June 1, 2005
Washington, D.C.

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It is wonderful to be here with all of you today for this historic first conference of HRSA’s Health Professions grantees.
 
I am told that 1,300 grantees are in attendance.  In thinking about this conference, it occurred to me that we at HRSA know, sitting in our catbird seat, who all of our health professions grantees are, but that you in the audience may not know the other grantees or what they do.
 
So let me tell you about the partners that HRSA supports through our health professions programs.  We have here today:
 

• Students and faculty;
• Medical and health care institutions; and
• State governments and professional associations – all friends of HRSA.

Students and the faculty that teach them are a major focus of our health professions programs.
 
Students, of course,   because we need to make sure that we have enough students entering the health professions pipeline to meet projected future demand for their services.  And HRSA has several “pipeline” programs, such as Kids Into Health Careers and the Health Careers Opportunities program.
 
We need a diverse student body, so that as health professionals they can respond more fully to the needs of America's ever more diverse population.
 
We need them to work in medically underserved, geographically dispersed areas.
 
And we need them to be culturally competent in the services they provide.
 
HRSA’s health professions programs also support institutions.
 
We support institutions of higher learning where the faculty work and the students learn.  We support stand-alone children’s hospitals, where many of our pediatricians develop their skills.  Area Health Education Centers -- AHECs.  Public Health Training Centers and Centers of Excellence, among many others.
 
We also support institutions that serve geriatric patients – an area of huge increases -- and rural populations, where 65 million people live.
 
State governments are another important HRSA partner.  Our Health Professions grants, for example, fund state Primary Care Offices – many of which are here today.  These offices work to coordinate the various streams of resources that come into a state for primary care services for underserved populations.
 
All of you -- along with HRSA’s partners in the professional associations that represent particular professions -- are here in this room.
 
You are an interdisciplinary mix of health professionals and service providers that reflects a diversity seldom seen at a single health conference.  You help educate and train a qualified, culturally competent health workforce that is placed where needs are most severe.  On behalf of all of us at HRSA, I welcome you to Washington and thank you for your service to our country and its people.
 
At this point, before I go any further – and I have a lot to tell you about what we’re doing at HRSA -- let me talk about the elephant in the room that we all know is here.  That elephant’s name is funding – funding for health professions programs.
 
The issue with funding comes down not so much to performance as to measurable performance.  The federal government, rightfully, wants to make sure that its investments produce the result desired by the Congress that approved and the President who signed the legislation that supports us. 
 
You believe strongly that the programs you administer have value to the nation.  But belief and anecdote do not constitute persuasive evidence.
 
The prevailing evidence shows that only 20 percent of our graduates go on to work in underserved areas.  As head of this agency, I am put in a dicey situation when we are told that HRSA’s Health Professions programs should be cut because I have no data to rebut this charge.
 
For HRSA’s health center program, by contrast, an abundance of yearly performance data is collected, as is also true with our Maternal and Child Health program.  These data help us make the case in black and white that funding for health centers increases access to health care for the most underserved segments of the population.  As a result, President Bush has poured additional hundreds of millions of dollars into health centers and launched a Presidential initiative to expand the entire network of centers.
 
But the data are not there for our Health Professions programs.  We cannot prove their value. 
 
All that is about to change.
 
Later this morning, Kerry Nesseler -- whom all of you know as associate administrator of health professions at HRSA – will explain the new program performance measures, core measures, and national outcome measures that have been developed for your programs.
 
We decided that we would not put these measures in final form without hearing your views.  Kerry and her staff have built into today’s agenda several dozen breakout sessions that will explain in detail the new measures, where they’ve come from, and how they will affect you.  We urge you to participate in these sessions and to make your views known to the HRSA staff.  They will take down your comments and we will go through another edit or two before the measures become final.
 
That said, let me thank the 50 or so experts and stakeholders who have worked with HRSA staff over the last two years in the BHPr Partnership Forum to refine the performance measures and outcomes.  These partners have truly done the programs and the nation a great service and I want to personally express my gratitude to all of the Forum contributors for their work.  Forum members, please stand to be recognized and thanked by all.
 
The importance of these new performance measures to Health Professions programs can hardly be overemphasized.  They will allow us to tell a richer story of the link between the education and training HRSA grants pay for and the federal government’s efforts to serve the underserved and reduce health disparities.
 
HRSA’s mission is to improve access to health care for Americans who are underserved.  So we must do all we can to make sure that the people who train to enter health professions thanks to HRSA grants take jobs that further our mission.
 
These new performance measures will help HRSA make the case that work of our Health Professions grantees move the agency closer to our goal of assuring comprehensive, culturally competent, quality health care for all Americans.
 
I’m sure many of you know that HRSA is now more than halfway through the President’s health center expansion initiative I mentioned earlier.  That initiative will create or expand 1,200 health center sites and serve an additional 6.1 million patients annually by the end of 2006. 
 
The expansion remains a priority for the President because he knows – thanks to the data collection I mentioned – that health centers work for America.  In 2004, the health center system served an estimated 13.2 million people – about 3 million more than in 2001 – at about 3,700 service delivery sites, an increase of more than 600 sites since 2001.  In 2005, we will fund 153 new or expanded health center sites and serve about 14 million patients.
 
The President’s FY 2006 budget will increase funds for health centers by $303 million.  Of those funds, $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 $24 million in the FY 2006 request for health centers will be used to develop new health center sites in 40 of the Nation’s poorest counties, with planning grants in 25 other high-poverty counties.
 
An expansion of this size, of course, provides great opportunities for health care professionals.  In fact, at the same time President Bush launched his health center growth 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.
 
Even though we are a bit past midway in the health center expansion, our need for health care professionals to staff the new health center sites remains strong.
 
