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Bob Burkett
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Bobbie Greene's Files
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Withdrawal/Redaction Sheet
Clinton Library
DOCUMENT NO.
SUBJECT/TITLE
DATE
RESTRICTION
AND TYPE
001. letter
Bill Clinton and Hillary Rodham Clinton to Sally Burkett re: address
12/02/1997
P6/b(6)
[partial] (1 page)
002. note
re: Fedex account number [partial] (1 page)
n.d.
P6/b(6)
COLLECTION:
Clinton Presidential Records
First Lady's Office
Bobbie Greene
OA/Box Number: 15627
FOLDER TITLE:
Bob Burkett
2012-0872-S
rc952
RESTRICTION CODES
Presidential Records Act - [44 U.S.C. 2204(a)]
Freedom of Information Act - |5 U.S.C. 552(b)]
P1 National Security Classified Information [(a)(1) of the PRAJ
b(1) National security classified information [(b)(1) of the FOIA]
P2 Relating to the appointment to Federal office [(a)(2) of the PRA]
b(2) Release would disclose internal personnel rules and practices of
P3 Release would violate a Federal statute [(a)(3) of the PRA]
an agency [(b)(2) of the FOIA]
P4 Release would disclose trade secrets or confidential commercial or
b(3) Release would violate a Federal statute [(b)(3) of the FOIA]
financial information [(a)(4) of the PRA]
b(4) Release would disclose trade secrets or confidential or financial
P5 Release would disclose confidential advice between the President
information [(b)(4) of the FOIA]
and his advisors, or between such advisors [a)(5) of the PRA]
b(6) Release would constitute a clearly unwarranted invasion of
P6 Release would constitute a clearly unwarranted invasion of
personal privacy |(b)(6) of the FOIA)
personal privacy [(a)(6) of the PRA|
b(7) Release would disclose information compiled for law enforcement
purposes |(b)(7) of the FOIA]
C. Closed in accordance with restrictions contained in donor's deed
b(8) Release would disclose information concerning the regulation of
of gift.
financial institutions [(b)(8) of the FOIA]
PRM. Personal record misfile defined in accordance with 44 U.S.C.
b(9) Release would disclose geological or geophysical information
2201(3).
concerning wells |(b)(9) of the FOIA]
RR. Document will be reviewed upon request.
from
Harry Brown
1/8
Dear Bobbie
Hoppy New Jew!
XX.00
Hany
HOWARD GILMAN
"Art collecting might seem to be a self-gratifying but meaningless
hoarding if the collector were not sustained by the idea that he is
only the transitory custodian of treasures it is his duty to preserve.
He can be responsible to his personal pleasure only to the degree
that he is able to share it with and preserve it for others."
-Howard Gilman
1924-1998
Photo: Heinrich Kuhn Flowers, 1907-1908 Gum bichromate print/Gilman Paper Company Collection
Order of Service
Juilliard Student Quartet
Rabbi David Posner, Congregation Emanu-El
Cantor Howard Nevison, Congregation Emanu-El
Pall Bearers
Lee Coleman
Pierre Friedrichs
Marcello Guidi, The Howard Gilman Foundation
Michael Gostigian
Ken John
John Lukas, White Oak Plantation
Pat Manocchia
Anthony Moody
Sal Viviano, Gilman Paper Company
Michael Pardo
91st Psalm.
Mark Tenore
Geraldine Laybourne, Disney/ABC Cable Networks
Honorary Pall Bearers
Joseph Adams
Joseph Franchini
Pat Manocchia, La Palestra
Henry Hodges
Thom Jones
William H. Luers, Metropolitan Museum of Art
Tim Norwood
Vincent Oppecker
Harvey Lichtenstein, Brooklyn Academy of Music
Werner Hoeflich
Robert Johansen, Papermill Playhouse
Honorary Ushers
American Ballet Theatre
23rd Psalm
Juilliard Student Quartet
Krzysztof Witek, Violin
Jeffrey S. Borer, M.D., New York Hospital-C.U.M.C.
