II

106TH CONGRESS

1ST SESSION S. 1956

To amend title 38, United States Code, to enhance the assurance of efficiency,

quality, and patient satisfaction in the furnishing of health care to

veterans by the Department of Veterans Affairs, and for other purposes.

IN THE SENATE OF THE UNITED STATES

NOVEMBER 18, 1999

Ms. SNOWE 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 enhance the

assurance of efficiency, quality, and patient satisfaction

in the furnishing of health care to veterans by the Department of Veterans Affairs, 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 ‘‘Veterans Health Care

5 Quality Assurance Act of 1999’’.

6 SEC. 2. FINDINGS.

7 Congress makes the following findings:
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1 (1) The Department of Veterans Affairs admin2 isters the largest health care network in the United

3 States, including 172 hospitals, 73 home care pro4 grams, more than 800 community-based outpatient

5 clinics, and numerous other specialized care facili6 ties.

7 (2) There are approximately 25,000,000 vet8 erans in the United States, including approximately

9 19,300,000 veterans of a period of war.

10 (3) The number of veterans seeking medical

11 care in Department medical facilities is increasing

12 nationwide.

13 (4) The fiscal year 1997 medical care caseload

14 of the Department was 2,700,000. The fiscal year

15 1999 medical care caseload of the Department was

16 projected to increase by 160,000 cases over the fis17 cal year 1998 caseload, and is projected to increase

18 by an additional 54,000 cases in fiscal year 2000,

19 resulting in a total caseload of 3,600,000 in fiscal

20 year 2000.

21 (5) The number of outpatient visits at Depart22 ment medical facilities in fiscal year 2000 is pro23 jected to increase by 2,500,000 over the number of

24 such visits in fiscal year 1999, to a total of

25 38,300,000 visits in fiscal year 2000.
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1 (6) The average age of veterans is increasing.

2 The increase in the average age of veterans is ex3 pected to result in additional demands for health

4 care services, including more frequent and long-term

5 health needs.

6 (7) The Department is attempting to meet in7 creasing demand for medical care without substan8 tial increases in appropriations, mainly through ef9 forts to increase efficiency.

10 (8) The need to treat more veterans without

11 substantial increases in available resources has re12 sulted in serious concerns about the potential for

13 loss of quality of care and of patient satisfaction.

14 (9) Many of the regional networks and hospitals

15 administered by the Veterans Health Administration

16 report that timely access to high quality health care

17 may be jeopardized by inadequate funding.

18 SEC. 3. SENSE OF CONGRESS ON MAXIMIZATION AND EFFI19 CIENT USE OF HEALTH CARE RESOURCES BY

20 THE DEPARTMENT OF VETERANS AFFAIRS.

21 It is the sense of Congress that the Secretary of Vet22 erans Affairs should—

23 (1) require the directors of the Department of

24 Veterans Affairs health care networks to systemati25 cally share information on means of maximizing re-
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1 sources and increasing efficiency without compro2 mising quality of care and patient satisfaction;

3 (2) require exchange and mentoring programs

4 among and between such networks in order to facili5 tate the sharing of such information;

6 (3) provide incentives to such networks to in7 crease efficiency and meet uniform quality and pa8 tient satisfaction goals; and

9 (4) institute a formal oversight process to en10 sure that—

11 (A) all such networks meet uniform effi12 ciency goals; and

13 (B) efforts to increase efficiency are equi14 table between and among such networks and

15 their facilities.

16 SEC. 4. QUALITY ASSURANCE AUDITS BY INSPECTOR GEN17 ERAL OF THE DEPARTMENT OF VETERANS

18 AFFAIRS.

19 Section 312 of title 38, United States Code, is

20 amended by adding at the end the following:

21 ‘‘(c)(1) In addition to the other responsibilities of the

22 Inspector General under this section, the Inspector Gen23 eral shall also conduct an audit of the quality of health

24 care furnished by each health care network, and by each

25 health care facility, of the Department.
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1 ‘‘(2) Each audit under paragraph (1) shall measure

2 the following:

3 ‘‘(A) The quality of health care furnished by

4 the Department.

5 ‘‘(B) The satisfaction of patients with the

6 health care furnished by the Department.

7 ‘‘(C) Resource and financial management.

8 ‘‘(D) The extent to which the funds allocated to

9 health care programs of the Department are ade10 quate to support such programs.

11 ‘‘(3) An audit shall be conducted under paragraph

12 (1) for each health care network, and for each health care

13 facility, not less often than once every three years.

14 ‘‘(4) The Inspector General may make such rec15 ommendations to the Secretary regarding means of im16 proving the quality of health care furnished to veterans

17 as the Inspector General considers appropriate as a result

18 of the audits under this subsection.’’.

19 SEC. 5. INFORMATION ON EFFICIENCY, QUALITY, AND PA20 TIENT SATISFACTION IN PROVISION OF

21 HEALTH CARE BY THE DEPARTMENT OF VET22 ERANS AFFAIRS.

23 (a) DISSEMINATION AND SHARING OF INFORMATION

24 ON EFFICIENT PROVISION OF HEALTH CARE.—(1) The

25 Secretary of Veterans Affairs, acting through the Under
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1 Secretary for Health of the Department of Veterans Af2 fairs, shall provide for the dissemination and sharing with3 in and among Department of Veterans Affairs health care

4 networks of information designed to ensure that all De5 partment medical care centers meet uniform efficiency

6 standards in the provision of health care to veterans.

