[Congressional Record (Bound Edition), Volume 145 (1999), Part 19]
[Senate]
[Pages 28157-28159]
[From the U.S. Government Publishing Office, www.gpo.gov]



              HEALTHCARE RESEARCH AND QUALITY ACT OF 1999

  Mr. GRAMM. Mr. President, I ask unanimous consent that the HELP 
Committee be discharged from further consideration of S. 580, and the 
Senate then proceed to its immediate consideration.
  The PRESIDING OFFICER. Without objection, it is so ordered. The clerk 
will report the bill by title.
  The legislative clerk read as follows:

       A bill (S. 580) to amend title IX of the Public Health 
     Service Act to revise and extend the Agency for Healthcare 
     Policy and Research.

  There being no objection, the Senate proceeded to consider the bill.


                           Amendment No. 2506

            (Purpose: To provide for a complete substitute)

  Mr. GRAMM. Mr. President, there is a substitute amendment at the desk 
submitted by Senators Frist, Jeffords, and Kennedy. I ask for its 
consideration.
  The PRESIDING OFFICER. The clerk will report.
  The legislative clerk read as follows:

       The Senator from Texas [Mr. Gramm], for Mr. Frist, for 
     himself, Mr. Jeffords, and Mr. Kennedy, proposes an amendment 
     numbered 2506.

  (The text of the amendment is printed in today's Record under 
``Amendments Submitted.'')
  Mr. KENNEDY. Mr. President, ten years ago, Congress created the 
Agency for Health Care Policy and Research to help us deal more 
effectively with critical national priorities in health care and 
research. I introduced the legislation with Senator Hatch, and it 
passed as part of the Omnibus Budget Reconciliation Act of 1989. It was 
based on a precursor organization--the National Center for Health 
Services Research--that was created by President Lyndon Johnson. The 
Agency's focus is primarily on health services research and other 
cutting edge methods to improve clinical practice. In its first decade, 
the Agency has proven its worth time and again by providing valuable 
information to Congress, health professionals, patients, businesses, 
and many others.
  This reauthorization begins a new chapter for the Agency. New 
responsibilities come with its new name, the Agency for Healthcare 
Research and Quality. While the Agency's intramural and extramural 
research will remain focused on general outcomes research and 
assessments of the how well the nation is doing with respect to 
coverage and provision of health care, there will also be increased 
activity on research to monitor and improve the quality of care.
  The Agency will serve an increasingly important role in the nation's 
effort to measure and improve the quality of health care, and to expand 
access to health insurance and health care. Research supported by the 
Agency provides critical information about the use, cost and quality of 
health services. As the health care market evolves, these data are 
necessary for informed decisions to help patients, providers, 
employers, government administrators, and policymakers. While the 
Agency is

[[Page 28158]]

