I 

110TH CONGRESS 

1ST SESSION H. R. 2749 

To amend title XVIII of the Social Security Act to provide for a transition 

to a new voluntary quality reporting program for physicians and other 

health professionals. 

IN THE HOUSE OF REPRESENTATIVES 

JUNE 15, 2007 

Mr. GORDON of Tennessee (for himself and Mr. SHADEGG) introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned 

A BILL 

To amend title XVIII of the Social Security Act to provide 

for a transition to a new voluntary quality reporting 

program for physicians and other health professionals. 

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 ‘‘Voluntary Medicare 

5 Quality Reporting Act of 2007’’. 

mstockstill on PROD1PC66 with BILLS

2 

•HR 2749 IH

1 SEC. 2. FINDINGS. 

2 (a) FINDINGS.—Congress makes the following find3 ings: 

4 (1) The health care system of the United States 

5 is the world’s most advanced health care system and 

6 delivers health care according to the highest quality 

7 standards. Physicians and other health professionals 

8 are committed to providing the highest quality of 

9 health care to beneficiaries under the Medicare pro10 gram. 

11 (2) Physicians have been actively engaged with 

12 the American Medical Association’s Physician Con13 sortium for Performance Improvement in the devel14 opment of evidence-based and clinically valid meas15 ures in order to improve the quality of health care 

16 and have also worked closely with the Centers for 

17 Medicare & Medicaid Services (‘‘CMS’’) in assuring 

18 the successful implementation of the Physician Vol19 untary Reporting Program (‘‘PVRP’’) developed to 

20 measure and evaluate quality of health care. 

21 (3) Physicians are actively collaborating with 

22 consensus organizations in their efforts to— 

23 (A) improve the quality of health care 

24 through the specification of quality measures 

25 for services; and 

mstockstill on PROD1PC66 with BILLS

3 

•HR 2749 IH

1 (B) develop a rational system for col2 lecting, aggregating, and reporting data across 

3 numerous public and private insurance pro4 grams in the least burdensome way. 

5 (4) Quality measures for covered professional 

6 services (as defined in section 1848(k)(3)(A) of the 

7 Social Security Act (42 U.S.C. 1395w–4(k)(3)(A)) 

8 must be— 

9 (A) evidence-based and clinically valid; 

10 (B) regularly updated to reflect current 

11 medical practice; 

12 (C) specialty specific; and 

13 (D) developed by relevant medical and 

14 other health professional specialty societies with 

15 expertise in the area of health care involved. 

16 (5) All quality measures for covered profes17 sional services (as so defined) should be pilot-tested 

18 in a variety of practice settings and across all rel19 evant medical and other health professional special20 ties before they are included in a value-based pur21 chasing system for such services. 

22 (6) Physicians must be actively engaged in all 

23 aspects of the development and implementation of 

24 an effective quality reporting and value-based pur25 chasing system for covered professional services (as 

mstockstill on PROD1PC66 with BILLS

4 

•HR 2749 IH

1 so defined). The development process for such sys2 tem must be transparent to all physicians and ad3 here to a consistent set of rules. 

4 (7) Any effective quality reporting system for 

5 covered professional services (as so defined) must 

6 recognize the actual health information technology 

7 and administrative costs physicians and other health 

8 professionals incur for participating in the system. 

9 (8) Any quality reporting program for covered 

10 professional services (as so defined) should focus on 

11 meaningful improvements in patient care rather 

12 than requiring physicians to report for the sake of 

13 reporting. 

14 (9) Most physicians and other health profes15 sionals have not had any experience in quality re16 porting and lack the necessary health information 

17 technology and administrative infrastructures to par18 ticipate in a value-based purchasing system for phy19 sicians’ services. 

20 (10) The 6-month program under section 

21 1848(k) of the Social Security Act (42 U.S.C. 

22 1395w–4(k)), as added by section 101(b) of division 

23 B of the Tax Relief and Health Care Act of 2006 

24 (Public Law 109–432; 120 Stat. 2975), the 2007 

25 Physician Quality Reporting Initiative (‘‘PQRI’’), 

mstockstill on PROD1PC66 with BILLS

5 

•HR 2749 IH

1 does not provide a sufficient amount of time to test 

2 and evaluate the appropriateness and effectiveness 

3 of this new reporting system. Therefore, it is pre4 mature to implement a permanent Medicare quality 

5 reporting system for physicians in 2008. 

