[Congressional Record Volume 144, Number 83 (Tuesday, June 23, 1998)]
[Senate]
[Pages S6888-S6889]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. FRIST:
  S. 2208. A bill to amend title IX of the Public Health Service Act to 
revise and extend the Agency for Healthcare Policy and Research; to the 
Committee on Labor and Human Resources.


               HEALTHCARE QUALITY ENHANCEMENT ACT OF 1998

  Mr. FRIST. Mr. President, I rise today to advocate better healthcare 
for Americans and to introduce legislation strengthening the scientific 
foundation of healthcare quality improvement efforts. Let me make a few 
introductory comments before summarizing the ``Healthcare Quality 
Enhancement Act of 1998.''
  First, I want to make it clear: all patients deserve better 
healthcare quality, not just HMO enrollees as recent discussions have 
most frequently focused on regarding consumer protections.
  All Americans deserve better healthcare. We need healthcare quality 
improvement that reaches everybody through better healthcare plans, 
tertiary care centers, fee-for-service solo practices, and all other 
kinds of patient care.
  We should not wait for another movie like the one titled ``As Good as 
It Gets'' to talk about healthcare quality for 70% percent of employees 
and 86% of Medicare beneficiaries who are not traditional-HMO 
enrollees.
  Quality of care fundamentally rests on the achievements of biomedical 
research. We all know that sound science is the best way to improve 
quality in patient care. All components of the outcome of healthcare 
can be effectively improved by statistically valid science: health 
status can be turned around by transplantation when someone's life is 
in jeopardy due to a diseased organ; social functioning can be improved 
by shock wave lithotripsy that leads to faster recovery; and patient 
satisfaction can be better when children with moderate or severe asthma 
get proper anti-inflammatory treatment.
  While being amazed by the promise of new scientific achievements, few 
patients realize the implications of abundant and growing production in 
biomedical research.
  Over the past 20 years, the number of articles indexed annually in 
the Medline database of the National Library of Medicine nearly 
doubled.
  Randomized clinical trials are considered sources of the highest 
quality evidence on the value of a new intervention. Over the past two 
decades, the number of clinical trials in my own field of cardiology 
have increased five-fold.
  In health services research, 10 times more clinical trials are 
published today than 20 years ago (e.g., clinical trials comparing 
inpatient care with outpatient care, trials of physician profiling and 
other information interventions).
  But we are falling short in our success to disseminate our findings 
and influence practice behavior.
  In spite of all these scientific achievements, we cannot further 
build up biomedical research production for the next millennium if our 
network for sharing it with practitioners remains on a nineteenth's 
century level.
  The landmark Early Treatment Diabetic Retinopathy Study was published 
in 1985. This randomized controlled clinical trial validated a 
scientific achievement almost a decade earlier. The American Diabetes 
Association published its eye care guidelines for patients with 
diabetes mellitus in 1988. Today, the national rate for annual diabetic 
eye exam is still only 38.4%.
  There are more scientific discoveries than ever before, but practical 
introduction of new scientific discoveries does not seem to be much 
faster today than it was more than 100 years ago. We need to close the 
gap between what we know and what we do in healthcare. That requires a 
federal role in sharing information about what works to improve 
quality.
  All Americans want better healthcare and the federal government must 
respond by offering helpful information on quality, channeling 
scientific evidence to clinicians, and investing in research on 
improving health services.
  For this reason, today I am introducing legislation to establish the 
``Agency for Healthcare Quality'' which builds on the platform of the 
current Agency for Healthcare Policy and Research, but refocuses it on 
quality to become the central figure in our efforts to improve the 
quality of healthcare.
  Healthcare quality is a matter of personal preference--it means 
different things to different people. We all remember when healthcare 
quality became a political showdown, the low back pain guidelines 
backfired because they were viewed as an attempt to mandate ``cook 
book'' medicine, and the Agency for Healthcare Policy and Research had 
a near death experience.
  Over the past three years, since I first came to the United States 
Senate, I have looked very closely at this agency. The Subcommittee on 
Public Health and Safety, which I chair, has held three hearings to 
invite public input on this agency. As a result, this legislation 
responds to many of the past criticisms of the agency. This legislation 
will take AHCPR--under a new name--to new heights and will establish it 
as the center of healthcare quality research for the country.

  The new Agency for Healthcare Quality will:
  1. promote quality by sharing information. While proven medical 
advances are made daily, patients are waiting too long to benefit from 
these discoveries. We must get the science to the people by better 
sharing of information and more effective dissemination. In addition, 
the Agency will develop evidence-rating systems to help people in 
judging the quality of science.
  2. build public-private partnerships to advance and share true 
quality measures. Quality means different things to different people. 
In collaboration with the private sector, the Agency shall conduct 
research that can figure out what quality really means to patients and 
to clinicians, how to measure quality, and what actions can improve the 
outcome of healthcare.
  3. report annually on the state of quality, and cost, of the nation's 
healthcare. Americans want to know if they receive good quality 
healthcare. But compared to what? Statistically accurate, sample-based 
national surveys will efficiently provide reliable and affordable data 
--without excessive, overly intrusive, and potentially destructive 
mandatory reporting requirements.
  4. aggressively support improved information systems for health 
quality. Currently, quality measurement too often requires manual chart 
reviews for such simple data as frequency of procedures, infection 
rates, or other complications. Improved computer systems will advance 
quality scoring and facilitate quality-based decision-making in patient 
treatment.

[[Page S6889]]

  5. support primary care research, and address issues of access in 
underserved areas. While most policy discussions this year are 
targeting managed care, quality improvement is just as important to the 
solo private practitioner. The Agency's authority is expanded to 
support healthcare improvement in all types of office practice--not 
just managed care. The agency shall specifically address quality in 
rural and other undeserved areas by advancing telemedicine services 
which share clinical expertise with more patients.
  6. facilitate innovation in patient care with streamlined evaluation 
and assessment of new technologies. Patients should benefit from proven 
breakthrough technologies sooner, while inefficient methods should be 
phased out faster. Today, manufacturers and distributors of new 
technologies face major hurdles in trying to secure coverage. The 
Medicare technology committee has been particularly criticized for its 
process. Criteria are unclear, delays are long, and decisions are 
unpredictable. The Agency will be accessible to both private and public 
entities for technology assessments and will share information on 
assessment methodologies.
  7. coordinate quality improvement efforts of the government. Most of 
the many federal healthcare programs today support some kind of health 
services research and conduct various quality improvement projects. The 
Agency shall coordinate these many initiatives to avoid disjointed, 
uncoordinated, or duplicative efforts.
  In summary, we need to practice, not just publish, better patient 
care. We all want to see better quality.
  Real improvement can come from progress in health sciences, from 
promoting innovation in patient care, and from better practical 
application of new scientific advances. The Agency for Healthcare 
Quality will focus on overall improvement in healthcare and enable us 
to judge the quality of care we receive.
  Americans want better healthcare and the federal government shall 
respond by offering helpful information on quality, channeling 
scientific evidence to clinicians, and investing in research on 
improving health services.
  Mr. President the ``Healthcare Quality Enhancement Act of 1998'' will 
reduce the gap between what we know and what we do in healthcare. The 
refocused Agency for Healthcare Quality is the right step forward and I 
urge my colleagues to support this legislation to improve healthcare 
for all Americans.

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