HR 4463 IHCommentsClose CommentsPermalink

To amend title 38, United States Code, to improve the quality of care provided to veterans in Department of Veterans Affairs medical facilities, to encourage highly qualified doctors to serve in hard-to-fill positions in such medical facilities, and for other purposes.CommentsClose CommentsPermalink

December 12, 2007

Mr. COSTELLO (for himself, Mr. MITCHELL, Mr. SHIMKUS, and Mr. WHITFIELD) introduced the following bill; which was referred to the Committee on Veterans' Affairs, and in addition to the Committee on Oversight and Government Reform, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concernedCommentsClose CommentsPermalink

To amend title 38, United States Code, to improve the quality of care provided to veterans in Department of Veterans Affairs medical facilities, to encourage highly qualified doctors to serve in hard-to-fill positions in such medical facilities, and for other purposes.CommentsClose CommentsPermalink

Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled,CommentsClose CommentsPermalink

SECTION 1. SHORT TITLE.

This Act may be cited as the `Veterans Health Care Quality Improvement Act'.CommentsClose CommentsPermalink

SEC. 2. STANDARDS FOR APPOINTMENT AND PRACTICE OF PHYSICIANS IN DEPARTMENT OF VETERANS AFFAIRS MEDICAL FACILITIES.

(a) Standards-CommentsClose CommentsPermalink





(1) IN GENERAL- Subchapter I of chapter 74 of title 38, United States Code, is amended by inserting after section 7402 the following new section:CommentsClose CommentsPermalink

`Sec. 7402A. Appointment and practice of physicians: standards

`(a) In General- The Secretary shall, acting through the Under Secretary for Health, prescribe standards to be met by individuals in order to qualify for appointment in the Administration in the position of physician and to practice as a physician in medical facilities of the Administration. The standards shall incorporate the requirements of this section.CommentsClose CommentsPermalink





`(b) Disclosure of Certain Information Before Appointment- Each individual seeking appointment in the Administration in the position of physician shall do the following:CommentsClose CommentsPermalink





`(1) Provide the Secretary a full and complete explanation of the following:CommentsClose CommentsPermalink





`(A) Each lawsuit, civil action, or other claim (whether open or closed) brought against the individual for medical malpractice or negligence (other than a lawsuit, action, or claim closed without any judgment against or payment by or on behalf of the individual).CommentsClose CommentsPermalink





`(B) Each payment made by or on behalf of the individual to settle any lawsuit, action, or claim covered by subparagraph (A).CommentsClose CommentsPermalink





`(C) Each investigation or disciplinary action taken against the individual relating to the individual's performance as a physician.CommentsClose CommentsPermalink





`(2) Submit a written request and authorization to the State licensing board of each State in which the individual holds or has held a license to practice medicine to disclose to the Secretary any information in the records of such State on the following:CommentsClose CommentsPermalink





`(A) Each lawsuit, civil action, or other claim brought against the individual for medical malpractice or negligence covered by paragraph (1)(A) that occurred in such State.CommentsClose CommentsPermalink





`(B) Each payment made by or on behalf of the individual to settle any lawsuit, action, or claim covered by subparagraph (A).CommentsClose CommentsPermalink





`(C) Each medical malpractice judgment against the individual by the courts or administrative agencies or bodies of such State.CommentsClose CommentsPermalink





`(D) Each disciplinary action taken or under consideration against the individual by an administrative agency or body of such State.CommentsClose CommentsPermalink





`(E) Any change in the status of the license to practice medicine issued the individual by such State, including any voluntary or nondisciplinary surrendering of such license by the individual.CommentsClose CommentsPermalink





`(F) Any open investigation of the individual by an administrative agency or body of such State, or any outstanding allegation against the individual before such an administrative agency or body.CommentsClose CommentsPermalink