6 SEC. 3. TRANSITION TO NEW VOLUNTARY MEDICARE QUAL7 ITY REPORTING PROGRAM. 

8 (a) EVALUATING THE TRANSITIONAL QUALITY RE9 PORTING SYSTEM ESTABLISHED FOR 2007.— 

10 (1) EVALUATION.—The Secretary of Health 

11 and Human Services shall evaluate the quality re12 porting system under paragraph (1) of section 

13 1848(k) of the Social Security Act (42 U.S.C. 

14 1395w–4(k)) (as added by section 101(b) of division 

15 B of the Tax Relief and Health Care Act of 2006 

16 (Public Law 109–432)), as applied for 2007 using 

17 the quality measures described in paragraph (2)(A) 

18 of such section to determine the following: 

19 (A) The extent to which such quality meas20 ures were valid, clinically relevant, practicable, 

21 and not overly burdensome. 

22 (B) The percentage of eligible professionals 

23 (as defined in paragraph (3)(B) of such section) 

24 in each category of eligible professionals demstockstill on PROD1PC66 with BILLS

6 

•HR 2749 IH

1 scribed in such paragraph that had such quality 

2 measures to report for such year. 

3 (C) The rate of participation in such qual4 ity reporting system of eligible professionals de5 scribed in subparagraph (B) in each such cat6 egory. 

7 (D) The average administrative costs of 

8 medical practices of such eligible professionals 

9 for reporting such quality measures, as it re10 lates to the size of such practices. 

11 (2) REPORT.—Not later than June 1, 2008, the 

12 Secretary of Health and Human Services shall sub13 mit to Congress a report containing the findings of 

14 the evaluation under paragraph (1). 

15 (b) TRANSITIONAL QUALITY REPORTING AFTER DE16 CEMBER 31, 2007, AND BEFORE IMPLEMENTATION OF

17 NEW VOLUNTARY MEDICARE QUALITY REPORTING PRO18 GRAM.— 

19 (1) IN GENERAL.—Section 1848(k)(2)(B) of 

20 the Social Security Act (42 U.S.C. 1395w– 

21 4(k)(3)(B)) is amended to read as follows: 

22 ‘‘(B) FOR 2008 AND 2009.—Eligible profes23 sionals may continue to report to the Secretary 

24 quality measures specified under subparagraph 

25 (A) after December 31, 2007, and before Demstockstill on PROD1PC66 with BILLS

7 

•HR 2749 IH

1 cember 31, 2009, in order for the Secretary to 

2 refine systems for reporting quality measures.’’. 

3 (2) PROHIBITING USE OF PHYSICIAN ASSIST4 ANCE AND QUALITY INITIATIVE FUND FOR QUALITY

5 REPORTING BONUS PAYMENTS IN 2008.—Section 

6 1848(l)(2)(B) of the Social Security Act (42 U.S.C. 

7 1395w–4(l)(2)(B)), as added by section 101(d) of di8 vision B of the Tax Relief and Health Care Act of 

9 2006 (Public Law 109–432), is amended by adding 

10 at the end the following new sentence: ‘‘The Sec11 retary shall not expend from the Fund any amounts 

12 for bonus incentive payments for quality reporting of 

13 data on quality measures with respect to services 

14 furnished during 2008.’’. 

15 SEC. 4. THE VOLUNTARY MEDICARE QUALITY REPORTING 

16 PROGRAM. 

17 (a) IN GENERAL.—Section 1848(k)(2) of the Social 

18 Security Act (42 U.S.C. 1395w–4(k)(2)) as added by sec19 tion 101(b) of Division B of the Tax Relief and Health 

20 Care Act of 2006 (Public Law 109–432; 120 Stat. 2975), 

21 is amended by adding at the end the following new sub22 paragraph: 

23 ‘‘(C) FOR 2010 AND SUCCEEDING YEARS.— 

24 ‘‘(i) IN GENERAL.—For purposes of 

25 reporting data on quality measures for covmstockstill on PROD1PC66 with BILLS

8 

•HR 2749 IH

1 ered professional services furnished during 

2 2010 and during succeeding years, the 

3 quality measures specified under this para4 graph for covered professional services are 

5 quality measures the Secretary has se6 lected in accordance with this subpara7 graph as part of the rulemaking process 

8 for payments under this section for 2010 

9 and succeeding years, respectively. 

