I 

111TH CONGRESS 

1ST SESSION H. R. 3693 

To amend title XVIII of the Social Security Act to modify Medicare physician 

reimbursement policies to ensure a future physician workforce, and for 

other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

OCTOBER 1, 2009 

Mr. BURGESS (for himself, Mr. DEAL of Georgia, Mr. LINDER, Mr. GINGREY

of Georgia, Mr. ROE of Tennessee, Mr. THORNBERRY, Mr. DENT, Mr. 

MCCAUL, Mr. SESSIONS, and Mr. WALDEN) 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 modify 

Medicare physician reimbursement policies to ensure a 

future physician workforce, 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; TABLE OF CONTENTS. 

4 (a) SHORT TITLE.—This Act may be cited as the 

5 ‘‘Ensuring the Future Physician Workforce Act of 2009’’. 

6 (b) TABLE OF CONTENTS.—The table of contents of 

7 this Act is as follows: 


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Sec. 1. Short title; table of contents. 

TITLE I—PAYMENT AND QUALITY INCENTIVES 

Sec. 101. Elimination of sustainable growth rate formula in 2011. 

Sec. 102. Quality incentives. 

TITLE II—HEALTH INFORMATION TECHNOLOGY INCENTIVES 

Sec. 201. Safe harbors to antikickback, civil penalties, and criminal penalties 

for provision of health information technology and training 

services. 

Sec. 202. Exception to limitation on certain physician referrals (under Stark) 

for provision of health information technology and training 

services to health care professionals. 

Sec. 203. Rules of construction regarding use of consortia. 

TITLE III—INFORMATION AND REPORTS 

Sec. 301. Information for physicians on Medicare billings. 

Sec. 302. Information for beneficiaries on Medicare expenditures. 

Sec. 303. Collection of data on Medicare savings from physicians’ services diversion. 

Sec. 304. Trustees’ ongoing examination of Medicare funding. 

Sec. 305. Study of reporting requirements on health care disparities. 

1 TITLE I—PAYMENT AND 

2 QUALITY INCENTIVES 

3 SEC. 101. ELIMINATION OF SUSTAINABLE GROWTH RATE 

4 FORMULA IN 2011. 

5 (a) IN GENERAL.—Section 1848(d) of the Social Se6 curity Act (42 U.S.C. 1395w–4(d)) is amended— 

7 (1) in paragraph (4)— 

8 (A) in subparagraph (B), by striking ‘‘sub9 paragraph (D)’’ and inserting ‘‘subparagraphs 

10 (D) and (G)’’; and 

11 (B) by adding at the end the following new 

12 subparagraph: 

13 ‘‘(G) REBASING TO 2009 FOR UPDATE AD14 JUSTMENT IN 2010.—In determining the update 


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1 adjustment factor under subparagraph (B) for 

2 2010— 

3 ‘‘(i) the allowed expenditures for 2009 

4 shall be equal to the amount of the actual 

5 expenditures for physicians’ services during 

6 2009; and 

7 ‘‘(ii) the reference in subparagraph 

8 (B)(ii)(I) to ‘April 1, 1996’ shall be treat9 ed as a reference to ‘January 1, 2009’.’’; 

10 and 

11 (2) by adding at the end the following new 

12 paragraph: 

13 ‘‘(10) UPDATE BEGINNING WITH 2011.—The 

14 update to the single conversion factor for each year 

15 beginning with 2011 shall be the percentage increase 

16 in the MEI (as defined in section 1842(i)(3)) for 

17 that year.’’. 

18 (b) CONFORMING SUNSET.—Section 1848(f)(1)(B) 

19 of such Act is amended by inserting ‘‘(ending with 2009)’’ 

20 after ‘‘each succeeding year’’. 

21 SEC. 102. QUALITY INCENTIVES. 

22 (a) EXTENSION OF CURRENT TRANSITIONAL BONUS

23 INCENTIVE PAYMENTS THROUGH 2011 AT 3 PERCENT.— 

24 Section 1848(m)(1) of the Social Security Act (42 U.S.C. 

25 1395w(m)(1)) is amended— 


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1 (1) in subparagraph (A), by striking ‘‘2010’’ 

2 and inserting ‘‘2011’’; and 

3 (2) in subparagraph (B)— 

4 (A) by striking ‘‘and’’ at the end of clause 

5 (i); 

6 (B) in clause (ii), by striking ‘‘and 2010, 

7 2 percent.’’ and inserting ‘‘, 2 percent; and’’; 

8 (C) by adding at the end the following new 

9 clause: 

10 ‘‘(iii) for 2010 and 2011, 3 percent.’’. 

