```

[Congressional Bills 111th Congress]
[From the U.S. Government Publishing Office]
[S. 246 Introduced in Senate (IS)]

111th CONGRESS
  1st Session
                                 S. 246

 To amend title 38, United States Code, to improve the quality of care 
    provided to veterans in Department of Veterans Affairs medical 
 facilities, to encourage highly qualified doctors to serve in hard-to-
   fill positions in such medical facilities, and for other purposes.

_______________________________________________________________________

                   IN THE SENATE OF THE UNITED STATES

                            January 14, 2009

  Mr. Durbin 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 improve the quality of care 
    provided to veterans in Department of Veterans Affairs medical 
 facilities, to encourage highly qualified doctors to serve in hard-to-
   fill positions in such medical facilities, and for other purposes.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Veterans Health Care Quality 
Improvement Act''.

SEC. 2. STANDARDS FOR APPOINTMENT AND PRACTICE OF PHYSICIANS IN 
              DEPARTMENT OF VETERANS AFFAIRS MEDICAL FACILITIES.

    (a) Standards.--
            (1) In general.--Subchapter I of chapter 74 of title 38, 
        United States Code, is amended by inserting after section 7402 
        the following new section:
``Sec. 7402A. Appointment and practice of physicians: standards
    ``(a) In General.--The Secretary shall, acting through the Under 
Secretary for Health, prescribe standards to be met by individuals in 
order to qualify for appointment in the Administration in the position 
of physician and to practice as a physician in medical facilities of 
the Administration. The standards shall incorporate the requirements of 
this section.
    ``(b) Disclosure of Certain Information Before Appointment.--Each 
individual seeking appointment in the Administration in the position of 
physician shall do the following:
            ``(1) Provide the Secretary a full and complete explanation 
        of the following:
                    ``(A) Each lawsuit, civil action, or other claim 
                (whether open or closed) brought against the individual 
                for medical malpractice or negligence (other than a 
                lawsuit, action, or claim closed without any judgment 
                against or payment by or on behalf of the individual).
                    ``(B) Each payment made by or on behalf of the 
                individual to settle any lawsuit, action, or claim 
                covered by subparagraph (A).
                    ``(C) Each investigation or disciplinary action 
                taken against the individual relating to the 
                individual's performance as a physician.
            ``(2) Submit a written request and authorization to the 
        State licensing board of each State in which the individual 
        holds or has held a license to practice medicine to disclose to 
        the Secretary any information in the records of such State on 
        the following:
                    ``(A) Each lawsuit, civil action, or other claim 
                brought against the individual for medical malpractice 
                or negligence covered by paragraph (1)(A) that occurred 
                in such State.
                    ``(B) Each payment made by or on behalf of the 
                individual to settle any lawsuit, action, or claim 
                covered by subparagraph (A).
                    ``(C) Each medical malpractice judgment against the 
                individual by the courts or administrative agencies or 
                bodies of such State.
                    ``(D) Each disciplinary action taken or under 
                consideration against the individual by an 
                administrative agency or body of such State.
                    ``(E) Any change in the status of the license to 
                practice medicine issued the individual by such State, 
                including any voluntary or nondisciplinary surrendering 
                of such license by the individual.
                    ``(F) Any open investigation of the individual by 
                an administrative agency or body of such State, or any 
                outstanding allegation against the individual before 
                such an administrative agency or body.
                    ``(G) Any written notification to the individual by 
                such State of a potential termination of such license 
                for cause or otherwise.
    ``(c) Disclosure of Certain Information Following Appointment.--(1) 
Each individual appointed in the Administration in the position of 
physician after the date of the enactment of the Veterans Health Care 
Quality Improvement Act shall, as a condition of service under the 
appointment, disclose to the Secretary, not later than 30 days after 
the occurrence of such event, the following:
            ``(A) A judgment against the individual for medical 
        malpractice or negligence.
            ``(B) A payment made by or on behalf of the individual to 
        settle any lawsuit, action, or claim disclosed under paragraph 
        (1) or (2) of subsection (b).
            ``(C) Any disposition of or material change in a matter 
        disclosed under paragraph (1) or (2) of subsection (b).
