April 15, 2009

New Legislation Would Increase Funds for Bradley Residency Program

Whitehouse/Kennedy Bill Closes Loophole Excluding Children’s Psychiatric Hospitals from Graduate Medical Education Payments

Providence, RI – U.S. Senator Sheldon Whitehouse (D-RI) and U.S. Congressman Patrick Kennedy (D-RI) are introducing legislation to help Bradley Hospital get its fair share of federal funding designated for teaching hospitals.

Bradley is one of the few children’s psychiatric hospitals that trains physicians in residencies in child and adolescent psychiatry, pediatrics, and general psychiatry. Most pediatric teaching hospitals receive payments to cover the extra costs associated with taking on residents, but current law excludes Bradley and other children’s hospitals that focus on psychiatric care.

During a roundtable discussion with Bradley residents and medical faculty today, Whitehouse announced legislation to close that loophole. If enacted, the Children’s Hospitals Education Equity Act could provide hundreds of thousands of federal funding to support Bradley’s residency programs. Kennedy will introduce companion legislation in the House of Representatives.

“Teaching hospitals offer new doctors invaluable experience working with patients, and the federal government has long recognized that additional funding helps make these residency programs possible. At a time when we’re facing a shortage of psychiatrists trained to work with children and young people, we can’t afford to let programs like Bradley’s fall through the cracks,” Whitehouse said.

“I’m proud to be introducing legislation to ensure that children’s psychiatric hospitals are eligible for Graduate Medical Education payments through the Children’s Hospital pool, and specifically, that would help children in Rhode Island get the services they need. Our nation is experiencing a critical shortage of child and adolescent psychiatrists, and we need to take steps to increase the pool of trained child psychiatrists so that our nation’s children can get the services they need. This bill aims to increase the supply of child and adolescent psychiatrists, thereby increasing both access to services and the quality of the services provided to our nation’s children,” said Kennedy.

Health care providers trained in child psychiatry are in severe demand across the country. According to the Annapolis Coalition’s 2007 Action Plan on Behavioral Health Workforce Development, citing a report by the American Academy of Child and Adolescent Psychiatry [AACAP] Task Force, “the federal government has projected the need for 12,624 child and adolescent psychiatrists by 2020, far exceeding the projected supply of 8,312. Currently there are only 6,300 such psychiatrists nationwide, and relatively few are located in rural and low-income areas.”

Bradley trains 10 psychiatry residents per year through a partnership with the Hasbro Children’s Hospital and the Alpert Medical School at Brown University. The hospital supports a residency program in child and adolescent psychiatry; a “Triple Board” program that trains residents in pediatrics, general psychiatry, and child and adolescent psychiatry; and postdoctoral fellowships in clinical psychology and a National Institutes of Health-funded research training program. According to its web site, Bradley is “one of only four hospital-based programs in the United States that is affiliated with a medical school and that specializes in serving children with both psychiatric disorders and developmental disabilities.”

Most teaching hospitals receive Medicare funds called graduate medical education (GME) payments to cover the expense of educating residents, including time attending doctors spend training residents, space and other administrative costs, and equipment use. Children’s hospitals, however, which serve few or no Medicare beneficiaries, receive their GME payments from a separate pool called the Children’s Hospitals Graduate Medical Education Payment Program (CHGME). This pool was created in 1999 and includes roughly 75 hospitals. In Fiscal Year 2008, $301.6 million was available for CHGME payments.

To qualify for CHGME, hospitals must meet the Social Security Act’s definition of a “children’s hospital,” which is “a hospital whose inpatients are predominantly individuals under 18 years of age,” among other qualifications. For years, however, Bradley has been unable to qualify for CHGME payments because it is licensed as a psychiatric hospital, and thus did not fit the description of a children’s hospital.

The Children’s Hospitals Education Equity Act would expand the definition of a “children’s hospital” to include “a freestanding psychiatric hospital with 90 percent or more inpatients under the age of 18, that has its own Medicare provider number as of December 6, 1999, and that has an accredited residency program.” While specific appropriations for the CHGME fund vary from year to year, Bradley has estimated that if it had been eligible for these payments in Fiscal Year 2008, it could have received as much as $390,000 in additional funds.

“We are grateful that Senator Whitehouse and Congressman Kennedy have taken the lead to help correct this glaring example of unintentional but serious stigmatizing of children with psychiatric disorders,” said Gregory K. Fritz, M.D., Academic Director at Bradley Hospital. “Freestanding children’s psychiatric hospitals with a major commitment to residency education, like Bradley, will no longer be ‘second class citizens’ in the world of academic medicine. We will use the GME monies to enhance our training programs in an effort to increase the access to high quality children’s mental health services, both locally and nationwide.”

The bill has been endorsed by the American Academy of Child & Adolescent Psychiatry, the Association for Behavioral Health and Wellness, the National Alliance on Mental Illness, the National Association for Children’s Behavioral Health, and the National Association of Psychiatric Health Systems.


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Meaghan McCabe, (202) 224-2921