II 

111TH CONGRESS 

1ST SESSION S. 1427 

To amend title 38, United States Code, to establish a Hospital Quality 

Report Card Initiative to report on health care quality in Department 

of Veterans Affairs Medical Centers, and for other purposes. 

IN THE SENATE OF THE UNITED STATES 

JULY 9, 2009 

Mr. WYDEN (for himself and Mr. JOHANNS) introduced the following bill; 

which was read twice and referred to the Committee on Veterans’ Affairs 

A BILL 

To amend title 38, United States Code, to establish a Hospital Quality Report Card Initiative to report on health 

care quality in Department of Veterans Affairs Medical 

Centers, and for other purposes. 

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 ‘‘Department of Vet5 erans Affairs Hospital Quality Report Card Act of 2009’’. 


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1 SEC. 2. DEPARTMENT OF VETERANS AFFAIRS HOSPITAL 

2 QUALITY REPORT CARD INITIATIVE. 

3 (a) PURPOSE.—The purpose of this section is to pro4 vide for the establishment within the Department of Vet5 erans Affairs of an initiative to be known as the ‘‘Hospital 

6 Quality Report Card Initiative’’ to ensure that information 

7 on the quality and performance of hospitals administered 

8 by the Secretary of Veterans Affairs is readily available 

9 and accessible for purposes as follows: 

10 (1) To inform patients and consumers about 

11 health care quality in such hospitals. 

12 (2) To assist health care providers of the De13 partment of Veterans Affairs in identifying opportu14 nities for quality improvement and cost containment. 

15 (3) To enhance the understanding of policy 

16 makers and public officials of health care issues, 

17 raise public awareness of hospital quality issues, and 

18 help constituents of such policy makers and officials 

19 identify quality health care options for the Depart20 ment of Veterans Affairs. 

21 (b) ESTABLISHMENT.—Subchapter I of chapter 17 of 

22 title 38, United States Code, is amended by inserting after 

23 section 1706 the following new section: 


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1 ‘‘§ 1706A. Management of health care: Hospital Qual2 ity Report Card Initiative 

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

4 the date of the enactment of the Department of Veterans 

5 Affairs Hospital Quality Report Card Act of 2009, the 

6 Secretary shall establish and implement an initiative, to 

7 be known as the ‘Hospital Quality Report Card Initiative’ 

8 (in this section referred to as the ‘Initiative’), to report 

9 on health care quality in Department medical centers. 

10 ‘‘(b) PUBLICATION OF INFORMATION ON QUALITY

11 AND PERFORMANCE OF DEPARTMENT MEDICAL CEN12 TERS.—(1)(A) Under the Initiative, not less frequently 

13 than twice each year, the Secretary shall make available 

14 to the public a report containing the most current infor15 mation on the quality and performance of each Depart16 ment medical center. Such information shall include qual17 ity measures that allow for an assessment with respect to 

18 health care provided by Department medical centers, of 

19 the following: 

20 ‘‘(i) Effectiveness. 

21 ‘‘(ii) Safety. 

22 ‘‘(iii) Timeliness. 

23 ‘‘(iv) Efficiency. 

24 ‘‘(v) Patient centered. 

25 ‘‘(vi) Patient satisfaction. 


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1 ‘‘(vii) Satisfaction of health professionals em2 ployed at Department medical centers. 

3 ‘‘(viii) The equity of care provided to various 

4 patient populations, including female, geriatric, dis5 abled, rural, homeless, mentally ill, and racial and 

6 ethnic minority populations. 

7 ‘‘(B) For each quality measure reported under sub8 paragraph (A), the Secretary shall include a quality meas9 ure represented by an incremental letter grade scale, with 

10 ‘A+’ being the highest and ‘F’ being the lowest, based 

11 on information reported in paragraph (2) and such other 

12 information as the Secretary considers appropriate. 

13 ‘‘(2)(A) In reporting information pursuant to para14 graph (1), the Secretary shall, except as provided in sub15 paragraph (B), include to the maximum extent practicable 

16 information about Department medical centers relating 

17 to— 

18 ‘‘(i) staffing levels of nurses and other health 

19 professionals, as appropriate; 

20 ‘‘(ii) rates of nosocomial infections; 

21 ‘‘(iii) the volume of each of the different types 

22 of procedures performed; 

23 ‘‘(iv) hospital sanctions and other violations; 

24 ‘‘(v) the quality of care provided to various pa25 tient populations, including female, geriatric, disVerDate Nov 24 2008 01:38 Jul 10, 2009 Jkt 079200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S1427.IS S1427

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1 abled, rural, homeless, mentally ill, and racial and 

2 ethnic minority populations; 

3 ‘‘(vi) the availability of emergency rooms, inten4 sive care units, maternity care, and specialty serv5 ices; 

6 ‘‘(vii) the quality of care in various hospital set7 tings, including inpatient, outpatient, emergency, 

8 maternity, and intensive care unit settings; 

9 ‘‘(viii) ongoing patient safety initiatives; 

10 ‘‘(ix) use of health information technology sys11 tems; and 

12 ‘‘(x) such other matters the Secretary considers 

13 appropriate. 

14 ‘‘(B) In making a report available to the public under 

15 paragraph (1), the Secretary may provide information in 

16 addition to the information required by subparagraph (A) 

17 or provide information in lieu of the information required 

18 by subparagraph (A) if the Secretary— 

19 ‘‘(i) not later than 15 days before the date on 

20 which such report is made available to the public, 

21 submits to the Committee on Veterans’ Affairs of 

22 the Senate and the Committee on Veterans’ Affairs 

23 of the House of Representatives a certification in 

24 writing that such additional or substituted informaVerDate Nov 24 2008 01:38 Jul 10, 2009 Jkt 079200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\S1427.IS S1427

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1 tion is more appropriate for purposes of carrying out 

2 the requirement of paragraph (2)(B); and 

3 ‘‘(ii) includes in such report and certification an 

4 indication of which information has been added or 

5 substituted under this subparagraph. 

