1.This Act may be cited as
the Voluntary Medicare Quality
Reporting Act of 2007
.
2.
(a)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.
3.Transition to
new voluntary Medicare quality reporting program
(a)Evaluating the
transitional quality reporting system established for
2007
(1)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)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 registriesBeginning 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)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)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 2008Section 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.
.
4.The voluntary Medicare quality reporting
program
(a)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)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 measuresThe 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)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 reportedThe 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 areasNot 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 areasNot 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 measuresNot
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 measuresNot 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)In
this subparagraph:
(I)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)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)The term outcome measure means a measure
that provides information on how health care affects patients.
(IV)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 projectsSection 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 projectsIn 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.
.