Helen Kim, Violin
Ralph Ferris, Viola
Senator Joseph Lieberman of Connecticut
Roman McKinialov, Cello
Mary Rodgers Guettel, The Juilliard School
Michael Tilson Thomas
Brahms Rhapsody in B minor, Opus79, number 1
A reception will be held for family and friends
Rabbi David Posner
from 4pm - 6pm at La Palestra, 11 West 67th Street.
Cantor Howard Nevison
Congregation Emanu-El Choir
He, Watching over Israel
Oratorio Isaiah, Psalm 121, Mendelsohn
The family and friends of Howard Gilman ask that anyone
who would like to make a donation in his memory do so to
one of the following organizations which were so important
to him during his lifetime.
American Ballet Theater
890 Broadway
New York, NY 10003-1278
American Friends of Tel Aviv University
360 Lexington Avenue
New York, 10017
Brooklyn Academy of Music
30 Lafayette Avenue
Brooklyn, NY 11217-1486
God's Love We Deliver
166 Avenue of the Americas
New York, NY 10013
Human Rights Watch
485 Fifth Avenue
New York, NY 10017-6104
International Rhino Foundation
85 East Gay Street, Ste. 603
Columbus, OH 43215
Division of Cardiovascular Pathophysiology
New York Hospital, Cornell
University Medical Center
525 East 68th Street, Room F-467
New York, NY 10021-4873
NYU Medical Center
AIDS Research/Att: Dr. Alvin Friedman-Kien
530 First Avenue, 7th Floor
New York, NY 10016
THE WHITE HOUSE
WASHINGTON
Office of the First Lady
Ph: (202) 456-6266
Fax: (202) 456-6244
To: Steve Grimes
Phone No.:
Fax No.: 714 816 6711
From:
No. of pages (including cover): r
Comments:
THE WHITE HOUSE
WASHINGTON
December 8, 1997
Mr. Mikoto Yamashina
Bandai Co., Ltd.
2-5-4 Komagata
Taito-Ku, Tokyo
Japan 111-81
Dear Mr. Yamashina:
It was with great sadness that we learned of the recent loss of Mr.
Noaharu Yamashina, the beloved and respected founder of the
Bandai Corporation. The American business community admired
Mr. Yamashina as a business leader, innovator, philanthropist and
corporate giant with a human touch. In many ways, Mr.
Yamashina was quintessentially Japanese: creative, determined and
modest. But he was also a citizen of the world who leaves it better
than he found it.
This letter is to express condolences to Mr. Yamashina's sons, the
other members of his family, and to all those touched by his
extraordinary life.
Sincerely,
Bobbie Greene
Deputy Chief of Staff
to the First Lady
Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
SUBJECT/TITLE
DATE
RESTRICTION
AND TYPE
001. letter
Bill Clinton and Hillary Rodham Clinton to Sally Burkett re: address
12/02/1997
P6/b(6)
[partial] (1 page)
COLLECTION:
Clinton Presidential Records
First Lady's Office
Bobbie Greene
OA/Box Number: 15627
FOLDER TITLE:
Bob Burkett
2012-0872-S
rc952
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)]
Freedom of Information Act - 15 U.S.C. 552(b)]
P1 National Security Classified Information [(a)(1) of the PRA]
b(1) National security classified information [(b)(1) of the FOIA]
P2 Relating to the appointment to Federal office [(a)(2) of the PRA]
b(2) Release would disclose internal personnel rules and practices of
P3 Release would violate a Federal statute [(a)(3) of the PRA|
an agency |(b)(2) of the FOIA]
P4 Release would disclose trade secrets or confidential commercial or
b(3) Release would violate a Federal statute |(b)(3) of the FOIA]
financial information [(a)(4) of the PRA]
b(4) Release would disclose trade secrets or confidential or financial
P5 Release would disclose confidential advice between the President
information [(b)(4) of the FOIA]
and his advisors, or between such advisors |a)(5) of the PRA]
b(6) Release would constitute a clearly unwarranted invasion of
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA]
personal privacy [(a)(6) of the PRA]
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) of the FOIA]
C. Closed in accordance with restrictions contained in donor's deed
b(8) Release would disclose information concerning the regulation of
of gift.
financial institutions [(b)(8) of the FOIA]
PRM. Personal record misfile defined in accordance with 44 U.S.C.
b(9) Release would disclose geological or geophysical information
2201(3).
concerning wells [(b)(9) of the FOIA]
RR. Document will be reviewed upon request.
file
THE WHITE HOUSE
WASHINGTON
December 2, 1997
Sallv Burkett
P6/(b)(6)
[001]
Dear Sally:
Happy 50th birthday! We hope your celebration
of this special occasion is filled with joy and
you are surrounded by the love and fellowship
of family and friends.
