II 

111TH CONGRESS 

2D SESSION S. 3318 

To amend title XVIII of the Social Security Act to eliminate contributing 

factors to disparities in breast cancer treatment through the development 

of a uniform set of consensus-based breast cancer treatment performance 

measures for a 6-year quality reporting system and value-based purchasing system under the Medicare Program. 

IN THE SENATE OF THE UNITED STATES 

MAY 5, 2010 

Mrs. GILLIBRAND 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 eliminate 

contributing factors to disparities in breast cancer treatment through the development of a uniform set of consensus-based breast cancer treatment performance measures for a 6-year quality reporting system and valuebased purchasing system under the Medicare Program. 

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 ‘‘Eliminating Dispari5 ties in Breast Cancer Treatment Act of 2010’’. 


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1 SEC. 2. FINDINGS. 

2 Congress finds the following: 

3 (1) Delays in receiving care after breast cancer 

4 diagnosis are reported to be greater for African5 American women than White women. 

6 (2) Recent studies indicate that African-Amer7 ican women with breast cancer are less likely to re8 ceive standard therapy than White women. 

9 (3) African-American and Hispanic patients are 

10 significantly more likely than White patients to be 

11 diagnosed at a more advanced stage of breast can12 cer. 

13 (4) Investigators found that regardless of insur14 ance status, African-American women are 1.9 times 

15 more likely to be diagnosed with an advanced stage 

16 of breast cancer than White women and Hispanic 

17 women are 1.4 times more likely to be diagnosed 

18 with an advanced stage of breast cancer than White 

19 women. 

20 (5) African-American women are ten percent 

21 more likely not to receive tests to determine if breast 

22 cancer has spread to axillary (underarm) lymph 

23 nodes. Studies show that health insurance status, 

24 race, income, and educational background are di25 rectly linked to irregularity in administering this 

26 vital screening. 


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1 (6) According to American Cancer Society re2 searchers, substantial disparities remain or persist 

3 regarding cancer diagnosis and treatment. 

4 SEC. 3. PURPOSE. 

5 The purpose of this Act is to promote the implemen6 tation of standardized health care practices for breast can7 cer treatment under the Medicare program to eliminate 

8 disparities in the provision of care to such patients based 

9 on race, level of education, income, and health insurance 

10 status of such patients. 

11 SEC. 4. CONSENSUS-BASED BREAST CANCER TREATMENT 

12 PERFORMANCE MEASURES SYSTEM UNDER 

13 MEDICARE. 

14 Title XVIII of the Social Security Act is amended by 

15 adding at the end the following new section: 

16 ‘‘SEC. 1899. BREAST CANCER TREATMENT PERFORMANCE 

17 MEASURES SYSTEM. 

18 ‘‘(a) IN GENERAL.—Not later than October 1, 2010, 

19 the Secretary shall establish, in accordance with the provi20 sions of this section, a 6-year breast cancer treatment 

21 quality performance system (in this section referred to as 

22 the ‘system’) to— 

23 ‘‘(1) assess and publicly disclose, through the 

24 use of quality measures, the quality of care provided 


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1 for the treatment of breast cancer by specified 

2 health care providers; and 

3 ‘‘(2) beginning October 1, 2013, base payment 

4 under this title to such providers for such treatment 

5 on the performance of such providers based on such 

6 measures. 

7 ‘‘(b) SPECIFIED HEALTH CARE PROVIDERS.— 

8 ‘‘(1) IN GENERAL.—The Secretary shall specify 

9 classes of providers of services and suppliers, includ10 ing hospitals, cancer centers, physicians, primary 

11 care providers, and specialty providers, to which the 

12 provisions of this section shall apply. 

13 ‘‘(2) DEFINITION.—For purposes of this sec14 tion, the term ‘specified health care provider’ means 

15 a provider of services or supplier specified under 

16 paragraph (1). 

17 ‘‘(c) IDENTIFICATION AND ENDORSEMENT OF

18 BREAST CANCER TREATMENT PERFORMANCE MEAS19 URES.— 

20 ‘‘(1) IN GENERAL.—Under the system, the Sec21 retary, shall enter into agreements with the National 

22 Quality Forum, an organization that operates as a 

23 voluntary consensus standards body as defined for 

24 purposes of section 12(d) of the National Tech25 nology Transfer and Advancement Act of 1995 


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1 (Public Law 104–113) and Office of Management 

2 and Budget Revised Circular A–119 (published in 

3 the Federal Register on February 10, 1998), under 

4 which the National Quality Forum shall identify a 

5 uniform set of consensus-based performance meas6 ures to evaluate the quality of care provided by spec7 ified health care providers for the treatment of 

8 breast cancer, endorse such set of measures through 

9 its multistakeholder consensus development process, 

10 and annually update such set of measures. 

11 ‘‘(2) MEASURES DESCRIBED.—The set of meas12 ures described in paragraph (1) shall include, with 

13 respect to the treatment of breast cancer, measures 

14 of patient outcomes, the process for delivering med15 ical care related to such treatment, patient coun16 seling and engagement in decisionmaking, patient 

17 experience of care, resource use, and practice capa18 bilities, such as care coordination. 