not directly involved in making policy, its research and expertise 
provide informed guidance to those who are. This legislation will help 
the Agency maintain and expand its efforts to encourage public-private 
partnerships at every level of the health care system.
  The American people deserve to know that their hard-earned dollars 
are buying high-quality care. They want to know, as they are 
voluntarily or involuntarily enrolled in managed care plans, that the 
quality of care they receive is improving, not declining. Employers 
deserve to know that their investments in health benefits lead to 
healthier employees. As a result of the Agency's work, more and more 
Americans will be able to make the right decisions about their health 
care.
  The Agency also provides an important link between advances in 
medical research and technology, and adoption of these practices by the 
public and private sectors. The research conducted and supported by the 
Agency helps identify erroneous denials of treatment, and informs the 
nation about treatments that are the most effective or have the highest 
quality. While the Agency is not in the business of developing or 
promoting practice guidelines, its recommendations and research 
findings lead to significant savings for patients, providers, health 
plans, and taxpayers, while simultaneously improving the quality of 
care.
  For example, if the Agency's recommendations were applied to even 20 
percent of patients, the nation could save hundreds of millions of 
dollars annually--ranging from $8.5 million for enhanced prenatal care 
for diabetic women to $130 million for therapies that prevent stroke. 
We should do all we can to see that decision-making on health care is 
guided by the best available scientific information. The Agency for 
Healthcare Research and Quality will to help us achieve that goal.
  The reauthorization of the Agency also provides an opportunity to 
expand research on health care for those with special needs. Our 
success in treating these patients is an important measure of the 
overall effectiveness of the nation's health care system. More needs to 
be done to evaluate how well our system treats those who need the most, 
and often the most complex, services. Persons with disabilities are 
often underrepresented in health services research. Assessing how well 
our fragmented system cares for a person with mental retardation or 
spina bifida or parapalegia or a person nearing the end-of-life will 
enable us to assess where better care can lead to both a higher quality 
of life and significant savings.
  Reliable information about medical technology is an essential 
component of providing high quality health care to all Americans at a 
reasonable cost. It is especially important for Congress to be able to 
compare and understand the effectiveness of different technologies. For 
this reason, I was a strong supporter of the Congressional Office of 
Technology Assessment, which evaluated technologies in a wide range of 
scientific disciplines and provided a great deal of useful information 
to Congress before its funding was cut off in 1995. Fortunately, the 
Agency is fulfilling this essential role in the area of health care, 
and its mission is now more important than ever.
  The ongoing biomedical revolution is bringing extraordinary benefits 
to our society. The next century may well be the century of life 
sciences. Every day, we hear about new medical procedures and 
technologies. To fulfill their promise, the quality and effectiveness 
of new procedures and technologies must be carefully evaluated. The 
Agency is uniquely qualified to meet this challenge, and to provide 
important information about the value and effectiveness of existing 
procedures and therapies.
  The assessment reports prepared by the Agency are based on sound 
scientific data. Expanding access to the Agency's findings is an 
important step toward improving the overall quality of health care for 
the nation. We need to do all we can to see that the extraordinary 
discoveries being made in biomedical research are brought as quickly as 
possible to the bedside of the patient.
  This reauthorization puts a new face on the Agency and refocuses and 
refines its functions. Adequate funding for the Agency is essential, 
and I look forward to working with the Appropriations Committees and 
the Administration to achieve these needed and wise investments in 
better health care for all.
  Mr. FRIST. Mr. President, I am pleased that we are witnessing today 
the passage of legislation that is critical to improving the quality of 
health care in this country. The ``Healthcare Research and Quality Act 
of 1999,'' which I introduced on March 10, 1999, will significantly 
increase our federal investment in health care research and science-
based evidence to improve the quality of patient care.
  The health care system is a dramatically different system today than 
a decade ago when the Congress established the Agency for Health Care 
Policy and Research. The financing and delivery of health care has 
changed as we have moved to more complex systems such as managed care. 
At the same time, there has been an explosion of new medical 
information stemming from our biomedical research advances. As a 
result, patients and providers face increased difficulty in tracking 
and understanding the latest scientific findings.
  As we have seen in the debate on the Patients' Bill of Rights Act, 
issues regarding the quality and appropriate use of health care 
services is a significant public policy concern. Thus, I felt it was 
important to include S. 580 in the Patients' Bill of Rights Act that 
passed the Health, Education, Labor, and Pensions Committee on March 
18, 1999, and subsequently passed the Senate on July 15, 1999. As one 
of the conferees on the Patients' Bill of Rights, I look forward to 
working with my colleagues in an effort to improve the quality of 
health care delivered in this country by passing strong patient 
protection legislation next year. However, as we have been working on 
the legislation regarding AHCPR for quite some time--I introduced the 
first version of the bill, S. 2208, on June 23, 1998--I felt strongly 
that we pass the legislation reauthorizing the agency this year.
  S. 580 reauthorizes the Agency for Health Care Policy and Research 
for fiscal years 2000-2005, renames the agency the ``Agency for 
Healthcare Research and Quality,'' and refocuses the agency's mission 
to become the focal point for supporting federal health care research 
and quality improvement activities.
  The new Agency for Healthcare Research and Quality will: promote 
quality by sharing information regarding medical advances; build 
public-private partnerships to advance and share true quality measures; 
report annually on the state of quality, and cost, of the nation's 
healthcare; aggressively support improved information systems for 
health quality; support primary care research, and address issues of 
access in underserved areas and among priority populations; facilitate 
innovation in patient care with streamlined evaluation and assessment 
of new technologies; and coordinate quality improvement efforts of the 
federal government to avoid disjointed, uncoordinated, or duplicative 
efforts.
  AHCPR fills a vital federal role by investing in health services 
research to ensure we reap the full rewards of our investment in basic 
and biomedical research. AHCPR takes these medical advances and helps 
us understand how to best utilize these advances in daily clinical 
practice. The Agency has demonstrated their ability to close this gap 
between basic research and clinical practice.
  I believe the Agency can truly make a difference in improving health 
care quality in this country. The work of the Agency fills a crucial 
need by translating advances in medicine into what works for me, as a 
physician, in my daily practice. I think these answers will help us 
address some of the critical issues raised in the patient protection or 
quality health care debate. I also believe the work of the Agency is 
essential for improving the long term stability of the Medicare program 
and improving the health care system in general by providing the tools 
we need

