II 

110TH CONGRESS 

1ST SESSION S. 692 

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

Report Card Initiative to report on health care quality in Veterans 

Affairs hospitals. 

IN THE SENATE OF THE UNITED STATES 

FEBRUARY 27, 2007 

Mr. OBAMA 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 Veterans Affairs 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 ‘‘VA Hospital Quality 

5 Report Card Act of 2007’’. 

6 SEC. 2. PURPOSE. 

7 The purpose of this Act is to establish the Hospital 

8 Quality Report Card Initiative under title 38, United 

9 States Code, to ensure that quality measures data for hosVerDate Aug 31 2005 22:38 Feb 28, 2007 Jkt 059200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\S692.IS S692

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1 pitals administered by the Secretary of Veterans Affairs 

2 are readily available and accessible in order to— 

3 (1) inform patients and consumers about health 

4 care quality in such hospitals; 

5 (2) assist Veterans Affairs health care providers 

6 in identifying opportunities for quality improvement 

7 and cost containment; and 

8 (3) enhance the understanding of policy makers 

9 and public officials of health care issues, raise public 

10 awareness of hospital quality issues, and to help con11 stituents of such policy makers and officials identify 

12 quality health care options. 

13 SEC. 3. VA HOSPITAL QUALITY REPORT CARD INITIATIVE. 

14 (a) IN GENERAL.—Subchapter III of chapter 17 of 

15 title 38, United States Code, is amended by adding at the 

16 end the following new section: 

17 ‘‘§ 1730A. Hospital Quality Report Card Initiative 

18 ‘‘(a) Not later than 18 months after the date of the 

19 enactment of the VA Hospital Quality Report Card Act 

20 of 2007, the Secretary shall establish and implement a 

21 Hospital Quality Report Card Initiative (in this section re22 ferred to as the ‘Initiative’) to report on health care qual23 ity in VA hospitals. 

24 ‘‘(b) For purposes of this section, the term ‘VA hos25 pital’ means a hospital administered by the Secretary. 


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1 ‘‘(c)(1)(A) Not less than 2 times each year, the Sec2 retary shall publish reports on VA hospital quality. Such 

3 reports shall include quality measures data that allow for 

4 an assessment of health care— 

5 ‘‘(i) effectiveness; 

6 ‘‘(ii) safety; 

7 ‘‘(iii) timeliness; 

8 ‘‘(iv) efficiency; 

9 ‘‘(v) patient-centeredness; and 

10 ‘‘(vi) equity. 

11 ‘‘(B) In collecting and reporting data as provided for 

12 under subparagraph (A), the Secretary shall include VA 

13 hospital information, as possible, relating to— 

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

15 professionals, as appropriate; 

16 ‘‘(ii) rates of nosocomial infections; 

17 ‘‘(iii) the volume of various procedures per18 formed; 

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

20 ‘‘(v) the quality of care for various patient pop21 ulations, including female, geriatric, disabled, rural, 

22 homeless, mentally ill, and racial and ethnic minority 

23 populations; 


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1 ‘‘(vi) the availability of emergency rooms, inten2 sive care units, maternity care, and specialty serv3 ices; 

4 ‘‘(vii) the quality of care in various hospital set5 tings, including inpatient, outpatient, emergency, 

6 maternity, and intensive care unit settings; 

7 ‘‘(viii) ongoing patient safety initiatives; and 

8 ‘‘(ix) other measures determined appropriate by 

9 the Secretary. 

10 ‘‘(C)(i) In reporting data as provided for under sub11 paragraph (A), the Secretary may risk adjust quality 

12 measures to account for differences relating to— 

13 ‘‘(I) the characteristics of the reporting VA hos14 pital, such as licensed bed size, geography, and 

15 teaching hospital status; and 

16 ‘‘(II) patient characteristics, such as health sta17 tus, severity of illness, and socioeconomic status. 

18 ‘‘(ii) If the Secretary reports data under subpara19 graph (A) using risk-adjusted quality measures, the Sec20 retary shall establish procedures for making the 

21 unadjusted data available to the public in a manner deter22 mined appropriate by the Secretary. 

23 ‘‘(D) Under the Initiative, the Secretary may verify 

24 data reported under this paragraph to ensure accuracy 

25 and validity. 


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1 ‘‘(E) The Secretary shall disclose the entire method2 ology for the reporting of data under this paragraph to 

3 all relevant organizations and VA hospitals that are the 

4 subject of any such information that is to be made avail5 able to the public prior to the public disclosure of such 

6 information. 

7 ‘‘(F)(i) The Secretary shall submit each report to the 

8 appropriate committees of Congress. 

9 ‘‘(ii) The Secretary shall ensure that reports are 

10 made available under this section in an electronic format, 

11 in an understandable manner with respect to various pop12 ulations (including those with low functional health lit13 eracy), and in a manner that allows health care quality 

14 comparisons to be made with local hospitals or regional 

15 hospitals, as appropriate. 

16 ‘‘(iii) The Secretary shall establish procedures for 

17 making report findings available to the public, upon re18 quest, in a non-electronic format, such as through a toll19 free telephone number. 

20 ‘‘(G) The analytic methodologies and limitations on 

21 data sources utilized by the Secretary to develop and dis22 seminate the comparative data under this section shall be 

23 identified and acknowledged as part of the dissemination 

24 of such data, and include the appropriate and inappro25 priate uses of such data. 


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1 ‘‘(H) On at least an annual basis, the Secretary shall 

2 compare quality measures data submitted by each VA hos3 pital with data submitted in the prior year or years by 

4 the same hospital in order to identify and report actions 

5 that would lead to false or artificial improvements in the 

6 hospital’s quality measurements. 

7 ‘‘(2)(A) The Secretary shall develop and implement 

8 effective safeguards to protect against the unauthorized 

9 use or disclosure of VA hospital data that is reported 

10 under this section. 

11 ‘‘(B) The Secretary shall develop and implement ef12 fective safeguards to protect against the dissemination of 

13 inconsistent, incomplete, invalid, inaccurate, or subjective 

14 VA hospital data. 

15 ‘‘(C) The Secretary shall ensure that identifiable pa16 tient data shall not be released to the public. 

17 ‘‘(d)(1) The Secretary shall evaluate and periodically 

18 submit a report to Congress on the effectiveness of the 

19 Initiative, including the effectiveness of the Initiative in 

20 meeting the purpose described in section 2 of the VA Hos21 pital Quality Report Card Act of 2007. The Secretary 

22 shall make such reports available to the public. 

23 ‘‘(2) The Secretary shall use the outcomes from the 

24 evaluation conducted pursuant to paragraph (1) to in25 crease the usefulness of the Initiative. 


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1 ‘‘(e) There are authorized to be appropriated to carry 

2 out this section such sums as may be necessary for each 

3 of fiscal years 2008 through 2016.’’. 

4 (b) CLERICAL AMENDMENT.—The table of sections 

5 at the beginning of chapter 17, United States Code, is 

6 amended by inserting after the item relating to section 

7 1730 the following new item: 

‘‘1730A. Hospital Quality Report Card Initiative.’’. 

Æ 


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