`(c) Disclosure of Certain Information Following Appointment- (1) Each individual appointed in the Administration in the position of physician after the date of the enactment of the Veterans Health Care Quality Improvement Act shall, as a condition of service under the appointment, disclose to the Secretary, not later than 30 days after the occurrence of such event, the following:CommentsClose CommentsPermalink





`(A) A judgment against the individual for medical malpractice or negligence.CommentsClose CommentsPermalink





`(B) A payment made by or on behalf of the individual to settle any lawsuit, action, or claim disclosed under paragraph (1) or (2) of subsection (b).CommentsClose CommentsPermalink





`(C) Any disposition of or material change in a matter disclosed under paragraph (1) or (2) of subsection (b).CommentsClose CommentsPermalink





`(2) Each individual appointed in the Administration in the position of physician as of the date of the enactment of the Veterans Health Care Quality Improvement Act shall do the following:CommentsClose CommentsPermalink





`(A) Not later than the end of the 60-day period beginning on the date of the enactment of that Act and as a condition of service under the appointment after the end of that period, submit the request and authorization described in subsection (b)(2).CommentsClose CommentsPermalink





`(B) Agree, as a condition of service under the appointment, to disclose to the Secretary, not later than 30 days after the occurrence of such event, the following:CommentsClose CommentsPermalink





`(i) A judgment against the individual for medical malpractice or negligence.CommentsClose CommentsPermalink





`(ii) A payment made by or on behalf of the individual to settle any lawsuit, action, or claim disclosed pursuant to subparagraph (A) or under this subparagraph.CommentsClose CommentsPermalink





`(iii) Any disposition of or material change in a matter disclosed pursuant to subparagraph (A) or under this subparagraph.CommentsClose CommentsPermalink





`(3) Each individual appointed in the Administration in the position of physician shall, as part of the biennial review of the performance of the physician under the appointment, submit the request and authorization described in subsection (b)(2). The requirement of this paragraph is in addition to the requirements of paragraph (1) or (2), as applicable.CommentsClose CommentsPermalink





`(d) Investigation of Disclosed Matters- (1) The Regional Director of the Veterans Integrated Services Network (VISN) in which an individual is seeking appointment in the Administration in the position of physician shall perform a comprehensive investigation (in such manner as the standards required by this section shall specify) of each matter disclosed under subsection (b) with respect to the individual.CommentsClose CommentsPermalink





`(2) The Regional Director of the Veterans Integrated Services Network in which an individual is appointed in the Administration in the position of physician shall perform a comprehensive investigation (in a manner so specified) of each matter disclosed under subsection (c) with respect to the individual.CommentsClose CommentsPermalink





`(3) The results of each investigation performed under this subsection shall be fully documented.CommentsClose CommentsPermalink





`(e) Approval of Appointments by Regional Directors of VISNs- (1) An individual may not be appointed in the Administration in the position of physician without the approval of the Regional Director of the Veterans Integrated Services Network in which the individual will first serve under the appointment.CommentsClose CommentsPermalink





`(2) In approving the appointment under this subsection of an individual for whom any matters have been disclosed under subsection (b), a Regional Director shall--CommentsClose CommentsPermalink





`(A) certify in writing the completion of the performance of the investigation under subsection (d)(1) of each such matter, including the results of such investigation; andCommentsClose CommentsPermalink





`(B) provide a written justification why any matters raised in the course of such investigation do not disqualify the individual from appointment.CommentsClose CommentsPermalink





`(f) Board Certification- (1) Except as provided in paragraph (2), an individual may not be appointed in the Administration in the position of physician unless the individual is board certified in the specialties in which the individual will practice under the appointment.CommentsClose CommentsPermalink





`(2) A Regional Director may waive the limitation in paragraph (1) with respect to any individual who has completed a residency program within the two-year period ending on the date of such waiver if the individual provides satisfactory evidence (as determined in accordance with the standards required by this section) of an intent to become board certified. The period of any waiver under this paragraph may not exceed one year.CommentsClose CommentsPermalink





