[Congressional Bills 110th Congress]
[From the U.S. Government Publishing Office]
[S. 1519 Introduced in Senate (IS)]







110th CONGRESS
  1st Session
                                S. 1519

   To amend title XVIII of the Social Security Act to provide for a 
transition to a new voluntary quality reporting program for physicians 
                    and other health professionals.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                              May 24, 2007

Mr. Cardin (for himself and Mr. Specter) introduced the following bill; 
     which was read twice and referred to the Committee on Finance

_______________________________________________________________________

                                 A BILL


 
   To amend title XVIII of the Social Security Act to provide for a 
transition to a new voluntary quality reporting program for physicians 
                    and other health professionals.

    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 ``Voluntary Medicare Quality Reporting 
Act of 2007''.

SEC. 2. FINDINGS.

    (a) Findings.--Congress makes the following findings:
            (1) The health care system of the United States is the 
        world's most advanced health care system and delivers health 
        care according to the highest quality standards. Physicians and 
        other health professionals are committed to providing the 
        highest quality of health care to beneficiaries under the 
        Medicare program.
            (2) Physicians have been actively engaged with the American 
        Medical Association's Physician Consortium for Performance 
        Improvement in the development of evidence-based and clinically 
        valid measures in order to improve the quality of health care 
        and have also worked closely with the Centers for Medicare & 
        Medicaid Services (``CMS'') in assuring the successful 
        implementation of the Physician Voluntary Reporting Program 
        (``PVRP'') developed to measure and evaluate quality of health 
        care.
            (3) Physicians are actively collaborating with consensus 
        organizations in their efforts to--
                    (A) improve the quality of health care through the 
                specification of quality measures for services; and
                    (B) develop a rational system for collecting, 
                aggregating, and reporting data across numerous public 
                and private insurance programs in the least burdensome 
                way.
            (4) Quality measures for covered professional services (as 
        defined in section 1848(k)(3)(A) of the Social Security Act (42 
        U.S.C. 1395w-4(k)(3)(A)) must be--
                    (A) evidence-based and clinically valid;
                    (B) regularly updated to reflect current medical 
                practice;
                    (C) specialty specific; and
                    (D) developed by relevant medical and other health 
                professional specialty societies with expertise in the 
                area of health care involved.
            (5) All quality measures for covered professional services 
        (as so defined) should be pilot-tested in a variety of practice 
        settings and across all relevant medical and other health 
        professional specialties before they are included in a value-
        based purchasing system for such services.
            (6) Physicians must be actively engaged in all aspects of 
        the development and implementation of an effective quality 
        reporting and value-based purchasing system for covered 
        professional services (as so defined). The development process 
        for such system must be transparent to all physicians and 
        adhere to a consistent set of rules.
            (7) Any effective quality reporting system for covered 
        professional services (as so defined) must recognize the actual 
        health information technology and administrative costs 
        physicians and other health professionals incur for 
        participating in the system.
            (8) Any quality reporting program for covered professional 
        services (as so defined) should focus on meaningful 
        improvements in patient care rather than requiring physicians 
        to report for the sake of reporting.
            (9) Most physicians and other health professionals have not 
        had any experience in quality reporting and lack the necessary 
        health information technology and administrative 
        infrastructures to participate in a value-based purchasing 
        system for physicians' services.
            (10) The 6-month program under section 1848(k) of the 
        Social Security Act (42 U.S.C. 1395w-4(k)), as added by section 
        101(b) of division B of the Tax Relief and Health Care Act of 
        2006 (Public Law 109-432; 120 Stat. 2975), the 2007 Physician 
        Quality Reporting Initiative (``PQRI''), does not provide a 
        sufficient amount of time to test and evaluate the 
        appropriateness and effectiveness of this new reporting system. 
        Therefore, it is premature to implement a permanent Medicare 
        quality reporting system for physicians in 2008.

SEC. 3. TRANSITION TO NEW VOLUNTARY MEDICARE QUALITY REPORTING PROGRAM.

