II 

109TH CONGRESS 

2D SESSION S. 2359 

To amend title XVIII of the Social Security Act to establish a Hospital 

Quality Report Card Initiative under the Medicare program to assess 

and report on health care quality in hospitals. 

IN THE SENATE OF THE UNITED STATES 

MARCH 2, 2006 

Mr. OBAMA introduced the following bill; which was read twice and referred 

to the Committee on Finance 

A BILL 

To amend title XVIII of the Social Security Act to establish 

a Hospital Quality Report Card Initiative under the 

Medicare program to assess and report on health care 

quality in hospitals. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Hospital Quality Re5 port Card Act of 2006’’. 

6 SEC. 2. PURPOSE. 

7 The purpose of this Act is to expand hospital quality 

8 reporting by establishing the Hospital Quality Report 


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1 Card Initiative under the Medicare program to ensure that 

2 hospital quality measures data are readily available and 

3 accessible in order to— 

4 (1) assist patients and consumers in making de5 cisions about where to get health care; 

6 (2) assist purchasers and insurers in making 

7 decisions that determine where employees, sub8 scribers, members, or participants are able to go for 

9 their health care; 

10 (3) assist health care providers in identifying 

11 opportunities for quality improvement and cost con12 tainment; and 

13 (4) enhance the understanding of policy makers 

14 and public officials of health care issues, raise public 

15 awareness of hospital quality issues, and to help con16 stituents of such policy makers and officials identify 

17 quality health care options. 

18 SEC. 3. HOSPITAL QUALITY REPORT CARD INITIATIVE. 

19 (a) IN GENERAL.—Title XVIII of the Social Security 

20 Act (42 U.S.C. 1395 et seq.) is amended by adding at 

21 the end the following new section: 

22 ‘‘SEC. 1898. HOSPITAL QUALITY REPORT CARD INITIATIVE. 

23 ‘‘(a) IN GENERAL.—Not later than 18 months after 

24 the date of the enactment of the Hospital Quality Report 

25 Card Act of 2006, the Secretary, acting through the AdVerDate Aug 31 2005 03:12 Mar 04, 2006 Jkt 049200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S2359.IS S2359

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1 ministrator of the Centers for Medicare & Medicaid Serv2 ices (in this section referred to as the ‘Administrator’) and 

3 in consultation with the Director of the Agency for 

4 Healthcare Research and Quality, shall, directly or 

5 through contracts with States, establish and implement a 

6 Hospital Quality Report Card Initiative (in this section re7 ferred to as the ‘Initiative’) to report on health care qual8 ity in subsection (d) hospitals. 

9 ‘‘(b) SUBSECTION (d) HOSPITAL.—For purposes of 

10 this section, the term ‘subsection (d) hospital’ has the 

11 meaning given such term in section 1886(d)(1)(B). 

12 ‘‘(c) REQUIREMENTS OF INITIATIVE.— 

13 ‘‘(1) QUALITY MEASUREMENT REPORTS FOR

14 HOSPITALS.— 

15 ‘‘(A) QUALITY MEASURES.—Not less than 

16 2 times each year, the Secretary shall publish 

17 reports on hospital quality. Such reports shall 

18 include quality measures data submitted under 

19 section 1886(b)(3)(B)(viii), and other data as 

20 feasible, that allow for an assessment of health 

21 care— 

22 ‘‘(i) effectiveness; 

23 ‘‘(ii) safety; 

24 ‘‘(iii) timeliness; 

25 ‘‘(iv) efficiency; 


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1 ‘‘(v) patient-centeredness; and 

2 ‘‘(vi) equity. 

3 ‘‘(B) REPORT CARD FEATURES.—In col4 lecting and reporting data as provided for 

5 under subparagraph (A), the Secretary shall in6 clude hospital information, as possible, relating 

7 to— 

8 ‘‘(i) staffing levels of nurses and other 

9 health professionals, as appropriate; 

10 ‘‘(ii) rates of nosocomial infections; 

11 ‘‘(iii) the volume of various procedures 

12 performed; 

13 ‘‘(iv) the availability of interpreter 

14 services on-site; 

15 ‘‘(v) the accreditation of hospitals, as 

16 well as sanctions and other violations 

17 found by accreditation or State licensing 

18 boards; 

19 ‘‘(vi) the quality of care for various 

20 patient populations, including pediatric 

21 populations and racial and ethnic minority 

22 populations; 

23 ‘‘(vii) the availability of emergency 

24 rooms, intensive care units, obstetrical 

25 units, and burn units; 


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1 ‘‘(viii) the quality of care in various 

2 hospital settings, including inpatient, out3 patient, emergency, maternity, and inten4 sive care unit settings; 

5 ‘‘(ix) the use of health information 

6 technology, telemedicine, and electronic 

7 medical records; 

8 ‘‘(x) ongoing patient safety initiatives; 

9 and 

10 ‘‘(xi) other measures determined ap11 propriate by the Secretary. 

