[Congressional Record Volume 148, Number 98 (Thursday, July 18, 2002)]
[Senate]
[Pages S7035-S7036]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

       By Mr. JEFFORDS (for himself, Mr. Frist, Mr. Gregg, Mr. Breaux, 
        and Mr. Feingold):
  S. 2752. A bill to amend title XVIII of the Social Security Act to 
provide for the establishment of medicare demonstration programs to 
improve health care quality; to the Committee on Finance.
  Mr. JEFFORDS. Mr. President, I appreciate the opportunity to speak 
today on an issue that has been and will continue to be important and 
vital to the health of all Medicare beneficiaries. Medicare's origins 
date back to 1965; since that time little has changed in the 
relationship between incentives to provide care and quality of care 
received. The current system does not reward or provide incentives for 
providing quality health care. Instead, what has evolved over the last 
years is a perplexing data base of well documented facts concerning 
quality and utilization. This information is very difficult to explain 
but hard to ignore. Why is it that the utilization of some surgical 
procedures varies tremendously from one part of the country to the 
next? Why is it that the cost of care per beneficiary varies from 
location to location without clear differences in outcomes, survival, 
or quality? Today, after much work with numerous health systems, 
patient advocacy organizations, and medical quality researchers, my 
colleagues Senators Frist, Gregg, Breaux and Feingold and I are pleased 
to announce the introduction of legislation to create Medicare 
demonstration projects to address these issues.
  The incentives, both financial and non-financial, to provide best 
healthcare to Medicare beneficiaries are complex and poorly understood. 
These incentives have historically been rooted in the longstanding 
Medicare fee-for-service payment model. In an effort to better align 
the incentives to provide care with best practice guidelines, 
appropriate utilization, adherence to best medical information, and 
best outcomes we have written legislation to address these issues 
through a Medicare demonstration project. This project will implement 
continuous quality improvement mechanisms that are aimed at integrating 
primary care, referral care, support care, and outpatient services. The 
bill will encourage patient participation in care decisions; strive to 
achieve the proper allocation of health care resources; identify the 
appropriate use of culturally and ethnically sensitive services in 
health care delivery; and document the financial effects of these 
decisions on the medical marketplace.
  As we enter an era of rapidly increasing numbers of Medicare 
beneficiaries, it will be increasingly important that we re-evaluate 
the Medicare program to insure that the quality of care received is 
uniformly exceptional in its delivery and quality. It is appropriate 
that we continue to find better ways to insure that the norms of 
quality health care are established and followed. It is my sincere hope 
that my colleges will join me in this endeavor.
  Mr. FRIST. Mr. President, I rise today to introduce the Medicare 
Quality Improvement Act--a bill to help revitalize the Medicare Program 
by providing for the alignment of payment and other incentives. I want 
to thank Senators Jeffords, Gregg, and Breaux for their work in helping 
craft this crucial legislation.
  To meet the needs of the 21st century health care system, it is 
critical that payment policies be aligned to encourage and support 
quality improvement efforts. Even among health professionals motivated 
to provide the best care possible, the structure of payment and other 
incentives may not facilitate the actions needed to systematically 
improve the quality of care, and may even prevent such actions. For 
example, redesigning care processes to improve follow-up for 
chronically ill patients through electronic communication may reduce 
office visits and decrease revenues for a medical group under some 
payment schemes.
  Current payment practices are complex and contradictory; and although 
incremental improvements are possible, more fundamental reform will be 
needed. In this report, ``Crossing the Quality Chasm,'' the Institute 
of Medicine encouraged the Centers for Medicare and Medicaid Services 
and the Agency for Healthcare Research and Quality to develop a 
research agenda to identify, test, and evaluate options for better 
aligning payment methods with quality improvement goals. The 
demonstration project authorized by this legislation is part of that 
larger research agenda--to help us understand the appropriate alight of 
payment and other incentives and improve the quality of health care in 
a way that will not increase the overall costs of Medicare.

[[Page S7036]]

  We already have identified appropriate ways to align provider 
incentives. Research supported by the Robert Wood Johnson Foundation 
has noted at least 11 different incentive models--models that can be 
implemented by a wide variety of organizations and applied to a range 
of medical groups, providers, and health plans. In many circumstances, 
key components of these models have been implemented in several health 
care markets, and the research has shown that both financial and 
nonfinancial incentives, such as technical assistance, are important in 
motiving appropriate care. However, we do not know how these incentives 
might apply to Medicare, and that is why this demonstration is so 
vital.
  It has been an honor and a pleasure to work closely with my 
distinguished colleagues on this bill, and I look forward to continuing 
to work with them and others as we move forward on the debate about how 
to more appropriately reform Medicare.
                                 ______