II 

110TH CONGRESS 

1ST SESSION S. 1519 

To amend title XVIII of the Social Security Act to provide for a transition 

to a new voluntary quality reporting program for physicians and other 

health professionals. 

IN THE SENATE OF THE UNITED STATES 

MAY 24, 2007 

Mr. CARDIN (for himself and Mr. SPECTER) introduced the following bill; 

which was read twice and referred to the Committee on Finance 

A BILL 

To amend title XVIII of the Social Security Act to provide 

for a transition to a new voluntary quality reporting 

program for physicians and other health professionals. 

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 ‘‘Voluntary Medicare 

5 Quality Reporting Act of 2007’’. 

6 SEC. 2. FINDINGS. 

7 (a) FINDINGS.—Congress makes the following find8 ings: 

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1 (1) The health care system of the United States 

2 is the world’s most advanced health care system and 

3 delivers health care according to the highest quality 

4 standards. Physicians and other health professionals 

5 are committed to providing the highest quality of 

6 health care to beneficiaries under the Medicare pro7 gram. 

8 (2) Physicians have been actively engaged with 

9 the American Medical Association’s Physician Con10 sortium for Performance Improvement in the devel11 opment of evidence-based and clinically valid meas12 ures in order to improve the quality of health care 

13 and have also worked closely with the Centers for 

14 Medicare & Medicaid Services (‘‘CMS’’) in assuring 

15 the successful implementation of the Physician Vol16 untary Reporting Program (‘‘PVRP’’) developed to 

17 measure and evaluate quality of health care. 

18 (3) Physicians are actively collaborating with 

19 consensus organizations in their efforts to— 

20 (A) improve the quality of health care 

21 through the specification of quality measures 

22 for services; and 

23 (B) develop a rational system for col24 lecting, aggregating, and reporting data across 

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1 numerous public and private insurance pro2 grams in the least burdensome way. 

3 (4) Quality measures for covered professional 

4 services (as defined in section 1848(k)(3)(A) of the 

5 Social Security Act (42 U.S.C. 1395w–4(k)(3)(A)) 

6 must be— 

7 (A) evidence-based and clinically valid; 

8 (B) regularly updated to reflect current 

9 medical practice; 

10 (C) specialty specific; and 

11 (D) developed by relevant medical and 

12 other health professional specialty societies with 

13 expertise in the area of health care involved. 

14 (5) All quality measures for covered profes15 sional services (as so defined) should be pilot-tested 

16 in a variety of practice settings and across all rel17 evant medical and other health professional special18 ties before they are included in a value-based pur19 chasing system for such services. 

20 (6) Physicians must be actively engaged in all 

21 aspects of the development and implementation of 

22 an effective quality reporting and value-based pur23 chasing system for covered professional services (as 

24 so defined). The development process for such sysmstockstill on PROD1PC66 with BILLS

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1 tem must be transparent to all physicians and ad2 here to a consistent set of rules. 

3 (7) Any effective quality reporting system for 

4 covered professional services (as so defined) must 

5 recognize the actual health information technology 

6 and administrative costs physicians and other health 

7 professionals incur for participating in the system. 

8 (8) Any quality reporting program for covered 

9 professional services (as so defined) should focus on 

10 meaningful improvements in patient care rather 

11 than requiring physicians to report for the sake of 

12 reporting. 

13 (9) Most physicians and other health profes14 sionals have not had any experience in quality re15 porting and lack the necessary health information 

16 technology and administrative infrastructures to par17 ticipate in a value-based purchasing system for phy18 sicians’ services. 

19 (10) The 6-month program under section 

20 1848(k) of the Social Security Act (42 U.S.C. 

21 1395w–4(k)), as added by section 101(b) of division 

22 B of the Tax Relief and Health Care Act of 2006 

23 (Public Law 109–432; 120 Stat. 2975), the 2007 

24 Physician Quality Reporting Initiative (‘‘PQRI’’), 

25 does not provide a sufficient amount of time to test 

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1 and evaluate the appropriateness and effectiveness 

2 of this new reporting system. Therefore, it is pre3 mature to implement a permanent Medicare quality 

4 reporting system for physicians in 2008. 

