[Congressional Record Volume 145, Number 64 (Wednesday, May 5, 1999)]
[Extensions of Remarks]
[Page E860]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]


   IMPROVING MEDICARE QUALITY THROUGH PURCHASING: THE OHIO EXPERIENCE

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                        HON. FORTNEY PETE STARK

                             of california

                    in the house of representatives

                         Wednesday, May 5, 1999

  Mr. STARK. Mr. Speaker, three weeks ago, I introduced H.R. 1392, the 
``Centers of Excellence'' bill. H.R. 1392 would allow Medicare to 
provide incentives for beneficiaries to use certain high-volume, high-
quality facilities. This initiative would both save lives, and save 
money for Medicare.
  It is a widely acknowledged fact that facilities that perform large 
numbers of complex procedures have lower mortality rates and fewer 
adverse outcomes. These facilities, known as ``Centers of Excellence,'' 
have become an important private sector tool for quality improvement 
and cost containment.
  An April 22 article in the Wall Street Journal highlighted an Ohio 
HMO with a Centers of Excellence program for heart procedures. After 
automatically removing facilities that performed fewer than 250 heart 
procedures per year from their list of preferred providers, the HMO 
conducted an extensive quality survey to determine the rating of the 
remaining facilities. This resulted in several more facilities being 
removed from the list, including some very reputable hospitals in the 
area. The Ohio experience showed that facilities with the best 
reputations for excellence did not necessarily have the best outcomes.
  Being removed from the Ohio HMO's preferred provider list was a 
strong competitive incentive for lower-quality facilities to improve 
their procedures. For one facility, the rate of heart attack following 
bypass surgery dropped from 2.8 percent in 1993 to 0.9 percent in 1997. 
A national ``Centers of Excellence'' program would likely have the same 
result, spurring facilities with a lower quality rating to improve 
their services and raising quality standards overall.
  Not only will H.R. 1392 improve quality, it will also lower costs for 
Medicare. Fewer complications after surgery mean less follow up care 
and fewer medical expenses. Targeting patient volume to certain 
facilities can also result in discounted prices.
  Although ``Centers of Excellence'' passed the House in 1997, 
political motivations have kept it from becoming law. quality health 
care should not be a pawn in the political chess game. We have a second 
chance to implement this important change for Medicare. I strongly urge 
my colleagues' support for H.R. 1392.

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