1.This Act may be cited as
the Veterans Health Care Quality
Improvement Act
.
2.Standards for
appointment and practice of physicians in Department of Veterans Affairs
medical facilities
(a)
(1)Subchapter I of chapter 74 of title 38, United States
Code, is amended by inserting after section 7402 the following new
section:
7402A.Appointment
and practice of physicians: standards
(a)The Secretary shall, acting through the Under Secretary
for Health, prescribe standards to be met by individuals in order to qualify
for appointment in the Administration in the position of physician and to
practice as a physician in medical facilities of the Administration. The
standards shall incorporate the requirements of this section.
(b)Disclosure of
certain information before appointmentEach individual seeking
appointment in the Administration in the position of physician shall do the
following:
(1)Provide the
Secretary a full and complete explanation of the following:
(A)Each lawsuit,
civil action, or other claim (whether open or closed) brought against the
individual for medical malpractice or negligence (other than a lawsuit, action,
or claim closed without any judgment against or payment by or on behalf of the
individual).
(B)Each payment made
by or on behalf of the individual to settle any lawsuit, action, or claim
covered by subparagraph (A).
(C)Each
investigation or disciplinary action taken against the individual relating to
the individual's performance as a physician.
(2)Submit a written
request and authorization to the State licensing board of each State in which
the individual holds or has held a license to practice medicine to disclose to
the Secretary any information in the records of such State on the
following:
(A)Each lawsuit,
civil action, or other claim brought against the individual for medical
malpractice or negligence covered by paragraph (1)(A) that occurred in such
State.
(B)Each payment made
by or on behalf of the individual to settle any lawsuit, action, or claim
covered by subparagraph (A).
(C)Each medical
malpractice judgment against the individual by the courts or administrative
agencies or bodies of such State.
(D)Each disciplinary
action taken or under consideration against the individual by an administrative
agency or body of such State.
(E)Any change in the
status of the license to practice medicine issued the individual by such State,
including any voluntary or nondisciplinary surrendering of such license by the
individual.
(F)Any open
investigation of the individual by an administrative agency or body of such
State, or any outstanding allegation against the individual before such an
administrative agency or body.
(c)Disclosure of
certain information following appointment(1)Each individual
appointed in the Administration in the position of physician after the date of
the enactment of the Veterans Health Care Quality Improvement Act shall, as a
condition of service under the appointment, disclose to the Secretary, not
later than 30 days after the occurrence of such event, the following:
(A)A judgment against the individual for
medical malpractice or negligence.
(B)A payment made by or on behalf of the
individual to settle any lawsuit, action, or claim disclosed under paragraph
(1) or (2) of subsection (b).
(C)Any disposition of or material change
in a matter disclosed under paragraph (1) or (2) of subsection (b).
(2)Each individual appointed in the
Administration in the position of physician as of the date of the enactment of
the Veterans Health Care Quality Improvement Act shall do the following:
(A)Not later than the end of the 60-day
period beginning on the date of the enactment of that Act and as a condition of
service under the appointment after the end of that period, submit the request
and authorization described in subsection (b)(2).
(B)Agree, as a condition of service under
the appointment, to disclose to the Secretary, not later than 30 days after the
occurrence of such event, the following:
(i)A judgment against the individual
for medical malpractice or negligence.
(ii)A payment made by or on behalf of
the individual to settle any lawsuit, action, or claim disclosed pursuant to
subparagraph (A) or under this subparagraph.
(iii)Any disposition of or material
change in a matter disclosed pursuant to subparagraph (A) or under this
subparagraph.
(3)Each individual appointed in the
Administration in the position of physician shall, as part of the biennial
review of the performance of the physician under the appointment, submit the
request and authorization described in subsection (b)(2). The requirement of
this paragraph is in addition to the requirements of paragraph (1) or (2), as
applicable.
(d)Investigation
of disclosed matters(1)The Regional Director
of the Veterans Integrated Services Network (VISN) in which an individual is
seeking appointment in the Administration in the position of physician shall
perform a comprehensive investigation (in such manner as the standards required
by this section shall specify) of each matter disclosed under subsection (b)
with respect to the individual.
(2)The Regional Director of the Veterans
Integrated Services Network in which an individual is appointed in the
Administration in the position of physician shall perform a comprehensive
investigation (in a manner so specified) of each matter disclosed under
subsection (c) with respect to the individual.
(3)The results of each investigation
performed under this subsection shall be fully documented.
