[Congressional Record Volume 152, Number 114 (Thursday, September 14, 2006)]
[Senate]
[Pages S9636-S9638]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. GREGG (for himself, Mr. Frist, Mr. Burr, Mr. Cornyn, and 
        Mr. Bennett):
  S. 3900. A bill to amend title XVIII of the Social Security Act to 
improve the quality and efficiency of health care, to provide the 
public with information on provider and supplier performance, and to 
enhance the education and awareness of consumers for evaluating health 
care services through the development and release of reports based on 
Medicare enrollment, claims, survey, and assessment data; to the 
Committee on Finance.
  Mr. GREGG. Mr. President, I rise today to introduce the Medicare 
Quality Enhancement Act of 2006 to improve quality and reduce the cost 
of health care.
  The Medicare Quality Enhancement Act addresses three important 
problems in our Nation's health care delivery system: rising costs, 
broad variations in the quality of care, and a lack of information on 
health care quality and cost.
  Among the most pressing issues that need to be addressed in the area 
of health care is the issue of rapidly rising health care costs. The 
United States spends more on health care as a percentage of GDP than 
any other industrialized country. According to the Centers for Medicare 
and Medicaid Services (CMS), total health expenditures are estimated to 
be $2.16 trillion

[[Page S9637]]

in 2006 and are projected to rise to over $4 trillion in 2015.
  The pressures of rising health care costs are being felt by 
consumers, providers, employers, State and local governments, and the 
Federal budget alike--with no end in sight. Premiums for employer-based 
health insurance rose by 9.2 percent in 2005--the fifth consecutive 
year of increases over 9 percent. Health insurance expenses are the 
fastest growing expense to employers, consuming more and more of each 
company's bottom line.
  From a Federal budget perspective, over the next 10 years, Medicare 
will grow on average 8.5 percent to $885 billion and Medicaid will grow 
similarly at 8 percent to $413 billion. These programs along with 
Social Security will take up 56 percent of the total budget in 2016. 
Such rate of growth is unsustainable.
  Despite this enormous level of spending, there is wide variation in 
the quality of the care Americans receive. In addition to the existing 
crisis of ever increasing costs, we are now learning that there are 
vast variations in the ratio of spending to outcomes, meaning that more 
care is not necessarily better care. A recent report by the Dartmouth 
Atlas Project demonstrated this point and showed no correlation between 
high utilization of services and high quality of care. This information 
provides an opportunity to improve care and reduce costs. We simply 
cannot afford business as usual in health care, especially when we have 
no way of determining the value of what we are purchasing.
  The Agency on Healthcare Research and Quality (AHRQ) also reports 
wide variation in health care practice. AHRQ claims that millions of 
Americans fail to receive necessary care resulting in complications and 
increased costs. Others, they say, receive health care services that 
are completely unnecessary, which also increases costs.
  These problems are compounded by a third issue the lack of 
information available to consumers and purchasers on quality and cost. 
Currently, health care consumers do not have the tools necessary to 
make sound quality and cost decisions about their care. The few tools 
that are available to them are based on limited amounts of privately 
held data and their analysis is often not broad enough to provide the 
most accurate results.
  The Medicare Quality Enhancement Act gives consumers, employers, 
providers and others the tools they need to begin controlling 
unnecessary spending; improves quality of care in our nation's health 
care delivery system; and provides the public with reports to make 
informed health care decisions.
  The bill works by sharing taxpayer funded Medicare data with private 
sector Medicare Quality Reporting Organizations (MQROs), allowing them 
to develop reports to measure health care quality for the public. 
Consumer groups, employers, insurance companies, labor unions and 
others have repeatedly requested access to Medicare claims data to 
improve the quality of the health care provided to their members, 
employees, and beneficiaries and to help control the ever-rising costs 
of health care. The Medicare Quality Enhancement Act ensures that the 
data collected by Medicare and paid for by the taxpayer can be utilized 
by qualified organizations to measure quality and control costs while 
protecting beneficiary privacy.
  The measure also empowers consumer groups, providers, employers, 
insurance plans, labor unions and others by allowing them to request 
health care quality and efficiency reports from the newly-formed 
MQROs--information that will assist in better-informed purchasing 
decisions. Further, the bill provides for the public release of all 
reports, including detailed information on the methodology, standards 
and measures of quality used in developing the reports ensuring the 
information is available for the general public. In addition, MQROs 
that contract with the Department of Health and Human Services will be 
authorized to aggregate both private and public data, providing a 
significantly more robust assessment of both quality and efficiency.
  In the development of this bill, my first goal was to protect 
beneficiary privacy. Specifically, the bill limits the number of MQRO 
participants and explicitly holds them to the strict standards of both 
the Health Insurance Portability and Accountability Act (HIPAA) and the 
Privacy Act. It also requires MQROs to have operational standards and 
procedures in place to provide for the security of the database. 
Lastly, the bill requires a privacy review by the Department of Health 
and Human Services of each analytical report prior to release.
  The Medicare Quality Enhancement Act promotes the development of 
model quality standards through a newly established Quality Advisory 
Board within the Department of Health and Human Services and encourages 
the Administration to continue its extraordinary work with providers, 
consumers, insurers and others in the health care community toward 
sound quality measurement for all patients. Collaborative groups such 
as the Ambulatory Care Quality Alliance (AQA) and the Hospital Quality 
Alliance (HQA) are working hard to establish standards and the Medicare 
Quality Enhancement Act encourages their work to continue.
  Under the bill, researchers are granted additional access to Medicare 
data and are allowed to report in a provider- and supplier-identifiable 
format as long as they meet existing strict criteria for the use of 
Medicare data within CMS. Some of our best information on quality and 
efficiency has been borne of fine academic institutions and private 
study and they, too, should have the opportunities to use this data to 
improve our health care system.
  In closing, the Medicare Quality Enhancement Act is needed in order 
for America's health care system to improve. The public needs to 
understand the quality of the care they are purchasing and the time has 
come for the health care community to compete on quality, value, and 
cost payment should not simply be for the volume of care provided, but 
instead for the quality of the care provided.
  The Medicare Quality Enhancement Act takes important steps to provide 
health care consumers with the information they need to make educated 
decisions about health care; information they already have to make 
decisions on nearly every other product they purchase in the 
marketplace. It requires that information paid for by the taxpayer and 
held by Medicare is fully available to improve our health care system. 
The public will then finally have the tools necessary to make informed 
health care decisions for themselves and their families.
  This bill has the support of groups that represent consumers, 
providers, employers and insurers. I hope my colleagues will see the 
merit of this legislation and that it will be considered before we 
adjourn this year.
  Mr. FRIST. Mr. President, for decades, healthcare analysts and 
industry experts have wondered whether healthcare should consume 16 
percent of our Nation's economic output, as it currently does.
  By virtually any measure, we spend more on healthcare than any other 
country in the world.
  Consider the facts. According to the World Health Organization; we 
spend twice as much per person on healthcare as Britain and Japan; and 
we spend nearly 30 percent more than second-ranking Monaco.
  In the past 5 years alone, the cost of health insurance to companies 
has nearly doubled--from $4,200 to $8,100 per family.
  But experts also concur that rising healthcare costs does not mean 
the quality of healthcare is improving. Just this summer, the Institute 
of Medicine released the most extensive report ever on medication 
errors.
  The results? At least 1.5 million Americans are sickened, injured, or 
killed each year by errors in prescribing, dispensing, and taking 
medications.
  Errors are widespread--on average, a hospital patient is subjected to 
1 error each day he or she occupies a hospital bed--and they are 
costly, at an estimated expense of $3.5 billion per year.
  We have good reason to question the cost and quality of our 
healthcare services. That is why, in August, President Bush issued an 
executive order requiring all Federal agencies with a health insurance 
program to increase price transparency and provide options promoting 
quality and efficiency of care.

