II 

110TH CONGRESS 

1ST SESSION S. 1824 

To amend title XVIII of the Social Security Act to establish a Hospital 

Quality Report Card Initiative under the Medicare program to assess 

and report on health care quality in hospitals. 

IN THE SENATE OF THE UNITED STATES 

JULY 19, 2007 

Mr. OBAMA 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 establish 

a Hospital Quality Report Card Initiative under the 

Medicare program to assess and report on health care 

quality in 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 ‘‘Hospital Quality Re5 port Card Act of 2007’’. 

6 SEC. 2. PURPOSE. 

7 The purpose of this Act is to expand hospital quality 

8 reporting by establishing the Hospital Quality Report 


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1 Card Initiative under the Medicare program to ensure that 

2 hospital quality measures data are readily available and 

3 accessible in order to— 

4 (1) assist patients and consumers in making de5 cisions about where to get health care; 

6 (2) assist purchasers and insurers in making 

7 decisions that determine where employees, sub8 scribers, members, or participants are able to go for 

9 their health care; and 

10 (3) assist health care providers in identifying 

11 opportunities for quality improvement and cost con12 tainment. 

13 SEC. 3. HOSPITAL QUALITY REPORT CARD INITIATIVE. 

14 (a) IN GENERAL.—Title XVIII of the Social Security 

15 Act (42 U.S.C. 1395 et seq.) is amended by adding at 

16 the end the following new section: 

17 ‘‘HOSPITAL QUALITY REPORT CARD INITIATIVE

18 ‘‘SEC. 1898. (a) IN GENERAL.—Not later than 18 

19 months after the date of the enactment of the Hospital 

20 Quality Report Card Act of 2007, the Secretary, acting 

21 through the Administrator of the Centers for Medicare & 

22 Medicaid Services (in this section referred to as the ‘Ad23 ministrator’) and in consultation with the Director of the 

24 Agency for Healthcare Research and Quality, shall, di25 rectly or through contracts with States or appropriate en26 tities (such as utilization and quality control peer review 


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1 organizations under part B of title XI, commonly known 

2 as Quality Improvement Organizations), establish and im3 plement a Hospital Quality Report Card Initiative (in this 

4 section referred to as the ‘Initiative’) to report on health 

5 care quality in subsection (d) hospitals. 

6 ‘‘(b) SUBSECTION (d) HOSPITAL.—For purposes of 

7 this section, the term ‘subsection (d) hospital’ has the 

8 meaning given such term in section 1886(d)(1)(B). 

9 ‘‘(c) REQUIREMENTS OF INITIATIVE.— 

10 ‘‘(1) QUALITY MEASUREMENT REPORTS FOR

11 HOSPITALS.— 

12 ‘‘(A) QUALITY MEASURES.—Not less than 

13 2 times each year, the Secretary shall publish 

14 reports on hospital quality. Such reports shall 

15 include quality measures data submitted under 

16 section 1886(b)(3)(B)(viii), and other data as 

17 feasible, that allow for an assessment of health 

18 care— 

19 ‘‘(i) effectiveness; 

20 ‘‘(ii) safety; 

21 ‘‘(iii) timeliness; 

22 ‘‘(iv) efficiency; 

23 ‘‘(v) patient-centeredness; and 

24 ‘‘(vi) equity. 


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1 ‘‘(B) REPORT CARD FEATURES.—In col2 lecting and reporting data as provided for 

3 under subparagraph (A), the Secretary shall in4 clude hospital information, as possible, relating 

5 to— 

6 ‘‘(i) staffing levels of nurses and other 

7 health professionals, as appropriate; 

8 ‘‘(ii) rates of hospital acquired infec9 tions; 

10 ‘‘(iii) the volume of various procedures 

11 performed; 

12 ‘‘(iv) the availability of interpreter 

13 services on-site; 

14 ‘‘(v) the accreditation of hospitals, as 

15 well as sanctions and other violations 

16 found by accreditation or State licensing 

17 boards; 

18 ‘‘(vi) the quality of care for various 

19 patient populations, including pediatric 

20 populations and racial and ethnic minority 

21 populations; 

22 ‘‘(vii) the availability and accessibility 

23 of emergency rooms, including measures of 

24 crowding such as diversion status, patient 


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1 boarding in the emergency room, and un2 treated patients due to extended wait time; 

3 ‘‘(viii) the availability of intensive care 

4 units, obstetrical units, and burn units; 

5 ‘‘(ix) the quality of care in various 

6 hospital settings, including inpatient, out7 patient, emergency, maternity, and inten8 sive care unit settings; 

9 ‘‘(x) the use of health information 

10 technology, telemedicine, and electronic 

11 medical records; 

12 ‘‘(xi) ongoing patient safety initia13 tives; and 

14 ‘‘(xii) other measures determined ap15 propriate by the Secretary. 