Our best wishes for a year filled with good
health and much happiness.
Sincerely,
Biu cuiten
Hillary Rodham Clinton
CC Bobbie Ducne
DEOD 100
Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
SUBJECT/TITLE
DATE
RESTRICTION
AND TYPE
002. note
re: Fedex account number [partial] (1 page)
n.d.
P6/b(6)
COLLECTION:
Clinton Presidential Records
First Lady's Office
Bobbie Greene
OA/Box Number: 15627
FOLDER TITLE:
Bob Burkett
2012-0872-S
rc952
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)]
Freedom of Information Act - [5 U.S.C. 552(b)]
P1 National Security Classified Information [(a)(1) of the PRA]
b(1) National security classified information [(b)(1) of the FOIA]
P2 Relating to the appointment to Federal office [(a)(2) of the PRAJ
b(2) Release would disclose internal personnel rules and practices of
P3 Release would violate a Federal statute [(a)(3) of the PRA]
an agency |(b)(2) of the FOIA]
P4 Release would disclose trade secrets or confidential commercial or
b(3) Release would violate a Federal statute [(b)(3) of the FOIA]
financial information |(a)(4) of the PRA
b(4) Release would disclose trade secrets or confidential or financial
P5 Release would disclose confidential advice between the President
information [(b)(4) of the FOIA]
and his advisors, or between such advisors |a)(5) of the PRA|
b(6) Release would constitute a clearly unwarranted invasion of
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA|
personal privacy |(a)(6) of the PRA
b(7) Release would disclose information compiled for law enforcement
purposes |(b)(7) of the FOIA|
C. Closed in accordance with restrictions contained in donor's deed
b(8) Release would disclose information concerning the regulation of
of gift.
financial institutions [(b)(8) of the FOIA]
PRM. Personal record misfile defined in accordance with 44 U.S.C.
b(9) Release would disclose geological or geophysical information
2201(3).
concerning wells [(b)(9) of the FOIA]
RR. Document will be reviewed upon request.
THE WHITE HOUSE
WASHINGTON
Fed Ex 3 It
Burlatt Grp.
P6/(b)(6)
[002]
To I mr. Mikoto lamashina
refax w cover
Sheet to mr.
Has Hiro
B cupology
Noa
Yamashima Family
HRC -Bunkett
Pls. Sent this m WH
December 2, 1997
letterhead fn me,
with name. my title under my
Dear
Thanks
It was with great sadness that we learned of the recent loss of Mr.
Noaharu Yamashina, the beloved and respected founder of the
The American business community admired
Bandai Corporation. Mr. Yamashina reputation as a business
leader, innovator, philanthropist and corporate giant with a
decidedly human touch was well known and deeply admired by the
x
American business community. His career, his methods and the body
of his work stand as a model for anyone of vision. In many ways,
Mr. Yamashina was quintessentially Japanese: creative, leaves determined
and modest. But he was also a citizen of the world who left it better
than he found it and whose life embodied the "eternal things" to to-)
which he was so committed.
Condolences
other
This letter is to express to Mr. Yamashina's sons, themembers Life. of his
family and to all those touched by this extraordinary man our deep
admiration for him and our profound condolences on his passing.
I ve
Sincerely,
first then need + to to Fax
($ See attached) Burkett to the ( 5eet family eatheled
They
B
DEC. - 08' 97 (MON) 12:14
TEL: 2122624108
P. 001
Post-it° Fax Note
7671
Date 12/8
d of
pages
L
To BOBBIE GREENE
From HARRY BROWN
Co/Dept.
