[Congressional Record Volume 153, Number 127 (Friday, August 3, 2007)]
[Senate]
[Pages S10888-S10889]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                   WIRED FOR HEALTH CARE QUALITY ACT

  Mr. GRASSLEY. Mr. President, I want to take a few minutes to explain 
the action I am taking related to S. 1693, the Wired for Health Care 
Quality Act. Today, with great reluctance, I have asked Republican 
Leader McConnell to consult with us prior to any action regarding the 
consideration of this bill, which the Health, Education, Labor, and 
Pensions Committee reported on August 1, 2007.
  The Wired for Health Care Quality Act would encourage the development 
of interoperable standards for health information technology, IT, offer 
incentives for providers to acquire qualified health IT systems to 
improve the quality and efficiency of health care, and facilitate the 
secure exchange of electronic health information. The bill also 
includes provisions to require all federal agencies to comply with 
standards and specifications adopted by the Federal Government for 
purposes determined appropriate by the Secretary of Health and Human 
Services, HHS, and to ensure quality measurement and reporting of 
provider performance under the Public Health Service Act.
  I fully support fostering the adoption of health information 
technology to assist providers in making quality improvements in our 
health care system. In 2005, Senator Baucus and I introduced the 
Medicare Value Purchasing Act, S. 1356, in conjunction with Senators 
Enzi and Kennedy's legislation known as the Better Healthcare Through 
Information Technology Act, S. 1355. Although the Medicare Value 
Purchasing Act did not pass in its entirety, provisions based on our 
bill have been enacted in other legislation.
  Medicare is the single largest purchaser of health care in the 
Nation, so 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. 
Medicare can drive quality improvement through payment incentives. The 
adoption of information technology is also desirable, both to 
facilitate the reporting of quality measures and to increase the 
efficiency and quality of our health care system. These two concepts 
should work together.
  A number of legislative initiatives have been enacted in Medicare in 
recent years to promote the development and reporting of quality 
measures. The Medicare Prescription Drug, Improvement, and 
Modernization Act of 2003, MMA, included provisions that required the 
reporting of quality measures for inpatient hospitals. The Deficit 
Reduction Act of 2005 expanded the reporting of quality measures for 
inpatient hospital services and extended quality measures to home 
health settings.
  Last year, the Tax Relief and Health Care Act of 2006, TRHCA, 
extended quality measure reporting to hospital outpatient services and 
ambulatory service centers. TRHCA also authorized the 2007 Physician 
Quality Reporting Initiative, PQRI, a voluntary quality reporting 
system in Medicare for physicians and other eligible health care 
professionals. Beginning July 1, 2007, the new PQRI program provides 
Medicare incentive payments for the successful reporting of quality 
measures that have been adopted or endorsed by a consensus 
organization. The Centers for Medicare and Medicaid Services, CMS, has 
worked diligently with the

[[Page S10889]]

American Medical Association Physician Consortium for Performance 
Improvement, the Ambulatory Quality Alliance, and the National Quality 
Forum in the development, adoption, endorsement, and selection of 
quality measures for this program.
  Considerable time and effort have been devoted to the development and 
reporting of quality measures for various providers in Medicare under 
the Social Security Act. Many of these programs have now been up and 
running for some time. This is why I am greatly troubled that, as 
currently drafted, the Wired for Health Care Quality Act would require 
the development and reporting of quality measures under the Public 
Health Service Act.
  It is hard to comprehend how the quality measurement system created 
by S. 1693 would interact with the various quality measurement programs 
that have already been enacted by Congress under the Social Security 
Act and implemented by CMS. Creating two different quality measurement 
systems would have the potential to create differing or even 
duplicative quality measurement systems which could drastically 
interfere with our common goal of improving the quality of health care 
in this country.
  Under the bill, the Secretary also would establish Federal standards 
and implementation specifications for data collection. Within three 
years of their adoption, all Federal agencies would have to implement 
these standards according to the specifications. While this sounds 
appealing, I am concerned about the reality of implementing such 
standards--across the myriad programs at the Departments of Health and 
Human Services, Veterans Affairs, Defense, and all the other Federal 
agencies that may have health care data. It would be an enormous 
challenge. Agencies collect data for many different purposes, using 
many different data systems. Six years ago, when Secretary Thompson 
first arrived at the Department of Health and Human Services, the 
department had eight different computer systems. Presumably other 
agencies similarly have multiple systems. All will be expensive and 
difficult to retrofit to meet new federal standards.
  The bill also would require the HHS Secretary to provide federal 
health data, including the Medicare claims databases, to at least three 
``Quality Reporting Organizations'' that agreed to provide public 
reports based on the data.
  The Quality Reporting Organizations would be required to release 
regular reports on quality performance that are provider- and supplier-
specific. Any organization, including those with commercial interests, 
could request that the Quality Reporting Organizations compile specific 
reports based on the requester's methodology. So, for example, drug 
companies could request data on physician prescribing patterns to 
determine which physicians their salespeople should target.
  In overseeing Medicare, Congress is working to bring more quality 
reporting into the program. As I mentioned before, just this past 
December Congress enacted the Tax Relief and Health Care Act of 2006, 
which implemented a physician pay-for-reporting program in Medicare. 
The Finance Committee has been working for some time now to phase-in 
the use of quality measures with various providers. Eventually, I hope 
that Medicare can compensate providers appropriately for providing 
high-quality care.
  I am, however, concerned about public disclosure of provider-specific 
information without appropriate safeguards. If not used properly, the 
data could be misinterpreted. For example, hospitals that specialize in 
very difficult cases might seem to provide lower quality of care than 
those treating less severe cases. This would set up the wrong 
incentives for hospitals and other health care providers.
  I agree that it would be helpful to standardize data reporting 
throughout the federal government, and to use that data appropriately 
to assess the quality of care provided by clinicians, hospitals, and 
other health care organizations. At the same time, I have serious 
concerns about how this bill is structured with respect to the 
disclosure and use of the data from federal health entitlement programs 
which are within the sole jurisdiction of the Finance Committee.
  I welcome the opportunity to work with the sponsors of S. 1693, 
Senators Kennedy, Enzi, Clinton, and Hatch, along with members of the 
Health, Education, Labor, and Pensions Committee on this matter. I had 
hoped we could work out an agreement on legislative language that was 
acceptable to both the Finance Committee and the HELP Committee before 
the bill was on the floor. I appreciate the efforts that my colleagues, 
Senators Enzi and Kennedy, have undertaken with us over the last month 
to resolve the concerns of the Finance Committee. However, I remain 
deeply troubled that, as currently drafted, the Wired for Health Care 
Quality Act could end up unintentionally delaying or frustrating the 
goal we all share of improving the quality of health care for all 
Americans.

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