6 ‘‘(3)(A) In reporting information as provided for 

7 under paragraph (1), the Secretary may risk adjust qual8 ity measures to account for differences relating to— 

9 ‘‘(i) the characteristics of the reporting Depart10 ment medical center, such as licensed bed size, geog11 raphy, and teaching hospital status; and 

12 ‘‘(ii) patient characteristics, such as health sta13 tus, severity of illness, and socioeconomic status. 

14 ‘‘(B) If the Secretary reports data under paragraph 

15 (1) using risk-adjusted quality measures, the Secretary 

16 shall establish procedures for making the unadjusted data 

17 available to the public in a manner determined appropriate 

18 by the Secretary. 

19 ‘‘(4) Under the Initiative, the Secretary may verify 

20 information reported under this subsection to ensure accu21 racy and validity. 

22 ‘‘(5) Before disclosing to the public any information 

23 under this subsection, the Secretary shall disclose the 

24 methodology for the reporting of such information and the 

25 nature and scope of such information to each— 


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1 ‘‘(A) organization the Secretary considers rel2 evant to such information; and 

3 ‘‘(B) Department medical center that is the 

4 subject of such information. 

5 ‘‘(6)(A) For each report made available to the public 

6 under paragraph (1), the Secretary shall submit to the 

7 Committee on Veterans’ Affairs of the Senate and the 

8 Committee on Veterans’ Affairs of the House of Rep9 resentatives a copy of such report. 

10 ‘‘(B) The Secretary shall ensure that each report 

11 made available to the public under paragraph (1) is made 

12 available— 

13 ‘‘(i) in an electronic format; 

14 ‘‘(ii) in a manner that can be understood by in15 dividuals who are not medical professionals and indi16 viduals with low functional health literacy; and 

17 ‘‘(iii) at each Department medical centers cov18 ered by the report. 

19 ‘‘(C) The Secretary shall ensure that information on 

20 health care quality is provided in a manner that is condu21 cive for comparisons with other local hospitals or regional 

22 hospitals, as appropriate. 

23 ‘‘(D) The Secretary shall establish procedures for 

24 making the information covered by reports made available 

25 to the public under paragraph (1) available to the public 


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1 upon request in non-electronic format, such as through a 

2 toll-free telephone number. 

3 ‘‘(7) The analytic methodologies and limitations on 

4 information sources utilized by the Secretary to develop 

5 and disseminate the comparative information under this 

6 subsection shall be identified and acknowledged in a notice 

7 or disclaimer as part of the dissemination of such informa8 tion, and include the appropriate and inappropriate uses 

9 of such information. 

10 ‘‘(c) IDENTIFYING AND REPORTING ACTIONS THAT

11 COULD LEAD TO FALSE OR ARTIFICIAL IMPROVEMENTS

12 IN QUALITY MEASUREMENTS.—Not less frequently than 

13 annually, the Secretary shall compare quality measures 

14 data submitted by each Department medical center to the 

15 Secretary with quality measures data submitted to the 

16 Secretary in the prior year or years by each such Depart17 ment medical center in order to identify and report actions 

18 that could lead to false or artificial improvements in the 

19 quality measurements of such Department medical cen20 ters. 

21 ‘‘(d) PRIVACY AND SECURITY.—(1) The Secretary 

22 shall develop and implement effective safeguards to pro23 tect against the unauthorized use or disclosure of Depart24 ment medical center data that is reported under this sec25 tion. 


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1 ‘‘(2) The Secretary shall develop and implement ef2 fective safeguards to protect against the dissemination of 

3 inconsistent, incomplete, invalid, inaccurate, or subjective 

4 Department medical center data. 

5 ‘‘(3) The Secretary shall ensure that identifiable pa6 tient data shall not be released to the public. 

7 ‘‘(e) PERIODIC REPORTS.—(1) The Secretary shall 

8 periodically submit to Congress a report on the effective9 ness of the Initiative. 

10 ‘‘(2) Each report required by paragraph (1) shall in11 clude the following: 

12 ‘‘(A) An assessment of the effectiveness of the 

13 Initiative in meeting the purpose described in section 

14 2(a) of the Department of Veterans Affairs Hospital 

15 Quality Report Card Act of 2009. 

16 ‘‘(B) A description of the measures the Sec17 retary can undertake to ensure that the Initiative 

18 meets such purpose. 

19 ‘‘(3) The Secretary shall carry out each measure the 

20 Secretary includes in a report under paragraph (2)(B). 

21 ‘‘(4) The Secretary shall make each report submitted 

22 under paragraph (1) available to the public. 

23 ‘‘(f) DEPARTMENT MEDICAL CENTER DEFINED.—In 

24 this section, the term ‘Department medical center’ means 


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1 a Department of Veterans Affairs Medical Center admin2 istered by the Secretary. 

3 ‘‘(g) AUTHORIZATION OF APPROPRIATIONS.—There 

4 are authorized to be appropriated to carry out this section 

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

6 2010 through 2018.’’. 

7 (c) CLERICAL AMENDMENT.—The table of sections 

8 at the beginning of chapter 17 of such title is amended 

9 by inserting after the item relating to section 1706 the 

10 following new item: 

‘‘1706A. Management of health care: Hospital Quality Report Card Initiative.’’. 

Æ 


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