12 ‘‘(C) TAILORING OF HOSPITAL QUALITY

13 REPORTS.—The Director of the Agency for 

14 Healthcare Research and Quality may modify 

15 and publish hospital reports to include quality 

16 measures for diseases and health conditions of 

17 particular relevance to certain regions, States, 

18 or local areas. 

19 ‘‘(D) RISK ADJUSTMENT.— 

20 ‘‘(i) IN GENERAL.—In reporting data 

21 as provided for under subparagraph (A), 

22 the Secretary may risk adjust quality 

23 measures to account for differences relat24 ing to— 


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1 ‘‘(I) the characteristics of the re2 porting hospital, such as licensed bed 

3 size, geography, teaching hospital sta4 tus, and profit status; and 

5 ‘‘(II) patient characteristics, such 

6 as health status, severity of illness, in7 surance status, and socioeconomic sta8 tus. 

9 ‘‘(ii) AVAILABILITY OF UNADJUSTED

10 DATA.—If the Secretary reports data 

11 under subparagraph (A) using risk-ad12 justed quality measures, the Secretary 

13 shall establish procedures for making the 

14 unadjusted data available to the public in 

15 a manner determined appropriate by the 

16 Secretary. 

17 ‘‘(E) COSTS.—The Secretary shall— 

18 ‘‘(i) compile data relating to the aver19 age hospital cost for ICD-9 conditions for 

20 which quality measures data are collected; 

21 and 

22 ‘‘(ii) report such information in a 

23 manner that allows cost comparisons be24 tween or among subsection (d) hospitals. 


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1 ‘‘(F) VERIFICATION.—Under the Initiative, 

2 the Secretary may verify data reported under 

3 this paragraph to ensure accuracy and validity. 

4 ‘‘(G) DISCLOSURE.—The Secretary shall 

5 disclose the entire methodology for the report6 ing of data under this paragraph to all relevant 

7 organizations and all subsection (d) hospitals 

8 that are the subject of any such information 

9 that is to be made available to the public prior 

10 to the public disclosure of such information. 

11 ‘‘(H) PUBLIC INPUT.—The Secretary shall 

12 provide an opportunity for public review and 

13 comment with respect to the quality measures 

14 to be reported for subsection (d) hospitals 

15 under this section for at least 60 days prior to 

16 the finalization by the Secretary of the quality 

17 measures to be used for such hospitals. 

18 ‘‘(I) AVAILABILITY OF REPORTS AND FIND19 INGS.— 

20 ‘‘(i) ELECTRONIC AVAILABILITY.— 

21 The Secretary shall ensure that reports are 

22 made available under this section in an 

23 electronic format, in an understandable 

24 manner with respect to various populations 

25 (including those with low functional health 


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1 literacy), and in a manner that allows 

2 health care quality comparisons to be made 

3 between local hospitals. 

4 ‘‘(ii) FINDINGS.—The Secretary shall 

5 establish procedures for making report 

6 findings available to the public, upon re7 quest, in a non-electronic format, such as 

8 through the toll-free telephone number 1– 

9 800–MEDICARE. 

10 ‘‘(J) IDENTIFICATION OF METHOD11 OLOGY.—The analytic methodologies and limi12 tations on data sources utilized by the Sec13 retary to develop and disseminate the compara14 tive data under this section shall be identified 

15 and acknowledged as part of the dissemination 

16 of such data, and include the appropriate and 

17 inappropriate uses of such data. 

18 ‘‘(K) ADVERSE SELECTION OF PA19 TIENTS.—On at least an annual basis, the Sec20 retary shall compare quality measures data sub21 mitted by each subsection (d) hospital under 

22 section 1886(b)(3)(B)(viii) with data submitted 

23 in the prior year or years by the same hospital 

24 in order to identify and report actions that 

25 would lead to false or artificial improvements in 


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1 the hospital’s quality measurements, includ2 ing— 

3 ‘‘(i) adverse selection against patients 

4 with severe illness or other factors that 

5 predispose patients to poor health out6 comes; and 

7 ‘‘(ii) provision of health care that does 

8 not meet established recommendations or 

9 accepted standards for care. 

10 ‘‘(2) DATA SAFEGUARDS.— 

11 ‘‘(A) UNAUTHORIZED USE AND DISCLO12 SURE.—The Secretary shall develop and imple13 ment effective safeguards to protect against the 

14 unauthorized use or disclosure of hospital data 

15 that is reported under this section. 

16 ‘‘(B) INACCURATE INFORMATION.—The 

17 Secretary shall develop and implement effective 

18 safeguards to protect against the dissemination 

19 of inconsistent, incomplete, invalid, inaccurate, 

20 or subjective hospital data. 

