[Congressional Record Volume 167, Number 199 (Tuesday, November 16, 2021)]
[House]
[Pages H6281-H6283]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
{time} 1245
VA ASSESSMENT BY INDEPENDENT MEASURES ACT
Mr. TAKANO. Mr. Speaker, I move to suspend the rules and pass the
bill (H.R. 4626) to amend title 38, United States Code, to require an
independent assessment of health care delivery systems and management
processes of the Department of Veterans Affairs be conducted once every
10 years, and for other purposes, as amended.
The Clerk read the title of the bill.
The text of the bill is as follows:
H.R. 4626
Be it enacted by the Senate and House of Representatives of
the United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``VA Assessment by Independent
Measures Act'' or the ``VA AIM Act''.
SEC. 2. REQUIREMENT FOR ONGOING INDEPENDENT ASSESSMENTS OF
HEALTH CARE DELIVERY SYSTEMS AND MANAGEMENT
PROCESSES OF THE DEPARTMENT OF VETERANS
AFFAIRS.
(a) Ongoing Assessments.--Chapter 17 of title 38, United
States Code, is amended by inserting after section 1704 the
following new section:
``Sec. 1704A. Independent assessments of health care delivery
systems and management processes
``(a) Independent Assessments.--Not less frequently than
once every 10 years, the Secretary of Veterans Affairs shall
enter into one or more contracts with a private sector entity
or entities described in subsection (d) to conduct an
independent assessment of the hospital care, medical
services, and other health care furnished by the Department
of Veterans Affairs. Such assessment shall address each of
the following:
``(1) Current and projected demographics and unique health
care needs of the patient population served by the
Department.
``(2) The accuracy of models and forecasting methods used
by the Department to project health care demand, including
with respect to veteran demographics, rates of use of health
care furnished by the Department, the inflation of health
care costs, and such other factors as may be determined
relevant by the Secretary.
``(3) The reliability and accuracy of models and
forecasting methods used by the Department to project the
budgetary needs of the Veterans Health Administration and how
such models and forecasting methods inform budgetary trends.
``(4) The authorities and mechanisms under which the
Secretary may furnish hospital care, medical services, and
other health care at Department and non-Department
facilities, including through Federal and private sector
partners and at joint medical facilities, and the effect of
such authorities and mechanisms on eligibility and access to
care.
``(5) The organization, workflow processes, and tools used
by the Department to support clinical staffing, access to
care, effective length-of-stay management and care
transitions, positive patient experience, accurate
documentation, and subsequent coding of inpatient services.
``(6) The efforts of the Department to recruit and retain
staff at levels necessary to carry out the functions of the
Veterans Health Administration and the process used by the
Department to determine staffing levels necessary for such
functions.
``(7) The staffing level at each medical facility of the
Department and the productivity of each health care provider
at the medical facility, compared with health care industry
performance metrics, which may include the following:
``(A) An assessment of the case load of, and number of
patients treated by, each health care provider at such
medical facility during an average week.
``(B) An assessment of the time spent by each such health
care provider on matters other than the case load of the
health care provider, including time spent by the health care
provider as follows:
[[Page H6282]]
``(i) At a medical facility that is affiliated with the
Department.
``(ii) Conducting research.
``(iii) Training or supervising other health care
professionals of the Department.
``(8) The information technology strategies of the
Department with respect to furnishing and managing health
care, including an identification of any weaknesses or
opportunities with respect to the technology used by the
Department, especially those strategies with respect to
clinical documentation of hospital care, medical services,
and other health care, including any clinical images and
associated textual reports, furnished by the Department in
Department or non-Department facilities.
``(9) Business processes of the Veterans Health
Administration, including processes relating to furnishing
non-Department health care, insurance identification, third-
party revenue collection, and vendor reimbursement, including
an identification of mechanisms as follows:
``(A) To avoid the payment of penalties to vendors.
``(B) To increase the collection of amounts owed to the
Department for hospital care, medical services, or other
health care provided by the Department, for which
reimbursement from a third party is authorized and to ensure
that such amounts collected are accurate.
``(C) To increase the collection of any other amounts owed
to the Department with respect to hospital care, medical
services, or other health care and to ensure that such
amounts collected are accurate.
``(D) To increase the accuracy and timeliness of Department
payments to vendors and providers.
``(E) To reduce expenditures while improving the quality of
care furnished.
``(10) The purchase, distribution, and use of
pharmaceuticals, medical and surgical supplies, medical
devices, and health care-related services by the Department,
including the following:
``(A) The prices paid for, standardization of, and use by,
the Department with respect to the following:
``(i) Pharmaceuticals.
``(ii) Medical and surgical supplies.
``(iii) Medical devices.
``(B) The use by the Department of group purchasing
arrangements to purchase pharmaceuticals, medical and
surgical supplies, medical devices, and health care-related
services.
``(C) The strategy and systems used by the Department to
distribute pharmaceuticals, medical and surgical supplies,
medical devices, and health care-related services to Veterans
Integrated Service Networks and medical facilities of the
Department.
