Initiative by top University officials likely will result in less drastic reductions than previously expected to Medicare funding for the Medical Center.
Congressional leaders have committed to cutting $270 billion from Medicare spending during the next seven years. Federal funding for Medicare, which supports graduate medical education and care for the elderly, is of great concern to academic medical centers like Duke because these centers, unlike other hospitals, carry the additional burden of training health-care providers and caring disproportionately for Medicare recipients.
Under the most extreme proposals to reduce the size of Medicare, the University would stand to lose as much as $30 million in federal funding, said Paul Vick, director of government relations for the University.
But that possibility has diminished largely as a result of efforts by President Nan Keohane and Dr. Ralph Snyderman, chancellor for health affairs. In the past several months, Keohane has met with the heads of appropriations committees in both the House and the Senate, while Snyderman led a delegation of medical school deans from North Carolina to Washington, D.C., in June to articulate their concerns to the state's representatives. Vick said that these lobbying efforts have made a difference in the way that lawmakers think about the impact of Medicare cuts on the health-care system.
"On the whole, Congress has been very receptive to the message that leaders of academic medicine have been delivering," Vick said. "What we've tried to do... [is] make the point that such cuts disproportionately put too much of a burden on a key component of the health-care system--that is, the training of quality physicians."
Snyderman said that Republican Sens. Lauch Faircloth and Jesse Helms have indicated that they will oppose any proposals that drastically reduce Medicare funding for academic medical centers. This support, Snyderman said, may be a positive sign for the future. "I'm concerned [about possible cuts] but guardedly optimistic that key people are listening," he said.
Vick said that while academic leaders have asked Congress "to act responsibly" in balancing the budget without crippling the health-care system, academic medical centers have recognized the need to take their "fair share" of cuts. During the summer, Duke Hospital announced its intention to cut the number of resident positions by 30 percent during the next four years. Residents are medical school graduates who work long, grueling hours apprenticed to doctors anywhere from four to 10 years, and their training is almost completely funded by Medicare.
"Virtually all health-care providers... are trained in one way or another in academic medical centers," Snyderman said in a June interview. "All improvements in health care have [at some point] worked their way through academic medical centers. As academic medical centers, we take care of the majority of the indigent, of the very ill, and of [those with] rare [and] chronic diseases."
Because the bill's final form is currently uncertain--President Clinton has threatened to veto any bill that drastically reduces benefits for the elderly--it will be difficult to determine the degree to which the University will be affected for at least another month.
For example, the prospect of Medicare cuts may unexpectedly engender a new financial foundation for graduate medical education. Vick said that Congressman Bill Archer, R-Texas, has proposed in the House to create a new fund that would set aside money to protect graduate medical education from funding cuts to Medicare, but the idea has so far gone nowhere.
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