    ``(2) Each individual appointed in the Administration in the 
position of physician as of the date of the enactment of the Veterans 
Health Care Quality Improvement Act shall do the following:
            ``(A) Not later than the end of the 60-day period beginning 
        on the date of the enactment of that Act and as a condition of 
        service under the appointment after the end of that period, 
        submit the request and authorization described in subsection 
        (b)(2).
            ``(B) Agree, as a condition of service under the 
        appointment, to disclose to the Secretary, not later than 30 
        days after the occurrence of such event, the following:
                    ``(i) A judgment against the individual for medical 
                malpractice or negligence.
                    ``(ii) A payment made by or on behalf of the 
                individual to settle any lawsuit, action, or claim 
                disclosed pursuant to subparagraph (A) or under this 
                subparagraph.
                    ``(iii) Any disposition of or material change in a 
                matter disclosed pursuant to subparagraph (A) or under 
                this subparagraph.
    ``(3) Each individual appointed in the Administration in the 
position of physician shall, as part of the biennial review of the 
performance of the physician under the appointment, submit the request 
and authorization described in subsection (b)(2). The requirement of 
this paragraph is in addition to the requirements of paragraph (1) or 
(2), as applicable.
    ``(d) Investigation of Disclosed Matters.--(1) The Director of the 
Veterans Integrated Services Network (VISN) in which an individual is 
seeking appointment in the Administration in the position of physician 
shall perform an investigation (in such manner as the standards 
required by this section shall specify) of each matter disclosed under 
subsection (b) with respect to the individual.
    ``(2) The Director of the Veterans Integrated Services Network in 
which an individual is appointed in the Administration in the position 
of physician shall perform an investigation (in a manner so specified) 
of each matter disclosed under subsection (c) with respect to the 
individual.
    ``(3) The results of each investigation performed under this 
subsection shall be fully documented.
    ``(e) Approval of Appointments by Directors of VISNs.--(1) An 
individual may not be appointed in the Administration in the position 
of physician without the approval of the Director of the Veterans 
Integrated Services Network in which the individual will first serve 
under the appointment.
    ``(2) In approving the appointment under this subsection of an 
individual for whom any matters have been disclosed under subsection 
(b), a Director shall--
            ``(A) certify in writing the completion of the performance 
        of the investigation under subsection (d)(1) of each such 
        matter, including the results of such investigation; and
            ``(B) provide a written justification why any matters 
        raised in the course of such investigation do not disqualify 
        the individual from appointment.
    ``(3) A Director shall provide copies of the certification and the 
written justification with respect to an individual under paragraph (2) 
to the National Quality Assurance Officer and the Quality Assurance 
Officer of the Network in which the individual will first serve under 
the approved appointment.
    ``(f) Enrollment of Physicians With Practice Privileges in 
Proactive Disclosure Service.--Each medical facility of the Department 
at which physicians are extended the privileges of practice shall 
enroll each physician extended such privileges in the Proactive 
Disclosure Service of the National Practitioners Data Bank
    ``(g) Encouragement of Employment of Physicians With Board 
Certification.--The Secretary shall include in each performance 
contract with a Director of a Veterans Integrated Services Network a 
provision that encourages the Director to hire in such Network 
physicians who are board certified in the specialty in which the 
physicians will practice. Each such provision shall include such 
elements as the Secretary considers appropriate.''.
            (2) Clerical amendment.--The table of sections at the 
        beginning of chapter 74 of such title is amended by inserting 
        after the item relating to section 7402 the following new item:

``7402A. Appointment and practice of physicians: standards.''.
    (b) Effective Date and Applicability.--
            (1) Effective date.--Except as provided in paragraph (2) 
        and (3), the amendments made by subsection (a) shall take 
        effect on the date of the enactment of this Act.
            (2) Enrollment in proactive disclosure service of 
        physicians practicing on effective date.--In the case of an 
        individual appointed to the Veterans Health Administration in 
        the position of physician as of the date of the enactment of 
        this Act, the requirements of subsection (f) of section 7402A 
        of title 38, United States Code, as added by subsection (a), 
        shall take effect on the date that is 60 days after the date of 
        the enactment of this Act.
            (3) Contract provisions encouraging employment of 
        physicians with board certification.--The provisions of 
        subsection (g) of such section 7402A, as so added, shall apply 
        to any performance contract of a Director of a Veterans 
        Integrated Services Network entered into during or after the 
        first cycle of such performance contracts beginning on or after 
        that date.

