[Congressional Bills 106th Congress]
[From the U.S. Government Publishing Office]
[S. 1956 Introduced in Senate (IS)]







106th CONGRESS
  1st Session
                                S. 1956

  To amend title 38, United States Code, to enhance the assurance of 
  efficiency, quality, and patient satisfaction in the furnishing of 
health care to veterans by the Department of Veterans Affairs, and for 
                            other purposes.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                           November 18, 1999

   Ms. Snowe introduced the following bill; which was read twice and 
             referred to the Committee on Veterans' Affairs

_______________________________________________________________________

                                 A BILL


 
  To amend title 38, United States Code, to enhance the assurance of 
  efficiency, quality, and patient satisfaction in the furnishing of 
health care to veterans by the Department of Veterans Affairs, and for 
                            other purposes.

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

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Veterans Health Care Quality 
Assurance Act of 1999''.

SEC. 2. FINDINGS.

    Congress makes the following findings:
            (1) The Department of Veterans Affairs administers the 
        largest health care network in the United States, including 172 
        hospitals, 73 home care programs, more than 800 community-based 
        outpatient clinics, and numerous other specialized care 
        facilities.
            (2) There are approximately 25,000,000 veterans in the 
        United States, including approximately 19,300,000 veterans of a 
        period of war.
            (3) The number of veterans seeking medical care in 
        Department medical facilities is increasing nationwide.
            (4) The fiscal year 1997 medical care caseload of the 
        Department was 2,700,000. The fiscal year 1999 medical care 
        caseload of the Department was projected to increase by 160,000 
        cases over the fiscal year 1998 caseload, and is projected to 
        increase by an additional 54,000 cases in fiscal year 2000, 
        resulting in a total caseload of 3,600,000 in fiscal year 2000.
            (5) The number of outpatient visits at Department medical 
        facilities in fiscal year 2000 is projected to increase by 
        2,500,000 over the number of such visits in fiscal year 1999, 
        to a total of 38,300,000 visits in fiscal year 2000.
            (6) The average age of veterans is increasing. The increase 
        in the average age of veterans is expected to result in 
        additional demands for health care services, including more 
        frequent and long-term health needs.
            (7) The Department is attempting to meet increasing demand 
        for medical care without substantial increases in 
        appropriations, mainly through efforts to increase efficiency.
            (8) The need to treat more veterans without substantial 
        increases in available resources has resulted in serious 
        concerns about the potential for loss of quality of care and of 
        patient satisfaction.
            (9) Many of the regional networks and hospitals 
        administered by the Veterans Health Administration report that 
        timely access to high quality health care may be jeopardized by 
        inadequate funding.

SEC. 3. SENSE OF CONGRESS ON MAXIMIZATION AND EFFICIENT USE OF HEALTH 
              CARE RESOURCES BY THE DEPARTMENT OF VETERANS AFFAIRS.

    It is the sense of Congress that the Secretary of Veterans Affairs 
should--
            (1) require the directors of the Department of Veterans 
        Affairs health care networks to systematically share 
        information on means of maximizing resources and increasing 
        efficiency without compromising quality of care and patient 
        satisfaction;
            (2) require exchange and mentoring programs among and 
        between such networks in order to facilitate the sharing of 
        such information;
            (3) provide incentives to such networks to increase 
        efficiency and meet uniform quality and patient satisfaction 
        goals; and
            (4) institute a formal oversight process to ensure that--
                    (A) all such networks meet uniform efficiency 
                goals; and
                    (B) efforts to increase efficiency are equitable 
                between and among such networks and their facilities.

SEC. 4. QUALITY ASSURANCE AUDITS BY INSPECTOR GENERAL OF THE DEPARTMENT 
              OF VETERANS AFFAIRS.

    Section 312 of title 38, United States Code, is amended by adding 
at the end the following:
    ``(c)(1) In addition to the other responsibilities of the Inspector 
General under this section, the Inspector General shall also conduct an 
audit of the quality of health care furnished by each health care 
network, and by each health care facility, of the Department.
    ``(2) Each audit under paragraph (1) shall measure the following:
            ``(A) The quality of health care furnished by the 
        Department.
            ``(B) The satisfaction of patients with the health care 
        furnished by the Department.
            ``(C) Resource and financial management.
            ``(D) The extent to which the funds allocated to health 
        care programs of the Department are adequate to support such 
        programs.
    ``(3) An audit shall be conducted under paragraph (1) for each 
health care network, and for each health care facility, not less often 
than once every three years.
    ``(4) The Inspector General may make such recommendations to the 
Secretary regarding means of improving the quality of health care 
furnished to veterans as the Inspector General considers appropriate as 
a result of the audits under this subsection.''.

SEC. 5. INFORMATION ON EFFICIENCY, QUALITY, AND PATIENT SATISFACTION IN 
              PROVISION OF HEALTH CARE BY THE DEPARTMENT OF VETERANS 
              AFFAIRS.

