[Congressional Record (Bound Edition), Volume 145 (1999), Part 8]
[Extensions of Remarks]
[Page 12033]
[From the U.S. Government Publishing Office, www.gpo.gov]



   INTRODUCTION OF MEDICARE MODERNIZATION NO. 7: ``MEDICARE CLINICAL 
                    PRACTICE PATTERNS ACT OF 1999''

                                 ______
                                 

                        HON. FORTNEY PETE STARK

                             of california

                    in the house of representatives

                         Tuesday, June 8, 1999

  Mr. STARK. Mr. Speaker, today I rise to introduce the seventh bill in 
my Medicare modernization series: the ``Medicare Clinical Practice 
Patterns Act of 1999.'' This bill would give the Secretary the 
authority to document patterns of clinical practice in the Medicare 
program, determine the effectiveness of treatment, and bring medicare 
policy in line with that of the private sector. If implemented, the 
``Clinical Practice Patterns Act'' would help to standardize the 
delivery of health services within Medicare, thereby improving the 
quality of care provided to Medicare beneficiaries and achieving 
savings for the program overall.
  Earlier this year, I introduced H.R. 1544, the ``Patient Empowerment 
Act of 1999.'' The ``Patient Empowerment Act'' was the first step 
toward eliminating the wide variation in treatment patterns across the 
U.S., as identified by Dr. John Wennberg in the Dartmouth Atlas. The 
``Clinical Practice Patterns Act'' builds on this theme by developing 
evidence-based clinical guidelines to assist providers in treating 
various illness.
  Mr. Speaker, there are literally millions of doctors, nurses, and 
health administrators working in thousands of different hospitals, all 
trained at different schools in different communities, who provide care 
to the 39 million elderly, disabled, and ESRD patients covered by 
Medicare. With all of these elements interacting together, it's no 
wonder that we have such wide variation in treatment patterns across 
the United States.
  Medicare is a combination of both art and science. For most 
treatments, there are no empirical data on clinical effectiveness that 
suggest one method is better than another. In these cases, providers 
use their ``best guess'' to make treatment decisions--relying on their 
individual knowledge, preferences, and the resources available to them. 
This ``art'' of medicine exacerbates the variation in treatment 
patterns, and Medicare expenditures, across the U.S.
  Yet, as Wennberg notes, there is virtually no difference in health 
outcomes between low and high spending areas. If less expensive 
treatments are available, why aren't we prescribing them more readily? 
By collecting and distributing data on clinical effectiveness, and 
encouraging providers to use treatment guidelines, we may be able to 
minimize practice variation. We simultaneously may be able to achieve 
substantial savings for Medicare.
  Following is a portion of an interview from the May/June 1999 issue 
of Health Affairs by Princeton professor Uwe Reinhardt with HHS 
Secretary Donna Shalala discussing how Medicare's financial problems 
would be greatly reduced if the variation in clinical practices were 
minimized:

       Reinhardt. ``Count on me to be a real thorn in the side of 
     the status quo, then, because I believe that if everyone in 
     America could consume medical care while spending at rates 
     similar to those of Minnesota, Oregon, and Wisconsin, 
     providing health care to the aging baby-boom generation would 
     be a piece of cake, wouldn't it?''
       Shalala. ``Absolutely, and the doctors would feel as though 
     the system were fairer. But once the infrastructure is built 
     and physicians get comfortable with consuming a certain level 
     of resources, it's very difficult to work your way out unless 
     you buy yourself out, as we have attempted to do with the 
     downsizing of medical residency positions through HCFA's New 
     York demonstration.''

  Clinical practice guidelines are being used more and more throughout 
the private sector to improve the quality of health care as well as to 
increase the efficiency of the health industry. This practice does not 
in any way diminish the art of medicine, it only improves the science 
behind treatment decisions.
  Medicare is a natural candidate for clinical practice guidelines. 
With an outstanding database of information on beneficiaries across the 
country, and the resources of the NIH and AHCPR at hand, Medicare could 
effectively implement a program to improve clinical effectiveness and 
achieve savings through efficiency.

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