[Congressional Record Volume 145, Number 164 (Thursday, November 18, 1999)]
[Senate]
[Pages S14809-S14810]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Ms. SNOWE:
  S. 1956. A bill to amend title 38, United States Code, to enhance the 
assurance of efficiency, quality, and patient satisfaction in the 
furnishing of health care to veterans by the Department of Veterans 
Affairs, and for other purposes; to the Committee on Veterans' Affairs.


             The Veterans Health Care Quality Assurance Act

  Ms. SNOWE. Mr. President, I rise today to introduce the Veterans 
Health Care Quality Assurance Act of 1999.
  This legislation contains a number of proposals designed to ensure 
that access to high quality medical services for our veterans is not 
compromised as the Department of Veterans Affairs--the VA--strives to 
increase efficiency in its nationwide network of veterans hospitals.
  Mr. President, the VA administers the largest health care network in 
the U.S., including 172 hospitals, 73 home care programs, over 800 
community-based outpatient clinics, and numerous other specialized care 
facilities.
  Moreover, there are approximately 25 million veterans in the U.S., 
including approximately 19.3 million wartime veterans, and the number 
of veterans seeking medical care in VA hospitals is increasing. The 
FY99 VA medical care caseload was projected to increase by 160,000 
veterans over the FY98 level, and is projected to increase by an 
additional 54,000 in FY00, reaching a total of 3.6 million veterans, an 
increase from 2.7 million in FY97. In FY00, outpatient visits at VA 
medical facilities are projected to increase by 2.5 million to 38.3 
million. The average age of veterans is increasing as well, and this is 
expected to result in additional demands for health care services, 
including more frequent and long-term health needs.
  The VA is attempting to meet this unprecedented demand for health 
care services without substantial increases in funding, largely through 
efforts to increase efficiency. Not surprisingly, these seemingly 
competing objectives are generating serious concerns about the 
possibility that quality of care and/or patient satisfaction are being 
sacrificed.
  Mr. President, many VA regional networks and medical center directors 
report that timely access to high quality health care is being 
jeopardized,

[[Page S14810]]

and that is why I am introducing the Veterans Health Care Quality 
Assurance Act, legislation which seeks to ensure that no veteran's 
hospital is targeted unfairly for cuts, and that efforts to 
``streamline'' and increase efficiency are not followed by the 
unintended consequence of undermining quality of care or patient 
satisfaction.
  I believe that all veterans hospitals should be held to the same 
equitable VA-wide standards, and that quality and satisfaction must be 
guaranteed. Toward that end, the Veterans Health Care Quality Assurance 
Act calls for audits of every VA hospital every three years. This will 
ensure that each facility is subject to an outside, independent review 
of its operations on a regular basis, and each audit will include 
findings on how to improve services to our veterans.
  The legislation will also establish an Office of Quality Assurance 
within the VA to ensure that steps taken to increase efficiency in VA 
medical programs do not undermine quality or patient satisfaction. This 
office will collect and disseminate information on efforts that have 
proven to successfully increase efficiency and resource utilization 
without undermining quality or patient satisfaction. The director of 
this new Office of Quality Assurance should be an advocate for veterans 
and would be placed in the appropriate position in the VA command 
structure to ensure that he or she is consulted by the VA Secretary and 
Under Secretary for Veterans Health on matters that impact quality or 
satisfaction.
  The bill would require an initial report to Congress within six 
months of enactment, which would include a survey of each VA regional 
network and a report on each network's efforts to increase efficiency, 
as well as an assessment of the extent to which each network and VA 
hospital is or is not implementing the same uniform, VA-wide policies 
to increase efficiency.
  Under the bill's reporting requirement, the VA would also be required 
to publish--annually--an overview of VA-wide efficiency goals and 
quality/satisfaction standards that each veterans facility should be 
held to. Further, the VA would be required to report to Congress on 
each hospital's standing in relation to efficiency, quality, and 
satisfaction criteria, and how each facility compares to the VA-wide 
average.

  In an effort to encourage innovation in efforts to increase 
efficiency within the agency, the bill would encourage the 
dissemination and sharing of information throughout the VA in order to 
facilitate implementation of uniform, equitable efficiency standards.
  Finally, Mr. President, the bill includes provisions calling for 
sharing of information on efforts to maximize resources and increase 
efficiency without compromising quality of care and patient 
satisfaction; exchange and mentoring initiatives among and between 
networks in order to facilitate sharing of such information; incentives 
for networks to increase efficiency and meet uniform quality/patient 
satisfaction targets; and formal oversight by the VA to ensure that all 
networks are meeting uniform efficiency criteria and that efforts to 
increase efficiency are equitable between networks and medical 
facilities.
  Last week America celebrated Veterans Day 1999--81 years after the 
Armistice was signed in France that silenced the guns and ended the 
carnage of World War I. World War I was supposed to be ``the war to end 
all wars'' . . . the war that made the world safe for democracy. Sadly, 
that was not to be, and America has been repeatedly reminded that the 
defense of democracy is an on-going duty.
  Mr. President, keeping our promise to our veterans is also an ongoing 
duty. The debt of gratitude we owe to our veterans can never be fully 
repaid. What we can and must do for our veterans is repay the financial 
debt we owe to them. Central to that solemn duty is ensuring that the 
benefits we promised our veterans when they enlisted are there for them 
when they need them.
  I consider it a great honor to represent veterans, these brave 
Americans. So many of them continue to make contributions in our 
communities upon their transition from military to civilian life--
through youth activities and scholarship programs, homeless assistance 
initiatives, efforts to reach out to fellow veterans in need, and 
national leadership on issues of importance to veterans and all 
Americans. The least we can do is make good on our promise, such as the 
promise of access to high quality health care.
  I have nothing but the utmost respect for those who have served their 
country, and this legislation is but a small tribute to the men and 
women and their families who have served this country with courage, 
honor and distinction. They answered the call to duty when their 
country needed them, and this is a component of my on-going effort to 
ensure that we, as elected officials, answer their call when they need 
us.
  I urge my colleagues to join me in supporting this legislation.
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