11 (b) ESTABLISHMENT OF NEW QUALITY INCENTIVE

12 SYSTEM EFFECTIVE IN 2012.— 

13 (1) IN GENERAL.—Section 1848 of the Social 

14 Security Act (42 U.S.C. 1395w) is amended by 

15 striking subsection (k) and by adding at the end the 

16 following: 

17 ‘‘(p) PHYSICIAN QUALITY INCENTIVE SYSTEM.— 

18 ‘‘(1) IN GENERAL.—The Secretary shall estab19 lish a reporting system (in this subsection referred 

20 to as the ‘Physician Quality Incentive System’ or 

21 ‘System’) for quality measures relating to physi22 cians’ services that focuses on disease-specific high 

23 cost conditions. Not later than January 1, 2012, the 

24 Secretary shall— 


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1 ‘‘(A) identify the 10 health conditions that 

2 have the highest proportion of spending under 

3 this part, due in part to a gap in patient care, 

4 and for which reporting measures are feasible; 

5 and 

6 ‘‘(B) adopt reporting measures on these 

7 conditions, based on measures developed by the 

8 Physician Consortium of the American Medical 

9 Association. 

10 ‘‘(2) ADD-ON PAYMENT.— 

11 ‘‘(A) IN GENERAL.—The Secretary shall 

12 provide, in a form and manner specified by the 

13 Secretary, for a bonus or other add-on payment 

14 for physicians that submit information required 

15 on the conditions identified under paragraph 

16 (1). 

17 ‘‘(B) AMOUNT.—Such a bonus or add-on 

18 payment shall be equal to 1.0 percent of the 

19 payment amount otherwise computed under this 

20 section. 

21 ‘‘(C) TIMELY PAYMENTS.—Such a pay22 ment shall be made, with respect to information 

23 submitted for a month, by not later than 30 

24 days after the date the information is submitted 

25 for such month. 


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1 ‘‘(D) DEDUCTIBLE AND COINSURANCE NOT

2 APPLICABLE.—Such payment shall not be sub3 ject to the deductible or coinsurance otherwise 

4 applicable to physicians’ services under this 

5 part. 

6 ‘‘(E) USE OF REGISTRY.—In carrying out 

7 subparagraph (A), the Secretary shall allow the 

8 submission of the required information through 

9 an appropriate medical registry identified by 

10 the Secretary. 

11 ‘‘(3) MONITORING.—The Secretary shall mon12 itor and report to Congress on an annual basis phy13 sician participation in the Physician Quality Incen14 tive System, administrative burden encountered by 

15 participants, barriers to participation, as well as sav16 ings accrued to the Medicare program due to quality 

17 care improvements based on measures established 

18 under the Physician Quality Incentive System.’’. 

19 (2) EFFECTIVE DATE.—The amendment made 

20 by paragraph (1) shall apply to payment for physi21 cians’ services for services furnished in years begin22 ning with 2012. 


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1 TITLE II—HEALTH INFORMA2 TION TECHNOLOGY INCEN3 TIVES 

4 SEC. 201. SAFE HARBORS TO ANTIKICKBACK, CIVIL PEN5 ALTIES, AND CRIMINAL PENALTIES FOR PRO6 VISION OF HEALTH INFORMATION TECH7 NOLOGY AND TRAINING SERVICES. 

8 (a) FOR CIVIL PENALTIES.—Section 1128A of the 

9 Social Security Act (42 U.S.C. 1320a–7a) is amended— 

10 (1) in subsection (b), by adding at the end the 

11 following new paragraph: 

12 ‘‘(4) For purposes of this subsection, inducements to 

13 reduce or limit services described in paragraph (1) shall 

14 not include the practical or other advantages resulting 

15 from health information technology or related installation, 

16 maintenance, support, or training services.’’; and 

17 (2) in subsection (i), by adding at the end the 

18 following new paragraph: 

19 ‘‘(8) The term ‘health information technology’ 

20 means hardware, software, license, right, intellectual 

21 property, equipment, or other information tech22 nology (including new versions, upgrades, and 

23 connectivity) designed or provided primarily for the 

24 electronic creation, maintenance, or exchange of 


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1 health information to better coordinate care or im2 prove health care quality, efficiency, or research.’’. 