Co.
Phone #
Phone #
212 2463300
Fax #
Fax #
GILMAN STRATEGIC DEVELOF-
Robert L. Burkett
President
December 8, 1997
Bobbie Greene
Office of the First Lady
Washington, DC
Dear Bobbie,
Here is the address:
M
Mr. Hiro Nemoto
Bandai Co., Ltd.
2-5-4 Komagata
Taito-Ku, Tokyo
Japan 111-81
They ask that you first fax it to him at 011.813.3847.503 and the,Fed Ex the
hard copy to the above address.
Many thanks,
Harry Harry Brown
III West 30th Street, New York, NY 10020 212-246-3300 FAX 212-262-4108
THE WHITE HOUSE
WASHINGTON
Office of the First Lady
Ph: (202) 456-6266
Fax: (202) 456-6244
To: Mr. Hiro Nemoto
Phone No.:
Fax No.:
From: # Bobbie Greene
No. of pages (including cover): 2
Comments:
THE WHITE HOUSE
WASHINGTON
Office of the First Lady
Ph: (202) 456-6266
Fax: (202) 456-6244
To: Harry
Phone No.:
Fax No.: 212 262 4108
From: NOA MEYER
No. of pages (including cover): 2
Comments:
THE WHITE HOUSE
WASHINGTON
Office of the First Lady
Ph: (202) 456-6266
Fax: (202) 456-6244
To: Hiro Nemoto
Phone No.:
Fax No.:
From: Noa Meyer
No. of pages (including cover):
Comments: My apologies about the mistaken
letter Sent previously. wewere Workery
off faulty information
Roberta W. Greene
10/17/97 07:45:06 PM
Record Type:
Record
To:
Nancy V. Hernreich/WHO/EOP
CC:
Rebecca A. Cameron/WHO/EOP
Subject:
One of our supporters has asked us to get an autographed picture of the POTUS for a very close
friend who is a big fan of the presidents and a major autograph collector. Would you be so kind as
to have him inscribe a photo, "With best wishes to Henry Dennis". Please let me know if there's a
problem with this.
Thanks.
Bobbie
-
file -
" Bub
" Bob Binkett"
OCT. 17'97 (FRI) 11:09
TEL: 2122624108
10/17/97
P. 001
Memo sent to
Nancy Hernreich
w CC to Reforca
GILMAN STRATEGIC DEVELOPMENT INC.
Cameron W request
Robert L. Burkett
Pressient
that they let me
know if there's a
BOBBIE GREENE
problems.
TO:
FROM:
BOB BURKETT E. HARRYB.
DATE:
17 OCTOBER '97
# Pages (Including cover sheet):
I
MESSAGE:
Dear Bobbie,
Many thanks for doing this if at all possible. If the
President could simply sign a picture of himself with
best wishes to Henry Dennis it would be wonderful. He
apparently has a large collection of such photographs
from politicians he voted for and greatly admires and
it would be great if Bob could get this for him. Time
is not an issue but please keep me posted.
Thanks again,
Dany.
If there are any problems with this transmission, please call Harry Brown
at 212.246.3300, ext. 286. Thank you.
111 West 50th Street, New York, NY 10020 212-246-3300 FAX 212-262-4108
University,
Deaths
HOWARD GILMAN
his friend, dancer Mikhail Baryshni-
He is survived by his mother,
in Brook
Businessman
kov.
Sylvia Gilman of New York.
He collected photographs, which
A. HARONA
Howard Gilman, 73, a paper mag-
were exhibited at the Metropolitan
RICHARD ELMAN
Pilot
nate and a benefactor of dance, en-
Museum of Art in New York and the
Writer
A.
dangered species and the Democrat-
ic Party. died Jan. 3 in Florida of a
National Gallery of Art in Washing-
Richard Elman, 63. a novelist and
pioneer was
heart attack.
ton. In October, the Metropolitan
poet who for many years taught at
to fly
Mr. Gilman was chairman and
Museum of Art opened the Howard
the Bennington College Summer
in Palm
Gilman Gallery.
chief executive of Gilman Paper Co.,
Writing Workshops in Vermont, died
death washing
Mr. Gilman also created White
the country's largest privately held
of lung cancer Dec. 31 in New York.
