S 1824 ISCommentsClose CommentsPermalink

To amend title XVIII of the Social Security Act to establish a Hospital Quality Report Card Initiative under the Medicare program to assess and report on health care quality in hospitals.CommentsClose CommentsPermalink

July 19, 2007

Mr. OBAMA introduced the following bill; which was read twice and referred to the Committee on FinanceCommentsClose CommentsPermalink

To amend title XVIII of the Social Security Act to establish a Hospital Quality Report Card Initiative under the Medicare program to assess and report on health care quality in hospitals.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 `Hospital Quality Report Card Act of 2007'.CommentsClose CommentsPermalink

SEC. 2. PURPOSE.

The purpose of this Act is to expand hospital quality reporting by establishing the Hospital Quality Report Card Initiative under the Medicare program to ensure that hospital quality measures data are readily available and accessible in order to--CommentsClose CommentsPermalink





(1) assist patients and consumers in making decisions about where to get health care;CommentsClose CommentsPermalink





(2) assist purchasers and insurers in making decisions that determine where employees, subscribers, members, or participants are able to go for their health care; andCommentsClose CommentsPermalink





(3) assist health care providers in identifying opportunities for quality improvement and cost containment.CommentsClose CommentsPermalink

SEC. 3. HOSPITAL QUALITY REPORT CARD INITIATIVE.

(a) In General- Title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) is amended by adding at the end the following new section:CommentsClose CommentsPermalink

`HOSPITAL QUALITY REPORT CARD INITIATIVE

`Sec. 1898. (a) In General- Not later than 18 months after the date of the enactment of the Hospital Quality Report Card Act of 2007, the Secretary, acting through the Administrator of the Centers for Medicare & Medicaid Services (in this section referred to as the `Administrator') and in consultation with the Director of the Agency for Healthcare Research and Quality, shall, directly or through contracts with States or appropriate entities (such as utilization and quality control peer review organizations under part B of title XI, commonly known as Quality Improvement Organizations), establish and implement a Hospital Quality Report Card Initiative (in this section referred to as the `Initiative') to report on health care quality in subsection (d) hospitals.CommentsClose CommentsPermalink





`(b) Subsection (d) Hospital- For purposes of this section, the term `subsection (d) hospital' has the meaning given such term in section 1886(d)(1)(B).CommentsClose CommentsPermalink





`(c) Requirements of Initiative-CommentsClose CommentsPermalink





`(1) QUALITY MEASUREMENT REPORTS FOR HOSPITALS-CommentsClose CommentsPermalink





`(A) QUALITY MEASURES- Not less than 2 times each year, the Secretary shall publish reports on hospital quality. Such reports shall include quality measures data submitted under section 1886(b)(3)(B)(viii), and other data as feasible, that allow for an assessment of health care--CommentsClose CommentsPermalink





`(i) effectiveness;CommentsClose CommentsPermalink





`(ii) safety;CommentsClose CommentsPermalink





`(iii) timeliness;CommentsClose CommentsPermalink





`(iv) efficiency;CommentsClose CommentsPermalink





`(v) patient-centeredness; andCommentsClose CommentsPermalink





`(vi) equity.CommentsClose CommentsPermalink





`(B) REPORT CARD FEATURES- In collecting and reporting data as provided for under subparagraph (A), the Secretary shall include hospital information, as possible, relating to--CommentsClose CommentsPermalink





`(i) staffing levels of nurses and other health professionals, as appropriate;CommentsClose CommentsPermalink





`(ii) rates of hospital acquired infections;CommentsClose CommentsPermalink





`(iii) the volume of various procedures performed;CommentsClose CommentsPermalink





`(iv) the availability of interpreter services on-site;CommentsClose CommentsPermalink





`(v) the accreditation of hospitals, as well as sanctions and other violations found by accreditation or State licensing boards;CommentsClose CommentsPermalink





`(vi) the quality of care for various patient populations, including pediatric populations and racial and ethnic minority populations;CommentsClose CommentsPermalink





`(vii) the availability and accessibility of emergency rooms, including measures of crowding such as diversion status, patient boarding in the emergency room, and untreated patients due to extended wait time;CommentsClose CommentsPermalink





`(viii) the availability of intensive care units, obstetrical units, and burn units;CommentsClose CommentsPermalink





`(ix) the quality of care in various hospital settings, including inpatient, outpatient, emergency, maternity, and intensive care unit settings;CommentsClose CommentsPermalink





`(x) the use of health information technology, telemedicine, and electronic medical records;CommentsClose CommentsPermalink





