more if we know more about each other.  So I ask all the big health center grantees to take a moment during this meeting to find out a bit more about the Black Lung, Native Hawaiian and Radiation Exposure programs.  Seek out their operators, and see if there’s a new and inventive way you can figure out to work together to your mutual benefit.
 
I imagine all of you know that HRSA is now more than halfway through our implementation of  President Bush’s health center expansion initiative.  That initiative, of course, will create or expand 1,200 health center sites and serve an additional 6 million patients annually by the end of 2006. 
 
The expansion remains a priority for the President because he knows that health centers work for America.  According to almost-final UDS statistics, in 2004 health centers served an estimated 13.1 million people – close to 3 million more patients than were served in 2001 – at about 3,700 comprehensive primary care delivery sites.
 
Let me stop here for a second and praise the Uniform Data System.  I could imagine, if I were working in a health center, that I might at some point wonder why the federal government needs to know all this about what we’re doing.  I could imagine complaining every now and then that I could be doing something more valuable with my time than recording all this data.
 
Don’t think that for a minute.  There aren’t many programs in the federal bureaucracy that can chart their performance and their progress to meeting set goals as well as health centers.  And that’s thanks to the UDS.  With budgets getting ever tighter in Washington, administration budgeteers and legislators alike want to see hard proof in black and white that they’re getting the bang they expect for the bucks they provide.  That’s what the UDS does for you.
 
I just spent most of a week at an all-grantee meeting for HRSA’s health professions grantees.  Their budgets are threatened with drastic cuts or elimination every year – and they have been for many years, through administrations of both parties.   Much of the meeting was devoted to an introduction and explanation of a new performance measurement system we will implement to cover those programs.
 
Health professions grantees believe strongly that the programs they administer have value to the nation.  But until now they’ve had no way to measure their success – they had no UDS.  And I can tell you from years of experience that belief and anecdote do not constitute persuasive evidence in Washington.   The issue, I told them, is not so much performance as it is measurable performance. 
 
In this environment, it’s not enough to know in your heart that you do a great job.  You have to be able to prove it.  And when you can – as health centers can through the UDS – you have a much better chance of winning support on Capitol Hill and at the White House. 
 
The health center program, with the UDS, is already where everyone else should be, and I congratulate you for that.
 
In Fiscal Year 2005, HRSA will fund 153 new or expanded health center sites and expects to serve about 14 million patients.  The 2005 grants will bring to 770 the number of new or expanded health centers created under the President’s initiative. 
 
HRSA is delighted that incoming HHS Secretary Mike Leavitt is so supportive of health centers and the expansion initiative.  And we’re also fortunate to have support for the expansion from key Congressional leaders.  They support health centers because they know we serve America’s neediest people: 
 

• Health centers treated nearly 5.3 million uninsured patients last year.  That’s 40 percent of all health center patients, a level that hasn’t been reached since 2000.
  
  
• Patients with incomes at or below 200 percent of the Federal poverty line increased to 91 percent in 2004, a full percentage point increase over 2003.
  
  
• The number of homeless patients rose by almost 94,000 to 770,000 in 2004, a 14 percent increase over 2003.

And in the midst of serving a more difficult patient load, health centers are finding new and creative ways to build financial strength and self-reliance.  Patient revenue in 2004 rose to 57 percent of total revenue, and grant revenue dropped in percentage.
 
Additionally, the services that patients receive at health centers are more responsive to their full needs.  More than ever before, health centers serve the whole person, treating the mouth and the mind as well as the body.
 
If you compare 2004 UDS statistics to those from 2001, you see that while medical encounters rose about 27 percent over that three-year period, dental encounters rose 58 percent and mental health encounters 86 percent!
 
Last year health centers treated more than 2.1 million dental patients, an increase of more than a quarter of a million people (258,156).  These patients made more than 5.1 million visits to dental health professionals at health centers, an increase of more than 650,000 visits over 2003 totals.
 
I have told many audiences over that past few years that health care professionals need to look at patients in their entirety, because that is how they come to us.  The brain and the mouth are inseparable from the body, component parts of a single entity.  We must treat the whole person.
 
In terms of oral health in particular, we all know that the United States can do a lot better in providing oral health care to those who need it.  This is one of my passions.  And I like to think that I’ve been successful in spreading this passion to others throughout the agency.

One big thing we’ve done – with the leadership of my Senior Advisor, Steve Smith, and the help of oral health professionals inside and outside the agency -- is to put down on paper HRSA’s oral health mission, goals, and objectives -- and strategies to reach those objectives.  Our oral health mission is:
 
“To improve the nation’s health by assuring access to comprehensive, culturally competent, quality oral health care for all, as an integral component of comprehensive health care.”
 