21 ‘‘(C) IDENTIFIABLE DATA.—The Secretary 

22 shall ensure that identifiable patient data shall 

23 not be released to the public. 

24 ‘‘(d) GRANTS AND TECHNICAL ASSISTANCE.—The 

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1 tions, partnerships, or other entities that may assist with 

2 hospital quality improvement. 

3 ‘‘(e) HOSPITAL QUALITY ADVISORY COMMITTEE.— 

4 ‘‘(1) ESTABLISHMENT.—The Administrator, in 

5 consultation with the Director of the Agency for 

6 Healthcare Research and Quality, shall establish the 

7 Hospital Quality Advisory Committee (in this sub8 section referred to as the ‘Advisory Committee’) to 

9 provide advice to the Administrator on the submis10 sion, collection, and reporting of quality measures 

11 data. The Administrator shall serve as the chair12 person of the Advisory Committee. 

13 ‘‘(2) MEMBERSHIP.—The Advisory Committee 

14 shall include representatives of the following (except 

15 with respect to subparagraphs (A) through (D), to 

16 be appointed by the Administrator): 

17 ‘‘(A) The Agency for Healthcare Research 

18 and Quality. 

19 ‘‘(B) The Health Resources and Services 

20 Administration. 

21 ‘‘(C) The Department of Veterans Affairs. 

22 ‘‘(D) The Centers for Disease Control and 

23 Prevention. 

24 ‘‘(E) National membership organizations 

25 that focus on health care quality improvement. 


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1 ‘‘(F) Public and private hospitals. 

2 ‘‘(G) Physicians, nurses, and other health 

3 professionals. 

4 ‘‘(H) Patients and patient advocates. 

5 ‘‘(I) Health insurance purchasers and 

6 other payers. 

7 ‘‘(J) Health researchers, policymakers, and 

8 other experts in the field of health care quality. 

9 ‘‘(K) Health care accreditation entities. 

10 ‘‘(L) Other agencies and groups as deter11 mined appropriate by the Administrator. 

12 ‘‘(3) DUTIES.—The Advisory Committee shall 

13 review and provide guidance and recommendations 

14 to the Administrator on— 

15 ‘‘(A) the establishment of the Initiative; 

16 ‘‘(B) integration and coordination of Fed17 eral quality measures data submission require18 ments, to avoid needless duplication and ineffi19 ciency; 

20 ‘‘(C) legal and regulatory barriers that 

21 may hinder quality measures data collection 

22 and reporting; and 

23 ‘‘(D) necessary technical and financial as24 sistance to encourage quality measures data col25 lection and reporting; 


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1 ‘‘(4) STAFF AND RESOURCES.—The Adminis2 trator shall provide the Advisory Committee with ap3 propriate staff and resources for the functioning of 

4 the Advisory Committee. 

5 ‘‘(5) DURATION.—The Advisory Committee 

6 shall terminate at the discretion of the Adminis7 trator, but in no event later than 5 years after the 

8 date of enactment of this section. 

9 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 

10 are authorized to be appropriated to carry out this section 

11 such sums as may be necessary for each of fiscal years 

12 2007 through 2016.’’. 

13 (b) CONFORMING AMENDMENT.—Section 

14 1886(b)(3)(B)(viii) of the Social Security Act (42 U.S.C. 

15 1395ww(b)(3)(B)(viii)), as added by section 5001 of the 

16 Deficit Reduction Act of 2005, is amended to read as fol17 lows: 

18 ‘‘(VII) The Secretary shall use the 

19 data submitted under this clause for the 

20 Hospital Quality Report Card Initiative 

21 under section 1898.’’. 

22 SEC. 4. EVALUATION OF THE HOSPITAL QUALITY REPORT 

23 CARD INITIATIVE. 

24 (a) IN GENERAL.—The Director of the Agency for 

25 Healthcare Research and Quality, directly or through conVerDate Aug 31 2005 03:12 Mar 04, 2006 Jkt 049200 PO 00000 Frm 00012 Fmt 6652 Sfmt 6201 E:\BILLS\S2359.IS S2359

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1 tract, shall evaluate and periodically report to Congress 

2 on the effectiveness of the Hospital Quality Report Card 

3 Initiative established under section 1898 of the Social Se4 curity Act, as added by section 3, including the effective5 ness of the Initiative in meeting the purpose described in 

6 section 2. The Director shall make such reports available 

7 to the public. 

8 (b) RESEARCH.—The Director of the Agency for 

9 Healthcare Research and Quality, in consultation with the 

10 Administrator of the Centers for Medicare & Medicaid 

11 Services, shall use the outcomes from the evaluation con12 ducted pursuant to subsection (a) to increase the useful13 ness of the Hospital Quality Report Card Initiative, par14 ticularly for patients, as necessary. 

Æ 


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