5 SEC. 3. TRANSITION TO NEW VOLUNTARY MEDICARE QUAL6 ITY REPORTING PROGRAM. 

7 (a) EVALUATING THE TRANSITIONAL QUALITY RE8 PORTING SYSTEM ESTABLISHED FOR 2007.— 

9 (1) EVALUATION.—The Secretary of Health 

10 and Human Services shall evaluate the quality re11 porting system under paragraph (1) of section 

12 1848(k) of the Social Security Act (42 U.S.C. 

13 1395w–4(k)) (as added by section 101(b) of division 

14 B of the Tax Relief and Health Care Act of 2006 

15 (Public Law 109–432)), as applied for 2007 using 

16 the quality measures described in paragraph (2)(A) 

17 of such section to determine the following: 

18 (A) The extent to which such quality meas19 ures were valid, clinically relevant, practicable, 

20 and not overly burdensome. 

21 (B) The percentage of eligible professionals 

22 (as defined in paragraph (3)(B) of such section) 

23 in each category of eligible professionals de24 scribed in such paragraph that had such quality 

25 measures to report for such year. 

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1 (C) The rate of participation in such qual2 ity reporting system of eligible professionals de3 scribed in subparagraph (B) in each such cat4 egory. 

5 (D) The average administrative costs of 

6 medical practices of such eligible professionals 

7 for reporting such quality measures, as it re8 lates to the size of such practices. 

9 (2) REPORT.—Not later than June 1, 2008, the 

10 Secretary of Health and Human Services shall sub11 mit to Congress a report containing the findings of 

12 the evaluation under paragraph (1). 

13 (b) DEMONSTRATION PROJECTS ON DATA REG14 ISTRIES.—Beginning January 1, 2008, the Secretary of 

15 Health and Human Services shall enter into contracts for 

16 conducting demonstrations for defining appropriate mech17 anisms whereby eligible professionals (as defined in sec18 tion 1848(k)(3)(B) of the Social Security Act (42 U.S.C. 

19 1395w–4(k)(3)(B)) may provide data on quality measures 

20 to the Secretary through an appropriate medical registry. 

21 The Secretary shall require that all mechanisms developed 

22 under this subsection be for purposes of reporting data 

23 to the Secretary only. The Secretary shall consider such 

24 data as confidential and not make such data available to 

25 other parties or persons. 

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1 (c) TRANSITIONAL QUALITY REPORTING AFTER DE2 CEMBER 31, 2007, AND BEFORE IMPLEMENTATION OF

3 NEW VOLUNTARY MEDICARE QUALITY REPORTING PRO4 GRAM.— 

5 (1) IN GENERAL.—Section 1848(k)(2)(B) of 

6 the Social Security Act (42 U.S.C. 1395w– 

7 4(k)(3)(B)) is amended to read as follows: 

8 ‘‘(B) FOR 2008 AND 2009.—Eligible profes9 sionals may continue to report to the Secretary 

10 quality measures specified under subparagraph 

11 (A) after December 31, 2007, and before De12 cember 31, 2009, in order for the Secretary to 

13 refine systems for reporting quality measures.’’. 

14 (2) PROHIBITING USE OF PHYSICIAN ASSIST15 ANCE AND QUALITY INITIATIVE FUND FOR QUALITY

16 REPORTING BONUS PAYMENTS IN 2008.—Section 

17 1848(l)(2)(B) of the Social Security Act (42 U.S.C. 

18 1395w–4(l)(2)(B)), as added by section 101(d) of di19 vision B of the Tax Relief and Health Care Act of 

20 2006 (Public Law 109–432), is amended by adding 

21 at the end the following new sentence: ‘‘The Sec22 retary shall not expend from the Fund any amounts 

23 for bonus incentive payments for quality reporting of 

24 data on quality measures with respect to services 

25 furnished during 2008.’’. 