    (a) Evaluating the Transitional Quality Reporting System 
Established for 2007.--
            (1) Evaluation.--The Secretary of Health and Human Services 
        shall evaluate the quality reporting system under paragraph (1) 
        of section 1848(k) of the Social Security Act (42 U.S.C. 1395w-
        4(k)) (as added by section 101(b) of division B of the Tax 
        Relief and Health Care Act of 2006 (Public Law 109-432)), as 
        applied for 2007 using the quality measures described in 
        paragraph (2)(A) of such section to determine the following:
                    (A) The extent to which such quality measures were 
                valid, clinically relevant, practicable, and not overly 
                burdensome.
                    (B) The percentage of eligible professionals (as 
                defined in paragraph (3)(B) of such section) in each 
                category of eligible professionals described in such 
                paragraph that had such quality measures to report for 
                such year.
                    (C) The rate of participation in such quality 
                reporting system of eligible professionals described in 
                subparagraph (B) in each such category.
                    (D) The average administrative costs of medical 
                practices of such eligible professionals for reporting 
                such quality measures, as it relates to the size of 
                such practices.
            (2) Report.--Not later than June 1, 2008, the Secretary of 
        Health and Human Services shall submit to Congress a report 
        containing the findings of the evaluation under paragraph (1).
    (b) Demonstration Projects on Data Registries.--Beginning January 
1, 2008, the Secretary of Health and Human Services shall enter into 
contracts for conducting demonstrations for defining appropriate 
mechanisms whereby eligible professionals (as defined in section 
1848(k)(3)(B) of the Social Security Act (42 U.S.C. 1395w-4(k)(3)(B)) 
may provide data on quality measures to the Secretary through an 
appropriate medical registry. The Secretary shall require that all 
mechanisms developed under this subsection be for purposes of reporting 
data to the Secretary only. The Secretary shall consider such data as 
confidential and not make such data available to other parties or 
persons.
    (c) Transitional Quality Reporting After December 31, 2007, and 
Before Implementation of New Voluntary Medicare Quality Reporting 
Program.--
            (1) In general.--Section 1848(k)(2)(B) of the Social 
        Security Act (42 U.S.C. 1395w-4(k)(3)(B)) is amended to read as 
        follows:
                    ``(B) For 2008 and 2009.--Eligible professionals 
                may continue to report to the Secretary quality 
                measures specified under subparagraph (A) after 
                December 31, 2007, and before December 31, 2009, in 
                order for the Secretary to refine systems for reporting 
                quality measures.''.
            (2) Prohibiting use of physician assistance and quality 
        initiative fund for quality reporting bonus payments in 2008.--
        Section 1848(l)(2)(B) of the Social Security Act (42 U.S.C. 
        1395w-4(l)(2)(B)), as added by section 101(d) of division B of 
        the Tax Relief and Health Care Act of 2006 (Public Law 109-
        432), is amended by adding at the end the following new 
        sentence: ``The Secretary shall not expend from the Fund any 
        amounts for bonus incentive payments for quality reporting of 
        data on quality measures with respect to services furnished 
        during 2008.''.

SEC. 4. THE VOLUNTARY MEDICARE QUALITY REPORTING PROGRAM.

