I 
111TH CONGRESS 
1ST SESSION H. R. 1776 
To amend title XVIII of the Social Security Act to expand the development 
of quality measures for inpatient hospital services, to implement a per-
formance-based payment methodology for the provision of such services 
under the Medicare Program, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
MARCH 30, 2009 
Mr. ALTMIRE introduced the following bill; which was referred to the 
Committee on Ways and Means 
A BILL 
To amend title XVIII of the Social Security Act to expand 
the development of quality measures for inpatient hos-
pital services, to implement a performance-based pay-
ment methodology for the provision of such services 
under the Medicare Program, and for other purposes. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Quality FIRST (From 
Incentives, Reporting, Standards, and Technology) Act of 
2009’’. 
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SEC. 2. EXPANSION OF REPORTING AND DEVELOPMENT OF 
QUALITY MEASURES FOR INPATIENT HOS-
PITAL SERVICES; IMPLEMENTATION OF PER-
FORMANCE-BASED 
PAYMENT 
UNDER 
THE 
PROSPECTIVE PAYMENT SYSTEM FOR SUCH 
SERVICES. 
(a) IN GENERAL.—Title XVIII of the Social Security 
Act (42 U.S.C. 1395 et seq.) is amended by inserting after 
section 1886 the following new section: 
‘‘PERFORMANCE-BASED PAYMENT SYSTEM FOR 
INPATIENT HOSPITAL SERVICES 
‘‘SEC. 1886A. (a) EXPANSION OF REPORTING AND 
DEVELOPMENT OF QUALITY MEASURES.— 
‘‘(1) REQUIREMENT
TO
REPORT
DATA
ON 
QUALITY
MEASURES.—For purposes of section 
1886(b)(3)(B)(i) for fiscal year 2010 and each sub-
sequent fiscal year before fiscal year 2014, in the 
case of a hospital that does not submit, to the Sec-
retary in accordance with this section, data required 
to be submitted on specified quality measures (as de-
fined in paragraph (4)(A)) with respect to such fis-
cal year, the applicable percentage increase under 
section 1886(b)(3)(B)(i) for such fiscal year shall be 
reduced by 2.0 percentage points (or 1.5, 1.0, and 
0.5 percentage points in the case of fiscal years 
2011, 2012, and 2013, respectively). 
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‘‘(2) APPLICATION
OF
REDUCTION
ONLY
TO 
FISCAL
YEAR
INVOLVED.—Any reduction under 
paragraph (1) shall apply only with respect to the 
fiscal year involved. The Secretary shall not take 
into account such reduction in computing the appli-
cable 
percentage 
increase 
under 
section 
1886(b)(3)(B)(i) for a subsequent fiscal year. 
‘‘(3) DATA SUBMISSION.—Each hospital shall 
submit to the Secretary the required data on speci-
fied quality measures under this section in the form 
and manner provided under subsection (h). 
‘‘(4) DEFINITIONS.—In this section: 
‘‘(A) The term ‘specified quality measures’ 
means quality measures— 
‘‘(i) specified under clause (vii)(II) of 
section 1886(b)(3)(B); 
‘‘(ii) selected under clause (viii) of 
such section; and 
‘‘(iii) selected under subsection (b). 
‘‘(B) The term ‘hospital’ means a sub-
section (d) hospital (as defined in section 
1886(d)(1)(B)). 
‘‘(b) ADDITION OF NEW QUALITY MEASURES.— 
‘‘(1) IN GENERAL.—In addition to the specified 
quality measures described in clauses (i) and (ii) of 
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subsection (a)(4)(A), the Secretary shall select under 
this subsection such quality measures as the Sec-
retary determines to be appropriate for the measure-
ment of the quality of care furnished by hospitals in 
inpatient settings. 
‘‘(2) EXPANSION
AND
REFINEMENT
OF
PER-
FORMANCE MEASURES.—Effective for payments be-
ginning with fiscal year 2009, in selecting additional 
quality measures under paragraph (1), the Secretary 
shall expand and revise the baseline set of perform-
ance 
measures 
adopted 
under 
section 
1886(b)(3)(B)(viii)(IV). Subject to the succeeding 
provisions of this subsection, the Secretary shall add 
such additional measures that reflect consensus 
among affected parties and, to the extent feasible 
and practicable, shall include measures set forth by 
one or more national consensus-building organiza-
tions (as defined in paragraph (4)(B)). 
‘‘(3) 
REQUIREMENT
FOR
EVIDENCE-BASED 
MEASURES.— 
‘‘(A) IN GENERAL.—With respect to fiscal 
year 2009 and each subsequent fiscal year, the 
Secretary may not add any quality measure 
under this subsection unless that quality meas-
ure— 
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‘‘(i) is evidence-based and statistically 
valid; 
‘‘(ii) subject to paragraph (7)(C), is 
endorsed by the National Quality Forum 
or such other similar consensus-building 
organization as the Secretary may des-
ignate; 
‘‘(iii) is recommended for use by the 
Hospital Quality Alliance; and 
‘‘(iv) has been sufficiently field tested, 
as provided in subparagraph (C), to ensure 
the measure is accurate and efficacious 
and to determine the resources required of 
a hospital to collect and report data on the 
measure. 
‘‘(B) PROHIBITION ON USE OF QUALITY 
MEASURE
FOR
PUBLIC
REPORTING
OR
PER-
FORMANCE-BASED
PAYMENT
UNLESS
EN-
DORSED AND RECOMMENDED.—A quality meas-
ure proposed to be added under this subsection 
may not be made available to the public under 
subsection (e) or otherwise, or used in the per-
formance-based payment program under sub-
section (f), before the date on which the meas-
ure has been endorsed as provided in subpara-
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graph (A)(ii) and recommended as provided in 
subparagraph (A)(iii). 
‘‘(C) FIELD TESTING.—The Secretary may 
not specify a measure under this paragraph for 
use in the determination of performance-based 
payments under this section unless there has 
been a field test of the measure for a period of 
not less than six months. For purposes of the 
preceding sentence, the term ‘field test’ means, 
with respect to a measure, the voluntary imple-
mentation of the measure by hospitals to test 
the feasibility, usefulness, and costs associated 
with implementing the measure, including— 
‘‘(i) validating the accuracy, precision, 
sensitivity, specificity, predictive value, and 
efficacy of the measure; 
‘‘(ii) determining whether the measure 
is useful for the internal quality improve-
ment efforts of hospitals; 
‘‘(iii) evaluating the training, staffing, 
and time required for data collection and 
submission; 
‘‘(iv) assessing the unintended con-
sequences, if any, associated with the use 
of the measure; 
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