3 (b) FOR CRIMINAL PENALTIES.—Section 1128B of 

4 such Act (42 U.S.C. 1320a–7b) is amended— 

5 (1) in subsection (b)(3)— 

6 (A) in subparagraph (G), by striking 

7 ‘‘and’’ at the end; 

8 (B) in the subparagraph (H) added by sec9 tion 237(d) of the Medicare Prescription Drug, 

10 Improvement, and Modernization Act of 2003 

11 (Public Law 108–173; 117 Stat. 2213)— 

12 (i) by moving such subparagraph 2 

13 ems to the left; and 

14 (ii) by striking the period at the end 

15 and inserting a semicolon; 

16 (C) in the subparagraph (H) added by sec17 tion 431(a) of such Act (117 Stat. 2287)— 

18 (i) by redesignating such subpara19 graph as subparagraph (I); 

20 (ii) by moving such subparagraph 2 

21 ems to the left; and 

22 (iii) by striking the period at the end 

23 and inserting ‘‘; and’’; and 

24 (D) by adding at the end the following new 

25 subparagraph: 


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1 ‘‘(J) any nonmonetary remuneration (in the 

2 form of health information technology, as defined in 

3 section 1128A(i)(8), or related installation, mainte4 nance, support, or training services) made to a per5 son by a specified entity (as defined in subsection 

6 (g)) if— 

7 ‘‘(i) the provision of such remuneration is 

8 without an agreement between the parties or 

9 legal condition that— 

10 ‘‘(I) limits or restricts the use of the 

11 health information technology to services 

12 provided by the physician to individuals re13 ceiving services at the specified entity; 

14 ‘‘(II) limits or restricts the use of the 

15 health information technology in conjunc16 tion with other health information tech17 nology; or 

18 ‘‘(III) conditions the provision of such 

19 remuneration on the referral of patients or 

20 business to the specified entity; 

21 ‘‘(ii) such remuneration is arranged for in 

22 a written agreement that is signed by the par23 ties involved (or their representatives) and that 

24 specifies the remuneration solicited or received 

25 (or offered or paid) and states that the proviVerDate Nov 24 2008 03:01 Oct 02, 2009 Jkt 089200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H3693.IH H3693

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1 sion of such remuneration is made for the pri2 mary purpose of better coordination of care or 

3 improvement of health quality, efficiency, or re4 search; and 

5 ‘‘(iii) the specified entity providing the re6 muneration (or a representative of such entity) 

7 has not taken any action to disable any basic 

8 feature of any hardware or software component 

9 of such remuneration that would permit inter10 operability.’’; and 

11 (2) by adding at the end the following new sub12 section: 

13 ‘‘(g) SPECIFIED ENTITY DEFINED.—For purposes of 

14 subsection (b)(3)(J), the term ‘specified entity’ means an 

15 entity that is a hospital, group practice, prescription drug 

16 plan sponsor, a Medicare Advantage organization, or any 

17 other such entity specified by the Secretary, considering 

18 the goals and objectives of this section, as well as the goals 

19 to better coordinate the delivery of health care and to pro20 mote the adoption and use of health information tech21 nology.’’. 

22 (c) EFFECTIVE DATE AND EFFECT ON STATE

23 LAWS.— 

24 (1) EFFECTIVE DATE.—The amendments made 

25 by subsections (a) and (b) shall take effect on the 


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1 date that is 120 days after the date of the enact2 ment of this Act. 

3 (2) PREEMPTION OF STATE LAWS.—No State 

4 (as defined in section 1101(a) of the Social Security 

5 Act (42 U.S.C. 1301(a)) for purposes of title XI of 

6 such Act) shall have in effect a State law that im7 poses a criminal or civil penalty for a transaction de8 scribed in section 1128A(b)(4) or section 

9 1128B(b)(3)(J) of such Act, as added by subsections 

10 (a)(1) and (b), respectively, if the conditions de11 scribed in the respective provision, with respect to 

12 such transaction, are met. 

13 (d) STUDY AND REPORT TO ASSESS EFFECT OF

14 SAFE HARBORS ON HEALTH SYSTEM.— 

15 (1) IN GENERAL.—The Secretary of Health and 

16 Human Services shall conduct a study to determine 

17 the impact of each of the safe harbors described in 

18 paragraph (3). In particular, the study shall examine 

19 the following: 

20 (A) The effectiveness of each safe harbor 

21 in increasing the adoption of health information 

22 technology. 

