[Congressional Record Volume 140, Number 112 (Friday, August 12, 1994)]
[Extensions of Remarks]
[Page E]
From the Congressional Record Online through the Government Printing Office [www.gpo.gov]


[Congressional Record: August 12, 1994]
From the Congressional Record Online via GPO Access [wais.access.gpo.gov]

 
   INTRODUCTION OF THE CONSUMER HEALTH QUALITY PROTECTION ACT OF 1994

                                 ______


                             HON. RON WYDEN

                               of oregon

                    in the house of representatives

                        Friday, August 12, 1994

  Mr. WYDEN. Mr. Speaker, by now it seems that every major interest 
group has newspaper and TV ads and lobbyists fully engaged in the 
health reform debate. But in my opinion, the single most important 
voice in the health reform debate has also been one of the quietest 
vocies--the voice of the consumer.
  In an effort to address this imbalance of influence, on May 10, 1993, 
I joined representatives of 30 national consumer organizations--the 
core members of what is not the Coalition for Consumer Protection and 
Quality in Health Reform--to launch a campaign for health care reform 
built on consumer protection and quality improvement.
  We acted out of a shared conviction that there is nothing automatic 
about achieving quality and accountability in health care reform. I 
agreed with these consumer groups that the new health care system 
Congress is now designing must include specific provisions on health 
care quality. These provisions must not only protect existing quality 
safeguards from the financial pressures of the health care marketplace, 
but correct defects in the current system, establish accountability for 
health insurance companies, and expand opportunities for meaningful 
consumer choice.
  Since we kicked off our campaign for quality care, this coalition of 
consumer groups has testified before all of the major House and Senate 
committees, as well as the Subcommittee on Regulation, which I chair, 
Over the past 18 months, representatives of these 30 organizations have 
worked closely with me and my staff to draft legislation to promote the 
health quality agenda.
  The legislation I am introducing today was originally drafted as an 
amendment to health reform legislation marked up by the Committee on 
Energy and Commerce. Unfortunately, disagreements prevented our 
committee from reporting a bill. Subsequently, I have shared this 
language with the committee chairmen who drafted the House bill with 
the majority leader, and asked for its incorporation in that 
legislation.
  Some of these provisions have been incorporated into the House and 
Senate health reform bills, and I am hopeful that all will find their 
way into the bill that emerges from conference.
  As decisions are made on each of the consumer protection provisions, 
one key point I intend to emphasize over the next month is that 
consumer protections must be funded as fully and equally important 
components of the new health system Congress is now constructing. I say 
this because in the current declining budget for discretionary funding, 
quality assurance mechanisms that depend on new appropriations for 
funding are unlikely to be funded or to provide meaningful consumer 
protection.
  My legislation funds these essential functions through the same kind 
of premium draw that is used in both House and Senate bills to fund 
medical research. I wholeheartedly support medical research, but there 
is little sense in a policy that gives researchers a more secure 
funding base than health care quality protections for consumers.
  The bill I am introducing today will identify the policies that 
consumers feel are needed, and, I hope, will provide a useful reference 
point in evaluating the quality of care safeguards in any legislation 
considered by the House and Senate.
  Here is a brief list of several quality safeguards high on the 
consumer agenda, which are incorporated in this legislation.


                      CONSUMER QUALITY INFORMATION

  Within the next 60 days, the Congress will most likely finish its 
work on national health reform legislation that significantly 
restructures the health care system in this country. Many aspects of 
health reform are uncertain. But this much is clear: tomorrow's 
consumers are going to be asked to be more involved in the choice of 
their health care and their providers.
  In my judgment, if the reformed health system is to be built on the 
principle of consumer choice, consumers must have ready access to 
reliable, comparative information on quality.
  This is no radical, futuristic concept. The last Congress enacted 
bipartisan legislation I sponsored to publish infertility clinic 
pregnancy success rates, so consumers can choose which clinic, if any, 
to invest with their hopes and their cash. In October 1995 this first 
legally required comparative health outcomes information will hit the 
streets and start helping consumers to make better health care 
decisions.
  This kind of performance report on health plans is sometimes called a 
report card. But some report cards provide objective information, and 
some do not. Health insurance plans are already starting to put out 
report cards comparing themselves with their competitors, without 
disclosing their financial interests. Because consumers need to know 
they are reading an advertisement, and when they are reading objective 
facts, my bill includes sunshine standards for advertisements 
masquerading as report cards, to head off a new category of consumer 
fraud.
  But, Mr. Speaker, it's not enough to give consumers information on 
the quality of health insurance plans. A health plan may be the key 
component of the health care system to economists and providers, but 
consumers are more interested in the quality of care provided by 
doctors, hospitals, and clinics. In fact, when they can afford to, 
people choose their health plans because of which doctors the plan will 
let them see, not the other way around.

