[Congressional Record (Bound Edition), Volume 151 (2005), Part 12]
[Senate]
[Pages 16602-16603]
[From the U.S. Government Publishing Office, www.gpo.gov]




                       PUBLIC HEALTH SERVICE ACT

  Mr. GRASSLEY. Mr. President, I want to take a few minutes to explain 
my recent action related to S. 1418, the Wired for Health Care Quality 
Act. Today, with great reluctance, I asked Leader Frist to consult with 
us prior to any action related to consideration of this bill, which the 
Health, Education, Labor, and Pensions Committee reported by voice vote 
this morning.
  The Wired for Health Care Quality Act would promote the use of 
electronic health records by adopting standards for the electronic 
exchange of information, offer incentives for health care providers to 
create networks for secure exchange of electronic health information, 
and ensure quality measurement and reporting of provider performance 
under the Public Health Service Act.
  I fully support linking the adoption of health information technology 
to quality improvements in our health care system. They go hand in 
hand. Which is why Senator Baucus and I decided to introduce our 
Medicare Value Purchasing Act, S. 1356, jointly with Senators Enzi and 
Kennedy's Better Healthcare Through Information Technology Act, S. 
1355. The thought behind a dual introduction was to enforce the message 
that Medicare can drive quality improvement through payment incentives, 
and that the adoption of information technology is also a necessary 
step not only to facilitate the reporting of quality measures but also 
to increase efficiency and quality in our health care delivery system.
  Our bill creates quality payments under Medicare for all provider 
groups. A considerable amount of time was devoted towards ensuring that 
the development of quality measures and the implementation of value-
based purchasing programs under Medicare were properly vetted with 
provider groups, beneficiary groups, and the administration. We did not 
want to reinvent the wheel; we wanted to build on the initiatives that 
already exist to develop and adopt quality measures. And because 
Medicare is the single largest purchaser of health care in the Nation, 
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.
  Which is why I am troubled, that as currently drafted, S. 1418 would 
require the development of quality measures

[[Page 16603]]

under the Public Health Service Act. It is hard to comprehend how the 
quality measurement system in this bill intersects with the quality 
measurement system developed in the Medicare Value Purchasing Act. The 
last thing we want to do is end up with two different quality 
measurement systems. This has the potential to derail both proposals, 
effectively terminating or at least postponing the common goal of 
improving the quality of patient care.
  The Wired for Health Care Quality Act would also direct the Secretary 
of Health and Human Services, along with the Secretary of Defense, the 
Secretary of Veterans Affairs, and other heads of relevant Federal 
agencies to jointly develop a quality measurement system. The 
coordination among all these Federal agencies alone is a massive 
project that could indefinitely stall the development and 
implementation of appropriate quality measures or result in one that 
falls to the lowest common denominator. That could actually set back 
quality efforts.
  I welcome the opportunity to work with the sponsors of S. 1418, 
Senators Enzi, Kennedy, Frist, and Clinton along with members of the 
Health, Education, Labor, and Pensions Committee on this matter. I had 
hoped to accomplish that before the bill was introduced on the floor. 
Unfortunately, that did not happen. I do not take actions such as these 
lightly. But I am deeply troubled that, as currently drafted, the Wired 
for Health Care Quality Act could end up unintentionally delaying our 
common goal of improving the quality of health care for all Americans.
  Mr. BAUCUS. Mr. President, I rise to address possible floor 
consideration of S. 1418, a bill to amend the Public Health Service Act 
to enhance the adoption of a nationwide interoperable health 
information technology system and to improve the quality and reduce the 
costs of health care in the United States.
  Senator Grassley and I have been working since January with Senators 
Enzi and Kennedy on issues of quality and health information 
technology. Together, we introduced two bills on June 30--one that 
deals with Medicare quality, and another to enhance quality through the 
widespread adoption of health IT. The latter is S. 1356, the Medicare 
Value Purchasing Act of 2005, which develops a system of quality 
measurement and implements pay-for-performance in Medicare.
  In drafting these two bills, we worked hard to craft language that 
was complementary rather than contradictory. Ultimately, we viewed 
these two pieces of policy as working together to build a comprehensive 
and workable health care quality system.
  S. 1418 potentially disrupts the work we have done thus far, by 
including language that will force the duplication of quality 
measurement systems. It also raises questions about the jurisdictional 
reach of the Committee on Health, Education, Labor, and Pensions.
  Medicare is the dominant payer in health care, with annual spending 
exceeding $300 billion. Furthermore, it is Medicare's payment systems 
that are often adopted by private insurance groups. Private payers use 
the Medicare physician fee schedule for their own book of business, and 
we would expect these same insurers to follow Medicare's lead on pay-
for-quality.
  I appreciate the process that Senators Enzi and Kennedy have 
undertaken with us over the last several months. And I appreciate the 
majority leader's desire to move important health IT legislation. 
Congressional action on this issue is long overdue. But until common 
ground can be reached on a feasible system of measuring quality, I must 
reluctantly object to moving forward with S. 1418. I believe that the 
process outlined in this bill for the development of quality measures 
may well be unworkable and that it will raise deep concerns for 
hospitals, physicians, and other providers.
  I also believe that the language on the development of quality 
measures in this bill ought to be designed for Public Health Service 
Act programs and explicitly applicable to these programs, not to 
Medicare or Medicaid.
  I hope that our colleague, Senators Enzi, Kennedy, Frist, and 
Clinton, will work with us to craft a bill that is appropriate for 
programs under the PHSA and that complements the Medicare Value 
Purchasing Act of 2005. Ultimately, I believe that we have the same 
goals in mind. If we can come to an agreement now, we can continue 
moving forward with these important policies that can change the shape, 
quality, and ultimately the cost and benefit of our health care system.

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