Additionally, we have worked with Surgeon General Rich Carmona and other HHS agencies to answer his call to action on oral health – especially in the area of building partnerships to increase access to oral health care for the people we serve.
 
I am delighted that health centers heard me and have responded to my pleas.  I congratulate you for doing so.  By so dramatically expanding access to oral and mental health services, you have improved the content of the health care you deliver even as you deepen your commitment to serving the hardest-to-serve.
 
The President’s budget for FY 2006 continues his strong support for health centers, asking Congress for an increase of $303 million.  Of those dollars, $277 million will complete our push to meet the goals of the President’s five-year initiative by creating 275 health center sites and expanding operations at 303 existing centers.
 
The remaining $26 million in the FY 2006 request for health centers will be used in accordance with an initiative proposed by President Bush in his latest State of the Union to develop new health centers in 40 of the Nation’s poorest counties, with planning grants going to 25 other high-poverty counties.
 
Funding for these sites will follow the requirements and competitive processes now in place for Consolidated Health Centers, with the exception of the proportional funding requirement for migrant, homeless, and public housing health centers.  We will target these poor counties through a limited competition which considers only applications that propose to establish a new health center in one of the targeted counties.
 
All other aspects of the competition and of the implementation and operation of the new centers will follow current program procedures.  We also expect to place incentives in the application process to encourage applicants to serve multiple counties.
 
Making sure health center grants go to areas that need them most will be the essence of this latest Presidential initiative.  But that quest has, in fact, been a theme of the entire expansion process.
 
To improve our ability to help the neediest communities, I asked staff in Primary Health Care, together with experts at the University of North Carolina, to analyze how need is assessed and how the process could be improved.
 
Earlier this year we published a Federal Register notice detailing that analysis and invited public comment on a proposed “Need For Assistance” worksheet and on how “need” is graded in an application. 
 
I want to thank those of you who responded.  Overall, the comments were well-received and your suggestions were incorporated into the decision-making process.  The outcome, I believe, will strengthen the application process and ensure that new grants are going to the areas of greatest need.
 
As a result, I have instructed staff to proceed with a revised worksheet, to incorporate it into the ORC process rather than using it as a screening device, and to increase the weighting of “need” within the application (meaning narrative plus worksheet) to 35 percent. 
 
What this means is that “need” will now count for a third of the application and the business plan will count for two-thirds.  These improvements, which include a data source “cookbook,” will help communities with the greatest “need” develop applications that are more competitive than they have been to date.
 
We plan to implement the new (NFA) process in the President’s initiative that focuses on the 40 poorest counties.
 
Here let me take a moment to focus on another internal matter -- plans for this year’s base adjustment assistance.  As you know, Congress instructed HRSA to set aside $31 million for existing health centers to help cover the rising cost of delivering services and treating more patients.  That sum is $6 million more than last year, by the way.
 
I am happy to say that we anticipate using the same methodology as last year for distributing those funds, with awards expected to be announced in early July.  These funds acknowledge the outstanding work all of you do in caring for the underserved and the sacrifices you make in treating the uninsured.
 
Even as we push forward with the expansion, I want to assure you that HRSA remains committed to helping existing health centers get the resources you need to meet rising costs and growing demand for your services.
 
An expansion the size of the one we’re involved in, of course, provides great opportunities for health care professionals.  All of you know that at the same time President Bush launched his health center initiative, he also gave HRSA the complementary responsibility of expanding the National Health Service Corps.  That made perfect sense, since half of all NHSC physicians, dentists, nurses, physician assistants and other professionals work in health centers.  And we are proud to say that the total number of NHSC clinicians in the field, serving in some of America’s neediest areas, nearly reached 4,000 last year.
 
Let me stop here and ask all current and past NHSC clinicians to stand, wherever you are.  You have provided valuable medical care and assistance to the people of America and I want you to get the recognition you deserve.  Let’s give them all a big hand.   HRSA plans to tap your experiences and your expertise to persuade more and more incoming health professionals to sign up to serve America through the Corps.  You’ll all be hearing more from us soon about this campaign.
 
At the beginning of the health center expansion, we estimated that the new health center sites would need about 36,000 new staff, with about a third of that total being health care professionals.
 
As I just mentioned, hundreds of more grants will be awarded this year and the next as we approach the President’s goals.  So we still anticipate openings for thousands of health professionals in the new and expanded sites.
 