16 ‘‘(C) TAILORING OF HOSPITAL QUALITY

17 REPORTS.—The Director of the Agency for 

18 Healthcare Research and Quality may modify 

19 and publish hospital reports to include quality 

20 measures for diseases and health conditions of 

21 particular relevance to certain regions, States, 

22 or local areas. 

23 ‘‘(D) RISK ADJUSTMENT.— 

24 ‘‘(i) IN GENERAL.—In reporting data 

25 as provided for under subparagraph (A), 


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1 the Secretary may risk adjust quality 

2 measures to account for differences relat3 ing to— 

4 ‘‘(I) the characteristics of the re5 porting hospital, such as licensed bed 

6 size, geography, teaching hospital sta7 tus, and profit status; and 

8 ‘‘(II) patient characteristics, such 

9 as health status, severity of illness, in10 surance status, and socioeconomic sta11 tus. 

12 ‘‘(ii) AVAILABILITY OF UNADJUSTED

13 DATA.—If the Secretary reports data 

14 under subparagraph (A) using risk-ad15 justed quality measures, the Secretary 

16 shall establish procedures for making the 

17 unadjusted data available to the public in 

18 a manner determined appropriate by the 

19 Secretary. 

20 ‘‘(E) COSTS AND CHARGES.—The Sec21 retary shall— 

22 ‘‘(i) compile data relating to the aver23 age hospital cost and charges for ICD–9 

24 conditions for which quality measures data 

25 are collected; and 


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1 ‘‘(ii) report such information in a 

2 manner that allows cost and charge com3 parisons between or among subsection (d) 

4 hospitals. 

5 ‘‘(F) VERIFICATION.—Under the Initiative, 

6 the Secretary may verify data reported under 

7 this paragraph to ensure accuracy and validity. 

8 ‘‘(G) DISCLOSURE.—The Secretary shall 

9 disclose the entire methodology for the report10 ing of data under this paragraph to all relevant 

11 organizations and all subsection (d) hospitals 

12 that are the subject of any such information 

13 that is to be made available to the public prior 

14 to the public disclosure of such information. 

15 ‘‘(H) PUBLIC INPUT.—The Secretary shall 

16 provide an opportunity for public review and 

17 comment with respect to the quality measures 

18 to be reported for subsection (d) hospitals 

19 under this section for at least 60 days prior to 

20 the finalization by the Secretary of the quality 

21 measures to be used for such hospitals. 

22 ‘‘(I) AVAILABILITY OF REPORTS AND FIND23 INGS.— 

24 ‘‘(i) ELECTRONIC AVAILABILITY.— 

25 The Secretary shall ensure that reports are 


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1 made available under this section in an 

2 electronic format, in an understandable 

3 manner with respect to various populations 

4 (including those with low functional health 

5 literacy), and in a manner that allows 

6 health care quality comparisons to be made 

7 between local hospitals. 

8 ‘‘(ii) FINDINGS.—The Secretary shall 

9 establish procedures for making report 

10 findings available to the public, upon re11 quest, in a nonelectronic format, such as 

12 through the toll-free telephone number 1– 

13 800–MEDICARE. 

14 ‘‘(J) IDENTIFICATION OF METHOD15 OLOGY.—The analytic methodologies and limi16 tations on data sources utilized by the Sec17 retary to develop and disseminate the compara18 tive data under this section shall be identified 

19 and acknowledged as part of the dissemination 

20 of such data, and include the appropriate and 

21 inappropriate uses of such data. 

22 ‘‘(K) ADVERSE SELECTION OF PA23 TIENTS.—On at least an annual basis, the Sec24 retary shall compare quality measures data sub25 mitted by each subsection (d) hospital under 


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1 section 1886(b)(3)(B)(viii) with data submitted 

2 in the prior year or years by the same hospital 

3 in order to identify and report actions that 

4 would lead to false or artificial improvements in 

5 the hospital’s quality measurements, includ6 ing— 

7 ‘‘(i) adverse selection against patients 

8 with severe illness or other factors that 

9 predispose patients to poor health out10 comes; and 

11 ‘‘(ii) provision of health care that does 

12 not meet established recommendations or 

13 accepted standards for care. 

14 ‘‘(2) DATA SAFEGUARDS.— 

15 ‘‘(A) UNAUTHORIZED USE AND DISCLO16 SURE.—The Secretary shall develop and imple17 ment effective safeguards to protect against the 

18 unauthorized use or disclosure of hospital data 

19 that is reported under this section. 

20 ‘‘(B) INACCURATE INFORMATION.—The 

21 Secretary shall develop and implement effective 

22 safeguards to protect against the dissemination 

23 of inconsistent, incomplete, invalid, inaccurate, 

24 or subjective hospital data. 


