[Congressional Record Volume 146, Number 124 (Friday, October 6, 2000)]
[Extensions of Remarks]
[Pages E1703-E1704]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]


     MEDICARE COMPREHENSIVE QUALITY OF CARE AND SAFETY ACT OF 2000

                                 ______
                                 

                        HON. FORTNEY PETE STARK

                             of california

                    in the house of representatives

                       Thursday, October 5, 2000

  Mr. STARK. Mr. Speaker, in March of 1998, the President's Advisory 
Commission on Consumer Protection and Quality in the Health Care 
Industry (Quality Commission) issued its final report, raising concerns 
about medical errors and recommending steps to reduce the incidence of 
medical errors. The Quality Commission urged that measuring and 
improving quality of care be made a national priority.
  In June of 1998, the Congressional Medicare Payment Advisory 
Commission (MedPAC) reported on quality of care in Medicare, and in 
June of 1999, MedPAC made specific recommendations for improving 
quality of care in Medicare. MedPAC recommended:
  That quality of care goals for Medicare, including minimizing 
preventable errors and increasing participation by patients in their 
care should be established, reviewed and revised through a public 
process; that systems be established in Medicare for monitoring, 
improving and safeguarding quality of care; that the Secretary work 
with the private sector to develop and use common, core sets of quality 
measures for monitoring quality; and that to the extent possible, 
quality of care systems in the traditional Medicare fee-for-service 
program and Medicare+Choice be comparable.
  In July of last year, the Inspector General issued four reports 
citing major deficiencies in the accreditation of hospitals to ensure 
that quality of care provided in hospitals for Medicare by the Joint 
Commission on the Accreditation of Health Care Organizations (JCAHO). 
The Inspector General made a series of recommendations for improving 
the accreditation of hospitals to ensure that quality of care provided 
in hospitals met Medicare standards. Also last year, the General 
Accounting Office issued reports citing major deficiencies in the 
accreditation of nursing facilities.
  Then, in November of last year, the Institute of Medicine issued a 
report, ``To Err is Human'', which reported that almost 100,000 people 
may be killed each year by medical errors. The IOM recommended that 
improving health care safety be made a national priority and that a 
nationwide mandatory reporting system of medical errors by providers 
should be established. The IOM also called for a ``culture of safety'' 
in health care organizations. On February 10, 2000, the Ways and Means 
Health Subcommittee held hearings on the IOM report.
  And yesterday, October 4, 2000, the Journal of the American Medical 
Association (JAMA) published an article reporting on the findings of a 
study on quality of care furnished to Medicare fee-for-service (FFS) 
beneficiaries. The study examined Medicare hospital claims by State for 
24 quality of care performance indicators. The study found wide 
variation in quality of care both among States and among performance 
indicators.
  The authors state: ``Available data suggest that providing the 
services measured here could each save hundreds to thousands of lives a 
year.'' The authors report that ``there has been no systematic program 
for monitoring the quality of medical care provided to FFS
  Today, I along with Mr. Neal and Mr. Jefferson, am introducing 
legislation that would address the recommendations made by these 
distinguished organizations. For the first time since the Medicare 
program was enacted, my bill would establish quality of care as a major 
emphasis in Medicare.
  The ``Medicare Comprehensive Quality of Care and Safety Act of 2000'' 
would for the first time in the history of Medicare establish a 
comprehensive quality of care and safety system in Medicare for setting 
quality of care goals and priorities, conducting research and setting 
standards for quality of care, monitoring quality, safeguarding 
quality, and establishing systems to improve information and education 
of patients and providers concerning quality of care issues.
  Perhaps most important of all, my legislation will create a ``culture 
of safety and quality'' in health care by requiring every provider to 
establish a ``Medicare Quality of Care and Safety Program'' (MQCSP). 
Based on model fraud and abuse compliance plans developed and 
implemented by the HHS Inspector General, every Medicare provider would 
be required to implement a quality monitoring and error reduction 
program--``Medicare Quality of Care and Safety Program''--and to report 
serious failures to meet quality standards and medical errors. The 
Secretary would be required to establish a national database of medical 
errors, as called for by the Institute of Medicine.
  This legislation would establish a Medicare Quality and Safety 
Advisory Committee, which would be charged with recommending annual 
goals and priorities on quality of care. In the Medicare comprehensive 
quality of care system, the Secretary would be required to establish 
quality standards, including performance measures. The Secretary would 
be required to coordinate Medicare quality of care activities with 
those in other Agencies of the Department. As an example, the Centers 
for Disease Control and Prevention have for many years established and 
implemented performance standards for certain aspects of care; the CDC

[[Page E1704]]

Medical Infection Disease System (MIDS) provides performance standards 
for limiting the spread of infectious diseases in hospitals. My 
legislation would require Medicare to make use of these standards and 
others already developed either in government or in the private sector. 
The Secretary would be required to establish systems to adopt these 
standards in Medicare and educate providers on their use.
  Providers would be required to report quality of care and medical 
error data in a completely confidential system, and the Secretary would 
be required to establish data systems to monitor the performance of 
providers regarding quality of care and medical errors. The Secretary 
would be required to use standard data so that comparisons could be 
made across providers.
  My legislation does not evision a punitive system, but rather a 
system of working together to achieve improvements in quality and error 
reduction. I believe that most medical errors are the result of systems 
failures, and my legislation would focus on correcting these systems 
errors. I also believe that improvement must come from within health 
care organizations, rather than being imposed from outside. That is why 
my legislation would focus on identifying and correcting systems 
failures from within. However, I also believe that information on best 
practices and standards must be collected at the national level and 
shared with health care providers.
  This legislation would build on the organizations that are already 
charged with sharing information and helping to improve quality of care 
are the Peer Review Organizations (PROs). The Secretary would be 
required to develop standards and train the PROs regarding those 
standards. PROs, in turn, would train health care providers in 
implementing those standards. PROs would also be required to 
investigate serious failures by providers to meet quality standards, 
including serious medical errors, and work with providers to implement 
corrective action plans to modify systems or take other actions to 
improve quality and minimize errors.
  As a way of increasing the confidence of providers in the PROs, fraud 
and abuse activities of the PROs would be phased out, and their work 
would be limited to quality related activities. The legislation would 
change the name of the PROs to ``Quality Improvement Organizations'' in 
keeping with their new emphasis in Medicare.
  The Secretary would be required to monitor quality and safety though 
a national data system, as recommended by virtually all of the 
organizations reporting on quality of care. To help providers feel more 
comfortable in reporting problems with quality or medical errors, the 
Secretary would be required to establish a confidential reporting 
system so that physicians, employees of providers, and others would be 
able to report errors or other failures on a confidential basis. 
Employees would be provided whistle blower protection for reporting 
quality failures and errors. Providers who achieve outstanding results 
in meeting quality standards and minimizing errors would be rewarded 
with the designation of ``Medicare Provider of Excellence.''

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