SEC. 3. ENHANCEMENT OF QUALITY ASSURANCE BY THE VETERANS HEALTH 
              ADMINISTRATION.

    (a) Enhancement of Quality Assurance Through Quality Assurance 
Officers.--
            (1) In general.--Subchapter II of chapter 73 of title 38, 
        United States Code, is amended by inserting after section 7311 
        the following new section:
``Sec. 7311A. Quality assurance officers
    ``(a) National Quality Assurance Officer.--(1) The Under Secretary 
for Health shall designate an official of the Veterans Health 
Administration to act as the principal quality assurance officer for 
the quality-assurance program required by section 7311 of this title. 
The official so designated may be known as the `National Quality 
Assurance Officer of the Veterans Health Administration' (in this 
section referred to as the `National Quality Assurance Officer').
    ``(2) The National Quality Assurance Officer shall report directly 
to the Under Secretary for Health in the discharge of responsibilities 
and duties of the Officer under this section.
    ``(3) The National Quality Assurance Officer shall be the official 
within the Administration who is principally responsible for the 
quality-assurance program referred to in paragraph (1). In carrying out 
that responsibility, the Officer shall be responsible for--
            ``(A) establishing and enforcing the requirements of that 
        program; and
            ``(B) carrying out such other responsibilities and duties 
        relating to quality assurance in the Administration as the 
        Under Secretary for Health shall specify.
    ``(4) The requirements under paragraph (3) shall include 
requirements regarding the following:
            ``(A) A confidential system for the submittal of reports by 
        Administration personnel regarding quality assurance at 
        Department facilities.
            ``(B) Mechanisms for the peer review of the actions of 
        individuals appointed in the Administration in the position of 
        physician.
            ``(C) Mechanisms for the accountability of the facility 
        director and chief medical officer of each Administration 
        medical facility for the actions of physicians in such 
        facility.
    ``(b) Quality Assurance Officers for VISNs.--(1) The Director of 
each Veterans Integrated Services Network (VISN) shall appoint an 
official of the Network to act as the quality assurance officer of the 
Network.
    ``(2) Each official appointed as a quality assurance officer under 
this subsection shall be a board-certified physician.
    ``(3) The quality assurance officer for a Veterans Integrated 
Services Network shall report to the Director of the Veterans 
Integrated Services Network, and to the National Quality Assurance 
Officer, regarding the discharge of the responsibilities and duties of 
the officer under this section.
    ``(4) The quality assurance officer for a Veterans Integrated 
Services Network shall--
            ``(A) direct the quality assurance office in the Network; 
        and
            ``(B) coordinate, monitor, and oversee the quality-
        assurance programs and activities of the Administration medical 
        facilities in the Network in order to ensure the thorough and 
        uniform discharge of quality assurance requirements under such 
        programs and activities throughout such facilities.
    ``(c) Quality Assurance Officers for Medical Facilities.--(1) The 
director of each Administration medical facility shall appoint a 
quality assurance officer for that facility.
    ``(2) Each official appointed as a quality assurance officer under 
this subsection shall be a board-certified physician.
    ``(3) The official appointed as a quality assurance officer for a 
facility under this subsection shall be a practicing physician at the 
facility. If the official appointed as quality assurance officer for a 
facility has other clinical or administrative duties, the director of 
the facility shall ensure that those duties are sufficiently limited in 
scope so as to ensure that those duties do not prevent the officer from 
effectively discharging the responsibilities and duties of quality 
assurance officer at the facility.
    ``(4) The quality assurance officer for a facility shall report 
directly to the director of the facility, and to the quality assurance 
officer of the Veterans Integrated Services Network in which the 
facility is located, regarding the discharge of the responsibilities 
and duties of the quality assurance officer under this section.
    ``(5) The quality assurance officer for a facility shall be 
responsible for designing, disseminating, and implementing quality-
assurance programs and activities for the facility that meet the 
requirements established by the National Quality Assurance Officer 
under subsection (a).''.
            (2) Clerical amendment.--The table of sections at the 
        beginning of chapter 73 of such title is amended by inserting 
        after the item relating to section 7311 the following new item:

``7311A. Quality assurance officers.''.