(e)Approval of
appointments by Regional Directors of VISNs(1)An individual may not
be appointed in the Administration in the position of physician without the
approval of the Regional Director of the Veterans Integrated Services Network
in which the individual will first serve under the appointment.
(2)In approving the appointment under
this subsection of an individual for whom any matters have been disclosed under
subsection (b), a Regional Director shall—
(A)certify in writing the completion of
the performance of the investigation under subsection (d)(1) of each such
matter, including the results of such investigation; and
(B)provide a written justification why
any matters raised in the course of such investigation do not disqualify the
individual from appointment.
(f)(1)Except as provided in
paragraph (2), an individual may not be appointed in the Administration in the
position of physician unless the individual is board certified in the
specialties in which the individual will practice under the appointment.
(2)A Regional Director may waive the
limitation in paragraph (1) with respect to any individual who has completed a
residency program within the two-year period ending on the date of such waiver
if the individual provides satisfactory evidence (as determined in accordance
with the standards required by this section) of an intent to become board
certified. The period of any waiver under this paragraph may not exceed one
year.
(g)State license
required for practice in in-State VA medical facilitiesEach
physician practicing at a medical facility of the Department in a State,
whether under an appointment in the Administration or through the extension of
privileges of practice, shall, as a condition of such practice, hold a license
to practice medicine in the State within one year of appointment.
(h)Enrollment of
physicians with practice privileges in Proactive Disclosure
ServiceEach medical facility of the Department at which
physicians are extended the privileges of practice shall enroll each physician
extended such privileges in the Proactive Disclosure Service of the National
Practitioners Data
Base.
.
(2)The table of sections at the beginning of chapter 74 of
such title is amended by inserting after the item relating to section 7402 the
following new item:
7402A. Appointment and practice of physicians:
standards.
.
(b)Effective date
and applicability
(1)Except as provided in paragraph (2), the amendments made by
subsection (a) shall take effect on the date of the enactment of this
Act.
(2)Applicability
of certain requirements to physicians practicing on effective
dateIn the case of an individual appointed to the Veterans
Health Administration in the position of physician as of the date of the
enactment of this Act—
(A)the requirements
of subsections (f) and (g) of section 7402A, United States Code, as added by
subsection (a) of this section, shall take effect on the date that is one year
after the date of the enactment of this Act; and
(B)the requirements
of subsection (h) of such section 7402A, as so added, shall take effect on the
date that is 60 days after the date of the enactment of this Act.
3.Enhancement of
quality assurance by the Veterans Health Administration
(a)Enhancement of
quality assurance through quality assurance officers
(1)Subchapter II of chapter 73 of title 38, United States
Code, is amended by inserting after section 7311 the following new
section:
7311A.Quality
assurance officers
(a)National
quality assurance officer(1)The Under Secretary of
Health shall designate an official of the Administration to act as the
principal quality assurance officer for the quality-assurance program required
by section 7311 of this title. The official so designated may be known as the
National Quality Assurance Officer of the Veterans Health
Administration
(in this section referred to as the National
Quality Assurance Officer
).
(2)The National Quality Assurance
Officer shall report directly to the Under Secretary for Health in the
discharge of responsibilities and duties of the Officer under this
section.
(3)The National Quality Assurance
Officer shall be the official within the Administration who is principally
responsible for the quality-assurance program referred to in paragraph (1). In
carrying out that responsibility, the Officer shall be responsible for—
(A)establishing and enforcing the
requirements of that program; and
(B)carrying out such other
responsibilities and duties relating to quality assurance in the Administration
as the Under Secretary for Health shall specify.
(4)The requirements under paragraph (3)
shall include requirements regarding the following:
(A)A confidential system for the
submittal of reports by Administration personnel regarding quality assurance at
Administration facilities.
(B)Mechanisms for the peer review of the
actions of individuals appointed in the Administration in the position of
physician.
(C)Mechanisms for the accountability of
the facility director and chief medical officer of each Administration medical
facility for the actions of physicians in such facility.
(b)Quality
assurance officers for VISNs(1)The Regional Director
of each Veterans Integrated Services Network (VISN) shall appoint an official
of the Network to act as the quality assurance officer of the Network.
(2)Each official appointed as a quality
assurance officer under this subsection shall be a board-certified
physician.
(3)The quality assurance officer for a
Veterans Integrated Services Network shall report to the Regional Director of
the Veterans Integrated Services Network, and to the National Quality Assurance
Officer, regarding the discharge of the responsibilities and duties of the
officer under this section.
