II 

112TH CONGRESS 

2D SESSION S. 3201 

To reform graduate medical education payments, and for other purposes. 

IN THE SENATE OF THE UNITED STATES 

MAY 17, 2012 

Mr. REED (for himself and Mr. KYL) introduced the following bill; which was 

read twice and referred to the Committee on Finance 

A BILL 

To reform graduate medical education payments, 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 ‘‘Graduate Medical Edu5 cation Reform Act of 2012’’. 

6 SEC. 2. MEDICARE INDIRECT MEDICAL EDUCATION PER7 FORMANCE ADJUSTMENT. 

8 Section 1886 of the Social Security Act (42 U.S.C. 

9 1395ww) is amended by adding at the end the following 

10 new subsection: 


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1 ‘‘(t) INDIRECT MEDICAL EDUCATION PERFORMANCE

2 ADJUSTMENTS.— 

3 ‘‘(1) IN GENERAL.—Subject to the succeeding 

4 provisions of this subsection, the Secretary shall es5 tablish and implement procedures under which the 

6 amount of payments that a hospital (as defined in 

7 paragraph (11)(A)) would otherwise receive for indi8 rect medical education costs under subsection 

9 (d)(5)(B) for discharges occurring during a fiscal 

10 year is adjusted based on the reporting of measures 

11 and the performance of the hospital on measures of 

12 patient care priorities specified by the Secretary. 

13 ‘‘(2) ADJUSTMENTS TO BEGIN IN FISCAL YEAR

14 2017.—The adjustments shall apply to payments for 

15 discharges occurring— 

16 ‘‘(A) with respect to the adjustments for 

17 reporting under paragraph (8)(A), during fiscal 

18 year 2017; and 

19 ‘‘(B) with respect to the adjustments for 

20 performance under paragraph (8)(B), on or 

21 after October 1, 2017. 

22 ‘‘(3) MEASURES.—The measures of patient care 

23 priorities specified by the Secretary under this sub24 section shall include the extent of training provided 

25 in— 


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1 ‘‘(A) the delivery of services categorized as 

2 evaluation and management codes by the Cen3 ters for Medicare & Medicaid Services; 

4 ‘‘(B) a variety of settings and systems; 

5 ‘‘(C) the coordination of patient care 

6 across settings; 

7 ‘‘(D) the relevant cost and value of various 

8 diagnostic and treatment options; 

9 ‘‘(E) interprofessional and multidisci10 plinary care teams; 

11 ‘‘(F) methods for identifying system errors 

12 and implementing system solutions; and 

13 ‘‘(G) the use of health information tech14 nology. 

15 ‘‘(4) MEASURE DEVELOPMENT PROCESS.— 

16 ‘‘(A) IN GENERAL.—The measures of pa17 tient care specified by the Secretary under this 

18 subsection— 

19 ‘‘(i) shall— 

20 ‘‘(I) be measures that have been 

21 adopted or endorsed by an accrediting 

22 organization (such as the Accredita23 tion Council for Graduate Medical 

24 Education or the Commission on Os25 teopathic College Accreditation); and 


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1 ‘‘(II) be measures that the Sec2 retary identifies as having used a con3 sensus-based process for developing 

4 such measures; and 

5 ‘‘(ii) may include measures that have 

6 been submitted by teaching hospitals, med7 ical schools, and other stakeholders. 

8 ‘‘(B) PROPOSED SET OF INITIAL MEAS9 URES.—Not later than July 1, 2014, the Sec10 retary shall publish in the Federal Register a 

11 proposed initial set of measures for use under 

12 this subsection. The Secretary shall provide for 

13 a period of public comment on such measures. 

14 ‘‘(C) FINAL SET OF INITIAL MEASURES.— 

15 Not later than January 1, 2015, the Secretary 

16 shall publish in the Federal Register the set of 

17 initial measures to be specified by the Secretary 

18 for use under this subsection. 

19 ‘‘(D) UPDATE OF MEASURES.—The Sec20 retary may, through notice and comment rule21 making, periodically update the measures speci22 fied under this subsection pursuant to the re23 quirements under subparagraph (A). 

24 ‘‘(5) PERFORMANCE STANDARDS.—The Sec25 retary shall establish performance standards with reVerDate Mar 15 2010 05:46 May 18, 2012 Jkt 019200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S3201.IS S3201

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1 spect to measures specified by the Secretary under 

2 this subsection for a performance period for a fiscal 

3 year (as established under paragraph (6)). 

4 ‘‘(6) PERFORMANCE PERIOD.—The Secretary 

5 shall establish the performance period for a fiscal 

6 year. Such performance period shall begin and end 

7 prior to the beginning of such fiscal year. 

