[Congressional Record Volume 140, Number 17 (Thursday, February 24, 1994)]
[Extensions of Remarks]
[Page E]
From the Congressional Record Online through the Government Printing Office [www.gpo.gov]


[Congressional Record: February 24, 1994]
From the Congressional Record Online via GPO Access [wais.access.gpo.gov]

 
                  IMPROVING CARE FOR MEDICARE PATIENTS

                                 ______


                           HON. MIKE KREIDLER

                             of washington

                    in the house of representatives

                      Thursday, February 24, 1994

  Mr. KREIDLER. Mr. Speaker, we all want the best quality care for 
Americans who depend on the Medicare Program. But the system of fee-
for-service medicine that serves most Medicare patients makes it harder 
for physicians to provide that quality. Too often, a doctor has no 
systematic way of knowing what other professionals a patient is seeing, 
what services they are providing, or what it all costs. This lack of 
information is a disservice to patients and to doctors who want to play 
a more active role in managing their care and protecting their health.
  That is why I am introducing legislation that would require the 
Health Care Financing Administration, through a demonstration project, 
to provide physicians with periodic reports on the care their Medicare 
patients are receiving from other providers. These reports would give 
doctors information they need to make referrals and treatment 
recommendations in their patient's best interests. They would also help 
doctors who care about the cost of Medicare to identify cost-effective 
choices for their patients. The information in these reports could 
serve as a foundation for future incentives for professionals to use 
Medicare resources most effectively in their patients' interests.
  This bill is based on a suggestion from Dr. David Munoz, an internist 
in Tacoma, WA, who serves many elderly patients on Medicare. Dr. Munoz 
cares about his patients and about the costs of their treatment. He has 
done a lot of work to develop an information system that will help him 
make the best decisions and recommendations about their care, but he 
and others like him need systematic feedback from Medicare to help 
their patients make the best choices. That is why the Washington State 
Medical Association has adopted a resolution endorsing the concepts in 
this legislation.
  The bill requires the Secretary of Health and Human Services to 
establish a demonstration project in which physicians could choose to 
receive periodic Medicare referral reports, in either printed or 
electronic format, showing what other covered services their Medicare 
patients have received, what professional or facility provided them, 
the charges made, and the amounts Medicare paid. This information would 
be available only with respect to patients who had agreed to its 
release to their doctors. The Secretary would be required to consult 
with representatives of affected provider groups, beneficiaries, and 
health data collectors in designing the project, which could operate in 
several geographical areas. Physicians seeking reports would also 
receive orientation and training to help them make the best use of this 
information.
  I urge my colleagues to support this important step toward better 
care for Medicare beneficiaries.
  The bill follows:

                                H.R. --

       Be it enacted by the Senate and House of Representatives of 
     the United States of America in Congress assembled,

     SECTION 1. ESTABLISHMENT OF DEMONSTRATION PROJECT ON MEDICARE 
                   REFERRAL REPORTS.

       (a) In General.--Not later than January 1, 1995, the 
     Secretary of Health and Human Services (hereafter in this Act 
     referred to as the ``Secretary'') shall establish a 
     demonstration project under which, with respect to providers 
     of physicians' services for which payment may be made under 
     part B of title XVIII of the Social Security Act within the 
     designated area of the project, the Secretary shall 
     periodically furnish a medicare referral report (as described 
     in subsection (b)) to the provider on any individual entitled 
     to benefits under such title to whom the provider furnishes 
     such services during the period the project is in effect 
     (subject to subsection (c)). The Secretary shall furnish such 
     reports upon the request of a provider of physicians' 
     services under such title and at such other times as the 
     Secretary may consider appropriate.
       (b) Medicare Referral Report Described.--
       (1) In general.--In this section, a ``medicare referral 
     report'' means, with respect to an individual, a report (in 
     such format as the Secretary may establish) containing the 
     following information:
       (A) Any item or service furnished to the individual during 
     the period the project is in effect for which payment may be 
     made under title XVIII of the Social Security Act.
       (B) The identity of the individual or entity furnishing 
     such item or service.
       (C) The illness, injury, or condition (including any 
     applicable diagnostic code) on which the furnishing of the 
     item or service is based.
       (D) The amount of payment made for the item or service 
     under such title.
       (E) The amount of charges submitted to the Secretary with 
     respect to the item or service (if any) by the individual or 
     entity furnishing the item or service.
       (2) Format.--A medicare referral report shall be provided 
     in such electronic and printed formats as the secretary may 
     establish, and shall be furnished to a provider in the format 
     the provider specifies.
       (c) Patient Consent Required.--
       (1) In general.--No medicare referral report may be 
     furnished under the project with respect to information 
     relating to any individual unless the individual has provided 
     written consent to the Secretary (in such form as the 
     Secretary may require) for the reporting of such information.
       (2) Renewal of consent.--The Secretary may limit the period 
     for which the consent provided pursuant to paragraph (1) 
     shall be effective and establish a process under which an 
     individual may renew the consent for an additional period.
       (d) Consultation Requirement.--In carrying out this Act, 
     including the selection of the areas in which the 
     demonstration project will be carried out, the development of 
     formats for medicare referral reports, and the provision of 
     orientation and training services under section 2, the 
     Secretary shall consult with representatives of primary care 
     and other health professionals, hospitals and nursing homes, 
     medicare beneficiaries, health maintenance organizations and 
     other managed care providers, and health data collectors.

     SEC. 2. ORIENTATION AND TRAINING ON USE OF REFERRAL REPORTS.

       In carrying out the demonstration project established under 
     section 1, the Secretary shall provide orientation and 
     training services to assist providers of physicians' services 
     who are participating in the project in using the medicare 
     referral reports to effectively manage patient care, 
     including information regarding limitations on the usefulness 
     of such reports in making clinical decisions or evaluating 
     the effectiveness of treatments.

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