`(g) State License Required for Practice in In-State VA Medical Facilities- Each physician practicing at a medical facility of the Department in a State, whether under an appointment in the Administration or through the extension of privileges of practice, shall, as a condition of such practice, hold a license to practice medicine in the State within one year of appointment.CommentsClose CommentsPermalink





`(h) Enrollment of Physicians With Practice Privileges in Proactive Disclosure Service- Each medical facility of the Department at which physicians are extended the privileges of practice shall enroll each physician extended such privileges in the Proactive Disclosure Service of the National Practitioners Data Base.'.CommentsClose CommentsPermalink





(2) CLERICAL AMENDMENT- The table of sections at the beginning of chapter 74 of such title is amended by inserting after the item relating to section 7402 the following new item:CommentsClose CommentsPermalink





`7402A. Appointment and practice of physicians: standards.'.CommentsClose CommentsPermalink





(b) Effective Date and Applicability-CommentsClose CommentsPermalink





(1) EFFECTIVE DATE- Except as provided in paragraph (2), the amendments made by subsection (a) shall take effect on the date of the enactment of this Act.CommentsClose CommentsPermalink





(2) APPLICABILITY OF CERTAIN REQUIREMENTS TO PHYSICIANS PRACTICING ON EFFECTIVE DATE- In the case of an individual appointed to the Veterans Health Administration in the position of physician as of the date of the enactment of this Act--CommentsClose CommentsPermalink





(A) the requirements of subsections (f) and (g) of section 7402A, United States Code, as added by subsection (a) of this section, shall take effect on the date that is one year after the date of the enactment of this Act; andCommentsClose CommentsPermalink





(B) the requirements of subsection (h) of such section 7402A, as so added, shall take effect on the date that is 60 days after the date of the enactment of this Act.CommentsClose CommentsPermalink

SEC. 3. ENHANCEMENT OF QUALITY ASSURANCE BY THE VETERANS HEALTH ADMINISTRATION.

(a) Enhancement of Quality Assurance Through Quality Assurance Officers-CommentsClose CommentsPermalink





(1) IN GENERAL- Subchapter II of chapter 73 of title 38, United States Code, is amended by inserting after section 7311 the following new section:CommentsClose CommentsPermalink

`Sec. 7311A. Quality assurance officers

`(a) National Quality Assurance Officer- (1) The Under Secretary of Health shall designate an official of the Administration to act as the principal quality assurance officer for the quality-assurance program required by section 7311 of this title. The official so designated may be known as the `National Quality Assurance Officer of the Veterans Health Administration' (in this section referred to as the `National Quality Assurance Officer').CommentsClose CommentsPermalink





`(2) The National Quality Assurance Officer shall report directly to the Under Secretary for Health in the discharge of responsibilities and duties of the Officer under this section.CommentsClose CommentsPermalink





`(3) The National Quality Assurance Officer shall be the official within the Administration who is principally responsible for the quality-assurance program referred to in paragraph (1). In carrying out that responsibility, the Officer shall be responsible for--CommentsClose CommentsPermalink





`(A) establishing and enforcing the requirements of that program; andCommentsClose CommentsPermalink





`(B) carrying out such other responsibilities and duties relating to quality assurance in the Administration as the Under Secretary for Health shall specify.CommentsClose CommentsPermalink





`(4) The requirements under paragraph (3) shall include requirements regarding the following:CommentsClose CommentsPermalink





`(A) A confidential system for the submittal of reports by Administration personnel regarding quality assurance at Administration facilities.CommentsClose CommentsPermalink





`(B) Mechanisms for the peer review of the actions of individuals appointed in the Administration in the position of physician.CommentsClose CommentsPermalink





`(C) Mechanisms for the accountability of the facility director and chief medical officer of each Administration medical facility for the actions of physicians in such facility.CommentsClose CommentsPermalink