`(xi) ongoing patient safety initiatives; andCommentsClose CommentsPermalink





`(xii) other measures determined appropriate by the Secretary.CommentsClose CommentsPermalink





`(C) TAILORING OF HOSPITAL QUALITY REPORTS- The Director of the Agency for Healthcare Research and Quality may modify and publish hospital reports to include quality measures for diseases and health conditions of particular relevance to certain regions, States, or local areas.CommentsClose CommentsPermalink





`(D) RISK ADJUSTMENT-CommentsClose CommentsPermalink





`(i) IN GENERAL- In reporting data as provided for under subparagraph (A), the Secretary may risk adjust quality measures to account for differences relating to--CommentsClose CommentsPermalink





`(I) the characteristics of the reporting hospital, such as licensed bed size, geography, teaching hospital status, and profit status; andCommentsClose CommentsPermalink





`(II) patient characteristics, such as health status, severity of illness, insurance status, and socioeconomic status.CommentsClose CommentsPermalink





`(ii) AVAILABILITY OF UNADJUSTED DATA- If the Secretary reports data under subparagraph (A) using risk-adjusted quality measures, the Secretary shall establish procedures for making the unadjusted data available to the public in a manner determined appropriate by the Secretary.CommentsClose CommentsPermalink





`(E) COSTS AND CHARGES- The Secretary shall--CommentsClose CommentsPermalink





`(i) compile data relating to the average hospital cost and charges for ICD-9 conditions for which quality measures data are collected; andCommentsClose CommentsPermalink





`(ii) report such information in a manner that allows cost and charge comparisons between or among subsection (d) hospitals.CommentsClose CommentsPermalink





`(F) VERIFICATION- Under the Initiative, the Secretary may verify data reported under this paragraph to ensure accuracy and validity.CommentsClose CommentsPermalink





`(G) DISCLOSURE- The Secretary shall disclose the entire methodology for the reporting of data under this paragraph to all relevant organizations and all subsection (d) hospitals that are the subject of any such information that is to be made available to the public prior to the public disclosure of such information.CommentsClose CommentsPermalink





`(H) PUBLIC INPUT- The Secretary shall provide an opportunity for public review and comment with respect to the quality measures to be reported for subsection (d) hospitals under this section for at least 60 days prior to the finalization by the Secretary of the quality measures to be used for such hospitals.CommentsClose CommentsPermalink





`(I) AVAILABILITY OF REPORTS AND FINDINGS-CommentsClose CommentsPermalink





`(i) ELECTRONIC AVAILABILITY- The Secretary shall ensure that reports are made available under this section in an electronic format, in an understandable manner with respect to various populations (including those with low functional health literacy), and in a manner that allows health care quality comparisons to be made between local hospitals.CommentsClose CommentsPermalink





`(ii) FINDINGS- The Secretary shall establish procedures for making report findings available to the public, upon request, in a nonelectronic format, such as through the toll-free telephone number 1-800-MEDICARE.CommentsClose CommentsPermalink





`(J) IDENTIFICATION OF METHODOLOGY- The analytic methodologies and limitations on data sources utilized by the Secretary to develop and disseminate the comparative data under this section shall be identified and acknowledged as part of the dissemination of such data, and include the appropriate and inappropriate uses of such data.CommentsClose CommentsPermalink





`(K) ADVERSE SELECTION OF PATIENTS- On at least an annual basis, the Secretary shall compare quality measures data submitted by each subsection (d) hospital under section 1886(b)(3)(B)(viii) with data submitted in the prior year or years by the same hospital in order to identify and report actions that would lead to false or artificial improvements in the hospital's quality measurements, including--CommentsClose CommentsPermalink





`(i) adverse selection against patients with severe illness or other factors that predispose patients to poor health outcomes; andCommentsClose CommentsPermalink





`(ii) provision of health care that does not meet established recommendations or accepted standards for care.CommentsClose CommentsPermalink





`(2) DATA SAFEGUARDS-CommentsClose CommentsPermalink





`(A) UNAUTHORIZED USE AND DISCLOSURE- The Secretary shall develop and implement effective safeguards to protect against the unauthorized use or disclosure of hospital data that is reported under this section.CommentsClose CommentsPermalink





`(B) INACCURATE INFORMATION- The Secretary shall develop and implement effective safeguards to protect against the dissemination of inconsistent, incomplete, invalid, inaccurate, or subjective hospital data.CommentsClose CommentsPermalink





`(C) IDENTIFIABLE DATA- The Secretary shall ensure that identifiable patient data shall not be released to the public.CommentsClose CommentsPermalink