At the beginning of the 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.
 
The typical health center has 25 clinicians.  About 20 are physicians, nurse practitioners, physician assistant, certified nurse midwives, and nurses.  The other five are dentists, mental health and substance abuse specialists and other professionals, such as podiatrists, optometrists and pharmacists.
 
As I just mentioned, hundreds of more grants will be awarded this year and the next as we approach the President’s goals.  We anticipate openings for thousands of health professionals in the new and expanded sites.
 
To those of you who may be considering an option to serve America by providing primary and preventive care to people who most need our help, I invite you to look at the opportunities available at health centers today and in the future.
 
Additionally, we strongly encourage AHECs to link up with health centers so that health centers may 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.
 
We decided early on to increase access to oral health care as a central element of the overall health center expansion.
 
HRSA, of course, has long been a source of federal financial support for oral health professionals.  We have ongoing grantee programs for Residencies in General and Pediatric Dentistry and we have Residency Training in Dental Public Health that helps train several hundred dentists annually.
 
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 Steve Smith’s leadership 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.  HRSA’s 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.”
 
We believe that oral health – along with mental health – is an integral part of comprehensive primary and preventive care.  We need to see patients in their entirety:  their brains and their mouths are inseparable from their body.  They are component parts of a single entity, and we must treat them that way.  We must treat the whole person.
 
We have worked with Surgeon General Rich Carmona and other HHS components 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.
 
In 2003, the last year for which we have complete data, dental encounters at health centers reached almost 4.5 million, a rise of 38 percent since 2001.  That is an impressive increase in just two years.   Our compilation of 2004 statistics, with almost all health centers reporting, shows that dental encounters at health centers last year exceeded 5 million.  More great news.

We’re going to keep that figure rising in FY 2005.  In fact, HHS Secretary Mike Leavitt will soon announce the release of $1.8 million in grants to expand oral health services or create new capacity to deliver such services at 10 health centers stretching from Alaska to North Carolina. 
 
We’ll also be putting more of an emphasis in 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 – especially for the underserved.
 
Another issue HRSA and the Department is focusing attention and resources on is the nursing shortage.  Today, the nation faces a shortage of about 150,000 nurses in our hospitals and other health care facilities.
 
As our population grows and ages and medical services advance, the need for nurses will continue to increase.  In 2000, HRSA’s National Nurses Survey predicted a shortage of about 800,000 nurses by 2020 unless strong measures were taken.  A major factor in the projected shortage was that the number of nurses giving up their licenses would outnumber those entering the profession.
 
Since then, of course, strong measures have been taken by President Bush and the Department to increase the size of the basic nursing workforce and its diversity.  From 2000 to 2005, funds for nursing programs have grown 129%, rising from $65 million to $150 million in this fiscal year.
 
The President’s 2006 budget asks for another $150 million for nursing education programs.  Within this total is an increase of $10 million to $46 million for Basic Nurse Education, Practice and Retention grants.
 
The 2006 request also provides $31 million in loan repayments and scholarships.  These funds will support about 270 nursing students who agree to serve in a facility with a critical shortage of nurses for at least two years after graduating.  The funds also will support 850 loan repayments agreements, making nurses available immediately to facilities facing nursing shortages.
 
Additionally, the budget includes a $5 million increase to $21 million for nursing workforce diversity; $42 million for advanced nursing education, and $8 million in loans for nurse faculty and support for comprehensive geriatric education.
 
Many of you may know that HRSA houses federal efforts to expand organ donation.  Two weeks ago I was in Pittsburgh for a ceremony to honor 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 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.
 
We are proud to claim some credit for that fantastic result.  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. 
 
Before I close, there is one big issue looming that will impact all of HRSA’s grantees: upcoming changes in the Medicare program to expand drug coverage for seniors.  HRSA’s sister agency, the Centers for Medicare and Medicaid Services – better known as CMS -- has the lead on the implementing the new program.
 
Under the new law, prescription drug coverage will be made available to all 43 million Medicare beneficiaries, giving them substantial help in paying for their drugs.
 
The law also gives Medicare the ability, for the first time in the program's 40-year history, to provide additional help to those elderly in greatest need – especially beneficiaries with very high prescription drug costs and people with low incomes.
 
Our primary concern is that the Medicare beneficiaries served by HRSA grantees will 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. 
 
Our goal is to help CMS implement the new drug benefit as smoothly as possible.   In coming months, large parts of the Federal government will take part in a massive education project.  We have the great fortune of having the person in charge of administering Medicare, CMS Administrator Mark McClellan, here soon to tell you more about the entire process.
 
And as we receive additional information and instructions from CMS, HRSA will do our part to help our providers and their patients understand their choices and make good decisions.
 
Let me close by urging you to spend the next two and half days advancing ways we can work together to improve health care for Americans.
 
We hope you will develop partnerships with other grantees, discuss issues of common concern, and share best practices with the other grantees you meet.
 
And we urge you to collaborate in new and inventive ways.  In particular, I want you to think about ways to reach beyond the normal recruits you welcome into the programs you are involved in.
 
Think about how you can enroll more minorities and others who may be under-represented in your programs.
 
Think about the role distance learning can play in reaching those who may be under-represented.
 
And consider, too, how a person’s life experience and on-the-job skills can fit into and receive credit in competency-based learning programs.
 
HRSA, in fact, is about to announce a small initiative that links health centers with nursing schools to take advantage of these life experiences.  The aim is to encourage current health center employees – people already familiar with a primary care setting and service to the underserved – to go on and train to become nurses.
 
Finally, let me just say that I will be here today and tomorrow and I look forward to meeting and talking with as many of you as I can fit into my schedule.
 
Thank you.