1.This Act may be cited as
the Graduate Medical Education Reform
Act of 2012
.
2.Medicare
indirect medical education performance adjustmentSection 1886 of the Social Security Act (42
U.S.C. 1395ww) is amended by adding at the end the following new
subsection:
(t)Indirect
medical education performance adjustments
(1)Subject to the succeeding provisions of this subsection,
the Secretary shall establish and implement procedures under which the amount
of payments that a hospital (as defined in paragraph (11)(A)) would otherwise
receive for indirect medical education costs under subsection (d)(5)(B) for
discharges occurring during a fiscal year is adjusted based on the reporting of
measures and the performance of the hospital on measures of patient care
priorities specified by the Secretary.
(2)Adjustments to
begin in fiscal year 2017The adjustments shall apply to payments
for discharges occurring—
(A)with respect to
the adjustments for reporting under paragraph (8)(A), during fiscal year 2017;
and
(B)with respect to
the adjustments for performance under paragraph (8)(B), on or after October 1,
2017.
(3)The
measures of patient care priorities specified by the Secretary under this
subsection shall include the extent of training provided in—
(A)the delivery of
services categorized as evaluation and management codes by the Centers for
Medicare & Medicaid Services;
(B)a variety of
settings and systems;
(C)the coordination
of patient care across settings;
(D)the relevant cost
and value of various diagnostic and treatment options;
(E)interprofessional
and multidisciplinary care teams;
(F)methods for
identifying system errors and implementing system solutions; and
(G)the use of health
information technology.
(4)Measure
development process
(A)The measures of patient care specified by the Secretary
under this subsection—
(i)shall—
(I)be measures that
have been adopted or endorsed by an accrediting organization (such as the
Accreditation Council for Graduate Medical Education or the Commission on
Osteopathic College Accreditation); and
(II)be measures that
the Secretary identifies as having used a consensus-based process for
developing such measures; and
(ii)may include
measures that have been submitted by teaching hospitals, medical schools, and
other stakeholders.
(B)Proposed set of
initial measuresNot later than July 1, 2014, the Secretary shall
publish in the Federal Register a proposed initial set of measures for use
under this subsection. The Secretary shall provide for a period of public
comment on such measures.
(C)Final set of
initial measuresNot later than January 1, 2015, the Secretary
shall publish in the Federal Register the set of initial measures to be
specified by the Secretary for use under this subsection.
(D)The Secretary may, through notice and comment
rulemaking, periodically update the measures specified under this subsection
pursuant to the requirements under subparagraph (A).
(5)The Secretary shall establish performance standards
with respect to measures specified by the Secretary under this subsection for a
performance period for a fiscal year (as established under paragraph
(6)).
(6)The Secretary shall establish the performance period for a
fiscal year. Such performance period shall begin and end prior to the beginning
of such fiscal year.
(7)The procedures established and implemented under
paragraph (1) shall include a process under which hospitals shall submit data
on the measures specified by the Secretary under this subsection to the
Secretary in a form and manner, and at a time, specified by the Secretary for
purposes of this subsection.
(8)
(A)Reporting for
fiscal year 2017For fiscal year 2017, in the case of a hospital
that does not submit, to the Secretary in accordance with this subsection, data
required to be submitted under paragraph (7) for a period (determined
appropriate by the Secretary) for such fiscal year, the total amount that the
hospital would otherwise receive under subsection (d)(5)(B) for discharges in
such fiscal year shall be reduced by 0.5 percent.
(B)Performance for
fiscal year 2018 and subsequent fiscal years
(i)Subject to clause (ii), based on the performance of each
hospital with respect to compliance with the measures for a performance period
for a fiscal year (beginning with fiscal year 2018), the Secretary shall
determine the amount of any adjustment under this subparagraph to payments to
the hospital under subsection (d)(5)(B) for discharges in such fiscal year.
Such adjustment may not exceed an amount equal to 3 percent of the total amount
that the hospital would otherwise receive under such subsection for discharges
in such fiscal year.
(ii)In making adjustments under this subparagraph, the
Secretary shall ensure that the total amount of payments made to all hospitals
under subsection (d)(5)(B) for discharges in a fiscal year is equal to the
total amount of payments that would have been made to such hospitals under such
subsection for discharges in such fiscal year if this subsection had not been
enacted.
(9)No effect in subsequent fiscal
yearsAny adjustment under
subparagraph (A) or (B) of paragraph (8) shall apply only with respect to the
fiscal year involved, and the Secretary shall not take into account any such
adjustment in making payments to a hospital under this section in a subsequent
fiscal year.
(10)Evaluation of
submission of performance measuresNot later January 1, 2017, the
Secretary shall submit to Congress a report on the implementation of this
subsection, including—
(A)the measure
development procedures, including any barriers to measure development;
(B)the compliance
with reporting on the performance measures, including any barriers to such
compliance; and
(C)recommendations
to address any barriers described in subparagraph (A) or (B).
(11)In this subsection, the term hospital
means a hospital the receives payments under subsection
(d)(5)(B).
.
3.Increasing
graduate medical education transparency
(a)Not later than 2 years after the date of the enactment of
this Act, and annually thereafter, the Secretary of Health and Human Services
shall submit to Congress and the National Health Care Workforce Commission a
report on the graduate medical education payments that hospitals receive under
the Medicare program. The report shall include the following information with
respect to each hospital that receives such payments:
(1)The direct
graduate medical education payments made to the hospital under section 1886(h)
of the Social Security Act (42 U.S.C. 1395ww(h)).
(2)The total costs
of direct graduate medical education to the hospital as reported on the annual
Medicare Cost Reports.
(3)The indirect
medical education payments made to the hospital under section 1886(d)(5)(B) of
such Act (42 U.S.C. 1395ww(d)(1)(B)).
(4)The number of
full-time-equivalent residents counted for purposes of making the payments
described in paragraph (1).
(5)The number of
full-time-equivalent residents counted for purposes of making the payments
described in paragraph (3).
(6)The number of
full-time-equivalent residents, if any, that are not counted for purposes of
making payments described in paragraph (1).
(7)The number of
full-time-equivalent residents, if any, that are not counted for purposes of
making payments described in paragraph (3).
(8)The factors
contributing to the higher costs of patient care provided by the hospital,
including—
(A)the costs of
trauma, burn, other standby services;
(B)translation
services for disabled or non-english speaking patients;
(C)the cost of
uncompensated care;
(D)financial losses
with respect to Medicaid patients; and
(E)uncompensated
costs of clinical research.