Last year health centers added almost 5,300 full-time employees, including 400 primary care physicians, about 240 dental professionals, and more than 2,200 administrative staffers.
 
But health centers must continue to add full-time health care professionals and others at a rapid rate to meet the goals of the expansion.  We ask you to think creatively and look for partnership opportunities as a way to bring more committed people into the health center network.
 
For example, we strongly encourage health centers to link up wherever possible with HRSA-funded Area Health Education Centers, commonly called A-hecks.  AHECs build relationships between university health science centers and community-based health care systems to give young medical professionals broader work experiences and a better idea of the demand for health care at the community level.
 
By linking up with AHECs – and we know that hundreds of you already do so -- health centers can serve as sites for residency training, medical school rotations, and as a source of part-time jobs for young people interested in health careers.  Connections like these are a great way to influence young people to place their talents in service to the underserved.  So for those of you who don’t yet have a connection with your local AHEC, we urge you to look into it.
 
Let me say here that we also plan to put greater emphasis in all HRSA-funded programs on making sure we build up the number of health professionals who are skilled in identifying and treating cancer and caring for cancer patients.  It’s a complex issue, but we’ll be seeking more health professionals in general and more specialists in particular who have a focus on cancer care.
 
Now I’ll tell you something that many of you already know:  providing cost-effective comprehensive pharmacy services is an essential component of delivering primary health care.
 
Comprehensive pharmacy services consist of access to affordable medications, efficient pharmacy business practices, and medication management services that improve health outcomes.
 
HRSA has a wonderful resource – the Office of Pharmacy Affairs in our Healthcare Systems Bureau -- to help you to provide these services.  Its mission is to administer and maximize the value of the 340B Drug Pricing Program, which health centers and other safety-net providers use to buy prescription drugs at discounts that average 49 percent below market prices. 
 
Over the years, the value of 340B has become evident to most of you.  I’m proud to say that of the 958 health centers eligible for the program, 820, or 86 percent of the total, have signed up to buy drugs under 340B authority.
 
Another added service of our drug pricing program is the HRSA Prime Vendor Program. Even the smallest HRSA grantee program can join forces with over 1,000 safety-net providers, like large public hospital systems, to get even greater savings, negotiated by experts on behalf of all Prime Vendor Program participants.  The Prime Vendor currently offers access to over 1,900 drugs with prices that range from 2 to 50 % below the 340B ceiling prices.
 
Health centers have joined the Prime Vendor Program at a fast pace, with 35 percent of the 340B-participating health centers having signed up.
 
There is no cost to grantees to participate in either or both of the 340B Program or the Prime Vendor Program!  By doing so, you can begin saving real dollars on your drug spending, dollars that you can invest in even more services for patients.
 
The requirements of these very complex programs are, I admit, challenging.  But HRSA and the American Pharmacists Association have joined forces to help you through our Pharmacy Services Support Center.  You can access experts on these programs along with technical assistance on other pharmacy questions at no cost through the Support Center at 1-800-628-6297.  Again, that number is 1-800-628-6297.
 
I urge all of you call the Support Center and take advantage of these very beneficial cost-cutting programs so that you may provide more services to more patients without increasing resources.
 
All of you – all of us – face another huge issue involving the cost and distribution of pharmaceuticals: upcoming changes in the Medicare program to expand drug coverage for seniors.
 
HRSA’s sister agency, the Centers for Medicare and Medicaid Services – CMS – has the lead on the implementing the new program.
 
Under the new law, prescription drug coverage will be made available for the first time to all 43 million Medicare beneficiaries, giving them substantial help in paying for their drugs.
 
The law also gives Medicare the ability to provide additional help to the neediest seniors, especially those with low incomes and beneficiaries with very high prescription drug costs.
 
Our primary concern at HRSA is that the Medicare beneficiaries served by our grantees continue to get the medications they need to stay healthy.  But, of course, we also want HRSA-supported safety-net providers to continue to receive reimbursement for the prescriptions of Medicare clients and dual-eligible clients for whom Medicaid reimbursement is currently received. 
 
HRSA’s goal is to help CMS implement the new drug benefit as smoothly as possible.  Last week President Bush helped kick off a national outreach effort to explain the changes to the American people and outline how they can take advantage of the new benefits.  In coming months, large parts of the Federal government – including us at HRSA -- will be part of this massive education effort.  And as we receive additional information from CMS, HRSA will do our part to help our providers and their patients understand their choices and make good decisions.
 
