[Congressional Record Volume 151, Number 99 (Wednesday, July 20, 2005)]
[Senate]
[Pages S8546-S8547]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
PUBLIC HEALTH SERVICE ACT
Mr. GRASSLEY. Mr. President, I want to take a few minutes to explain
my recent action related to S. 1418, the Wired for Health Care Quality
Act. Today, with great reluctance, I asked Leader Frist to consult with
us prior to any action related to consideration of this bill, which the
Health, Education, Labor, and Pensions Committee reported by voice vote
this morning.
The Wired for Health Care Quality Act would promote the use of
electronic health records by adopting standards for the electronic
exchange of information, offer incentives for health care providers to
create networks for secure exchange of electronic health information,
and ensure quality measurement and reporting of provider performance
under the Public Health Service Act.
I fully support linking the adoption of health information technology
to quality improvements in our health care system. They go hand in
hand. Which is why Senator Baucus and I decided to introduce our
Medicare Value Purchasing Act, S. 1356, jointly with Senators Enzi and
Kennedy's Better Healthcare Through Information Technology Act, S.
1355. The thought behind a dual introduction was to enforce the message
that Medicare can drive quality improvement through payment incentives,
and that the adoption of information technology is also a necessary
step not only to facilitate the reporting of quality measures but also
to increase efficiency and quality in our health care delivery system.
Our bill creates quality payments under Medicare for all provider
groups. A considerable amount of time was devoted towards ensuring that
the development of quality measures and the implementation of value-
based purchasing programs under Medicare were properly vetted with
provider groups, beneficiary groups, and the administration. We did not
want to reinvent the wheel; we wanted to build on the initiatives that
already exist to develop and adopt quality measures. And because
Medicare is the single largest purchaser of health care in the Nation,
adopting quality payments in Medicare influences the level of quality
in all of health care. We have seen time and time again how when
Medicare leads, the other public and private purchasers follow.
Which is why I am troubled, that as currently drafted, S. 1418 would
require the development of quality measures under the Public Health
Service Act. It is hard to comprehend how the quality measurement
system in this bill intersects with the quality measurement system
developed in the Medicare Value Purchasing Act. The last thing we want
to do is end up with two different quality measurement systems. This
has the potential to derail both proposals, effectively terminating or
at least postponing the common goal of improving the quality of patient
care.
The Wired for Health Care Quality Act would also direct the Secretary
of Health and Human Services, along with the Secretary of Defense, the
Secretary of Veterans Affairs, and other heads of relevant Federal
agencies to jointly develop a quality measurement system. The
coordination among all these Federal agencies alone is a massive
project that could indefinitely stall the development and
implementation of appropriate quality measures or result in one that
falls to the lowest common denominator. That could actually set back
quality efforts.
I welcome the opportunity to work with the sponsors of S. 1418,
Senators Enzi, Kennedy, Frist, and Clinton along with members of the
Health, Education, Labor, and Pensions Committee on this matter. I had
hoped to accomplish that before the bill was introduced on the floor.
Unfortunately, that did not happen. I do not take actions such as these
lightly. But I am deeply troubled that, as currently drafted, the Wired
for Health Care Quality Act could end up unintentionally delaying our
common goal of improving the quality of health care for all Americans.
Mr. BAUCUS. Mr. President, I rise to address possible floor
consideration of S. 1418, a bill to amend the Public Health Service Act
to enhance the adoption of a nationwide interoperable health
information technology system and to improve the quality and reduce the
costs of health care in the United States.
Senator Grassley and I have been working since January with Senators
Enzi and Kennedy on issues of quality and health information
technology. Together, we introduced two bills on June 30--one that
deals with Medicare quality, and another to enhance quality through the
widespread adoption of health IT. The latter is S. 1356, the Medicare
Value Purchasing Act of 2005, which develops a system of quality
measurement and implements pay-for-performance in Medicare.
In drafting these two bills, we worked hard to craft language that
was complementary rather than contradictory. Ultimately, we viewed
these two pieces of policy as working together to build a comprehensive
and workable health care quality system.
S. 1418 potentially disrupts the work we have done thus far, by
including language that will force the duplication of quality
measurement systems. It also raises questions about the jurisdictional
reach of the Committee on Health, Education, Labor, and Pensions.
Medicare is the dominant payer in health care, with annual spending
exceeding $300 billion. Furthermore, it is Medicare's payment systems
that are often adopted by private insurance groups. Private payers use
the Medicare physician fee schedule for their own book of business, and
we would expect these same insurers to follow Medicare's lead on pay-
for-quality.
I appreciate the process that Senators Enzi and Kennedy have
undertaken with us over the last several months. And I appreciate the
majority leader's desire to move important health IT legislation.
Congressional action on this issue is long overdue. But until common
ground can be reached on a feasible system of measuring quality, I must
reluctantly object to moving forward with S. 1418. I believe that the
process outlined in this bill for the development of quality measures
may well be unworkable and that it will raise deep concerns for
hospitals, physicians, and other providers.
I also believe that the language on the development of quality
measures in this bill ought to be designed for Public Health Service
Act programs and explicitly applicable to these programs, not to
Medicare or Medicaid.
I hope that our colleague, Senators Enzi, Kennedy, Frist, and
Clinton, will work with us to craft a bill that is appropriate for
programs under the
[[Page S8547]]
PHSA and that complements the Medicare Value Purchasing Act of 2005.
Ultimately, I believe that we have the same goals in mind. If we can
come to an agreement now, we can continue moving forward with these
important policies that can change the shape, quality, and ultimately
the cost and benefit of our health care system.
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