8 ‘‘(7) REPORTING OF MEASURES.—The proce9 dures established and implemented under paragraph 

10 (1) shall include a process under which hospitals 

11 shall submit data on the measures specified by the 

12 Secretary under this subsection to the Secretary in 

13 a form and manner, and at a time, specified by the 

14 Secretary for purposes of this subsection. 

15 ‘‘(8) ADJUSTMENTS.— 

16 ‘‘(A) REPORTING FOR FISCAL YEAR 2017.— 

17 For fiscal year 2017, in the case of a hospital 

18 that does not submit, to the Secretary in ac19 cordance with this subsection, data required to 

20 be submitted under paragraph (7) for a period 

21 (determined appropriate by the Secretary) for 

22 such fiscal year, the total amount that the hos23 pital would otherwise receive under subsection 

24 (d)(5)(B) for discharges in such fiscal year 

25 shall be reduced by 0.5 percent. 


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1 ‘‘(B) PERFORMANCE FOR FISCAL YEAR

2 2018 AND SUBSEQUENT FISCAL YEARS.— 

3 ‘‘(i) IN GENERAL.—Subject to clause 

4 (ii), based on the performance of each hos5 pital with respect to compliance with the 

6 measures for a performance period for a 

7 fiscal year (beginning with fiscal year 

8 2018), the Secretary shall determine the 

9 amount of any adjustment under this sub10 paragraph to payments to the hospital 

11 under subsection (d)(5)(B) for discharges 

12 in such fiscal year. Such adjustment may 

13 not exceed an amount equal to 3 percent 

14 of the total amount that the hospital would 

15 otherwise receive under such subsection for 

16 discharges in such fiscal year. 

17 ‘‘(ii) BUDGET NEUTRAL.—In making 

18 adjustments under this subparagraph, the 

19 Secretary shall ensure that the total 

20 amount of payments made to all hospitals 

21 under subsection (d)(5)(B) for discharges 

22 in a fiscal year is equal to the total amount 

23 of payments that would have been made to 

24 such hospitals under such subsection for 


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1 discharges in such fiscal year if this sub2 section had not been enacted. 

3 ‘‘(9) NO EFFECT IN SUBSEQUENT FISCAL

4 YEARS.—Any adjustment under subparagraph (A) 

5 or (B) of paragraph (8) shall apply only with respect 

6 to the fiscal year involved, and the Secretary shall 

7 not take into account any such adjustment in mak8 ing payments to a hospital under this section in a 

9 subsequent fiscal year. 

10 ‘‘(10) EVALUATION OF SUBMISSION OF PER11 FORMANCE MEASURES.—Not later January 1, 2017, 

12 the Secretary shall submit to Congress a report on 

13 the implementation of this subsection, including— 

14 ‘‘(A) the measure development procedures, 

15 including any barriers to measure development; 

16 ‘‘(B) the compliance with reporting on the 

17 performance measures, including any barriers 

18 to such compliance; and 

19 ‘‘(C) recommendations to address any bar20 riers described in subparagraph (A) or (B). 

21 ‘‘(11) DEFINITION OF HOSPITAL.—In this sub22 section, the term ‘hospital’ means a hospital the re23 ceives payments under subsection (d)(5)(B).’’. 


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1 SEC. 3. INCREASING GRADUATE MEDICAL EDUCATION 

2 TRANSPARENCY. 

3 (a) IN GENERAL.—Not later than 2 years after the 

4 date of the enactment of this Act, and annually thereafter, 

5 the Secretary of Health and Human Services shall submit 

6 to Congress and the National Health Care Workforce 

7 Commission a report on the graduate medical education 

8 payments that hospitals receive under the Medicare pro9 gram. The report shall include the following information 

10 with respect to each hospital that receives such payments: 

11 (1) The direct graduate medical education pay12 ments made to the hospital under section 1886(h) of 

13 the Social Security Act (42 U.S.C. 1395ww(h)). 

14 (2) The total costs of direct graduate medical 

15 education to the hospital as reported on the annual 

16 Medicare Cost Reports. 

17 (3) The indirect medical education payments 

18 made to the hospital under section 1886(d)(5)(B) of 

19 such Act (42 U.S.C. 1395ww(d)(1)(B)). 

20 (4) The number of full-time-equivalent residents 

21 counted for purposes of making the payments de22 scribed in paragraph (1). 

23 (5) The number of full-time-equivalent residents 

24 counted for purposes of making the payments de25 scribed in paragraph (3). 


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1 (6) The number of full-time-equivalent resi2 dents, if any, that are not counted for purposes of 

3 making payments described in paragraph (1). 

4 (7) The number of full-time-equivalent resi5 dents, if any, that are not counted for purposes of 

6 making payments described in paragraph (3). 

7 (8) The factors contributing to the higher costs 

8 of patient care provided by the hospital, including— 

9 (A) the costs of trauma, burn, other stand10 by services; 

11 (B) translation services for disabled or 

12 non-english speaking patients; 

13 (C) the cost of uncompensated care; 

14 (D) financial losses with respect to Med15 icaid patients; and 

16 (E) uncompensated costs of clinical re17 search. 

Æ 


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