[[Page S9638]]

  The Executive Order builds on the Federal Govermment's efforts to 
release Medicare payment information for individual healthcare 
providers.
  While this is an important step toward transparency, more can be 
done. We need a way to analyze that data and make the results of the 
analysis consumer friendly, so that patients have real information they 
can use to make better informed healthcare decisions.
  The bill before us today--of which I am a proud cosponsor--picks up 
where current Federal efforts leave off. The Medicare Quality 
Enhancement Act establishes quality transparency in the Medicare 
Program.
  It doesn't require anything extra of providers. In fact, CMS is 
already collecting the data we need--because any provider that accepts 
Medicare patients must report quality data to CMS.
  Instead, the bill requires CMS to establish public-private 
partnerships with Medicare quality reporting organizations, or MQROs. 
CMS will provide MQROs with data CMS already collects--Medicare 
enrollment, claims, and survey and assessment data. The MQROs will then 
perform the analysis.
  Any entity or provider will be able to make report requests of MQROs, 
the results of which will be made public. The methodology an MQRO uses 
to analyze the data will also be made public. And providers can 
additionally instruct MQROs to use a certain methodology when making a 
report request.
  I know many providers are concerned about CMS's capacity and 
capability to analyze healthcare quality data.
  In part, that is why this bill requires CMS to contract with MQROs. 
The Secretary must determine that each MQRO has the research capability 
to conduct and complete reports as a condition for entering into the 
contract. MQROs must also demonstrate that they have the experience and 
expertise to analyze quality data.
  As an additional contract requirement, each MQRO must comply with 
Federal privacy regulations to ensure beneficiary confidentiality. 
Additionally, MQROs must disclose financial interests as a condition to 
contract.
  As a transplant surgeon, I understand the concerns and fears 
providers have. Many providers are worried that we aren't far enough 
along in terms of quality data collection to be able to analyze it.
  But we must push the envelope in this area. It is my hope that 
provider groups will take the lead and request reports using a 
methodology and standards of quality that represent the best care in 
each of their fields.
  Quality transparency is absolutely essential to improving healthcare. 
Without it, beneficiaries cannot make informed decisions about their 
healthcare.
  Consumers already enjoy transparency in other industries. When we buy 
a new car, we can open an Internet browser and in a matter of moments 
can make objective side-by-side comparisons of different models--and 
then we can take them for a test drive.
  When we need groceries, we pull out the Sunday supermarket ads to see 
what is on sale and where.
  And when we furnish our homes, we shop around--comparing style, 
price, color, quality, warranty, and service.
  But right now, we can't do that in healthcare. Whether it is a 
routine checkup or a heart transplant, we have no way of assessing how 
much bang we are getting for a buck.
  Only when we institute quality transparency do we empower 
beneficiaries to make informed decisions about their healthcare.
  This bill is a great step toward the goal of complete quality 
transparency. It is a formidable goal; that is why we are starting with 
something we know--Medicare.
  Senator Gregg has worked long hours to bring this bill to fruition, 
and I thank him for his efforts. I hope our colleagues will join us in 
supporting this important measure.
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