10 ‘‘(ii) CHARACTERISTICS OF MEAS11 URES.—The quality measures selected 

12 under clause (i) shall— 

13 ‘‘(I) include a mixture of struc14 tural measures, process measures, and 

15 outcomes measures (as such terms are 

16 defined in clause (v)); 

17 ‘‘(II) be evidence-based and clini18 cally valid; 

19 ‘‘(III) be relevant to physicians, 

20 other eligible professionals, and indi21 viduals entitled to benefits under part 

22 A or enrolled under this part; and 

23 ‘‘(IV) include measures that cap24 ture patients’ assessments of clinical 

25 care provided. 

mstockstill on PROD1PC66 with BILLS

9 

•HR 2749 IH

1 ‘‘(iii) FAIRNESS.—The selection of 

2 quality measures under this subparagraph 

3 shall be conducted (and such quality meas4 ures shall be applied) in a manner that— 

5 ‘‘(I) takes into account dif6 ferences in individual health status; 

7 ‘‘(II) takes into account an indi8 vidual’s compliance with health care 

9 orders; 

10 ‘‘(III) does not directly or indi11 rectly encourage patient selection or 

12 deselection; 

13 ‘‘(IV) does not penalize eligible 

14 professionals who furnish services to 

15 individuals entitled to benefits under 

16 part A or enrolled under this part who 

17 are frail, low-income, of racial or eth18 nic minority groups, or of limited 

19 English language proficiency; 

20 ‘‘(V) reduces health disparities 

21 across groups and areas; 

22 ‘‘(VI) uses appropriate statistical 

23 techniques to ensure valid results; and 

24 ‘‘(VII) assures that the Secretary 

25 is able to process data for the quality 

mstockstill on PROD1PC66 with BILLS

10 

•HR 2749 IH

1 measures as written by the individual 

2 or organization that developed the 

3 measure. 

4 ‘‘(iv) SELECTION PROCESS FOR MEAS5 URES TO BE REPORTED.—The measures 

6 selected under clause (i) for 2010 (and 

7 each succeeding year) shall be measures 

8 that have been published by the Secretary 

9 in the Federal Register not later than No10 vember 1 before the year as endorsed qual11 ity measures that are applicable to covered 

12 professional services during the year. For 

13 purposes of this subparagraph, the Sec14 retary may publish quality measures for 

15 2010 (or a succeeding year) in the Federal 

16 Register only if such measures are selected 

17 and endorsed as follows: 

18 ‘‘(I) RECOMMENDATIONS FOR

19 CLINICAL AREAS.—Not later than Oc20 tober 1, 2008 (and each succeeding 

21 October 1), the Secretary shall re22 quest, through notice in the Federal 

23 Register (without comment period), 

24 each physician specialty organization, 

25 each other eligible professional organimstockstill on PROD1PC66 with BILLS

11 

•HR 2749 IH

1 zation, and each quality improvement 

2 organization to submit to the Physi3 cian Consortium for Performance Im4 provement of the American Medical 

5 Association (referred to in this sub6 paragraph as the ‘Consortium’) by not 

7 later than December 31, 2008 (and 

8 each succeeding December 31), rec9 ommendations of clinical areas for the 

10 development of quality measures for 

11 purposes of this subparagraph. Not 

12 later than December 31, 2008 (and 

13 each succeeding December 31), the 

14 Secretary shall also submit to the 

15 Consortium recommendations of clin16 ical areas for the development of such 

17 quality measures. 