7 (2) The Secretary shall meet the requirement in para8 graph (1) through the publication of guidance materials

9 and best practice summaries and by such other means as

10 the Secretary considers appropriate.

11 (b) EFFICIENCY GOALS AND QUALITY AND PATIENT

12 SATISFACTION STANDARDS.—(1) The Secretary, acting

13 through the Under Secretary for Health, shall issue on

14 an annual basis efficiency goals and quality and patient

15 satisfaction standards in the provision of health care to

16 veterans for each Department health care facility. The ef17 ficiency goals and quality and patient satisfaction stand18 ards for each such facility shall be consistent with such

19 goals and standards as the Secretary shall establish for

20 the Department as a whole.

21 (2)(A) The Secretary shall, on an annual basis, sub22 mit to Congress a report on the extent to which each De23 partment health care facility met the efficiency goals and

24 quality and patient satisfaction standards for such facility

25 under paragraph (1) during the preceding year.
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1 (B) Each report under subparagraph (A) shall set

2 forth a comparison between the performance of each De3 partment health care facility with respect to the efficiency

4 goals and quality and satisfaction standards for such facil5 ity for the year involved and the average performance of

6 all Department health care facilities with respect to such

7 goals and standards for such year. The comparison shall

8 be stated in a manner which permits a clear and under9 standable comparison of the performance of each facility

10 with the average performance of all such facilities.

11 SEC. 6. OFFICE OF HEALTH CARE QUALITY ASSURANCE.

12 (a) ESTABLISHMENT.—(1) Subchapter II of chapter

13 73 of title 38, United States Code, is amended by adding

14 at the end the following:

15 ‘‘§ 7322. Office of Health Care Quality Assurance

16 ‘‘(a) IN GENERAL.—There shall be within the De17 partment an office to be known as the ‘Office of Health

18 Care Quality Assurance’ (in this section referred to as the

19 ‘Office’). The Office shall be located for administrative

20 purposes within the Office of the Under Secretary for

21 Health.

22 ‘‘(b) DIRECTOR.—The head of the Office is the Direc23 tor of Health Care Quality Assurance.

24 ‘‘(c) STAFF AND SUPPORT.—The Under Secretary

25 for Health shall provide the Office with such staff and
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1 other support as may be necessary for the Office to carry

2 out effectively its functions under this section.

3 ‘‘(d) FUNCTIONS.—The functions of the Office are as

4 follows:

5 ‘‘(1) To ensure the implementation of any rec6 ommendations of the Inspector General of the De7 partment as a result of audits conducted by the In8 spector General under section 312(c) of this title.

9 ‘‘(2) To collect and ensure the dissemination of

10 information on initiatives, programs, policies, proce11 dures, strategies, and best practices that have been

12 proven to increase efficiency and resource utilization

13 without undermining quality or patient satisfaction

14 in the furnishing of health care to veterans.

15 ‘‘(3) To take such other actions relating to the

16 assurance of quality in the furnishing of health care

17 by the Veterans Health Administration as the Under

18 Secretary for Health considers appropriate.’’.

19 (2) The table of sections at the beginning of chapter

20 73 of such title is amended by inserting after the item

21 relating to section 7321 the following new item:

‘‘7322. Office of Health Care Quality Assurance.’’.

22 (b) PLACEMENT IN OFFICE OF UNDER SECRETARY

23 FOR HEALTH.—Section 7306(a) of title 38, United States

24 Code, is amended—
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1 (1) by redesignating paragraph (9) as para2 graph (10); and

3 (2) by inserting after paragraph (8) the fol4 lowing new paragraph (9):

5 ‘‘(9) The Director of Health Care Quality As6 surance, who shall be responsible to the Under Sec7 retary for Health for the operation of the Office of

8 Health Care Quality Assurance.’’.

9 (c) SENSE OF CONGRESS ON DIRECTOR AS ADVO10 CATE FOR VETERANS.—It is the sense of Congress that

11 the Director of the Office of Health Care Quality Assur12 ance should act as an advocate for veterans in carrying

13 out activities under section 7322 of title 38, United States

14 Code, as added by subsection (a).

15 SEC. 7. REPORT ON EFFICIENCIES IN PROVISION OF

16 HEALTH CARE BY THE DEPARTMENT OF VET17 ERANS AFFAIRS.

18 (a) REQUIREMENT.—Not later than six months after

19 the date of the enactment of this Act, the Secretary of

20 Veterans Affairs shall submit to Congress a report on effi21 ciencies in the furnishing of health care to veterans in the

22 health care networks and facilities of the Department of

23 Veterans Affairs.

24 (b) ELEMENTS.—The report shall include the fol25 lowing:
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1 (1) A survey of each health care network of the

2 Department, including a summary of the efforts of

3 each network to increase efficiency in the furnishing

4 of health care to veterans.

5 (2) An assessment of the extent to which such

6 networks, and the facilities within such networks,

7 are or are not implementing uniform, Department8 wide policies to increase efficiency in the furnishing

9 of health care to veterans.

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