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1 SEC. 4. THE VOLUNTARY MEDICARE QUALITY REPORTING 

2 PROGRAM. 

3 (a) IN GENERAL.—Section 1848(k)(2) of the Social 

4 Security Act (42 U.S.C. 1395w–4(k)(2)) as added by sec5 tion 101(b) of Division B of the Tax Relief and Health 

6 Care Act of 2006 (Public Law 109–432; 120 Stat. 2975), 

7 is amended by adding at the end the following new sub8 paragraph: 

9 ‘‘(C) FOR 2010 AND SUCCEEDING YEARS.— 

10 ‘‘(i) IN GENERAL.—For purposes of 

11 reporting data on quality measures for cov12 ered professional services furnished during 

13 2010 and during succeeding years, the 

14 quality measures specified under this para15 graph for covered professional services are 

16 quality measures the Secretary has se17 lected in accordance with this subpara18 graph as part of the rulemaking process 

19 for payments under this section for 2010 

20 and succeeding years, respectively. 

21 ‘‘(ii) CHARACTERISTICS OF MEAS22 URES.—The quality measures selected 

23 under clause (i) shall— 

24 ‘‘(I) include a mixture of struc25 tural measures, process measures, and 

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1 outcomes measures (as such terms are 

2 defined in clause (v)); 

3 ‘‘(II) be evidence-based and clini4 cally valid; 

5 ‘‘(III) be relevant to physicians, 

6 other eligible professionals, and indi7 viduals entitled to benefits under part 

8 A or enrolled under this part; and 

9 ‘‘(IV) include measures that cap10 ture patients’ assessments of clinical 

11 care provided. 

12 ‘‘(iii) FAIRNESS.—The selection of 

13 quality measures under this subparagraph 

14 shall be conducted (and such quality meas15 ures shall be applied) in a manner that— 

16 ‘‘(I) takes into account dif17 ferences in individual health status; 

18 ‘‘(II) takes into account an indi19 vidual’s compliance with health care 

20 orders; 

21 ‘‘(III) does not directly or indi22 rectly encourage patient selection or 

23 deselection; 

24 ‘‘(IV) does not penalize eligible 

25 professionals who furnish services to 

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1 individuals entitled to benefits under 

2 part A or enrolled under this part who 

3 are frail, low-income, of racial or eth4 nic minority groups, or of limited 

5 English language proficiency; 

6 ‘‘(V) reduces health disparities 

7 across groups and areas; 

8 ‘‘(VI) uses appropriate statistical 

9 techniques to ensure valid results; and 

10 ‘‘(VII) assures that the Secretary 

11 is able to process data for the quality 

12 measures as written by the individual 

13 or organization that developed the 

14 measure. 

15 ‘‘(iv) SELECTION PROCESS FOR MEAS16 URES TO BE REPORTED.—The measures 

17 selected under clause (i) for 2010 (and 

18 each succeeding year) shall be measures 

19 that have been published by the Secretary 

20 in the Federal Register not later than No21 vember 1 before the year as endorsed qual22 ity measures that are applicable to covered 

23 professional services during the year. For 

24 purposes of this subparagraph, the Sec25 retary may publish quality measures for 

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1 2010 (or a succeeding year) in the Federal 

2 Register only if such measures are selected 

3 and endorsed as follows: 

4 ‘‘(I) RECOMMENDATIONS FOR

5 CLINICAL AREAS.—Not later than Oc6 tober 1, 2008 (and each succeeding 

7 October 1), the Secretary shall re8 quest, through notice in the Federal 

9 Register (without comment period), 

10 each physician specialty organization, 

11 each other eligible professional organi12 zation, and each quality improvement 

13 organization to submit to the Physi14 cian Consortium for Performance Im15 provement of the American Medical 

16 Association (referred to in this sub17 paragraph as the ‘Consortium’) by not 

18 later than December 31, 2008 (and 

19 each succeeding December 31), rec20 ommendations of clinical areas for the 

21 development of quality measures for 

22 purposes of this subparagraph. Not 

23 later than December 31, 2008 (and 

24 each succeeding December 31), the 

25 Secretary shall also submit to the 

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1 Consortium recommendations of clin2 ical areas for the development of such 

3 quality measures. 