Mr. Brown
Oak Plantation, in Yulee, Fla., for the
Mr. Elman wrote more than 20
World Warring
paper, company.
protection and reproduction of en-
books, including three volumes of
serve with
The St. Marys, Ga., firm was
dangered species. The center is
France. Health
founded in 1884 by Mr. Gilman's
poetry. At his death, he had three
home to 60 species of animals, in-
Tacoma, WITH
grandfather, but it was the younger
cluding rhinos and cheetahs.
books awaiting publication. includ-
he became
Gilman who steered it to the top after
He established the Howard Gil-
ing "Namedropping," a volume of
Lockheed
taking over in 1973.
reflections about his life and work.
man Foundation in 1981 to support
and he helpers
In addition to his accomplish-
the arts and conservation as well as
The book is to be released in the
tors as Ame
ments in business, Mr. Gilman was
medical research into HIV/AIDS
spring.
In 1930,
known for his philanthropic enter-
and cardiology. The foundation will
Mr. Elman also taught at Colum-
trans-Pacifica
prises and as a benefactor of the arts.
take over management of Mr. Gil-
bia University, Sarah Lawrence Col-
coma, using
He supported numerous dance com-
man's assets, including the paper
lege, the University of Michigan, the
plane. He
panies, including the American Bal-
company, said John Lukas, general
University of Pennsylvania and No-
flight because
let Theatre in New York. In 1989, he
manager of White Oak Plantation.
tre Dame University.
countered
set up the White Oak Dance Project
Mr. Gilman also was a major donor
Among his novels was "Tar
ing beetles
as a place where choreographers
to the Democratic Party and was
Beach," published in 1991, a comic
conditions a
could collaborate and as a venue for
active in party politics.
tale of an 8-year-old boy growing up
He was force
BOBBIE GREENE
Bab 12/29/97 Fear -
So much thanks
for SO little - -
Brainers you's
any other no
like from me ?
having a blast
Hope Jame
in
Happy new
year, Rear friend
Love,
BAN
DAI
Makoto Yamashina
Chairman
December 17, 1997
Bobbic Green
Deputy Chief of Staff
to the First Lady
Thank you for your very thoughtful letter of condolence. I know my father would have felt highly
honored by your kind words. Your message. which was read out at the funeral service on December
11, was a source of comfort and encouragement for all of us.
I intend to continue in my father's footsteps, which lead me and Bandai in the direction of greater
engagement with American society and the world at large. Wc hope you will continue to favor us with
your support and friendship in the future.
Yours sincerely,
Makoto Yamashina
Chairman
Bandai Co., Ltd.
Record Type:
Record
To:
CC:
Subject: Here is the Draft.
I tried to phone but no one in OFL answered. I will try again if I don't hear from you.
Thanks for the good draft. I've made a few suggestions to acknowledge his public contribution.
Hope that's OK.
Forwarded by Roberta W. Greene/WHO/EOP on 01/05/98 11:43 AM
Eugenie Bisulco
01/05/98 10:28:53 AM
Record Type:
Record
To:
Roberta W. Greene/WHO/EOP
CC:
Subject: Here is the Draft.
I tried to phone but no one in OFL answered. I will try again if I-don't hear from you.
Dear Friends and Family of Howard Gilman:
Hillary joins me in expressing our deep shock and sadness at
Howard's death. We wish we could be there with all of you who
have gathered to pay tribute to this remarkable, public-spirited
man. Howard's vision and commitment to the arts, to medical
research and other humanitarian concerns have enriched our
country and its citizens. And his generosity and kindness have
touched the lives of so many people, including ours. He will be
greatly missed.
