[Congressional Bills 110th Congress]
[From the U.S. Government Publishing Office]
[S. 1824 Introduced in Senate (IS)]







110th CONGRESS
  1st Session
                                S. 1824

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.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                             July 19, 2007

   Mr. Obama 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 establish a Hospital 
Quality Report Card Initiative under the Medicare program to assess and 
              report on health care quality in hospitals.

    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 ``Hospital Quality Report Card Act of 
2007''.

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--
            (1) assist patients and consumers in making decisions about 
        where to get health care;
            (2) assist purchasers and insurers in making decisions that 
        determine where employees, subscribers, members, or 
        participants are able to go for their health care; and
            (3) assist health care providers in identifying 
        opportunities for quality improvement and cost containment.

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:

               ``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.
    ``(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).
    ``(c) Requirements of Initiative.--
            ``(1) Quality measurement reports for hospitals.--
                    ``(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--
                            ``(i) effectiveness;
                            ``(ii) safety;
                            ``(iii) timeliness;
                            ``(iv) efficiency;
                            ``(v) patient-centeredness; and
                            ``(vi) equity.
                    ``(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--
                            ``(i) staffing levels of nurses and other 
                        health professionals, as appropriate;
                            ``(ii) rates of hospital acquired 
                        infections;
                            ``(iii) the volume of various procedures 
                        performed;
                            ``(iv) the availability of interpreter 
                        services on-site;
                            ``(v) the accreditation of hospitals, as 
                        well as sanctions and other violations found by 
                        accreditation or State licensing boards;
                            ``(vi) the quality of care for various 
                        patient populations, including pediatric 
                        populations and racial and ethnic minority 
                        populations;
                            ``(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;
                            ``(viii) the availability of intensive care 
                        units, obstetrical units, and burn units;
                            ``(ix) the quality of care in various 
                        hospital settings, including inpatient, 
                        outpatient, emergency, maternity, and intensive 
                        care unit settings;
                            ``(x) the use of health information 
                        technology, telemedicine, and electronic 
                        medical records;
                            ``(xi) ongoing patient safety initiatives; 
                        and
                            ``(xii) other measures determined 
                        appropriate by the Secretary.
                    ``(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.
                    ``(D) Risk adjustment.--
                            ``(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--
                                    ``(I) the characteristics of the 
                                reporting hospital, such as licensed 
                                bed size, geography, teaching hospital 
                                status, and profit status; and
                                    ``(II) patient characteristics, 
                                such as health status, severity of 
                                illness, insurance status, and 
                                socioeconomic status.
                            ``(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.
                    ``(E) Costs and charges.--The Secretary shall--
                            ``(i) compile data relating to the average 
                        hospital cost and charges for ICD-9 conditions 
                        for which quality measures data are collected; 
                        and
                            ``(ii) report such information in a manner 
                        that allows cost and charge comparisons between 
                        or among subsection (d) hospitals.
                    ``(F) Verification.--Under the Initiative, the 
                Secretary may verify data reported under this paragraph 
                to ensure accuracy and validity.
                    ``(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.
                    ``(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.
                    ``(I) Availability of reports and findings.--
                            ``(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.
                            ``(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.
                    ``(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.
                    ``(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--
                            ``(i) adverse selection against patients 
                        with severe illness or other factors that 
                        predispose patients to poor health outcomes; 
                        and
                            ``(ii) provision of health care that does 
                        not meet established recommendations or 
                        accepted standards for care.
            ``(2) Data safeguards.--
                    ``(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.
                    ``(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.
                    ``(C) Identifiable data.--The Secretary shall 
                ensure that identifiable patient data shall not be 
                released to the public.
    ``(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.
    ``(e) Hospital Quality Advisory Committee.--
            ``(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.
            ``(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):
                    ``(A) The Agency for Healthcare Research and 
                Quality.
                    ``(B) The Health Resources and Services 
                Administration.
                    ``(C) The Department of Veterans Affairs.
                    ``(D) The Centers for Disease Control and 
                Prevention.
                    ``(E) National membership organizations that focus 
                on health care quality improvement.
                    ``(F) Public and private hospitals.
                    ``(G) Physicians, nurses, and other health 
                professionals.
                    ``(H) Patients and patient advocates.
                    ``(I) Health insurance purchasers and other payers.
                    ``(J) Health researchers, policymakers, and other 
                experts in the field of health care quality.
                    ``(K) Health care accreditation entities.
                    ``(L) Representatives of utilization and quality 
                control peer review organizations under part B of title 
                XI.
                    ``(M) Other agencies and groups as determined 
                appropriate by the Administrator.
            ``(3) Duties.--The Advisory Committee shall review and 
        provide guidance and recommendations to the Administrator on--
                    ``(A) the establishment of the Initiative;
                    ``(B) integration and coordination of Federal 
                quality measures data submission requirements, to avoid 
                needless duplication and inefficiency;
                    ``(C) legal and regulatory barriers that may hinder 
                quality measures data collection and reporting; and
                    ``(D) necessary technical and financial assistance 
                to encourage quality measures data collection and 
                reporting.
            ``(4) Staff and resources.--The Administrator shall provide 
        the Advisory Committee with appropriate staff and resources for 
        the functioning of the Advisory Committee.
            ``(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.
    ``(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.''.
    (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:
    ``(VII) The Secretary shall use the data submitted under this 
clause for the Hospital Quality Report Card Initiative under section 
1898.''.

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.
    (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.
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