[[Page 28159]]

to assess and improve health care quality.
  I would also like to point out that the legislation we are passing 
today builds upon the good work of our House companion bill, H.R. 2506, 
introduced and passed by my colleagues Representatives Bilirakis, 
Bliley, Dingell, and Brown. The bill we are considering today, S. 580, 
has been modified to reflect agreement between the authorizing 
committees on the House and Senate passed versions of the bill. I will 
not list all of the changes we have made, but I would like to highlight 
a few.
  First, I am pleased that our bill has an increased emphasis on 
research regarding the delivery of health care in inner city and rural 
areas and of health care issues for priority populations including low-
income groups, minority groups, women, children, the elderly, and 
individuals with special health care needs including individuals with 
disabilities and individuals who need chronic care or end-of-life 
health care. The legislation will ensure that individuals with special 
health care needs will be addressed throughout the research portfolio 
of the Agency.
  A second provision included in the bill which I believe is extremely 
important for improving the health of our nation's children is the 
authorization to provide support for payments to children's hospitals 
for graduate medical education programs. The bill will provide funding 
to the 59 freestanding children's hospital across the country that do 
not receive any GME funds today. These 59 hospitals represent over 20% 
of the total number of children's hospitals in the U.S. and they train 
nearly 30% of the nation's pediatricians, about 50% of all pediatric 
specialists, and over 65% of all pediatric specialists. I believe this 
is a strong addition to our bill which will ensure the training of 
pediatric physicians to improve the quality of health care for our 
children.
  Mr. President, this legislation would not have come to fruition 
without the contributions of many individuals. I would like to take 
this moment to express my gratitude to Senator Nickles and the entire 
Health Care Quality Task Force for making this bill a legislative 
priority. I would also like to thank Senator Jeffords, Senator Kennedy, 
and all the members of the Health, Education, Labor, and Pensions 
committee who helped develop the legislation. The Administration and 
the Agency have been enormously helpful in providing their technical 
expertise as we rewrote the current statute, and I would especially 
like to thank Dr. John Eisenberg and Larry Patton for their tremendous 
contributions. Finally, I would like to thank my staff for their work 
on the bill, Andrew Balas, Susan Ramthun, and Anne Phelps. I look 
forward to working with my House colleagues and President Clinton to 
witness the enactment of S. 580 into law this year which will greatly 
improve the quality of health care for all Americans.
  Mr. KENNEDY. Mr. President, today marks an important landmark in our 
efforts to improve children's health. We are taking the first step 
toward ensuring that the nation's children's hospitals have the support 
they need to continue to train physicians to care for children.
  Less than one percent of the nation's hospitals are independent 
children's hospitals. Yet these hospitals train 30 percent of all 
pediatricians. These freestanding children's hospitals also train more 
than half of the country's pediatric specialists--the physicians who 
care for children with cancer, asthma, diabetes and many other chronic 
diseases and special needs.
  In addition to their teaching responsibilities, they care for 
uninsured children, conduct pediatric research, and provide state-of-
the-art specialty care for children in all parts of the nation. The 
services they provide and the activities they conduct are 
indispensable. When a child has a rare disease or complicated 
condition, children's hospitals are the hospitals of choice.
  In Massachusetts, Boston Children's Hospital provides excellent care 
and conducts needed pediatric research and training. It provides the 
highest quality of care for sick or disabled children from 
Massachusetts, New England and the world. It is a national resource. 