Incidentally, CMS’ deputy administrator, Leslie Norwalk, will be here at the conference to explain how the new benefit will be administered, so I advise you to attend her speech.  And daily seminars hosted by CMS staff have been scheduled throughout the meeting to give you even more information.
 
I can’t fail to address a grantee group without telling you, with some pride, about the great things HRSA is doing to promote organ donation.
 
Many of you know that HRSA houses federal efforts to expand organ donation, and this issue has been one we spend a lot of energy on.  Last month I traveled to Pittsburgh for a ceremony to honor 184 hospitals that in 2004 raised their donation rates to 75 percent of eligible donors who died in their facilities.  By contrast, the national average donation rate in all hospitals was 55 percent in 2003.
 
The work of these 184 hospitals helped increase organ donation in 2004 by an unprecedented 10.8 percent to a new annual record of 27,033 transplant operations. 
 
And results so far for the first four months of 2005 are breaking each of the monthly records established in 2004.  Last month – May – a new monthly record was set when the nation had 669 organ donors!  That total broke the earlier record, set in March of this year, of 652 donors.
 
We are proud to claim some credit for these fantastic totals.  The record increases in 2004 donation rates followed the launch by HRSA in 2003 of the “Organ Donation Breakthrough Collaborative.”  That initiative brought together donation professionals and hospital leaders to identify and share best practices to maximize organ donation rates from people who die in their facilities.   Staff from HRSA and Organ Procurement Organizations around the country helped participating hospitals identify, adapt, test, and implement practices known to produce high donation rates. 
 
With the encouraging results of that effort, I used the Pittsburgh ceremony to announce the creation of a new Organ Transplantation Breakthrough Collaborative.  This new effort will try to increase the number of transplant operations by encouraging medical professionals to adopt practices that maximize the number of transplantable organs from each donor.  The aim is to raise the average number of organs from each donor to 3.75 over the course of the next 500 days.  Currently the collection rate is about 3 per donor.
 
Let me wrap up by highlighting an issue that you will hear much more about from Secretary Leavitt and the federal government: Health Information Technology, or HIT.
 
You’ll also hear more at this conference from Deputy Administrator Dennis Williams about HRSA’s efforts to promote the integration of HIT in our programs and throughout the networks we fund.
 
Secretary Leavitt recently issued a new report citing investment in information technology as a high priority for the American health care system and the U.S. economy.  It found that the potential benefits of health IT far outweigh the costs of continuing with an outmoded, paper-based system.
 
The Secretary wants to see the federal government and private sector work collaboratively to drive changes that will lead to fewer medical errors, lower costs, less hassle and better care.
 
He says the federal government will use its leverage as the nation’s largest health care payer and provider to drive the adoption and implementation of health IT, which must be digital, privacy protected, and interchangeable.
 
Many of you know that the Federal government has been working to make fully electronic the method through which you locate and apply for our grants.  Now, for many Federal grants -- including Service Area Competitions for health centers -- you can do the whole thing online at www.grants.gov.
 
If you’re not doing so already, I encourage all of you to locate grant opportunities for Federal funds at the grants.gov site.  All Federal grant programs currently list information on their grants there.
 
Agencies are now phasing in the ability to apply online for these grants at grants.gov.  When fully operable, grants.gov will be the single electronic portal for organizations to send their funding applications.
 
At that point, grants.gov will bring several benefits:
 

• It will simplify the grant application process and reduce paperwork.
• By standardizing the process, applicants no longer will be forced to learn multiple agency- or program-specific processes and systems.
• And it will give users the ability to download an application package and complete it offline, whenever you want.   When the application is complete and ready for submission, you connect to the Internet and click the submit button.  Task completed!

We feel confident that grants.gov will make your life – and ours – much smoother in the near future, and I strongly encourage you to become familiar with its many tools.
 
In closing, I extend to all of you my sincere gratitude for your dedication to the cause of improving the health of the American people.   I also want to thank Michelle, whom you’ll hear from next, and her staff for working so hard to pull this meeting together. 
 
Meetings like these are wonderful opportunities to share information and resources in a way that expands understanding and increases the potential for networking among all our partners.  Health center grantees, I encourage you to seek out not only your health center peers, but the other primary health care grantees I mentioned at the beginning of my remarks – the Black Lung, Native Hawaiian and Radiation Exposure grantees.
  
Remember that partnerships make it possible to serve more people, to serve them better and to control costs.

I am honored that all of you are HRSA’s partners in expanding access to quality health care to all.  I thank you for your commitment to primary health care and to serving the underserved.   You continue a proud tradition of service to America.
 
Thank you for listening.