`(b) Quality Assurance Officers for VISNs- (1) The Regional Director of each Veterans Integrated Services Network (VISN) shall appoint an official of the Network to act as the quality assurance officer of the Network.CommentsClose CommentsPermalink





`(2) Each official appointed as a quality assurance officer under this subsection shall be a board-certified physician.CommentsClose CommentsPermalink





`(3) The quality assurance officer for a Veterans Integrated Services Network shall report to the Regional Director of the Veterans Integrated Services Network, and to the National Quality Assurance Officer, regarding the discharge of the responsibilities and duties of the officer under this section.CommentsClose CommentsPermalink





`(4) The quality assurance officer for a Veterans Integrated Services Network shall--CommentsClose CommentsPermalink





`(A) direct the quality assurance office in the Network; andCommentsClose CommentsPermalink





`(B) coordinate, monitor, and oversee the quality assurance programs and activities of the Administration medical facilities in the Network in order to ensure the thorough and uniform discharge of quality assurance requirements under such programs and activities throughout such facilities.CommentsClose CommentsPermalink





`(c) Quality Assurance Officers for Medical Facilities- (1) The director of each Administration medical facility shall appoint a quality assurance officer for that facility.CommentsClose CommentsPermalink





`(2) Each official appointed as a quality assurance officer under this subsection shall be a board-certified physician.CommentsClose CommentsPermalink





`(3) The official appointed as a quality assurance officer for a facility under this subsection shall be a practicing physician at the facility. If the official appointed as quality assurance officer for a facility has other clinical or administrative duties, the director of the facility shall ensure that those duties are sufficiently limited in scope so as to ensure that those duties do not prevent the officer from effectively discharging the responsibilities and duties of quality assurance officer at the facility.CommentsClose CommentsPermalink





`(4) The quality assurance officer for a facility shall report directly to the director of the facility, and to the quality assurance officer of the Veterans Integrated Services Network in which the facility is located, regarding the discharge of the responsibilities and duties of the quality assurance officer under this section.CommentsClose CommentsPermalink





`(5) The quality assurance officer for a facility shall be responsible for designing, disseminating, and implementing quality assurance programs and activities for the facility that meet the requirements established by the National Quality Assurance Officer under subsection (a).'.CommentsClose CommentsPermalink





(2) CLERICAL AMENDMENT- The table of sections at the beginning of chapter 73 of such title is amended by inserting after the item relating to section 7311 the following new item:CommentsClose CommentsPermalink





`7311A. Quality assurance officers.'.CommentsClose CommentsPermalink





(b) Board-Certified Physician Requirement for Individuals Appointed as Under Secretary for Health- Section 305(a)(2) of title 38, United States Code, is amended by inserting `shall be a board-certified physician and' before `shall be'.CommentsClose CommentsPermalink





(c) Reports on Quality Concerns Under Quality-Assurance Program- Section 7311(b) of such title is amended by adding at the end the following new paragraph:CommentsClose CommentsPermalink





`(4) As part of the quality-assurance program, the Under Secretary for Health shall establish mechanisms through which employees of Administration facilities may submit reports, on a confidential basis, on matters relating to quality of care in Administration facilities to the quality assurance officers of such facilities under section 7311A(c) of this title and to the quality assurance officers of the Veterans Integrated Services Networks (VISNs) in which such facilities are located under section 7311A(b) of this title. The mechanisms shall provide for the prompt and thorough review of any reports so submitted by the receiving officials.'.CommentsClose CommentsPermalink





(d) Review of Current Health Care Quality Safeguards-CommentsClose CommentsPermalink





(1) IN GENERAL- The Secretary of Veterans Affairs shall conduct a comprehensive review of all current policies and protocols of the Department of Veterans Affairs for maintaining health care quality and patient safety at Department of Veterans Affairs medical facilities. The review shall include a review and assessment of the National Surgical Quality Improvement Program (NSQIP), including an assessment of--CommentsClose CommentsPermalink