    (b) Reports on Quality Concerns Under Quality-Assurance Program.--
Section 7311(b) of such title is amended by adding at the end the 
following new paragraph:
    ``(4) As part of the quality-assurance program, the Under Secretary 
for Health shall establish mechanisms through which employees of 
Administration facilities may submit reports, on a confidential basis, 
on matters relating to quality of care in Administration facilities to 
the quality assurance officers of such facilities under section 
7311A(c) of this title and to the quality assurance officers of the 
Veterans Integrated Services Networks (VISNs) in which such facilities 
are located under section 7311A(b) of this title. The mechanisms shall 
provide for the prompt and thorough review of any reports so submitted 
by the receiving officials.''.
    (c) Review of Current Health Care Quality Safeguards.--
            (1) In general.--The Secretary of Veterans Affairs shall 
        conduct a comprehensive review of all current policies and 
        protocols of the Department of Veterans Affairs for maintaining 
        health care quality and patient safety at Department of 
        Veterans Affairs medical facilities. The review shall include a 
        review and assessment of the National Surgical Quality 
        Improvement Program (NSQIP), including an assessment of--
                    (A) the efficacy of the quality indicators under 
                the program;
                    (B) the efficacy of the data collection methods 
                under the program;
                    (C) the efficacy of the frequency with which 
                regular data analyses are performed under the program; 
                and
                    (D) the extent to which the resources allocated to 
                the program are adequate to fulfill the stated function 
                of the program.
            (2) Report.--Not later than 60 days after the date of the 
        enactment of this Act, the Secretary shall submit to Congress a 
        report on the review conducted under paragraph (1), including 
        the findings of the Secretary as a result of the review and 
        such recommendations as the Secretary considers appropriate in 
        light of the review.

SEC. 4. INCENTIVES TO ENCOURAGE HIGH-QUALITY PHYSICIANS TO SERVE IN THE 
              VETERANS HEALTH ADMINISTRATION.

    (a) Incentives Required.--
            (1) In general.--Subchapter III of chapter 74 of title 38, 
        United States Code, is amended by inserting after section 7431 
        the following new section:
``Sec. 7431A. Physicians: additional incentives for service in hard-to-
              fill positions
    ``(a) Loan Repayment for Physicians Who Serve in Hard-To-Fill 
Positions.--(1) In order to recruit and retain physicians in the 
Administration in hard-to-fill positions (as designated by the 
Secretary for purposes of this subsection), the Secretary shall carry 
out a program under which the Secretary may repay, for each individual 
who agrees to serve as a physician for a period of not less than three 
years in an Administration facility in such a position and seeks such 
repayment, any loan of such individual as follows:
            ``(A) Any loan of the individual described in paragraphs 
        (1) through (4) of section 16302(a) of title 10.
            ``(B) Any other loan of the individual designated by the 
        Secretary for purposes of this subsection the proceeds of which 
        were used by the individual to finance education leading to the 
        medical degree of the individual.
    ``(2) Each individual seeking repayment of loans under paragraph 
(1) shall enter into an agreement with the Secretary regarding the 
repayment of loans. Under the agreement, the individual shall agree--
            ``(A) to perform satisfactory service in a physician 
        position specified in the agreement in an Administration 
        facility specified in the agreement for such period of years as 
        the agreement shall specify; and
            ``(B) to possess and retain for the period of the agreement 
        such professional qualifications as are necessary for the 
        service specified under subparagraph (A).
    ``(3) Repayment of loans under this subsection shall be made on the 
basis of complete years of service under the agreement under this 
subsection. The amount to be repayed under an agreement under this 
subsection for a complete year of service specified in the agreement 
shall be such amount, not to exceed $30,000, for each complete year of 
service as the agreement shall specify.
    ``(4) An individual receiving loan repayment under paragraph (1) 
who does not satisfy the requirements of the agreement under paragraph 
(2) shall be subject to such repayment requirements as the Secretary 
shall specify in the agreement.
    ``(b) Tuition Reimbursement for Physician Students Who Agree To 
Serve in Hard-To-Fill Positions.--(1) In order to recruit and retain 
physicians in the Administration in hard-to-fill positions (as 
designated by the Secretary for purposes of this subsection), the 
Secretary shall carry out a program under which the Secretary may 
reimburse individuals who are enrolled in a course of education leading 
toward board certification as a physician and seek such reimbursement 
for the tuition charged for pursuit of such course of education if such 
individuals agree to serve as a physician in an Administration facility 
in such a position.