23 (B) The types of health information tech24 nology provided under each safe harbor. 


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1 (C) The extent to which the financial or 

2 other business relationships between providers 

3 under each safe harbor have changed as a re4 sult of the safe harbor in a way that adversely 

5 affects or benefits the health care system or 

6 choices available to consumers. 

7 (D) The impact of the adoption of health 

8 information technology on health care quality, 

9 cost, and access under each safe harbor. 

10 (2) REPORT.—Not later than three years after 

11 the effective date described in subsection (c)(1), the 

12 Secretary of Health and Human Services shall sub13 mit to Congress a report on the study under para14 graph (1). 

15 (3) SAFE HARBORS DESCRIBED.—For purposes 

16 of paragraphs (1) and (2), the safe harbors de17 scribed in this paragraph are— 

18 (A) the safe harbor under section 

19 1128A(b)(4) of such Act (42 U.S.C. 1320a– 

20 7a(b)(4)), as added by subsection (a)(1); and 

21 (B) the safe harbor under section 

22 1128B(b)(3)(J) of such Act (42 U.S.C. 1320a– 

23 7b(b)(3)(J)), as added by subsection (b). 


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1 SEC. 202. EXCEPTION TO LIMITATION ON CERTAIN PHYSI2 CIAN REFERRALS (UNDER STARK) FOR PRO3 VISION OF HEALTH INFORMATION TECH4 NOLOGY AND TRAINING SERVICES TO 

5 HEALTH CARE PROFESSIONALS. 

6 (a) IN GENERAL.—Section 1877(b) of the Social Se7 curity Act (42 U.S.C. 1395nn(b)) is amended by adding 

8 at the end the following new paragraph: 

9 ‘‘(6) INFORMATION TECHNOLOGY AND TRAIN10 ING SERVICES.— 

11 ‘‘(A) IN GENERAL.—Any nonmonetary re12 muneration (in the form of health information 

13 technology or related installation, maintenance, 

14 support or training services) made by a speci15 fied entity to a physician if— 

16 ‘‘(i) the provision of such remunera17 tion is without an agreement between the 

18 parties or legal condition that— 

19 ‘‘(I) limits or restricts the use of 

20 the health information technology to 

21 services provided by the physician to 

22 individuals receiving services at the 

23 specified entity; 

24 ‘‘(II) limits or restricts the use of 

25 the health information technology in 


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1 conjunction with other health informa2 tion technology; or 

3 ‘‘(III) conditions the provision of 

4 such remuneration on the referral of 

5 patients or business to the specified 

6 entity; 

7 ‘‘(ii) such remuneration is arranged 

8 for in a written agreement that is signed 

9 by the parties involved (or their represent10 atives) and that specifies the remuneration 

11 made and states that the provision of such 

12 remuneration is made for the primary pur13 pose of better coordination of care or im14 provement of health quality, efficiency, or 

15 research; and 

16 ‘‘(iii) the specified entity (or a rep17 resentative of such entity) has not taken 

18 any action to disable any basic feature of 

19 any hardware or software component of 

20 such remuneration that would permit 

21 interoperability. 

22 ‘‘(B) HEALTH INFORMATION TECHNOLOGY

23 DEFINED.—For purposes of this paragraph, the 

24 term ‘health information technology’ means 

25 hardware, software, license, right, intellectual 


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1 property, equipment, or other information tech2 nology (including new versions, upgrades, and 

3 connectivity) designed or provided primarily for 

4 the electronic creation, maintenance, or ex5 change of health information to better coordi6 nate care or improve health care quality, effi7 ciency, or research. 

8 ‘‘(C) SPECIFIED ENTITY DEFINED.—For 

9 purposes of this paragraph, the term ‘specified 

10 entity’ means an entity that is a hospital, group 

11 practice, prescription drug plan sponsor, a 

12 Medicare Advantage organization, or any other 

13 such entity specified by the Secretary, consid14 ering the goals and objectives of this section, as 

15 well as the goals to better coordinate the deliv16 ery of health care and to promote the adoption 

17 and use of health information technology.’’. 

18 (b) EFFECTIVE DATE; EFFECT ON STATE LAWS.— 

19 (1) EFFECTIVE DATE.—The amendment made 

20 by subsection (a) shall take effect on the date that 

21 is 120 days after the date of the enactment of this 

22 Act. 

23 (2) PREEMPTION OF STATE LAWS.—No State 

24 (as defined in section 1101(a) of the Social Security 

25 Act (42 U.S.C. 1301(a)) for purposes of title XI of 


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1 such Act) shall have in effect a State law that im2 poses a criminal or civil penalty for a transaction de3 scribed in section 1877(b)(6) of such Act, as added 

4 by subsection (a), if the conditions described in such 

5 section, with respect to such transaction, are met. 