``(11) The process of the Department for carrying out
construction and maintenance projects at medical facilities
of the Department and the medical facility leasing program of
the Department.
``(12) The competency of Department leadership with respect
to culture, accountability, reform readiness, leadership
development, physician alignment, employee engagement,
succession planning, and performance management.
``(13) The effectiveness of the authorities and programs of
the Department to educate and train health personnel pursuant
to section 7302 of this title.
``(14) The conduct of medical and prosthetic research of
the Department.
``(15) The provision of Department assistance to Federal
agencies and personnel involved in responding to a disaster
or emergency.
``(16) Such additional matters as may be determined
relevant by the Secretary.
``(b) Timing.--The private sector entity or entities
carrying out an assessment pursuant to subsection (a) shall
complete such assessment not later than one year after
entering into the contract described in such paragraph.
``(c) Data.--To the extent practicable, the private sector
entity or entities carrying out an assessment pursuant to
subsection (a) shall make use of existing data that has been
compiled by the Department, including data that has been
collected for--
``(1) the performance of quadrennial market assessments
under section 7330C of this title;
``(2) the quarterly publication of information on staffing
and vacancies with respect to the Veterans Health
Administration pursuant to section 505 of the VA MISSION Act
of 2018 (Public Law 115-182; 38 U.S.C. 301 note); and
``(3) the conduct of annual audits pursuant to section 3102
of the Johnny Isakson and David P. Roe, M.D. Veterans Health
Care and Benefits Improvement Act of 2020 (Public Law 116-
315; 38 U.S.C. 1701 note).
``(d) Private Sector Entities Described.--A private sector
entity described in this subsection is a private entity
that--
``(1) has experience and proven outcomes in optimizing the
performance of the health care delivery systems of the
Veterans Health Administration and the private sector and in
health care management; and
``(2) specializes in implementing large-scale
organizational and cultural transformations, especially with
respect to health care delivery systems.
``(e) Program Integrator.--(1) If the Secretary enters into
contracts with more than one private sector entity under
subsection (a) with respect to a single assessment under such
subsection, the Secretary shall designate one such entity
that is predominately a health care organization as the
program integrator.
``(2) The program integrator designated pursuant to
paragraph (1) shall be responsible for coordinating the
outcomes of the assessments conducted by the private sector
entities pursuant to such contracts.
``(f) Reports.--(1) Not later than 60 days after completing
an assessment pursuant to subsection (a), the private sector
entity or entities carrying out such assessment shall submit
to the Secretary of Veterans Affairs and the Committees on
Veterans' Affairs of the House of Representatives and the
Senate a report on the findings and recommendations of the
private sector entity or entities with respect to such
assessment. Such report shall include an identification of
the following:
``(A) Any changes with respect to the matters included in
such assessment since the date that is the later of the
following:
``(i) The date on which the independent assessment under
section 201 of the Veterans Access, Choice, and
Accountability Act of 2014 (Public Law 113-146; 38 U.S.C.
1701 note) was completed.
``(ii) The date on which the last assessment under
subsection (a) was completed.
``(B) Any recommendations regarding matters to be covered
by subsequent assessments under subsection (a), including any
additional matters to include for assessment or previously
assessed matters to exclude.
``(2) Not later than 30 days after receiving a report under
paragraph (1), the Secretary shall publish such report in the
Federal Register and on a publicly accessible internet
website of the Department.
``(3) Not later than 90 days after receiving a report under
paragraph (1), the Secretary shall submit to the Committees
on Veterans' Affairs of the House of Representatives and the
Senate a report outlining the feasibility, and advisability,
of implementing the recommendations made by the private
sector entity or entities in such report received, including
an identification of the timeline, cost, and any legislative
authorities necessary for such implementation.''.
(b) Clerical Amendments.--The table of sections at the
beginning of such chapter is amended by inserting after the
item relating to section 1704 the following new item:
``1704A. Independent assessments of health care delivery systems and
management processes.''.
(c) Deadline for Initial Assessment.--The initial
assessment under section 1704A of title 38, United States
Code, as added by subsection (a), shall be completed by not
later than December 31, 2025.
The SPEAKER pro tempore. Pursuant to the rule, the gentleman from
California (Mr. Takano) and the gentleman from Illinois (Mr. Bost) each
will control 20 minutes.
The Chair recognizes the gentleman from California.
General Leave
Mr. TAKANO. Mr. Speaker, I ask unanimous consent that all Members may
have 5 legislative days in which to revise and extend their remarks and
to insert extraneous material on H.R. 4626, as amended.
The SPEAKER pro tempore. Is there objection to the request of the
gentleman from California?
There was no objection.
Mr. TAKANO. Mr. Speaker, I yield myself such time as I may consume.
Mr. Speaker, I rise today in support of H.R. 4626, as amended, the VA
Assessment by Independent Measures Act, or VA AIM Act.