(A) the efficacy of the quality indicators under the program;CommentsClose CommentsPermalink





(B) the efficacy of the data collection methods under the program;CommentsClose CommentsPermalink





(C) the efficacy of the frequency with which regular data analyses are performed under the program; andCommentsClose CommentsPermalink





(D) the extent to which the resources allocated to the program are adequate to fulfill the stated function of the program.CommentsClose CommentsPermalink





(2) REPORT- Not later than 60 days after the date of the enactment of this Act, the Secretary shall submit to Congress a report on the review conducted under paragraph (1), including the findings of the Secretary as a result of the review and such recommendations as the Secretary considers appropriate in light of the review.CommentsClose CommentsPermalink

SEC. 4. INCENTIVES TO ENCOURAGE HIGH-QUALITY PHYSICIANS TO SERVE IN THE VETERANS HEALTH ADMINISTRATION.

(a) Incentives Required-CommentsClose CommentsPermalink





(1) IN GENERAL- Subchapter III of chapter 74 of title 38, United States Code, is amended by inserting after section 7431 the following new section:CommentsClose CommentsPermalink

`Sec. 7431A. Physicians: additional incentives for service in hard-to-fill positions

`(a) Loan Repayment for Physicians Who Serve in Hard-to-Fill Positions- (1) In order to recruit and retain physicians in the Administration in hard-to-fill positions (as designated by the Secretary for purposes of this subsection), the Secretary shall repay, for each individual who agrees to serve as a physician for a period of not less than three years in an Administration facility in such a position, any loan of such individual as follows:CommentsClose CommentsPermalink





`(A) Any loan of the individual described in paragraphs (1) through (4) of section 16302(a) of title 10.CommentsClose CommentsPermalink





`(B) Any other loan of the individual designated by the Secretary for purposes of this subsection the proceeds of which were used by the individual to finance education leading to the medical degree of the individual.CommentsClose CommentsPermalink





`(2) Each individual seeking repayment of loans under paragraph (1) shall enter into an agreement with the Secretary regarding the repayment of loans. Under the agreement, the individual shall agree--CommentsClose CommentsPermalink





`(A) to perform satisfactory service in a physician position specified in the agreement in an Administration facility specified in the agreement for such period of years as the agreement shall specify; andCommentsClose CommentsPermalink





`(B) to possess and retain for the period of the agreement such professional qualifications as are necessary for the service specified under subparagraph (A).CommentsClose CommentsPermalink





`(3) Repayment of loans under this subsection shall be made on the basis of complete years of service under the agreement under this subsection. The amount to be repayed under an agreement under this subsection for a complete year of service specified in the agreement shall be such amount, not to exceed $30,000, for each complete year of service as the agreement shall specify.CommentsClose CommentsPermalink





`(b) Tuition Reimbursement for Physician Students Who Agree To Serve in Hard-to-Fill Positions- (1) In order to recruit and retain physicians in the Administration in hard-to-fill positions (as designated by the Secretary for purposes of this subsection), the Secretary shall reimburse individuals who are enrolled in a course of education leading toward board certification as a physician for the tuition charged for pursuit of such course of education if such individuals agree to serve as a physician in an Administration facility in such a position.CommentsClose CommentsPermalink





`(2) Each individual seeking tuition reimbursement under paragraph (1) shall enter into an agreement with the Secretary regarding such tuition reimbursement. Under the agreement, the individuals shall agree--CommentsClose CommentsPermalink





`(A) to satisfactorily complete the course of education of the individual described in paragraph (1); andCommentsClose CommentsPermalink





`(B) upon completion of the course of education, to become board-certified as a physician; andCommentsClose CommentsPermalink





`(C) upon completion of the matters referred to in subparagraphs (A) and (B)--CommentsClose CommentsPermalink