    (a) In General.--Section 1848(k)(2) of the Social Security Act (42 
U.S.C. 1395w-4(k)(2)) as added by section 101(b) of Division B of the 
Tax Relief and Health Care Act of 2006 (Public Law 109-432; 120 Stat. 
2975), is amended by adding at the end the following new subparagraph:
                    ``(C) For 2010 and succeeding years.--
                            ``(i) In general.--For purposes of 
                        reporting data on quality measures for covered 
                        professional services furnished during 2010 and 
                        during succeeding years, the quality measures 
                        specified under this paragraph for covered 
                        professional services are quality measures the 
                        Secretary has selected in accordance with this 
                        subparagraph as part of the rulemaking process 
                        for payments under this section for 2010 and 
                        succeeding years, respectively.
                            ``(ii) Characteristics of measures.--The 
                        quality measures selected under clause (i) 
                        shall--
                                    ``(I) include a mixture of 
                                structural measures, process measures, 
                                and outcomes measures (as such terms 
                                are defined in clause (v));
                                    ``(II) be evidence-based and 
                                clinically valid;
                                    ``(III) be relevant to physicians, 
                                other eligible professionals, and 
                                individuals entitled to benefits under 
                                part A or enrolled under this part; and
                                    ``(IV) include measures that 
                                capture patients' assessments of 
                                clinical care provided.
                            ``(iii) Fairness.--The selection of quality 
                        measures under this subparagraph shall be 
                        conducted (and such quality measures shall be 
                        applied) in a manner that--
                                    ``(I) takes into account 
                                differences in individual health 
                                status;
                                    ``(II) takes into account an 
                                individual's compliance with health 
                                care orders;
                                    ``(III) does not directly or 
                                indirectly encourage patient selection 
                                or deselection;
                                    ``(IV) does not penalize eligible 
                                professionals who furnish services to 
                                individuals entitled to benefits under 
                                part A or enrolled under this part who 
                                are frail, low-income, of racial or 
                                ethnic minority groups, or of limited 
                                English language proficiency;
                                    ``(V) reduces health disparities 
                                across groups and areas;
                                    ``(VI) uses appropriate statistical 
                                techniques to ensure valid results; and
                                    ``(VII) assures that the Secretary 
                                is able to process data for the quality 
                                measures as written by the individual 
                                or organization that developed the 
                                measure.
                            ``(iv) Selection process for measures to be 
                        reported.--The measures selected under clause 
                        (i) for 2010 (and each succeeding year) shall 
                        be measures that have been published by the 
                        Secretary in the Federal Register not later 
                        than November 1 before the year as endorsed 
                        quality measures that are applicable to covered 
                        professional services during the year. For 
                        purposes of this subparagraph, the Secretary 
                        may publish quality measures for 2010 (or a 
                        succeeding year) in the Federal Register only 
                        if such measures are selected and endorsed as 
                        follows:
                                    ``(I) Recommendations for clinical 
                                areas.--Not later than October 1, 2008 
                                (and each succeeding October 1), the 
                                Secretary shall request, through notice 
                                in the Federal Register (without 
                                comment period), each physician 
                                specialty organization, each other 
                                eligible professional organization, and 
                                each quality improvement organization 
                                to submit to the Physician Consortium 
                                for Performance Improvement of the 
                                American Medical Association (referred 
                                to in this subparagraph as the 
                                `Consortium') by not later than 
                                December 31, 2008 (and each succeeding 
                                December 31), recommendations of 
                                clinical areas for the development of 
                                quality measures for purposes of this 
                                subparagraph. Not later than December 
                                31, 2008 (and each succeeding December 
                                31), the Secretary shall also submit to 
                                the Consortium recommendations of 
                                clinical areas for the development of 
                                such quality measures.
                                    ``(II) Selection of clinical 
                                areas.--Not later than March 31, 2009 
                                (and each subsequent March 31), the 
                                Consortium is requested to submit to 
                                the Secretary the recommendations 
                                described in subclause (I).
                                    ``(III) Development of proposed 
                                quality measures.--Not later than June 
                                1 of each year (beginning with 2009), 
                                the Consortium, in collaboration with 
                                physician specialty organizations and 
                                other eligible professional 
                                organizations, is requested to develop 
                                proposed quality measures for each 
                                clinical area identified under 
                                subclause (I). Such measures shall meet 
                                the requirements of clauses (ii) and 
                                (iii).
                                    ``(IV) Endorsement of quality 
                                measures.--Not later than June 15 of 
                                each year (beginning with 2009), the 
                                Consortium is requested to submit the 
                                proposed quality measures developed 
                                under subclause (III) to a consensus 
                                organization for endorsement. Not later 
                                than September 30 of each year 
                                (beginning with 2009), the consensus 
                                organization is requested to submit to 
                                the Secretary the quality measures that 
                                have been endorsed by the consensus 
                                organization.
                            ``(v) Definitions.--In this subparagraph:
                                    ``(I) Structural measure.--The term 
                                `structural measure' means a measure 
                                that reflects the organizational, 
                                technological, and human resources 
                                infrastructure of a system necessary 
                                for the delivery of quality health care 
                                (such as the use of health information 
                                technology for submission of measures).
                                    ``(II) Process measure.--The term 
                                `process measure' means a measure 
                                associated with the practice of health 
                                care or the furnishing of a service 
                                that is known to be effective.
                                    ``(III) Outcome measure.--The term 
                                `outcome measure' means a measure that 
                                provides information on how health care 
                                affects patients.
                                    ``(IV) Consensus organization.--The 
                                term `consensus organization' means an 
                                organization, such as the National 
                                Quality Forum, that the Secretary 
                                identifies as--
                                            ``(aa) having experience in 
                                        using a process for reaching a 
                                        group consensus with respect to 
                                        quality measures relating to 
                                        the performance of those 
                                        providing health care services; 
                                        and
                                            ``(bb) including in such 
                                        process practicing physicians, 
                                        practitioners with experience 
                                        in the care of the frail 
                                        elderly and individuals with 
                                        multiple complex chronic 
                                        conditions, organizations and 
                                        individuals representative of 
                                        the specialty involved, 
                                        individuals entitled to 
                                        benefits under part A or 
                                        enrolled under this part, 
                                        experts in health care quality, 
                                        individuals with experience in 
                                        the delivery of health care in 
                                        urban, rural, and frontier 
                                        areas and to underserved 
                                        populations, and 
                                        representatives of the 
                                        Secretary.''.
    (b) Taking Into Account Results of Demonstration Projects.--Section 
1848(k) of the Social Security Act (42 U.S.C. 1395w-4(k)) as added by 
section 101(b) of Division B of the Tax Relief and Health Care Act of 
2006 (Public Law 109-432; 120 Stat. 2975) is amended--
            (1) by striking paragraph (4) (relating to registry based 
        reporting); and
            (2) by inserting after paragraph (3) the following new 
        paragraph:
            ``(4) Taking into account results of demonstration 
        projects.--In administering this subsection, the Secretary 
        shall take into account the relevant findings and results from 
        demonstration projects undertaken by the Secretary for 
        reporting quality measures applicable to covered professional 
        services.''.
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