This bill would require the Department of Veterans Affairs to
contract with one or more private-sector entities to conduct
independent assessments of its healthcare delivery systems and
management processes once every 10 years.
This bill would make permanent an independent assessment process that
is nearly identical to the one that was mandated by the Veterans
Access, Choice, and Accountability Act of 2014.
Among other things, the review would examine VA patient demographics
and healthcare needs now and in the future; the accuracy and
reliability of the models used to project VA's healthcare budget;
veterans' access to healthcare through community providers and other
Federal facilities; VA's healthcare appointment scheduling processes;
and VA's process for determining its staffing needs and recruiting and
retaining clinical staff.
I am pleased that Ranking Member Bost and Representative Bergman were
open to incorporating my feedback when this bill was considered by our
committee this summer. We added a provision to the bill that requires
VA to submit to Congress a report outlining the feasibility and
advisability of implementing any recommendations made through these
independent assessments. This will help us hold the Department
accountable for improving its delivery of the healthcare benefits our
Nation's veterans have earned.
[[Page H6283]]
Mr. Speaker, I urge my colleagues to join me in supporting H.R. 4626,
as amended, the VA AIM Act, and I reserve the balance of my time.
Mr. BOST. Mr. Speaker, I yield myself such time as I may consume.
Mr. Speaker, I rise today in support of H.R. 4626, as amended, the VA
Assessment by Independent Measures Act, or AIM Act.
The AIM Act is sponsored by my friend and fellow Marine Corps
veteran, General Jack Bergman. General Bergman is the ranking member of
the Subcommittee on Health, and I thank him for his dedication to
ensuring that the VA is providing good care for each one of our
Nation's veterans.
The AIM Act would require an independent assessment of the VA
healthcare system once every decade, starting in the year 2025.
When the VA was in the midst of a nationwide access and
accountability crisis in 2014, Congress passed the Choice Act to help
right the ship. The Choice Act included a provision requiring an
independent assessment of the VA healthcare system. That led to many of
the reforms that are occurring across the VA system today. Establishing
a mechanism for regular independent assessments will ensure that the VA
continues to improve in the decades ahead.
I appreciate Chairman Takano and his staff for working with me and
General Bergman while the AIM Act was pending in committee. I hope that
this bill will have the same level of bipartisan support today.
Mr. Speaker, I reserve the balance of my time.
Mr. TAKANO. Mr. Speaker, I have no further speakers. I am prepared to
close, and I reserve the balance of my time.
Mr. BOST. Mr. Speaker, I yield 3 minutes to the gentleman from
Michigan (Mr. Bergman).
Mr. BERGMAN. Mr. Speaker, I am proud to rise today in support of my
bill, H.R. 4626, as amended, the Department of Veterans Affairs
Assessment by Independent Measures Act, or AIM Act.
When it comes to bureaucracies, I have never believed that
maintaining the status quo is an acceptable path forward. In fact, it
is an impossible path forward.
The world is constantly in a state of change. The way American men
and women defend freedom around the world, and the way those same men
and women seek care when they come home, is constantly changing as
well. The VA healthcare system must change, too, or it will never
fulfill its obligations to all of our veterans.
That is where the AIM Act comes in. The AIM Act would require an
independent assessment of the operations and management of the VA
healthcare system once every decade, beginning in 2025.
The independent assessment framework in the AIM Act is modeled after
the independent assessment that was required in the Choice Act, which
was signed into law in 2014 following the nationwide VA access and
accountability crisis that saw some veterans literally dying on VA
facilities' waiting lists.
That independent assessment was completed in 2015, and the findings
and recommendations it contained directly underpinned many of the
necessary improvements that have occurred in the VA healthcare system
since then.
The AIM Act would ensure that this successful model is not a one-and-
done but instead regularly recurs to ensure that the VA keeps improving
for veterans long into the future.
I am grateful for the support the AIM Act has received from veterans
service organizations, particularly the Veterans of Foreign Wars, the
Wounded Warrior Project, and the Minority Veterans of America.
I am also grateful for the bipartisan support the AIM Act received in
the Veterans' Affairs Committee. I thank all of my colleagues for that.
I hope that there will be a similar show of bipartisan support for the
bill today. My fellow veterans have earned it.
Mr. TAKANO. Mr. Speaker, I am prepared to close, and I reserve the
balance of my time.
Mr. BOST. Mr. Speaker, I encourage all of my colleagues to support
this bill, and I yield back the balance of my time.
Mr. TAKANO. Mr. Speaker, I ask all of my colleagues to join me in
passing this important piece of legislation, H.R. 4626, as amended, and
I yield back the balance of my time.
The SPEAKER pro tempore. The question is on the motion offered by the
gentleman from California (Mr. Takano) that the House suspend the rules
and pass the bill, H.R. 4626, as amended.
The question was taken; and (two-thirds being in the affirmative) the
rules were suspended and the bill, as amended, was passed.
A motion to reconsider was laid on the table.
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