[Congressional Record Volume 153, Number 86 (Thursday, May 24, 2007)]
[Senate]
[Pages S6889-S6890]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. CARDIN (for himself and Mr. Specter):
  S. 1519. A bill to amend title XVIII of the Social Security Act to 
provide for a transition to a new voluntary quality reporting program 
for physicians and other health professionals; to the Committee on 
Finance.
  Mr. CARDIN. Mr. President, today I rise to introduce the Voluntary 
Medicare Quality Reporting Act of 2007. I thank my good friend, the 
gentleman from Pennsylvania, Mr. Specter, for joining me in this 
effort. This is an important bill for tens of millions of Medicare 
beneficiaries, for the physicians, nurse practitioners and allied 
health professionals who treat them, and for the future of the Medicare 
program.
  At the end of this year, providers will again face the prospect of an 
across-the-board cut in their Medicare reimbursements. The scheduled 
cut for 2008 is the largest ever, 9.9 percent. These cuts are the 
result of a flawed reimbursement system created in 1997 that uses the 
Sustainable Growth Rate formula, or SGR, to determine an acceptable 
increase in the growth of provider expenditures.
  Medicare reimbursements increase when the previous year's payments do 
not exceed a target level that is based on the growth of our economy. 
However, when the previous year's payments exceed that target level, 
reimbursements are cut. According to MedPAC, the SGR formula would 
reduce Medicare provider reimbursements by 40 percent over the next 
eight years if Congress does not act. MedPAC is also concerned that 
over the next several years these reductions ``would threaten 
beneficiary access to physician services over time, particularly those 
provided by primary care physicians.'' MedPAC recognizes the importance 
of provider participation in the Medicare program, particularly in our 
rural and underserved urban areas where the decision to not accept new 
Medicare patients can make all the difference in seniors' access to 
medical care.
  Congress recognizes this as well, and so we have intervened to 
prevent scheduled cuts resulting from SGR from taking effect. For all 
except the newest members of this body, this process of enacting a 
``physician fix'' is a familiar scenario. For the past four years, 
Congress has acted to prevent these cuts to providers, usually through 
a last-minute provision added to a must-pass bill.

[[Page S6890]]

  In the 109th Congress, I introduced bipartisan legislation 
implementing MedPAC's recommendations and calling for Congress to 
repeal the SGR formula and update provider reimbursements by the cost 
of care. Replacing SGR will require a thoughtful and protracted process 
involving the input of lawmakers and the provider community, and it is 
costly, but it is something that we must do.
  The most recent ``fix'' was made to the 2006 Tax Relief and Health 
Care Act, Public Law 109-432. That law froze payment rates, staving off 
an across-the-board cut of 5.1 percent. Congress also added a quality 
reporting system called the Physician Quality Reporting Initiative 
program PQRI, which made providers eligible for a bonus payment of 1.5 
percent of their total allowed Medicare charges if they report to HHS 
on certain quality measures starting in July 2007.
  This new system is also known as ``pay-for-reporting,'' and it is 
based on the concept that physicians should receive an increase in 
Medicare reimbursement only once they have participated in extensive 
quality reporting. Across my State, I have heard serious concerns that 
this will lead to a mandatory reporting system in the near future, and 
that we will soon see an untested ``pay-for-performance'' system in 
place.
  Now, I think all my colleagues would agree that our seniors deserve 
the highest quality care. But in our quest for improved quality, we 
must answer two questions here: should we proceed with an untested 
system of reporting requirements just for the sake of reporting, and 
will we actually achieve better care for our seniors via the PQRI.
  I am very concerned about implementing reporting requirements that 
have not been tested. I believe that we must have the right process in 
place for defining a quality reporting system for services provided to 
Medicare beneficiaries by health care professionals. We should not be 
establishing reporting requirements for health professionals just for 
the sake of reporting, and we should not be moving forward with this 
system until we have adequate time to evaluate each stage of its 
development.
  Current law does not provide sufficient time to assess the 
appropriateness and effectiveness of this new system. Nor do they take 
into account the fact that most physicians and other health 
professionals have no experience in quality reporting and do not have 
in place the necessary health information technology and administrative 
infrastructures to participate in a reporting system.
  The bill I am introducing today will assure that health professionals 
will be at the center of the process for defining areas where quality 
measures are needed, as well as for defining the relevant measures 
themselves. Why is this important? Health professionals must be 
actively engaged in developing and implementing an effective reporting 
system because they are on the front lines of health care delivery, and 
they best understand the nexus between care delivery and quality 
measurement. The development process for quality measures must be 
transparent and consistent for all health professionals because they 
are the ones who will determine its successful implementation.
  Additionally, quality measures should be tested across a variety of 
specialties and practice settings before they are included in a 
reporting system because measures must be clinically valid to be 
relevant for defining quality, and because physicians and health 
professionals practice in a variety of settings, for example: small vs. 
large practices, urban vs. suburban vs. rural locations, office-based 
vs. hospital-base practices.
  Most importantly, we should not be using hastily devised quality 
measures to justify reimbursement cuts. There are some who advocate 
pay-for-performance as a way to slow the growth of physician spending. 
They think we can accomplish lower physician expenditures by setting 
arbitrary standards and then cutting payments to physicians who fail to 
meet them. But across America, there are practices that would face 
tremendous obstacles in meeting such standards: they lack of the 
information technology necessary to document and report standards in a 
timely manner; they see patients with economic and language barriers 
that will result in higher noncompliance rates; they treat a patient 
population for whom ethnic and racial differences require different 
clinical interventions than for other patients. Ignoring these 
considerations will not only fail to dramatically improve quality, it 
will significantly penalize providers who treat traditionally 
underserved populations.
  This bill provides an opportunity to thoughtfully and carefully 
develop effective quality measures that reflect differences in practice 
patterns, to share our findings, and to determine and encourage the 
most cost-effective methods of providing the highest quality care.
  Rather than moving forward precipitously in 2008 with a permanent 
Medicare quality reporting system after a transitional 6-month period 
this year, as current law requires, our bill, the Voluntary Medicare 
Quality Reporting Act of 2007, instead would establish a more realistic 
timeline for quality measure reporting by health professionals. It does 
so by:
  Requiring the Secretary first to evaluate the 6-month transitional 
reporting system and reporting findings to the Congress by June 1, 
2008;
  Requiring the Secretary to undertake demonstrations for defining 
appropriate mechanisms whereby health professionals may provide data on 
quality measures to the Secretary through an appropriate medical 
registry;
  Allowing physicians and other eligible professionals to continue 
reporting to the Secretary quality measures developed for 2007, in 
order for the Secretary to refine systems for reporting quality 
measures;
  After completion of the evaluation, phasing in a permanent Voluntary 
Medicare Quality Reporting Program, with implementation beginning 
January 1, 2010, based on a consistent set of rules that define an 
orderly and transparent process of quality measure development;
  Requiring that the Physician Consortium for Performance Improvement 
of the American Medical Association be the beginning point for the 
designation of clinical areas where quality measures are needed;
  Having the Consortium, in collaboration with physician specialty 
organizations and other eligible professional organizations, develop 
and propose quality measures to a consensus organization such as the 
National Quality Forum for endorsement; and
  Prohibiting the Secretary from using any measures that have not been 
recommended by the Consortium and endorsed by the consensus 
organization.
  I am confident that with all of these measures we will achieve a 
successful and effective quality reporting system that will truly make 
a difference in the quality of care that our Medicare beneficiaries 
receive. At the end of this year, as Congress moves forward to address 
the physician reimbursement issue, I urge my colleagues to support this 
rational approach to promoting quality and guaranteeing access to care.
                                 ______