6 (c) STUDY AND REPORT TO ASSESS EFFECT OF EX7 CEPTION ON HEALTH SYSTEM.— 

8 (1) IN GENERAL.—The Secretary of Health and 

9 Human Services shall conduct a study to determine 

10 the impact of the exception under section 1877(b)(6) 

11 of such Act (42 U.S.C. 1395nn(b)(6)), as added by 

12 subsection (a). In particular, the study shall examine 

13 the following: 

14 (A) The effectiveness of the exception in 

15 increasing the adoption of health information 

16 technology. 

17 (B) The types of health information tech18 nology provided under the exception. 

19 (C) The extent to which the financial or 

20 other business relationships between providers 

21 under the exception have changed as a result of 

22 the exception in a way that adversely affects or 

23 benefits the health care system or choices avail24 able to consumers. 


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1 (D) The impact of the adoption of health 

2 information technology on health care quality, 

3 cost, and access under the exception. 

4 (2) REPORT.—Not later than three years after 

5 the effective date described in subsection (b)(1), the 

6 Secretary of Health and Human Services shall sub7 mit to Congress a report on the study conducted 

8 under paragraph (1). 

9 SEC. 203. RULES OF CONSTRUCTION REGARDING USE OF 

10 CONSORTIA. 

11 (a) APPLICATION TO SAFE HARBOR FROM CRIMINAL

12 PENALTIES.—Section 1128B(b)(3) of the Social Security 

13 Act (42 U.S.C. 1320a–7b(b)(3)) is amended by adding 

14 after and below subparagraph (J), as added by section 

15 202(b)(1), the following: ‘‘For purposes of subparagraph 

16 (J), nothing in such subparagraph shall be construed as 

17 preventing a specified entity, consistent with the specific 

18 requirements of such subparagraph, from forming a con19 sortium composed of health care providers, payers, em20 ployers, and other interested entities to collectively pur21 chase and donate health information technology, or from 

22 offering health care providers a choice of health informa23 tion technology products in order to take into account the 

24 varying needs of such providers receiving such products.’’. 


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1 (b) APPLICATION TO STARK EXCEPTION.—Para2 graph (6) of section 1877(b) of the Social Security Act 

3 (42 U.S.C. 1395nn(b)), as added by section 203(a), is 

4 amended by adding at the end the following new subpara5 graph: 

6 ‘‘(D) RULE OF CONSTRUCTION.—For pur7 poses of subparagraph (A), nothing in such 

8 subparagraph shall be construed as preventing 

9 a specified entity, consistent with the specific 

10 requirements of such subparagraph, from— 

11 ‘‘(i) forming a consortium composed 

12 of health care providers, payers, employers, 

13 and other interested entities to collectively 

14 purchase and donate health information 

15 technology; or 

16 ‘‘(ii) offering health care providers a 

17 choice of health information technology 

18 products in order to take into account the 

19 varying needs of such providers receiving 

20 such products.’’. 


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1 TITLE III—INFORMATION AND 

2 REPORTS 

3 SEC. 301. INFORMATION FOR PHYSICIANS ON MEDICARE 

4 BILLINGS. 

5 (a) IN GENERAL.—Section 1848 of the Social Secu6 rity Act, as amended by section 102(b), is amended by 

7 adding at the end the following new subsection: 

8 ‘‘(q) ANNUAL REPORTING OF INFORMATION TO PHY9 SICIANS.— 

10 ‘‘(1) IN GENERAL.—The Secretary shall annu11 ally report to each physician information on total bil12 lings by the physician (including laboratory tests 

13 and other items and services ordered by the physi14 cian) under this title. Such information shall be pro15 vided in a comparative format by code, weighting for 

16 practice size, number of Medicare patients treated, 

17 and relative number of Medicare beneficiaries in the 

18 geographical area. 

19 ‘‘(2) CONFIDENTIALITY.—Information reported 

20 under paragraph (1) is confidential and shall not be 

21 disclosed to anyone other than the physician to 

22 whom the information relates. 