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1 ‘‘(C) IDENTIFIABLE DATA.—The Secretary 

2 shall ensure that identifiable patient data shall 

3 not be released to the public. 

4 ‘‘(d) GRANTS AND TECHNICAL ASSISTANCE.—The 

5 Secretary may award grants to national or State organiza6 tions, partnerships, utilization and quality control peer re7 view organizations under part B of title XI, or other enti8 ties that may assist with hospital quality improvement. 

9 ‘‘(e) HOSPITAL QUALITY ADVISORY COMMITTEE.— 

10 ‘‘(1) ESTABLISHMENT.—The Administrator, in 

11 consultation with the Director of the Agency for 

12 Healthcare Research and Quality, shall establish the 

13 Hospital Quality Advisory Committee (in this sub14 section referred to as the ‘Advisory Committee’) to 

15 provide advice to the Administrator on the submis16 sion, collection, and reporting of quality measures 

17 data. The Administrator shall serve as the chair18 person of the Advisory Committee. 

19 ‘‘(2) MEMBERSHIP.—The Advisory Committee 

20 shall include representatives of the following (except 

21 with respect to subparagraphs (A) through (D), to 

22 be appointed by the Administrator): 

23 ‘‘(A) The Agency for Healthcare Research 

24 and Quality. 


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1 ‘‘(B) The Health Resources and Services 

2 Administration. 

3 ‘‘(C) The Department of Veterans Affairs. 

4 ‘‘(D) The Centers for Disease Control and 

5 Prevention. 

6 ‘‘(E) National membership organizations 

7 that focus on health care quality improvement. 

8 ‘‘(F) Public and private hospitals. 

9 ‘‘(G) Physicians, nurses, and other health 

10 professionals. 

11 ‘‘(H) Patients and patient advocates. 

12 ‘‘(I) Health insurance purchasers and 

13 other payers. 

14 ‘‘(J) Health researchers, policymakers, and 

15 other experts in the field of health care quality. 

16 ‘‘(K) Health care accreditation entities. 

17 ‘‘(L) Representatives of utilization and 

18 quality control peer review organizations under 

19 part B of title XI. 

20 ‘‘(M) Other agencies and groups as deter21 mined appropriate by the Administrator. 

22 ‘‘(3) DUTIES.—The Advisory Committee shall 

23 review and provide guidance and recommendations 

24 to the Administrator on— 

25 ‘‘(A) the establishment of the Initiative; 


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1 ‘‘(B) integration and coordination of Fed2 eral quality measures data submission require3 ments, to avoid needless duplication and ineffi4 ciency; 

5 ‘‘(C) legal and regulatory barriers that 

6 may hinder quality measures data collection 

7 and reporting; and 

8 ‘‘(D) necessary technical and financial as9 sistance to encourage quality measures data col10 lection and reporting. 

11 ‘‘(4) STAFF AND RESOURCES.—The Adminis12 trator shall provide the Advisory Committee with ap13 propriate staff and resources for the functioning of 

14 the Advisory Committee. 

15 ‘‘(5) DURATION.—The Advisory Committee 

16 shall terminate at the discretion of the Adminis17 trator, but in no event later than 5 years after the 

18 date of enactment of this section. 

19 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 

20 are authorized to be appropriated to carry out this section 

21 such sums as may be necessary for each of fiscal years 

22 2008 through 2017.’’. 

23 (b) CONFORMING AMENDMENT.—Section 

24 1886(b)(3)(B)(viii)(VII) of the Social Security Act (42 

25 U.S.C. 1395ww(b)(3)(B)(viii)(VII)), as added by section 


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1 5001 of the Deficit Reduction Act of 2005, is amended 

2 to read as follows: 

3 ‘‘(VII) The Secretary shall use the data submitted 

4 under this clause for the Hospital Quality Report Card 

5 Initiative under section 1898.’’. 

6 SEC. 4. EVALUATION OF THE HOSPITAL QUALITY REPORT 

7 CARD INITIATIVE. 

8 (a) IN GENERAL.—The Director of the Agency for 

9 Healthcare Research and Quality, directly or through con10 tract, shall evaluate and periodically report to Congress 

11 on the effectiveness of the Hospital Quality Report Card 

12 Initiative established under section 1898 of the Social Se13 curity Act, as added by section 3, including the effective14 ness of the Initiative in meeting the purpose described in 

15 section 2. The Director shall make such reports available 

16 to the public. 

17 (b) RESEARCH.—The Director of the Agency for 

18 Healthcare Research and Quality, in consultation with the 

19 Administrator of the Centers for Medicare & Medicaid 

20 Services, shall use the outcomes from the evaluation con21 ducted pursuant to subsection (a) to increase the useful22 ness of the Hospital Quality Report Card Initiative, par23 ticularly for patients, as necessary. 

Æ 


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