Sincerely,
THE WHITE HOUSE
WASHINGTON
Office of the First Lady
Ph: (202) 456-6266
Fax: (202) 456-6244
To: Chris Jennings
Phone No.: 456-5560
Fax No.: 456 - 2557
From: Robbie Sceene
No. of pages (including cover):
Comments: Thanks fr your willinghes
to speak with Dr.
know, he's Chain of Dept of
on 2/4 at 11Am. As of Xhink ym
Madicine and wants to Years thereed for
@ children's Hospital in
Spaduate medical education En
childrens hospitals
theers,
Pls. file
"Burkett"
Bobbie
Thing
Robbie
-
JAN. - 14' 98 (WED) 13:07
TEL: 2122624108
P..002
GILMAN STRATEGIC DEVELOPMENT INC
Robert L. Burkett
President
January 14, 1998
Ms. Bobbie Greene
Office of the First Lady
Old Executive Office Building
Washington, DC
20501
Dear Bobbie:
As you know Phil Puzo is a member of the Board of the Pediatric AIDS
Foundation. He has forwarded the attached material to me and asked if I can
assist him in scheduling a meeting with Melanne Verveer. I'd be grateful if
you would review it and get back to me as to whether or not we could secure
such a meeting.
I send you many thanks, as always, for your help.
Sincerely,
Robert Burkett
RLB/hb/att.
111 West 50th Street, New York, NY 10020 212-246-3300 FAX 212-262-4108
JAN. - 14'98 (WED) 13:07
TEL: 2122624108
P. 003
JAN-12-1998 13:21
P.02
Congress of the United States
Mashington. DC 20515
December 17, 1997
The Honorable William J. Clinton
The White House
Washington, DC 20500-0005
Dear Mr. President
We are writing to urge your assistance in providing needed aid for the
nation's independent children's hospitals which currently have little or no support
at all for their graduate medical education programs to train medical residents.
Currently, Medicare is the only source of federal funds which contributes to
the costs of graduate medical education Increasingly fewer states pay for such
education through Medicaid, as the program moves to managed care. No hospital,
in this current competitive marketplace, can afford to shift these costs to other
payers.
Independent children's hospitals have only a very few Medicare patients,
based on Medicare's coverage of children with end-stage kidney disease. The
competitive disadvantage facing these hospitals is stark and unacceptable. In 1996,
Medicare provided an average of $77,000 per resident to all teaching hospitals,
compared to an average of $230 per resident at independent children's hospitals.
We strongly support the federal government's commitment to graduate
medical education through Medicare. But we also strongly support steps to provide
fair support for such education by children's hospitals.
Communities across the country are devoting major efforts to build and
sustain health care institutions to theet the needs of children. We must not,
inadvertently. contribute to their demise. There are less than 60 of these
independent children's hospitals nationwide. Yet, they train 25 percent of all general
pediatricians and the majority of all pediatric specialists. Their academic mission is
essential to advances in research, innovations in technology, and specialty care to
benefit children.
i 6 j
JAN. - 14':98 (WED) 13:08
TEL: 2122624108
P. 004
JAN-12-1998 13:22
P.03
We estimate that $300 million a year in federal aid would provide
independent children's hospitals with support for graduate medical education
commensurate with that provided to all other teaching hospitals. We urge you to
include this assistance in your budget for FY 1999, so that we can do all we can to
keep this inequitable gap from growing wider.
With our respect and appreciation
Sincerely
Patty nunay
Vdw rd M. Kennedy
Patty Minray
Christopher J. Dodd
PunersWillstone Paul Wellstone
Die Dn
Feinstein
Richard J. Durbin
Max Cleland
Max Cleland
Santorum Subtom
Heavy & Waremen
Henry A. Waxman
John Dingell
JAN. 14'98 (WED) 13:08
P. 005
Dr.
JAN-12-1998 13:22
617/355-6433 TEL: 2122624108 7681
P.04
Longwood Avenue
P.330
Boston. MA0205
Phone:
Sue
Partnl
David S. Weiner
Presidem
Children's Hospital
November 26, 1997
Out after 3pm Wed
back Mm 9th
Mrs. Hillary Rodham Clinton
The White House
Washington, D.C. 20500
Dear Mrs. Clinton:
We are writing to ask your help and the Administration's leadership on an
issue that is critically important to the future of our nation's children's hospitals.
Increasingly, we have little to no funding sources for Graduate Medical
Education (GME). This presents a substantial problem not only for our
hospital. but also for pediatric medical education.
