Dr. Vivian Lee, Testimony before HHS Subcommittee
By: Joe Borgenicht | Mar 25, 2014 1:00 AM
Dr. Vivian Lee, Senior Vice President for Health Sciences at the University of Utah, Dean of the University's School of Medicine, and CEO of University of Utah Health Care testified today about the unique relationship between academic medical centers and federal funding streams from HHS before the Subcommittee on Labor, Health and Human Services,Education and Related Agencies Committee on Appropriations for United States House of Representatives. Specifically, her testimony highlighted actress Angelina Jolie's preventive mastectomy and the importance of the National Institutes of Health and the cutting edge research that is transforming therapeutics being developed the University of Utah and the Utah Genome Project. She also stressed the importance of Health Professions Funding, and Title VII and Title VIII funds to academic medical centers. Her testimony will described how several federal funding streams throughout HHS allow the University of Utah to fulfill its research, academic, and clinical care missions.
A transcript can be found below.
Statement by Vivian S. Lee, M.D., Ph.D., M.B.A., Senior Vice President for Health Sciences, Dean of the School of Medicine, and CEO of University of Utah Health Care on FY 2015 Appropriations for the Department of Health and Human Services submitted to the Subcommittee on Labor, Health and Human Services, Education and Related Agencies Committee on Appropriations – United States House of Representatives March 25, 2014
Good morning, Chairman Kingston, Ranking Member DeLauro, and distinguished Members of the Subcommittee. Thank you for allowing me to testify. Today I would like to talk with you about the future of academic medical centers, transparency and accountability in government funding, and Angelina Jolie.
Academic Medical Centers: The Future of Health Care
Together we stand at a critical juncture in the history of health care, and University hospitals and medical centers like ours at the University of Utah are committed to securing the health of our nation through the delivery of high quality care and effective treatments. And we all know these are made possible through our diligent investments in research and education. Research and education are critical and yet the ways in which they are funded are clearly not sustainable. Historically, clinical revenues have been used to subsidize research and education shortfalls. But now, this model is no longer possible, as we all try to bend that cost curve-- clinical reimbursement rates continue to fall and uncompensated care costs continue to rise, all challenging us to do more with less. Funding for research and education is at a tipping point.
What are some examples of the cross subsidizations? Due to the high costs of biomedical research, academic medical centers spend an additional 25-40 cents for every $1 of external research funding received. For education in Utah, our medical school covers the cost of 65% of a medical student’s education, with only 5% funded by the state and 30% by tuition. Once these students graduate and enter residency, academic medical centers still cover more than a quarter of the costs of our residents’ and fellows’ training. At the same time, we serve as the safety net for many low-income and uninsured people, providing over $100M in charity care this year.
It is clear that this model of subsidizing research and education from clinical revenues is not sustainable, and it’s not right. To ensure the kind of transparency and accountability we want in good government, we need to provide the right funding for research to the NIH directly and the right funding for education, as in GME funding, and Title VII and VIII programs, directly.
When you make these direct investments, they yield a great return. An example is the story of Angelina Jolie and the Utah Genome Project.
Utah’s Large Families and the Utah Genome Project
Last year, Angelina Jolie, in an op-ed piece in the New York Times, shared her experience taking steps to reduce her high risk of breast cancer. Jolie’s mother had both breast and ovarian cancer, and her maternal grandmother had ovarian cancer, all diagnosed at younger-than-average ages. Through genetic testing, Jolie was found to have a mutation in the BRCA1 gene, and she writes about the measures she took to prevent the cancer from afflicting her.
What’s the Utah connection? In the early 1990’s after studying numerous Utah families, like Jolie’s where the mothers and daughters were affected by breast and ovarian cancer, researchers at the University of Utah helped to identify the BRCA1 gene, and in 1994, they sequenced the gene and created a test to determine a patient’s risk for getting the disease. This discovery has saved thousands of lives and changed how providers and patients, like Jolie, treat and prevent breast cancer worldwide.
This University of Utah discovery, and our discovery of more than 30 genes, including sudden cardiac death (long QT), the APC colon cancer gene, and dozens of other diseases, have been made possible through a unique resource, called the Utah Population Database which houses massive family genealogies connected to public health and medical records, by far the largest database of its kind in the world. Thanks to the foresight of leaders like you and scientific visionaries like Francis Collins, this is just the tip of the iceberg for genomic or personalized medicine. By using the Utah Population Database, the Utah Genome Project is finding those disease-causing genes by comparing the DNA of affected family members with those not affected by disease, in areas from autism to Alzheimer’s, from cancers to heart disease. It is a remarkably powerful tool, and as Congressman Stewart knows well, Utah’s large families have given us a great gift, a national treasure.
We respectfully request that your subcommittee fund the NIH at least $32 billion in FY 2015 to ensure that all of us and our children and their children, like Angelina Jolie, can outlive our family histories.
As we move into an era of personalized medicine, it is also important to ensure that we have the workforce to care for us as we age, and to secure a healthy future for the next generations. In Utah, Title VII and Title VIII funding is especially important. Of Utah’s 29 counties, 27 are designated as primary care Health Professional Shortage Areas. Title VII and Title VIII programs allow us to address these gaps by funding the education and training of nurses, family medicine physicians, and other health professionals. As the only federally funded programs dedicated for this purpose, these are crucial to ensuring that our communities – both rural and urban – receive the care they need. Therefore, we urge your subcommittee to provide $520 million for Titles VII and VIII in FY 2015.
In closing, we academic medical centers will work with you to ensure a healthy future for America. To do so, we need to make sure that our funding model is sustainable, transparent, and accountable. Thank you once again for the opportunity to appear before you. I welcome any questions you may have.