The primary care and specialist physicians it trains serve in countless 
communities in Massachusetts and throughout the country. Boston 
Children's Hospital has been recognized as a world-class institution. 
Researchers at the hospital continue to offer new hope for children and 
adults, as they break new ground in battles to fight pediatric 
diseases. For example, Dr. Judah Folkman has developed two powerful 
agents that show great promise in the war on cancer. These agents--
angiostatin and endostatin--have been shown to shrink cancerous tumors 
in animals. Clinical trials are now underway to test the effectiveness 
of bladder tissue grown in a laboratory, and to treat high-risk heart 
patients with a tiny device that can close holes in the heart without 
invasive surgery.
  These advances are the result of the teaching hospital environment 
that is the heart of the mission of Boston Children's Hospital. Senior 
clinicians and scientists work with new doctors in training. The 
interns, residents and fellows who train at Boston Children's Hospital 
and other children's hospitals are the pediatricians, pediatric 
specialists and pediatric researchers of tomorrow. The federal 
government should invest in their training, just as we have invested in 
the training of physicians who care for adults. The benefits to the 
nation are immeasurable.
  In general, graduate medical education activities are supported 
through Medicare. However, because children's hospitals treat very few 
Medicare patients, they receive almost no federal support to train 
physicians. In fact, they receive less than 1/200th per resident 
compared to other teaching hospitals. The lack of federal support makes 
no sense. It unintentionally penalizes children's hospitals, and we 
need to correct this problem as soon as possible.
  The legislation accompanying the reauthorization of the Agency for 
Health Care Policy and Research authorizes a new discretionary program 
to provide support for pediatric graduate medical education. It 
authorizes the funding necessary to provide adequate support--$280 
million in FY 2000 and $285 million in FY 2001. But this authorization 
is just a beginning. We need to continue to work together this year and 
next year to ensure that adequate funds are appropriated for this 
important new program to succeed.
  Adequate and stable funding for pediatric GME activities can best be 
achieved by a permanent mandatory program. The Senate Finance Committee 
has agreed to hold a hearing on this important issue next year, and I 
hope action will quickly follow. Senator Bob Kerrey and I have 
introduced legislation that will create a mandatory program. It has 
broad bipartisan support in the Senate. Forty senators, evenly divided 
among Democrats and Republicans, favor this approach, and I am 
confident that we will prevail in the end.
  However, this year we have an opportunity to begin to address this 
important children's health issue. Today's authorization lays the 
groundwork for a downpayment in the appropriations for FY2000. The 
President's budget proposed $40 million for pediatric graduate medical 
education. The Labor, Health and Human Services Appropriations 
conference bill includes $20 million for this program. Congress should 
follow the President's lead and provide at least $40 million for next 
year, while Congress pursues full funding through a long-term solution.
  It is an honor to support Boston Children's Hospital and other 
children's hospitals across the country as they strive to meet the 
health needs of the nation's children. I look forward to working with 
my colleagues in the House and Senate on this important issue in the 
coming year.
  Mr. GRAMM. I ask unanimous consent the substitute amendment be agreed 
to, the bill be read a third time and passed as amended, the motion to 
reconsider be laid upon the table, and any statements relating to the 
bill be printed in the Record.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  The substitute amendment (No. 2506) was agreed to.


  The bill (S. 580), as amended, was read the third time and passed.
  [The bill was not available for printing. It will appear in a future 
edition of the Record.]

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