(4)The quality assurance officer for a
Veterans Integrated Services Network shall—
(A)direct the quality assurance office in
the Network; and
(B)coordinate, monitor, and oversee the
quality assurance programs and activities of the Administration medical
facilities in the Network in order to ensure the thorough and uniform discharge
of quality assurance requirements under such programs and activities throughout
such facilities.
(c)Quality
assurance officers for medical facilities(1)The director of each
Administration medical facility shall appoint a quality assurance officer for
that facility.
(2)Each official appointed as a quality
assurance officer under this subsection shall be a board-certified
physician.
(3)The official appointed as a quality
assurance officer for a facility under this subsection shall be a practicing
physician at the facility. If the official appointed as quality assurance
officer for a facility has other clinical or administrative duties, the
director of the facility shall ensure that those duties are sufficiently
limited in scope so as to ensure that those duties do not prevent the officer
from effectively discharging the responsibilities and duties of quality
assurance officer at the facility.
(4)The quality assurance officer for a
facility shall report directly to the director of the facility, and to the
quality assurance officer of the Veterans Integrated Services Network in which
the facility is located, regarding the discharge of the responsibilities and
duties of the quality assurance officer under this section.
(5)The quality assurance officer for a
facility shall be responsible for designing, disseminating, and implementing
quality assurance programs and activities for the facility that meet the
requirements established by the National Quality Assurance Officer under
subsection
(a).
.
(2)The table of sections at the beginning of chapter 73 of
such title is amended by inserting after the item relating to section 7311 the
following new item:
7311A. Quality assurance
officers.
.
(b)Board-certified
physician requirement for individuals appointed as Under Secretary for
HealthSection 305(a)(2) of title 38, United States Code, is
amended by inserting shall be a board-certified physician and
before shall be
.
(c)Reports on
quality concerns under quality-assurance programSection 7311(b)
of such title is amended by adding at the end the following new
paragraph:
(4)As part of the quality-assurance
program, the Under Secretary for Health shall establish mechanisms through
which employees of Administration facilities may submit reports, on a
confidential basis, on matters relating to quality of care in Administration
facilities to the quality assurance officers of such facilities under section
7311A(c) of this title and to the quality assurance officers of the Veterans
Integrated Services Networks (VISNs) in which such facilities are located under
section 7311A(b) of this title. The mechanisms shall provide for the prompt and
thorough review of any reports so submitted by the receiving
officials.
.
(d)Review of
current health care quality safeguards
(1)The Secretary of Veterans Affairs shall conduct a
comprehensive review of all current policies and protocols of the Department of
Veterans Affairs for maintaining health care quality and patient safety at
Department of Veterans Affairs medical facilities. The review shall include a
review and assessment of the National Surgical Quality Improvement Program
(NSQIP), including an assessment of—
(A)the efficacy of
the quality indicators under the program;
(B)the efficacy of
the data collection methods under the program;
(C)the efficacy of
the frequency with which regular data analyses are performed under the program;
and
(D)the extent to
which the resources allocated to the program are adequate to fulfill the stated
function of the program.
(2)Not
later than 60 days after the date of the enactment of this Act, the Secretary
shall submit to Congress a report on the review conducted under paragraph (1),
including the findings of the Secretary as a result of the review and such
recommendations as the Secretary considers appropriate in light of the
review.
4.Incentives to
encourage high-quality physicians to serve in the Veterans Health
Administration
(a)
(1)Subchapter III of chapter 74 of title 38, United States
Code, is amended by inserting after section 7431 the following new
section:
7431A.Physicians:
additional incentives for service in hard-to-fill positions
(a)Loan repayment
for physicians who serve in hard-To-fill positions(1)In order to recruit and
retain physicians in the Administration in hard-to-fill positions (as
designated by the Secretary for purposes of this subsection), the Secretary
shall repay, for each individual who agrees to serve as a physician for a
period of not less than three years in an Administration facility in such a
position, any loan of such individual as follows:
(A)Any loan of the individual described
in paragraphs (1) through (4) of section 16302(a) of title 10.
(B)Any other loan of the individual
designated by the Secretary for purposes of this subsection the proceeds of
which were used by the individual to finance education leading to the medical
degree of the individual.
(2)Each individual seeking repayment of
loans under paragraph (1) shall enter into an agreement with the Secretary
regarding the repayment of loans. Under the agreement, the individual shall
agree—
(A)to perform satisfactory service in a
physician position specified in the agreement in an Administration facility
specified in the agreement for such period of years as the agreement shall
specify; and
(B)to possess and retain for the period
of the agreement such professional qualifications as are necessary for the
service specified under subparagraph (A).