23 ‘‘(3) REPORT NOT TO BE USED IN DETER24 MINING REIMBURSEMENT RATES FOR A SPECIFIC

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1 tion contained in a report under this subsection with 

2 respect to a physician in determining reimbursement 

3 rates under this part for items and services fur4 nished by that physician.’’. 

5 (b) EFFECTIVE DATE.—The Secretary of Health and 

6 Human Services shall first provide for reporting of infor7 mation under the amendment made by subsection (a) for 

8 billings during 2010. 

9 SEC. 302. INFORMATION FOR BENEFICIARIES ON MEDI10 CARE EXPENDITURES. 

11 (a) IN GENERAL.—Section 1804 of the Social Secu12 rity Act (42 U.S.C. 1395b–2) is amended by adding at 

13 the end the following new subsection: 

14 ‘‘(d) ANNUAL REPORT ON INDIVIDUAL RESOURCE

15 UTILIZATION.—The Secretary shall provide for the report16 ing, on an annual basis, to each individual entitled to ben17 efits under part A or enrolled under part B, on the amount 

18 of payments made to or on behalf of the individual under 

19 this title during the year involved. Such information shall 

20 be provided in a format that compares such amount with 

21 the average per capita expenditures in the region or area 

22 involved.’’. 

23 (b) EFFECTIVE DATE.—The Secretary of Health and 

24 Human Services shall first provide for reporting of inforVerDate Nov 24 2008 03:01 Oct 02, 2009 Jkt 089200 PO 00000 Frm 00020 Fmt 6652 Sfmt 6201 E:\BILLS\H3693.IH H3693

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1 mation under the amendment made by subsection (a) for 

2 payments made during 2010. 

3 SEC. 303. COLLECTION OF DATA ON MEDICARE SAVINGS 

4 FROM PHYSICIANS’ SERVICES DIVERSION. 

5 (a) IN GENERAL.—The Secretary of Health and 

6 Human Services shall collect data on annual savings in 

7 expenditures in the Medicare program due to physicians’ 

8 services that resulted in hospital or in-patient diversion. 

9 (b) REPORT.—The Secretary shall transmit to Con10 gress annually a summary of the data collected under sub11 section (a). 

12 SEC. 304. TRUSTEES’ ONGOING EXAMINATION OF MEDI13 CARE FUNDING. 

14 (a) EXAMINATION BY BOARD OF TRUSTEES.—The 

15 Board of Trustees of the Federal Hospital Insurance 

16 Trust Fund under section 1817 of the Social Security Act 

17 (42 U.S.C. 1395i) and of the Federal Supplementary Med18 ical Insurance Trust Fund under section 1841 of such Act 

19 (42 U.S.C. 1395t) shall monitor and examine the extent 

20 to which the different funding mechanisms under parts A, 

21 B, and D of title XVIII of such Act provide an appropriate 

22 alignment with the program goals of the respective parts. 

23 Such examination shall include an analysis of each of the 

24 following: 


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1 (1) The extent to which, as the volume of serv2 ices increases in physician settings under such part 

3 B, there is a corresponding reduction in similar serv4 ices provided in a hospital setting under such part 

5 A. 

6 (2) The extent to which, as a result of increased 

7 coordination between physicians and the delivery of 

8 prescription drugs under such part D, particularly 

9 with respect to individuals with chronic conditions, 

10 there will be a decrease in hospitalizations under 

11 such part A. 

12 (3) The extent to which other changes in physi13 cian or other health care practice results in a shift14 ing of expenditures among the various parts of such 

15 title XVIII. 

16 (b) INCLUSION IN ANNUAL REPORTS.—In each an17 nual report submitted to the Congress after the date of 

18 the enactment of this Act under section 1817(b)(2) or sec19 tion 1841(b)(2) of the Social Security Act (42 U.S.C. 

20 1395i(b)(2), 1395t(b)(2)), such Board of Trustees shall 

21 include information on the matters described in subsection 

22 (a). 


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1 SEC. 305. STUDY OF REPORTING REQUIREMENTS ON 

2 HEALTH CARE DISPARITIES. 

3 (a) IN GENERAL.—The Secretary of Health and 

4 Human Services shall provide for a study of health care 

5 disparities in high-risk health condition areas and minor6 ity communities about the impact reporting requirements 

7 may have on physician penetration in such communities. 

8 (b) REPORT.—The Secretary shall provide for the 

9 completion of the study conducted under subsection (a) 

10 by not later than January 1, 2012, and shall submit to 

11 Congress a report on the study upon its completion. 

Æ 


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