  The sad truth is Americans today have more product performance 
information available to them when purchasing breakfast cereal than 
when choosing a heart surgeon. This means that additional measures of 
quality are needed. Consumers must have easy access to comparative 
information on plans, providers, and the success rates of the 
treatments they provide. My bill will provide for these measures, and 
set deadlines for their publication.
  At the very least, consumers must be informed as to which doctors 
they may wish to avoid. The public has a tremendous appetite for 
information on disciplinary actions and other markers of poor quality 
care, and they are outraged to learn that such data exists for 
thousands of practitioners, but that it is now kept secret in a 
taxpayer-funded National Practitioner Data Bank. On April 21, 1994, I 
introduced a companion bill, H.R. 4274, legislation to open the data 
bank to the public and to close loopholes that allow doctors to avoid 
reporting to the data bank today. I have worked to persuade my 
colleagues in the House and Senate to include this important consumer 
protection provision in final health care reform legislation.


                           freedom of choice

  In my view, the freedom to choose one's medical providers will be a 
litmus test for any successful health reform plan enacted in this 
Congress. And the best information in the world is useless if consumers 
don't retain some freedom to choose their providers. At the urging of 
consumer groups and my personal appeals to the Clinton administration, 
the Health Security Act proposed requiring every HMO to offer a point 
of service option. Health plans with point of service features allow 
consumers to use out-of-network non-HMO providers, provided the 
consumer agrees to pay higher out of pocket charges.
  This market-proven alternative shows that you can have real consumer 
choice and cost containment in peaceful coexistence. It balances 
personal responsibility with freedom of choice at the individual 
level--where such decisions belong. What's more, health plans pay close 
attention to setting up high quality networks of doctors and other 
health professionals, knowing that a significant number of their 
enrollees are free to go outside of the network if, for example, they 
are told they have to wait 6 weeks for an appointment because the plan 
has too few OB-Gyns or mental health professionals. In this way, the 
point of service option provides powerful economic feedback that gives 
plans an incentive to build high quality, accessible networks.
  My bill would require every health plan that utilizes a provider 
network to make available to enrollees the option of going out of that 
network for care. Preferred Provider Organizations--PPO's--meet this 
requirement by their very nature; Health Maintenance Organizations--
HMO's--would have to offer enrollees an opportunity to purchase a rider 
that grants coverage for out of network items and services.
  People could still enroll in pure HMO's, without buying the point of 
service feature--but even those people would benefit from the careful 
management of the plan's provider network, made necessary by the 
existence of a substantial number of enrollees who are not locked in to 
the network for unsatisfactory care.
  The point of service feature is attractive for one additional reason: 
it allows people in traditional fee-for-service plans to join HMO's or 
other managed care plans with provider networks, without fear of being 
trapped in an unsatisfactory relationship with a limited group of 
health care practitioners. It is a tool for dramatically expanding 
enrollment in managed care organizations.
  For these reasons, I believe this requirement should be a feature of 
the House bill, along with specifying the level of out-of-network cost-
sharing to rule out unreasonably high coinsurance requirements by some 
health plans. My bill would also adjust coinsurance requirements for 
low income consumers, to make these choices meaningful to them.


                     independent quality oversight

  Comparative quality information has a long way to go before consumers 
can rely on it to make life or death decisions. At least for the 
forseeable future, therefore, consumers want and need reliable, 
independent oversight of quality. I am proposing the creation of two 
kinds of oversight organizations: a quality improvement foundation to 
work directly with doctors, and a consumer health care advocate to work 
with consumers.
  Quality improvement foundations--QIF's--would work with doctors on 
quality problems, and try to spur a bona fide quality improvement 
program in every health plan.
  The new quality improvement foundations would monitor and compare 
patient morbidity and mortality in HMO's, hospitals and clinics, 
looking for areas needing attention. And when they find evidence of 
quality problems, they can take their evidence to the hospital or HMO 
and ask that the issue be investigated and, if found to be genuine, 
corrected.
  They can spur collaborative efforts between health plans to address 
broader public health problems. They could offer to get experts 
together with doctors who need help to upgrade their skills. If the 
hospital, health plan, or practitioner is unresponsive or is unable to 
improve, the quality improvement foundation has the option of referring 
that plan or provider to State licensing officials or to the 
appropriate accreditation organization.


                     consumer health care advocate

  Consumers will need someone in their corner to contend with the new 
system. Their representatives in Washington have asked for a national 
network of health care advocates, modeled on the successful long term 
care ombudsman program that relies on trained volunteers to improve 
nursing home care. The health care advocate would help resolve 
complaints and grievances, and work to kick-start public and private 
officials to ensure that it jumps when consumers call for help.


                      state medical board reforms

  Numerous studies and reports from consumer groups and the HHS 
Inspector General have concluded that State medical licensure boards 
are underfunded and hamstrung by lack of legal authority and staff 
expertise to investigate quality of care cases.
  The legislation I am introducing today will require States, as a 
condition of receiving Medicaid matching moneys, to include public 
members on their governing boards, to utilize licensure fees charged to 
doctors to fund board operations, to provide the board with basic 
investigative and disciplinary powers lacking in too many States, and 
to report annually on the number and type of actions the board has 
taken with respect to problem practitioners.
  Mr. Speaker, I have spent my career working in the health field, and 
I know how complex the health policy can be. But protecting and 
improving the quality of health care is too important to let it slip 
through the cracks, or to go unfunded. I respectfully urge my 
colleagues to review and compare the safeguards in this bill with the 
versions which are adopted by the House and Senate, and work with me to 
get these important questions fully and squarely addressed by the 
conference committee that takes up health reform this year.