4 ‘‘(II) SELECTION OF CLINICAL

5 AREAS.—Not later than March 31, 

6 2009 (and each subsequent March 

7 31), the Consortium is requested to 

8 submit to the Secretary the rec9 ommendations described in subclause 

10 (I). 

11 ‘‘(III) DEVELOPMENT OF PRO12 POSED QUALITY MEASURES.—Not 

13 later than June 1 of each year (begin14 ning with 2009), the Consortium, in 

15 collaboration with physician specialty 

16 organizations and other eligible pro17 fessional organizations, is requested to 

18 develop proposed quality measures for 

19 each clinical area identified under 

20 subclause (I). Such measures shall 

21 meet the requirements of clauses (ii) 

22 and (iii). 

23 ‘‘(IV) ENDORSEMENT OF QUAL24 ITY MEASURES.—Not later than June 

25 15 of each year (beginning with 

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1 2009), the Consortium is requested to 

2 submit the proposed quality measures 

3 developed under subclause (III) to a 

4 consensus organization for endorse5 ment. Not later than September 30 of 

6 each year (beginning with 2009), the 

7 consensus organization is requested to 

8 submit to the Secretary the quality 

9 measures that have been endorsed by 

10 the consensus organization. 

11 ‘‘(v) DEFINITIONS.—In this subpara12 graph: 

13 ‘‘(I) STRUCTURAL MEASURE.— 

14 The term ‘structural measure’ means 

15 a measure that reflects the organiza16 tional, technological, and human re17 sources infrastructure of a system 

18 necessary for the delivery of quality 

19 health care (such as the use of health 

20 information technology for submission 

21 of measures). 

22 ‘‘(II) PROCESS MEASURE.—The 

23 term ‘process measure’ means a meas24 ure associated with the practice of 

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1 health care or the furnishing of a 

2 service that is known to be effective. 

3 ‘‘(III) OUTCOME MEASURE.—The 

4 term ‘outcome measure’ means a 

5 measure that provides information on 

6 how health care affects patients. 

7 ‘‘(IV) CONSENSUS ORGANIZA8 TION.—The term ‘consensus organiza9 tion’ means an organization, such as 

10 the National Quality Forum, that the 

11 Secretary identifies as— 

12 ‘‘(aa) having experience in 

13 using a process for reaching a 

14 group consensus with respect to 

15 quality measures relating to the 

16 performance of those providing 

17 health care services; and 

18 ‘‘(bb) including in such proc19 ess practicing physicians, practi20 tioners with experience in the 

21 care of the frail elderly and indi22 viduals with multiple complex 

23 chronic conditions, organizations 

24 and individuals representative of 

25 the specialty involved, individuals 

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1 entitled to benefits under part A 

2 or enrolled under this part, ex3 perts in health care quality, indi4 viduals with experience in the de5 livery of health care in urban, 

6 rural, and frontier areas and to 

7 underserved populations, and 

8 representatives of the Sec9 retary.’’. 

10 (b) TAKING INTO ACCOUNT RESULTS OF DEM11 ONSTRATION PROJECTS.—Section 1848(k) of the Social 

12 Security Act (42 U.S.C. 1395w–4(k)) as added by section 

13 101(b) of Division B of the Tax Relief and Health Care 

14 Act of 2006 (Public Law 109–432; 120 Stat. 2975) is 

15 amended— 

16 (1) by striking paragraph (4) (relating to reg17 istry based reporting); and 

18 (2) by inserting after paragraph (3) the fol19 lowing new paragraph: 

20 ‘‘(4) TAKING INTO ACCOUNT RESULTS OF DEM21 ONSTRATION PROJECTS.—In administering this sub22 section, the Secretary shall take into account the rel23 evant findings and results from demonstration 

24 projects undertaken by the Secretary for reporting 

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1 quality measures applicable to covered professional 

2 services.’’. 

Æ 

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