`(i) to perform satisfactory service in a physician position specified in the agreement in an Administration facility specified in the agreement for such period of years as the agreement shall specify; andCommentsClose CommentsPermalink





`(ii) to possess and retain for the period of the agreement such professional qualifications as are necessary for the service specified under clause (i).CommentsClose CommentsPermalink





`(3) The amount of reimbursement payable to an individual under paragraph (1) for a year may not exceed $30,000.CommentsClose CommentsPermalink





`(4) Any individual receiving tuition reimbursement under paragraph (1) who does not satisfy the requirements of the agreement under paragraph (2) shall be subject to such repayment requirements as the Secretary shall specify in the agreement.CommentsClose CommentsPermalink





`(5) An individual receiving tuition reimbursement under paragraph (1) for pursuit of a course of education shall also be paid a stipend in the amount of $5,000 for each academic year of pursuit of such course of education after entry into an agreement under paragraph (2).CommentsClose CommentsPermalink





`(c) Participation in FEHBP of Physicians Who Serve Part-Time in Hard-to-Fill Positions- (1) In order to recruit and retain physicians in the Administration in hard-to-fill positions (as designated by the Secretary for purposes of this subsection), an individual not otherwise eligible for health insurance under chapter 89 of title 5 who agrees to serve as a physician in an Administration facility in such a position for not less than five days per month (of which two days must occur in each 14-day period) shall be eligible for enrollment in the health benefit plans under chapter 89 of title 5 on a self only or self and family basis (as applicable).CommentsClose CommentsPermalink





`(2) The Secretary shall administer this subsection in consultation with the Director of the Office of Personnel Management.CommentsClose CommentsPermalink





`(d) Additional Programs- It is the sense of Congress that the Secretary should undertake active and on-going efforts to establish additional incentive programs to encourage individuals to serve in the position of physician in the Administration, or otherwise practice in the Administration, in hard-to-fill positions, including, in particular, incentive programs to encourage more experienced physicians to serve or practice in such positions.CommentsClose CommentsPermalink





`(e) Construction- The incentives required under this section are in addition to any other special pays or benefits to which the individuals covered by this section are eligible or entitled under law.'.CommentsClose CommentsPermalink





(2) CLERICAL AMENDMENT- The table of sections at the beginning of chapter 74 of such title is amended by inserting after the item relating to section 731 the following new item:CommentsClose CommentsPermalink





`7431A. Physicians: additional incentives for service in hard-to-fill positions.'.CommentsClose CommentsPermalink





(b) Affiliation of Department of Veterans Affairs Medical Facilities With Medical Schools- The Secretary of Veterans Affairs shall, to the extent practicable, require each medical facility of the Department of Veterans Affairs to seek to establish an affiliation with a medical school within reasonable proximity of such medical facility.CommentsClose CommentsPermalink

SEC. 5. REPORTS TO CONGRESS.

(a) Report- Not later than December 15, 2009, and each year thereafter through 2012, the Secretary of Veterans Affairs shall submit to the congressional veterans affairs committees a report on the implementation of this Act and the amendments made by this Act during the preceding fiscal year. Each report shall include, for the fiscal year covered by such report, the following:CommentsClose CommentsPermalink





(1) A comprehensive description of the implementation of this Act and the amendments made by this Act.CommentsClose CommentsPermalink





(2) Such recommendations as the Secretary considers appropriate for legislative or administrative action to improve the authorities and requirements in this Act and the amendments made by this Act or to otherwise improve the quality of health care and the quality of the physicians in the Veterans Health Administration.CommentsClose CommentsPermalink





(b) Congressional Veterans Affairs Committees Defined- In this section, the term `congressional veterans affairs committees' means--CommentsClose CommentsPermalink





(1) the Committees on Veterans' Affairs and Appropriations of the Senate; andCommentsClose CommentsPermalink





(2) the Committees on Veterans' Affairs and Appropriations of the House of Representatives.CommentsClose CommentsPermalink