`(d) Grants and Technical Assistance- The Secretary may award grants to national or State organizations, partnerships, utilization and quality control peer review organizations under part B of title XI, or other entities that may assist with hospital quality improvement.CommentsClose CommentsPermalink





`(e) Hospital Quality Advisory Committee-CommentsClose CommentsPermalink





`(1) ESTABLISHMENT- The Administrator, in consultation with the Director of the Agency for Healthcare Research and Quality, shall establish the Hospital Quality Advisory Committee (in this subsection referred to as the `Advisory Committee') to provide advice to the Administrator on the submission, collection, and reporting of quality measures data. The Administrator shall serve as the chairperson of the Advisory Committee.CommentsClose CommentsPermalink





`(2) MEMBERSHIP- The Advisory Committee shall include representatives of the following (except with respect to subparagraphs (A) through (D), to be appointed by the Administrator):CommentsClose CommentsPermalink





`(A) The Agency for Healthcare Research and Quality.CommentsClose CommentsPermalink





`(B) The Health Resources and Services Administration.CommentsClose CommentsPermalink





`(C) The Department of Veterans Affairs.CommentsClose CommentsPermalink





`(D) The Centers for Disease Control and Prevention.CommentsClose CommentsPermalink





`(E) National membership organizations that focus on health care quality improvement.CommentsClose CommentsPermalink





`(F) Public and private hospitals.CommentsClose CommentsPermalink





`(G) Physicians, nurses, and other health professionals.CommentsClose CommentsPermalink





`(H) Patients and patient advocates.CommentsClose CommentsPermalink





`(I) Health insurance purchasers and other payers.CommentsClose CommentsPermalink





`(J) Health researchers, policymakers, and other experts in the field of health care quality.CommentsClose CommentsPermalink





`(K) Health care accreditation entities.CommentsClose CommentsPermalink





`(L) Representatives of utilization and quality control peer review organizations under part B of title XI.CommentsClose CommentsPermalink





`(M) Other agencies and groups as determined appropriate by the Administrator.CommentsClose CommentsPermalink





`(3) DUTIES- The Advisory Committee shall review and provide guidance and recommendations to the Administrator on--CommentsClose CommentsPermalink





`(A) the establishment of the Initiative;CommentsClose CommentsPermalink





`(B) integration and coordination of Federal quality measures data submission requirements, to avoid needless duplication and inefficiency;CommentsClose CommentsPermalink





`(C) legal and regulatory barriers that may hinder quality measures data collection and reporting; andCommentsClose CommentsPermalink





`(D) necessary technical and financial assistance to encourage quality measures data collection and reporting.CommentsClose CommentsPermalink





`(4) STAFF AND RESOURCES- The Administrator shall provide the Advisory Committee with appropriate staff and resources for the functioning of the Advisory Committee.CommentsClose CommentsPermalink





`(5) DURATION- The Advisory Committee shall terminate at the discretion of the Administrator, but in no event later than 5 years after the date of enactment of this section.CommentsClose CommentsPermalink





`(f) Authorization of Appropriations- There are authorized to be appropriated to carry out this section such sums as may be necessary for each of fiscal years 2008 through 2017.'.CommentsClose CommentsPermalink





(b) Conforming Amendment- Section 1886(b)(3)(B)(viii)(VII) of the Social Security Act (42 U.S.C. 1395ww(b)(3)(B)(viii)(VII)), as added by section 5001 of the Deficit Reduction Act of 2005, is amended to read as follows:CommentsClose CommentsPermalink





`(VII) The Secretary shall use the data submitted under this clause for the Hospital Quality Report Card Initiative under section 1898.'.CommentsClose CommentsPermalink

SEC. 4. EVALUATION OF THE HOSPITAL QUALITY REPORT CARD INITIATIVE.

(a) In General- The Director of the Agency for Healthcare Research and Quality, directly or through contract, shall evaluate and periodically report to Congress on the effectiveness of the Hospital Quality Report Card Initiative established under section 1898 of the Social Security Act, as added by section 3, including the effectiveness of the Initiative in meeting the purpose described in section 2. The Director shall make such reports available to the public.CommentsClose CommentsPermalink





(b) Research- The Director of the Agency for Healthcare Research and Quality, in consultation with the Administrator of the Centers for Medicare & Medicaid Services, shall use the outcomes from the evaluation conducted pursuant to subsection (a) to increase the usefulness of the Hospital Quality Report Card Initiative, particularly for patients, as necessary.CommentsClose CommentsPermalink