1.This Act may be cited as
the Veterans Health Care Improvement
Act of 2008
.
2.Congress makes the following
findings:
(1)Veterans of the
Armed Forces have made tremendous sacrifices in the defense of freedom and
liberty.
(2)Congress
recognizes these great sacrifices and reaffirms America’s strong commitment to
its veterans.
(3)As part of the
on-going congressional effort to recognize the sacrifices made by America’s
veterans, Congress has dramatically increased funding for the Department of
Veterans Affairs for veterans health care in the years since September 11,
2001.
(4)Part of the
funding for the Department of Veterans Affairs for veterans health care is
allocated toward community-based outpatient clinics (CBOCs).
(5)Many CBOCs are
administered by private contractors.
(6)CBOCs
administered by private contractors operate on a capitated basis.
(7)Some current
contracts for CBOCs may create an incentive for contractors to sign up as many
veterans as possible, without ensuring timely access to high quality health
care for such veterans.
(8)The top
priorities for CBOCs should be to provide quality health care and patient
satisfaction for America’s veterans.
(9)The Department of
Veterans Affairs currently tracks the quality of patient care through its
Computerized Patient Record System. However, fees paid to contractors are not
currently adjusted automatically to reflect the quality of care provided to
patients.
(10)A
pay-for-performance payment model offers a promising approach to health care
delivery by aligning the payment of fees to contractors with the achievement of
better health outcomes for patients.
(11)The Department
of Veterans Affairs should begin to emphasize pay-for-performance in its
contracts with CBOCs.
3.Pay-for-performance
under Department of Veterans Affairs contracts with community-based outpatient
health care clinics
(a)Not later than one year after the date of the enactment
of this Act, the Secretary of Veterans Affairs shall submit to Congress a plan
to introduce pay-for-performance measures into contracts which compensate
contractors of the Department of Veterans Affairs for the provision of health
care services through community-based outpatient clinics (CBOCs).
(b)The
plan required by subsection (a) shall include the following:
(1)Measures to
ensure that contracts of the Department for the provision of health care
services through CBOCs begin to utilize pay-for-performance compensation
mechanisms for compensating contractors for the provision of such services
through such clinics, including mechanisms as follows:
(A)To provide
incentives for clinics that provide high-quality health care.
(B)To provide
incentives to better assure patient satisfaction.
(C)To impose
penalties (including termination of contract) for clinics that provide
substandard care.
(2)Mechanisms to
collect and evaluate data on the outcomes of the services generally provided by
CBOCs in order to provide for an assessment of the quality of health care
provided by such clinics.
(3)Mechanisms to
eliminate abuses in the provision of health care services by CBOCs under
contracts that continue to utilize capitated-basis compensation mechanisms for
compensating contractors.
(c)The
Secretary shall commence the implementation of the plan required by subsection
(a) unless Congress enacts an Act, not later than 60 days after the date of the
submittal of the plan, prohibiting or modifying implementation of the plan. In
implementing the plan, the Secretary may initially carry out one or more pilot
programs to assess the feasability and advisability of mechanisms under the
plan.
(d)Not
later than 180 days after the date of the enactment of this Act and every 180
days thereafter, the Secretary shall submit to Congress a report setting forth
the recommendations of the Secretary as to the feasability and advisability of
utilizing pay-for-performance compensation mechanisms in the provision of
health care services by the Department by means in addition to CBOCs.