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Dear Faculty and Staff: As an integral part of our institution's success, you know quite well the Medical University of South Carolina's commitment to providing excellent and advanced patient care, fostering the growth of new medical knowledge through research, and offering superior educational opportunities to the physicians of tomorrow.  In order to continue these endeavors, I need your help in addressing a public policy matter of concern to each of us, which also affects every hospital in the United States.   In the Federal Balanced Budget Act of 1997 (BBA), Congress reduced Medicare reimbursements in a number of domains. Physicians and hospitals are slated to absorb 2/3 of the projected Medicare savings.  While all hospitals are impacted, teaching hospitals are particularly adversely effected. Major teaching hospitals nationwide account for only 6 percent of all hospitals, but we provide 44 percent of the hospital care to the un-insured and train 75 percent of all residents. We house 41 percent of regional trauma centers, 70 percent of burn units, and more than half of all pediatric intensive care units, and teaching hospitals perform the vast majority of ALL clinical research done in hospitals. But, we cannot continue to provide all this, at the level of excellence that our community has the right to expect, if Medicare support continues to be cut.  During the first three years (1998-2000) the effect of the BBA (both Medicaid and Medicare) at MUSC was $34 million. It is anticipated that the impact for the remaining two years (with no changes) will be approximately $34 million more, for a grand total of $68 million.  The impact of Medicare alone at MUSC is $21 million for the first three years (1998-2000) and an additional $20 million for the last two years for a grand total of $41 million. These cutbacks don't just threaten MUSC and our community, but the health community as a whole. Putting our teaching hospitals in jeopardy also puts the future of American medicine at risk. Physician and Senator Bill Frist (R-Tenn.), well respected by his colleagues for his perspective on health issues, recently joined as a co-sponsor to Sen. Daniel Patrick Moynihan's (D-NY) and Rep. Charles Rangel's (D-NY) legislation that would further halt BBA cuts to the Medicare indirect medical education adjustment. The bill now has 22 co-sponsors, including five republicans.    However, others in Congress still need to be persuaded of the real risk to vulnerable populations if the BBA mandates are carried out. It is for this reason that I write to ask you to contact your congressional representatives with these concerns. Knowing how busy you are, we've tried to make it easy for you to do so.   By using a web site created for this purpose by the Association of American Medical Colleges, <http://medicare.aamc.org>, you can follow a simple procedure and personalize a prepared letter. The site will inform you of the correct address for those whom you select to send your letter to, either electronically, by fax or mail. The content of the prepared letter is focused on the impact of BBA cuts on teaching hospitals; you may expand the focus of the letter by adding your personal experiences and concerns.  If it is convenient, we would appreciate your sending a copy of your communication to us at the Office of Development, 268 Calhoun Street, P.O. Box 250182, Charleston, S.C. 29424, Attention - Jennifer Witt or by e-mail at wittj@MUSC.edu. Thank you for your help. While teaching hospitals have a particular interest in advocating for BBA corrections, the compelling reason to speak up at this time is on behalf of the patients whose care may be compromised. Balancing the budget is a great concern to the American people, but to do so at the expense of teaching hospitals is going too far.  I hope you will join me in this effort. Sincerely, Dr. R. Layton McCurdy Vice President for Medical Affairs Dean, College of Medicine