19 ‘‘(d) REPORTING PROCESS.— 

20 ‘‘(1) IN GENERAL.—Under the system, for peri21 ods (as specified by the Secretary) beginning on or 

22 after October 1, 2010, the Secretary shall establish 

23 a reporting process, with respect to treatment fur24 nished for breast cancer, that provides for a method 

25 for specified health care providers to submit to the 


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1 Secretary data on the performance of such providers 

2 during each period through use of the performance 

3 measures developed pursuant to subsection (c)(1). 

4 Such data shall be submitted in a form and manner 

5 and at a time specified by the Secretary. 

6 ‘‘(2) VOLUNTARY SUBMISSION DURING INITIAL

7 3 YEARS.—The reporting process under paragraph 

8 (1) shall provide for the voluntary submission of 

9 data (and incentives for such submission) under the 

10 process for periods ending before October 1, 2013. 

11 ‘‘(3) CHARACTERISTICS OF DATA SUBMITTED

12 UNDER REPORTING PROCESS.—Data submitted by a 

13 specified health care provider under the reporting 

14 process under paragraph (1) shall— 

15 ‘‘(A) take into account the quality of 

16 breast cancer treatment furnished to all pa17 tients of the provider, regardless of the type of 

18 health insurance coverage of the patient or 

19 whether or not the patient has such coverage; 

20 and 

21 ‘‘(B) be structured in a manner that allows 

22 for comparison according to race, educational 

23 level, income, insurance status, and any other 

24 category specified by the Secretary. 


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1 ‘‘(e) PUBLIC DISCLOSURE.—Under the system, the 

2 Secretary shall establish procedures to require that infor3 mation with respect to the quality demonstrated by a spec4 ified health care provider of treatment furnished for breast 

5 cancer during a period (based on the performance meas6 ures data submitted pursuant to subsection (c)(1) by the 

7 provider for such period) is made available on the official 

8 public Internet site of the Department of Health and 

9 Human Services in a clear and understandable form. Such 

10 procedures shall ensure that a specified health care pro11 vider has the opportunity to review the information that 

12 is to be made public with respect to the provider at least 

13 30 days prior to such data being made public and shall 

14 provide for an appeals process in the case a provider 

15 claims such information to be incorrect or incomplete. 

16 ‘‘(f) VALUE-BASED PURCHASING FOR PERIODS BE17 GINNING OCTOBER 1, 2013.— 

18 ‘‘(1) IN GENERAL.—Under the system, for peri19 ods beginning on or after October 1, 2013, and end20 ing before October 1, 2016, the Secretary shall es21 tablish and implement, a value-based purchasing 

22 program, with respect to specified health care pro23 viders that furnish treatment for breast cancer dur24 ing such a period, under which— 


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1 ‘‘(A) in the case of such a provider that 

2 does not submit data in accordance with the re3 porting process under subsection (d)(1) for 

4 such treatment furnished during such period, 

5 the Secretary shall reduce payment under this 

6 title for such treatment by an amount specified 

7 by the Secretary; and 

8 ‘‘(B) in the case of such a provider that 

9 submits data in accordance with the reporting 

10 process under subsection (d)(1) for such treat11 ment furnished during such period— 

12 ‘‘(i) subject to clause (ii), if the Sec13 retary determines such provider furnished 

14 low quality care (in accordance with a 

15 method specified by the Secretary) for 

16 such treatment, the Secretary shall reduce 

17 the amount that would otherwise be paid 

18 to such provider under this title for such 

19 treatment by an amount specified by the 

20 Secretary; 

21 ‘‘(ii) if the Secretary determines such 

22 provider furnished low quality care (in ac23 cordance with the method specified under 

24 clause (i)) for such treatment, but the 

25 quality of care has improved as compared 


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1 to the quality of care the provider fur2 nished during the previous period, the Sec3 retary shall reduce the amount that would 

4 otherwise be paid to such provider under 

5 this title for such treatment in accordance 

6 with an incremental method established by 

7 the Secretary that ensures that the amount 

8 of such reduction— 

9 ‘‘(I) is less than the amount 

10 specified by the Secretary under 

11 clause (i); and 

12 ‘‘(II) is based on the extent of 

13 improvement in the quality of care; 

14 and 

15 ‘‘(iii) if the Secretary determines such 

16 provider did not furnish low quality care 

17 (in accordance with the method specified 

18 under clause (i)) for such treatment, the 

19 Secretary shall provide to such provider 

20 the amount to be paid to such provider 

21 under this title for such treatment. 

22 ‘‘(2) RESULTS-BASED PAYMENTS.—The amount 

23 of a reduction under subparagraph (A) or (B)(i) of 

24 paragraph (1) shall be determined in accordance 

25 with a method established by the Secretary. 


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1 ‘‘(g) REPORTS.—Not later than October 1, 2011, and 

2 for each 6-month period thereafter (before fiscal year 

3 2017), the Secretary shall submit to Congress a report 

4 that evaluates the development and implementation of the 

5 system, including— 

6 ‘‘(1) an evaluation of the number of specified 

7 health care providers that submit data pursuant to 

8 subsection (c)(1); 

9 ‘‘(2) an analysis of the effect of such system on 

10 reducing disparities in the provision of breast cancer 

11 treatment to patients based on race, level of edu12 cation, income, and health insurance status of such 

13 patients; and 

14 ‘‘(3) recommendations on whether (and to what 

15 extent) to extend the system under this section. 

16 ‘‘(h) APPLICATION TO PART C.—The Secretary shall 

17 provide for a method to apply the provisions of this section 

18 to treatment furnished under a plan under part C.’’. 

Æ 


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