II 111th CONGRESS 1st Session S. 1427 IN THE SENATE OF THE UNITED STATES July 9, 2009 Mr. Wyden (for himself and Mr. Johanns) introduced the following bill; which was read twice and referred to the Committee on Veterans' Affairs A BILL To amend title 38, United States Code, to establish a Hospital Quality Report Card Initiative to report on health care quality in Department of Veterans Affairs Medical Centers, and for other purposes.

1.

Short title

This Act may be cited as the Department of Veterans Affairs Hospital Quality Report Card Act of 2009.

2.

Department of Veterans Affairs Hospital Quality Report Card Initiative

(a)

Purpose

The purpose of this section is to provide for the establishment within the Department of Veterans Affairs of an initiative to be known as the Hospital Quality Report Card Initiative to ensure that information on the quality and performance of hospitals administered by the Secretary of Veterans Affairs is readily available and accessible for purposes as follows: (1)To inform patients and consumers about health care quality in such hospitals. (2)To assist health care providers of the Department of Veterans Affairs in identifying opportunities for quality improvement and cost containment. (3)To enhance the understanding of policy makers and public officials of health care issues, raise public awareness of hospital quality issues, and help constituents of such policy makers and officials identify quality health care options for the Department of Veterans Affairs. (b)

Establishment

Subchapter I of chapter 17 of title 38, United States Code, is amended by inserting after section 1706 the following new section:

1706A.

Management of health care: Hospital Quality Report Card Initiative

(a)

In general

Not later than 18 months after the date of the enactment of the Department of Veterans Affairs Hospital Quality Report Card Act of 2009, the Secretary shall establish and implement an initiative, to be known as the Hospital Quality Report Card Initiative (in this section referred to as the Initiative), to report on health care quality in Department medical centers. (b)

Publication of information on quality and performance of Department medical centers

(1)(A)Under the Initiative, not less frequently than twice each year, the Secretary shall make available to the public a report containing the most current information on the quality and performance of each Department medical center. Such information shall include quality measures that allow for an assessment with respect to health care provided by Department medical centers, of the following: (i)Effectiveness. (ii)Safety. (iii)Timeliness. (iv)Efficiency. (v)Patient centered. (vi)Patient satisfaction. (vii)Satisfaction of health professionals employed at Department medical centers. (viii)The equity of care provided to various patient populations, including female, geriatric, disabled, rural, homeless, mentally ill, and racial and ethnic minority populations. (B)For each quality measure reported under subparagraph (A), the Secretary shall include a quality measure represented by an incremental letter grade scale, with A+ being the highest and F being the lowest, based on information reported in paragraph (2) and such other information as the Secretary considers appropriate. (2)(A)In reporting information pursuant to paragraph (1), the Secretary shall, except as provided in subparagraph (B), include to the maximum extent practicable information about Department medical centers relating to— (i)staffing levels of nurses and other health professionals, as appropriate; (ii)rates of nosocomial infections; (iii)the volume of each of the different types of procedures performed; (iv)hospital sanctions and other violations; (v)the quality of care provided to various patient populations, including female, geriatric, disabled, rural, homeless, mentally ill, and racial and ethnic minority populations; (vi)the availability of emergency rooms, intensive care units, maternity care, and specialty services; (vii)the quality of care in various hospital settings, including inpatient, outpatient, emergency, maternity, and intensive care unit settings; (viii)ongoing patient safety initiatives; (ix)use of health information technology systems; and (x)such other matters the Secretary considers appropriate. (B)In making a report available to the public under paragraph (1), the Secretary may provide information in addition to the information required by subparagraph (A) or provide information in lieu of the information required by subparagraph (A) if the Secretary— (i)not later than 15 days before the date on which such report is made available to the public, submits to the Committee on Veterans' Affairs of the Senate and the Committee on Veterans' Affairs of the House of Representatives a certification in writing that such additional or substituted information is more appropriate for purposes of carrying out the requirement of paragraph (2)(B); and (ii)includes in such report and certification an indication of which information has been added or substituted under this subparagraph. (3)(A)In reporting information as provided for under paragraph (1), the Secretary may risk adjust quality measures to account for differences relating to— (i)the characteristics of the reporting Department medical center, such as licensed bed size, geography, and teaching hospital status; and (ii)patient characteristics, such as health status, severity of illness, and socioeconomic status. (B)If the Secretary reports data under paragraph (1) 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. (4)Under the Initiative, the Secretary may verify information reported under this subsection to ensure accuracy and validity. (5)Before disclosing to the public any information under this subsection, the Secretary shall disclose the methodology for the reporting of such information and the nature and scope of such information to each— (A)organization the Secretary considers relevant to such information; and (B)Department medical center that is the subject of such information. (6)(A)For each report made available to the public under paragraph (1), the Secretary shall submit to the Committee on Veterans' Affairs of the Senate and the Committee on Veterans' Affairs of the House of Representatives a copy of such report. (B)The Secretary shall ensure that each report made available to the public under paragraph (1) is made available— (i)in an electronic format; (ii)in a manner that can be understood by individuals who are not medical professionals and individuals with low functional health literacy; and (iii)at each Department medical centers covered by the report. (C)The Secretary shall ensure that information on health care quality is provided in a manner that is conducive for comparisons with other local hospitals or regional hospitals, as appropriate. (D)The Secretary shall establish procedures for making the information covered by reports made available to the public under paragraph (1) available to the public upon request in non-electronic format, such as through a toll-free telephone number. (7)The analytic methodologies and limitations on information sources utilized by the Secretary to develop and disseminate the comparative information under this subsection shall be identified and acknowledged in a notice or disclaimer as part of the dissemination of such information, and include the appropriate and inappropriate uses of such information. (c)

Identifying and reporting actions that could lead to false or artificial improvements in quality measurements

Not less frequently than annually, the Secretary shall compare quality measures data submitted by each Department medical center to the Secretary with quality measures data submitted to the Secretary in the prior year or years by each such Department medical center in order to identify and report actions that could lead to false or artificial improvements in the quality measurements of such Department medical centers. (d)

Privacy and security

(1)The Secretary shall develop and implement effective safeguards to protect against the unauthorized use or disclosure of Department medical center data that is reported under this section. (2)The Secretary shall develop and implement effective safeguards to protect against the dissemination of inconsistent, incomplete, invalid, inaccurate, or subjective Department medical center data. (3)The Secretary shall ensure that identifiable patient data shall not be released to the public. (e)

Periodic reports

(1)The Secretary shall periodically submit to Congress a report on the effectiveness of the Initiative. (2)Each report required by paragraph (1) shall include the following: (A)An assessment of the effectiveness of the Initiative in meeting the purpose described in section 2(a) of the Department of Veterans Affairs Hospital Quality Report Card Act of 2009. (B)A description of the measures the Secretary can undertake to ensure that the Initiative meets such purpose. (3)The Secretary shall carry out each measure the Secretary includes in a report under paragraph (2)(B). (4)The Secretary shall make each report submitted under paragraph (1) available to the public. (f)

Department medical center defined

In this section, the term Department medical center means a Department of Veterans Affairs Medical Center administered by the Secretary. (g)

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 2010 through 2018.

. (c)

Clerical amendment

The table of sections at the beginning of chapter 17 of such title is amended by inserting after the item relating to section 1706 the following new item: 1706A. Management of health care: Hospital Quality Report Card Initiative. .