    (a) Dissemination and Sharing of Information on Efficient Provision 
of Health Care.--(1) The Secretary of Veterans Affairs, acting through 
the Under Secretary for Health of the Department of Veterans Affairs, 
shall provide for the dissemination and sharing within and among 
Department of Veterans Affairs health care networks of information 
designed to ensure that all Department medical care centers meet 
uniform efficiency standards in the provision of health care to 
veterans.
    (2) The Secretary shall meet the requirement in paragraph (1) 
through the publication of guidance materials and best practice 
summaries and by such other means as the Secretary considers 
appropriate.
    (b) Efficiency Goals and Quality and Patient Satisfaction 
Standards.--(1) The Secretary, acting through the Under Secretary for 
Health, shall issue on an annual basis efficiency goals and quality and 
patient satisfaction standards in the provision of health care to 
veterans for each Department health care facility. The efficiency goals 
and quality and patient satisfaction standards for each such facility 
shall be consistent with such goals and standards as the Secretary 
shall establish for the Department as a whole.
    (2)(A) The Secretary shall, on an annual basis, submit to Congress 
a report on the extent to which each Department health care facility 
met the efficiency goals and quality and patient satisfaction standards 
for such facility under paragraph (1) during the preceding year.
    (B) Each report under subparagraph (A) shall set forth a comparison 
between the performance of each Department health care facility with 
respect to the efficiency goals and quality and satisfaction standards 
for such facility for the year involved and the average performance of 
all Department health care facilities with respect to such goals and 
standards for such year. The comparison shall be stated in a manner 
which permits a clear and understandable comparison of the performance 
of each facility with the average performance of all such facilities.

SEC. 6. OFFICE OF HEALTH CARE QUALITY ASSURANCE.

    (a) Establishment.--(1) Subchapter II of chapter 73 of title 38, 
United States Code, is amended by adding at the end the following:
``Sec. 7322. Office of Health Care Quality Assurance
    ``(a) In General.--There shall be within the Department an office 
to be known as the `Office of Health Care Quality Assurance' (in this 
section referred to as the `Office'). The Office shall be located for 
administrative purposes within the Office of the Under Secretary for 
Health.
    ``(b) Director.--The head of the Office is the Director of Health 
Care Quality Assurance.
    ``(c) Staff and Support.--The Under Secretary for Health shall 
provide the Office with such staff and other support as may be 
necessary for the Office to carry out effectively its functions under 
this section.
    ``(d) Functions.--The functions of the Office are as follows:
            ``(1) To ensure the implementation of any recommendations 
        of the Inspector General of the Department as a result of 
        audits conducted by the Inspector General under section 312(c) 
        of this title.
            ``(2) To collect and ensure the dissemination of 
        information on initiatives, programs, policies, procedures, 
        strategies, and best practices that have been proven to 
        increase efficiency and resource utilization without 
        undermining quality or patient satisfaction in the furnishing 
        of health care to veterans.
            ``(3) To take such other actions relating to the assurance 
        of quality in the furnishing of health care by the Veterans 
        Health Administration as the Under Secretary for Health 
        considers appropriate.''.
    (2) The table of sections at the beginning of chapter 73 of such 
title is amended by inserting after the item relating to section 7321 
the following new item:

``7322. Office of Health Care Quality Assurance.''.
    (b) Placement in Office of Under Secretary for Health.--Section 
7306(a) of title 38, United States Code, is amended--
            (1) by redesignating paragraph (9) as paragraph (10); and
            (2) by inserting after paragraph (8) the following new 
        paragraph (9):
            ``(9) The Director of Health Care Quality Assurance, who 
        shall be responsible to the Under Secretary for Health for the 
        operation of the Office of Health Care Quality Assurance.''.
    (c) Sense of Congress on Director as Advocate for Veterans.--It is 
the sense of Congress that the Director of the Office of Health Care 
Quality Assurance should act as an advocate for veterans in carrying 
out activities under section 7322 of title 38, United States Code, as 
added by subsection (a).

SEC. 7. REPORT ON EFFICIENCIES IN PROVISION OF HEALTH CARE BY THE 
              DEPARTMENT OF VETERANS AFFAIRS.

    (a) Requirement.--Not later than six months after the date of the 
enactment of this Act, the Secretary of Veterans Affairs shall submit 
to Congress a report on efficiencies in the furnishing of health care 
to veterans in the health care networks and facilities of the 
Department of Veterans Affairs.
    (b) Elements.--The report shall include the following:
            (1) A survey of each health care network of the Department, 
        including a summary of the efforts of each network to increase 
        efficiency in the furnishing of health care to veterans.
            (2) An assessment of the extent to which such networks, and 
        the facilities within such networks, are or are not 
        implementing uniform, Department-wide policies to increase 
        efficiency in the furnishing of health care to veterans.
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