(3)Repayment of loans under this
subsection shall be made on the basis of complete years of service under the
agreement under this subsection. The amount to be repayed under an agreement
under this subsection for a complete year of service specified in the agreement
shall be such amount, not to exceed $30,000, for each complete year of service
as the agreement shall specify.
(b)Tuition
reimbursement for physician students who agree To serve in hard-To-fill
positions(1)In order to recruit and
retain physicians in the Administration in hard-to-fill positions (as
designated by the Secretary for purposes of this subsection), the Secretary
shall reimburse individuals who are enrolled in a course of education leading
toward board certification as a physician for the tuition charged for pursuit
of such course of education if such individuals agree to serve as a physician
in an Administration facility in such a position.
(2)Each individual seeking tuition
reimbursement under paragraph (1) shall enter into an agreement with the
Secretary regarding such tuition reimbursement. Under the agreement, the
individuals shall agree—
(A)to satisfactorily complete the course
of education of the individual described in paragraph (1); and
(B)upon completion of the course of
education, to become board-certified as a physician; and
(C)upon completion of the matters
referred to in subparagraphs (A) and (B)—
(i)to perform satisfactory service in
a physician position specified in the agreement in an Administration facility
specified in the agreement for such period of years as the agreement shall
specify; and
(ii)to possess and retain for the
period of the agreement such professional qualifications as are necessary for
the service specified under clause (i).
(3)The amount of reimbursement payable
to an individual under paragraph (1) for a year may not exceed $30,000.
(4)Any individual receiving tuition
reimbursement under paragraph (1) who does not satisfy the requirements of the
agreement under paragraph (2) shall be subject to such repayment requirements
as the Secretary shall specify in the agreement.
(5)An individual receiving tuition
reimbursement under paragraph (1) for pursuit of a course of education shall
also be paid a stipend in the amount of $5,000 for each academic year of
pursuit of such course of education after entry into an agreement under
paragraph (2).
(c)Participation
in FEHBP of physicians who serve part-time in hard-To-fill
positions(1)In order to recruit and
retain physicians in the Administration in hard-to-fill positions (as
designated by the Secretary for purposes of this subsection), an individual not
otherwise eligible for health insurance under chapter 89 of title 5 who agrees
to serve as a physician in an Administration facility in such a position for
not less than five days per month (of which two days must occur in each 14-day
period) shall be eligible for enrollment in the health benefit plans under
chapter 89 of title 5 on a self only or self and family basis (as
applicable).
(2)The Secretary shall administer this
subsection in consultation with the Director of the Office of Personnel
Management.
(d)It is the sense of Congress that the Secretary should
undertake active and on-going efforts to establish additional incentive
programs to encourage individuals to serve in the position of physician in the
Administration, or otherwise practice in the Administration, in hard-to-fill
positions, including, in particular, incentive programs to encourage more
experienced physicians to serve or practice in such positions.
(e)The
incentives required under this section are in addition to any other special
pays or benefits to which the individuals covered by this section are eligible
or entitled under
law.
.
(2)The table of sections at the beginning of chapter 74 of
such title is amended by inserting after the item relating to section 731 the
following new item:
7431A. Physicians: additional incentives for service in
hard-to-fill
positions.
.
(b)Affiliation of
Department of Veterans Affairs medical facilities with medical
schoolsThe Secretary of Veterans Affairs shall, to the extent
practicable, require each medical facility of the Department of Veterans
Affairs to seek to establish an affiliation with a medical school within
reasonable proximity of such medical facility.
5.
(a)Not later than December 15, 2009, and each
year thereafter through 2012, the Secretary of Veterans Affairs shall submit to
the congressional veterans affairs committees a report on the implementation of
this Act and the amendments made by this Act during the preceding fiscal year.
Each report shall include, for the fiscal year covered by such report, the
following:
(1)A comprehensive
description of the implementation of this Act and the amendments made by this
Act.
(2)Such
recommendations as the Secretary considers appropriate for legislative or
administrative action to improve the authorities and requirements in this Act
and the amendments made by this Act or to otherwise improve the quality of
health care and the quality of the physicians in the Veterans Health
Administration.
(b)Congressional
veterans affairs committees definedIn this section, the term
congressional veterans affairs committees means—
(1)the Committees on
Veterans' Affairs and Appropriations of the Senate; and
(2)the Committees on
Veterans' Affairs and Appropriations of the House of Representatives.