18 ‘‘(II) SELECTION OF CLINICAL

19 AREAS.—Not later than March 31, 

20 2009 (and each subsequent March 

21 31), the Consortium is requested to 

22 submit to the Secretary the rec23 ommendations described in subclause 

24 (I). 

mstockstill on PROD1PC66 with BILLS

12 

•HR 2749 IH

1 ‘‘(III) DEVELOPMENT OF PRO2 POSED QUALITY MEASURES.—Not 

3 later than June 1 of each year (begin4 ning with 2009), the Consortium, in 

5 collaboration with physician specialty 

6 organizations and other eligible pro7 fessional organizations, is requested to 

8 develop proposed quality measures for 

9 each clinical area identified under 

10 subclause (I). Such measures shall 

11 meet the requirements of clauses (ii) 

12 and (iii). 

13 ‘‘(IV) ENDORSEMENT OF QUAL14 ITY MEASURES.—Not later than June 

15 15 of each year (beginning with 

16 2009), the Consortium is requested to 

17 submit the proposed quality measures 

18 developed under subclause (III) to a 

19 consensus organization for endorse20 ment. Not later than September 30 of 

21 each year (beginning with 2009), the 

22 consensus organization is requested to 

23 submit to the Secretary the quality 

24 measures that have been endorsed by 

25 the consensus organization. 

mstockstill on PROD1PC66 with BILLS

13 

•HR 2749 IH

1 ‘‘(v) DEFINITIONS FOR TYPES OF

2 MEASURES.—In this subparagraph: 

3 ‘‘(I) STRUCTURAL MEASURE.— 

4 The term ‘structural measure’ means 

5 a measure that reflects the organiza6 tional, technological, and human re7 sources infrastructure of a system 

8 necessary for the delivery of quality 

9 health care (such as the use of health 

10 information technology for submission 

11 of measures). 

12 ‘‘(II) PROCESS MEASURE.—The 

13 term ‘process measure’ means a meas14 ure associated with the practice of 

15 health care or the furnishing of a 

16 service that is known to be effective. 

17 ‘‘(III) OUTCOME MEASURE.—The 

18 term ‘outcome measure’ means a 

19 measure that provides information on 

20 how health care affects patients. 

21 ‘‘(vi) CONSENSUS ORGANIZATION DE22 FINED.—In this subparagraph, the term 

23 ‘consensus organization’ means an organi24 zation, such as the National Quality 

25 Forum, that the Secretary identifies as— 

mstockstill on PROD1PC66 with BILLS

14 

•HR 2749 IH

1 ‘‘(I) having experience in using a 

2 process for reaching a group con3 sensus with respect to quality meas4 ures relating to the performance of 

5 those providing health care services; 

6 and 

7 ‘‘(II) including in such process 

8 practicing physicians, practitioners 

9 with experience in the care of the frail 

10 elderly and individuals with multiple 

11 complex chronic conditions, organiza12 tions and individuals representative of 

13 the specialty involved, individuals enti14 tled to benefits under part A or en15 rolled under this part, experts in 

16 health care quality, individuals with 

17 experience in the delivery of health 

18 care in urban, rural, and frontier 

19 areas and to underserved populations, 

20 and representatives of the Secretary.’’. 

21 (b) USE OF REGISTRY-BASED REPORTING.—Section 

22 1848(k) of the Social Security Act (42 U.S.C. 1395w– 

23 4(k)) as added by section 101(b) of Division B of the Tax 

24 Relief and Health Care Act of 2006 (Public Law 109– 

25 432; 120 Stat. 2975) is amended to read as follows: 

mstockstill on PROD1PC66 with BILLS

15 

•HR 2749 IH

1 ‘‘(4) USE OF REGISTRY-BASED REPORTING.— 

2 As part of the process for reporting quality meas3 ures under subparagraphs (B) and (C) of paragraph 

4 (2), the Secretary shall address a mechanism where5 by an eligible professional may provide data on qual6 ity measures through an appropriate medical reg7 istry, as identified by the Secretary. The Secretary 

8 shall require that any such mechanism be for pur9 poses of reporting data only to the Secretary. The 

10 Secretary shall treat such data as confidential and 

11 shall not make such data available to any other 

12 party or person. Any data obtained by the Secretary 

13 under this paragraph shall not be subject to dis14 covery or admitted into evidence in any Federal or 

15 State civil judicial or administrative proceeding.’’. 

Æ 

mstockstill on PROD1PC66 with BILLS