    ``(2) Each individual seeking tuition reimbursement under paragraph 
(1) shall enter into an agreement with the Secretary regarding such 
tuition reimbursement. Under the agreement, the individuals shall 
agree--
            ``(A) to satisfactorily complete the course of education of 
        the individual described in paragraph (1); and
            ``(B) upon completion of the course of education, to become 
        board-certified as a physician; and
            ``(C) upon completion of the matters referred to in 
        subparagraphs (A) and (B)--
                    ``(i) to perform satisfactory service in a 
                physician position specified in the agreement in an 
                Administration facility specified in the agreement for 
                such period of years as the agreement shall specify; 
                and
                    ``(ii) to possess and retain for the period of the 
                agreement such professional qualifications as are 
                necessary for the service specified under clause (i).
    ``(3) The amount of reimbursement payable to an individual under 
paragraph (1) for a year may not exceed $30,000.
    ``(4) Any individual receiving tuition reimbursement under 
paragraph (1) who does not satisfy the requirements of the agreement 
under paragraph (2) shall be subject to such repayment requirements as 
the Secretary shall specify in the agreement.
    ``(5) An individual receiving tuition reimbursement under paragraph 
(1) for pursuit of a course of education shall also be paid a stipend 
in the amount of $5,000 for each academic year of pursuit of such 
course of education after entry into an agreement under paragraph (2).
    ``(c) Participation in FEHBP of Physicians Who Serve Part-Time in 
Hard-To-Fill Positions.--(1) In order to recruit and retain physicians 
in the Administration in hard-to-fill positions (as designated by the 
Secretary for purposes of this subsection), an individual not otherwise 
eligible for health insurance under chapter 89 of title 5 who agrees to 
serve as a physician in an Administration facility in such a position 
for not less than five days per month (of which two days must occur in 
each 14-day period) shall be eligible for enrollment in the health 
benefit plans under chapter 89 of title 5 on a self only or self and 
family basis (as applicable).
    ``(2) The Secretary shall administer this subsection in 
consultation with the Director of the Office of Personnel Management.
    ``(d) Additional Programs.--It is the sense of Congress that the 
Secretary should undertake active and on-going efforts to establish 
additional incentive programs to encourage individuals to serve in the 
position of physician in the Administration, or otherwise practice in 
the Administration, in hard-to-fill positions, including, in 
particular, incentive programs to encourage more experienced physicians 
to serve or practice in such positions.
    ``(e) Construction.--The incentives required under this section are 
in addition to any other special pays or benefits to which the 
individuals covered by this section are eligible or entitled under 
law.''.
            (2) Clerical amendment.--The table of sections at the 
        beginning of chapter 74 of such title is amended by inserting 
        after the item relating to section 731 the following new item:

``7431A. Physicians: additional incentives for service in hard-to-fill 
                            positions.''.
    (b) Affiliation of Department of Veterans Affairs Medical 
Facilities With Medical Schools.--The Secretary of Veterans Affairs 
shall, to the extent practicable, require each medical facility of the 
Department of Veterans Affairs to seek to establish an affiliation with 
a medical school within reasonable proximity of such medical facility.

SEC. 5. REPORTS TO CONGRESS.

    (a) Report.--Not later than December 15, 2009, and each year 
thereafter through 2012, the Secretary of Veterans Affairs shall submit 
to the congressional veterans affairs committees a report on the 
implementation of this Act and the amendments made by this Act during 
the preceding fiscal year. Each report shall include, for the fiscal 
year covered by such report, the following:
            (1) A comprehensive description of the implementation of 
        this Act and the amendments made by this Act.
            (2) Such recommendations as the Secretary considers 
        appropriate for legislative or administrative action to improve 
        the authorities and requirements in this Act and the amendments 
        made by this Act or to otherwise improve the quality of health 
        care and the quality of the physicians in the Veterans Health 
        Administration.
    (b) Congressional Veterans Affairs Committees Defined.--In this 
section, the term ``congressional veterans affairs committees'' means--
            (1) the Committees on Veterans' Affairs and Appropriations 
        of the Senate; and
            (2) the Committees on Veterans' Affairs and Appropriations 
        of the House of Representatives.
                                 <all>
```