[Congressional Record Volume 151, Number 37 (Tuesday, April 5, 2005)]
[Senate]
[Pages S3214-S3215]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. Wyden (for himself and Mr. Smith):
  S. 708. A bill to amend title XVIII of the Social Security Act to 
provide medicare beneficiaries with access to information concerning 
the quality of care provided by skilled nursing facilities and to 
provide incentives to skilled nursing facilities to improve the quality 
of care provided by those facilities by linking the amount of payment 
under the medicare program to quality reporting and performance 
requirements, and for other purposes; to the Committee on Finance.
  Mr. SMITH. Mr. President, I rise today to introduce the Long Term 
Care Quality and Consumer Information Improvement Act of 2005. Medicare 
spending for skilled nursing facilities grew rapidly during the late 
1980s and 1990s increasing from almost $4 billion in 1992 to $12.9 
billion in 1997. While spending has increased under Medicare, there has 
not been an effort to reward skilled nursing facilities that have 
provided exceptional care to seniors.
  The bill I am introducing today with my colleague from Oregon, 
Senator Wyden, will establish a system to reward skilled nursing 
facilities that provide exceptional care. We should take steps to 
ensure that skilled nursing facilities that are providing the best care 
be rewarded. We must also create incentives for other facilities to 
strive to provide excellent care.
  The Long Term Care Quality and Consumer Information Improvement Act 
of 2005 directs the Secretary of Health and Human Services to establish 
10 to 15 quality measures for skilled nursing facilities. While 
establishing these measures, the Secretary must consult with residents 
of skilled nursing facilities, patient advocacy organizations, state 
regulatory representatives, representatives from the skilled nursing 
facility industry and quality measure experts. The quality ratings for 
the facilities will then be published on the Centers for Medicare and 
Medicaid Services' website and published in newspapers with a national 
circulation.
  The quality measures created by this bill will be used as an 
incentive for facilities to provide excellent care. Skilled nursing 
facilities that submit data shall receive a full market basket update 
and starting in fiscal year 2006 skilled nursing facilities that are in 
the top 10 percent of facilities will receive a 2 percent payment 
bonus. Skilled nursing facilities that are below the top 10 percent, 
but within the top 20 percent shall receive a one percent payment 
bonus.
  The increased public disclosure of facility-specific quality data and 
the financial incentives included in this bill will spur competition 
and improved performance in skilled nursing facilities. I believe that 
we need to help the 77 million elderly and disabled Americans who are 
in nursing homes by making sure they receive the highest quality care 
possible.
  Mr. President, I look forward to working with my fellow Senators and 
with the chairman of the Finance Committee on this important bill in 
the upcoming months, and I urge my colleagues to join us in support of 
this legislation.
  Mr. Wyden. Mr. President, I rise to discuss a bill I am introducing 
today, ``The Long Term Care Quality and Consumer Information Act''.
  As we begin discussions on how to assure that we reward quality 
health care, I believe we need to include long term care as part of 
that discussion. Nursing homes sever some of the most vulnerable among 
us, and assuring quality of care is encouraged and rewarded is 
important. I hope that this bill will spark a serious debate about how 
we pay for quality care. This proposal establishes a voluntary system 
under which nursing homes providing better quality of care would 
receive higher payment and in turn would provide more information about 
the quality of care provided. Information would include nurse staffing 
ratios and would be made public to consumers and their families.
  Historically, Americans have been paying the same for quality health 
care as for mediocre care. Efforts have been made by some in the 
private sector to better recognize and provide incentives for those 
providers who consistently provide a higher level of care. The 
Institute of Medicine in its report ``Leading by Example,'' declared 
the government should take the lead in improving health care by giving 
financial rewards to hospitals and doctors who improve care for 
beneficiaries in six Federal programs, including Medicare and Medicaid 
and the Veterans Health Administration. The IOM report also said the 
government should collect and make available to the public data 
comparing

[[Page S3215]]

the quality of care among poviders. The Centers for Medicare and 
Medicaid Services has begun pilot programs. I think nursing homes 
should also be an area in which we explore payment policies that regard 
those providing a higher quality of care.
  I look forward to continuing the discussion with all stakeholders 
about these concepts so we can assure a high level of care and find 
ways to help providers improve the level of care they provide.
                                 ______