About 60 children's hospitals nationwide are freestanding. Because we see
few Medicare patients, we receive virtually no Medicare GME--the only
significant source of GME funding in today's market. Yet children's hospitals
train 25 percent of all pediatricians and the great majority of pediatric
specialists, although they make up less than one percent of all U.S. hospitals.
The rapid growth of market competition is making it increasingly difficult for
teaching hospitals to fulfill their teaching missions while maintaining their
competitive financial viability. This problem is especially severe for children's
hospitals such as ours because of our payor mix, As a oediatric hospital with
few Medicare patients, we receive virtually no Medicare GME payments As
the market moves to managed care. private payers are refusing to pay for the
costs of GME. leaving Medicare as the only reliable GME payor Teaching
hospital, on average, receive $77,000 per resident per year through Medicare.
Children's Hospital, Boston receives approximately $600. If we were to
receive the national reimbursement for each of our 250 full time equivalent
resident positions. our revenue would increase by $19 million. As you can
see, this issue has enormous implications for our continued financial viability,
even in the near term.
JAN. 14'.98 (WED) 13:08
TEL: 2122624108
P. 006
JAN-12-1998 13:22
P.05
Mrs. Hillary Rodham Clinton
Page 2
November 26, 1997
We are facing a considerable dilemma. Our academic mission is interrelated
with our level of excellence in patient care and research. Our financial health
is essential to our ability to care for low-income children and often to serve as
the only resource for certain critical and specialized services. To solve this
dilemma, we must find a solution for funding GME.
For the past few years, we hoped that a solution for funding GME would be
possible through some broader-based financing mechanism. Now. with the
Bipartisan Commission on the Future of Medicare and MedPAC tasked with
reviewing such reform, a children's hospital solution under overall GME reform
appears unlikely in the near future. That is why Children's Hospital of Boston
is joining with the National Association of Children's Hospitals (NACH) in
asking that the Administration include some short-term, capped source of
federal funds for GME for freestanding children's hospitals in its fiscal 1999
budget.
We have supported the Clinton Administration in its efforts to advance the
health of children. in addition, we know that you, in particular. understand and
appreciate the contribution that children's hospitals make to the health of all of
our children, As both the center of excellence and safety net provider for the
children we serve. we train health professionals and provide breakthroughs in
science, treatment. and technology for all children.
The Administration's leadership on children's hospital GME can make a
substantial difference to our future.
Very truly yours,
Warl David S. Weiner
Philip A. Pizzo, M.D.
President
Physician-in-Chief
Chair, Department of Medicine
JAN. (WED) 13:08
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National Association of
Children's Hospitals
FEDERAL GRADUATE MEDICAL EDUCATION (GME) SUPPORT
NEEDED FOR CHILDREN'S TEACHING HOSPITALS
WITH THEIR OWN PROVIDER NUMBERS
N.A.C.H. supports efforts to provide commensurate federal GME support to children's
teaching hospitals with their own provider numbers. Although they train 5.4% of all
residents. including 25% of pediatricians and the majority of pediatric subspecialists,
these hospitals receive almost до federal funds for their training. Yet. teaching
hospitals. on average, receive $77,000 per resident through Medicare.
Children's hospitals perform three vital roles in meeting children's health care needs:
Pediatric Clinical Care They deliver primary through terriary care 9 the children of their
communities, serving 24 esfory net providers for low-incose children. essential providers for
children who need critical care. and regional centers for children who need specialty care.
Provider Training They are major reaching hospitals. providing CMB for pediatric residents. as
well as other residents requiring pediatric rotations. along with other health professionals.
Curting Edge Research They serve as centers for research. including basic biomedical and
clinical research, 25 well 28 health services research.
Throughthese three roles. children's hospitals have become centers of excellence that lead the way in
advancements in pediatric care and provider training. benefitting all children's health.
THE NEED FOR GME SUPPORT The rapid growth of market competition makes AL increasingly difficult
for all teaching hospitals 10 fulfill their teaching missions while maintaining their competitive and
financial viability Bur this problem is especially severe for the small number of children's hospitals
essential to the training of the next generation of peduatric providers.
Few Hospitals Fewer than GO children's reaching hospitals We for Medicare payment using theu
own provider number. mstead of sharing a number with a hospital for adults. They are virtually tbc
only teaching hospitals in the nation that do not benefit from Medicare GME payments. (Institutions
that cambine adult and children's hospitals under one provider number count all of their residents
to qualify for Medicare GME.
Fee Medicare Patients As they move to managed care. private payers and state Medicaid
programs are declining to pay for the costs of GME. Increasingly, Medicare is the only reliable
GME payer Since they serve only children children's teaching hospitals see virtually no
Medicare patients. creept the low children with end stage renal dialysis.
Minimal Medicare GME Funding In 1996. children I teaching hospitals wib separate provider
numbers trained 5.4% of all residents. yes received only 0 06% of Medicare GME funds. Medicare
GME funding covers about 40% of GME costs of 2 teaching hospital. on average about $77,000
per resident in direct and indirect medical education payments. Children's hospitals with their
own provider numbers received JUST 8230 per resident.
4111 Wyrhs Yest. Alexandria 11 2231-1
... Allibane of the Named Association of
(703) 684-1355 Fax (7031 GHI 1989
Children's Hospitals & Roberted Instructions
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Essential Pediatric GME Programs Although often smaller chan cheir adult
counterparts. these children $ hospitals. on average. have the same size teaching
programs. They train a quarter of all pediatricians and more than half of all pediacesc
subspecialists. some of which are in short supply
POTENTIAL SOLUTIONS Children's hospitals join all teaching hospitals in the behef that all
payers should support their fait share of direct and indurect CME costs. Mechanisms to provide
broader based. assured support - beyond Medicare - must be developed. However. in the
absence of all-payer funding, incremental steps are essential to provide children's hospitals and
their own provider numbers a level of federal GME funding commensurate to what other
teaching hospitals receive.
1995 Wave and Means Proposal In its FY 1996 budget reconcilistion БШ, the House
approved a Ways and Means Committee proposal to create a new GME trust fund. using
both Medicare and general revenue dollars The committee recognized that the use of
non-Medicare dollars could provide a pool of funds from which children's reaching
hospitals could receive GME support.
Commensurate Support Needed Now Whether through such 2 GME trust fund or
through another incremental approach that provides non-Medicare funds to children's
teaching hospitals wich their own provider numbers. commensurate federal support for
these hospitals is needed now.
A FEASIBLE APPROACH The Learn Group, working with the National Association of Children's
Hospitals, has developed an illustrative methodology by which such commensurate. federal GMP
support could be provided.
DME and IME The methodology would provide direct (resident and faculty
compensation) and indirect (added patient care costs associated with teaching and more
complex cars) GME payments to cligible children's hospitals.
Commensturate Amount The amount would be commensurate on average, with
Medicare GME payments 9 other teaching hospitals. The methodology would mirror
Medicare's and change as Medicare changes.
Assumptions In determining the commensurate amount, the average Medicare share of
inpatient days IN teaching hospitals are used in the Medicare direct medical education
(DME) payment formula. The ratio of Medicare DRG payments to total discharges in
teaching hospitals are used in the indirect education (IME) formula.
Actual Hospital Data Actual hospital data - either from the hospital cost report
information system (HCRIS) files or from individual children's hospitals - was used to
determine each hospital's number of residents.
Results While only one approach, Lewin's illustrative methodology would result in
children's hospitals with their own provider numbers receiving almost the same share of
federal GME funds 29 the share of resident training they provide Training about 5.4%
of all PTE hospital residents. these children's hospitals would receive. on average. 4.3%
of all DME funds and 5.4% of all IME funds under a new trust fund.
Estimated Cost The estimated COSL of pronding such commensurate support. using
this methodology. would be sbout 8327 million anqually in 1996 dollars. in that year.
Medicare's total GME payments to reaching hospitals were over " billion.
Lewin's methodology demonstrates a feasible mechanism for providing commensurate
federal support to children's teaching hospitals with their own provider numbers.