‘‘(v) assessing issues relating to data 
quality (such as accuracy and completeness 
of data), comparability across hospitals, 
and data sources; and 
‘‘(vi) determining whether all data ele-
ments required on the measure are capable 
of being transmitted to the Secretary on a 
timely basis and evaluating the ability of 
automated data capture through health in-
formation technology systems. 
‘‘(4) REQUIREMENT FOR COLLABORATION WITH 
CONSENSUS ORGANIZATIONS.— 
‘‘(A) IN GENERAL.—With respect to fiscal 
year 2010 and each subsequent fiscal year, the 
Secretary shall collaborate with consensus- 
building organizations to develop new quality 
measures in each of the following areas of inpa-
tient hospital services: 
‘‘(i) Efficiency. 
‘‘(ii) Clinical effectiveness. 
‘‘(iii) Patient-centeredness. 
‘‘(iv) Care coordination. 
‘‘(v) Patient safety. 
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‘‘(vi) Performance in areas where the 
Secretary identifies a need for an appro-
priate quality measure. 
‘‘(B) 
CONSENSUS-BUILDING
ORGANIZA-
TION.—For purposes of this subsection, the 
term ‘consensus-building organization’ means 
an organization, such as the National Quality 
Forum, that the Secretary identifies as— 
‘‘(i) having experience in using a 
transparent process for reaching a group 
consensus with respect to measures relat-
ing to performance of hospitals providing 
inpatient hospital services; and 
‘‘(ii) including in such process rep-
resentatives of the Secretary, hospitals, 
physicians’ organizations, individuals enti-
tled to benefits under part A, experts in 
health care quality, experts in measure de-
velopment, organizations with experience in 
measure implementation, and individuals 
with experience in the delivery of health 
care in urban, rural, and frontier areas 
and to underserved populations and those 
who serve a disproportionate share of mi-
nority patients. 
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‘‘(5) ALTERNATIVE
MEASURES
FOR
PATIENT 
OUTCOMES AND EXPERIENCE.— 
‘‘(A) IN
GENERAL.—In addition to the 
quality measures for clinical process selected by 
the Secretary under section 1886(b)(3)(B)(viii), 
the Secretary shall consider alternative meth-
odologies to measure quality that reflect patient 
outcomes and patient experience of care meas-
ures. Of the alternative methodologies available 
for the consideration of the Secretary, quality 
measures under this paragraph shall be based 
on a set of criteria that include importance, fea-
sibility, scientific acceptability, improvability, 
usability, controllability, potential for unin-
tended consequences, and contribution to com-
prehensiveness. 
‘‘(B) RISK-ADJUSTMENT.—With respect to 
quality measures for outcomes of care, the Sec-
retary shall provide for an appropriate adjust-
ment for such risk factors as age, disability sta-
tus, gender, institutional status, and such other 
factors as the Secretary determines to be appro-
priate to maintain incentives for hospitals to 
treat patients with severe illnesses or condi-
tions. 
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‘‘(6) SUBMISSION OF DATA ON PROPOSED NEW 
QUALITY MEASURES.— 
‘‘(A) PRELIMINARY DATA SUBMISSION PE-
RIOD.—With respect to any proposed new qual-
ity measure identified by the Secretary as a 
possible addition to specified quality measures 
in effect, data that are required to be submitted 
by hospitals for that new quality measure shall 
be submitted for a preliminary period of such 
length as the Secretary may specify. 
‘‘(B) 
CONFIDENTIALITY
OF
INFORMA-
TION.—Any data submitted under subpara-
graph (A) during the preliminary data submis-
sion period shall be treated as a confidential 
submission of information and may not be made 
available to the public. 
‘‘(C) APPLICATION
TO
PERFORMANCE- 
BASED
PAYMENTS.—A new quality measure 
may not be incorporated in the performance- 
based payment program established under sub-
section (f) unless— 
‘‘(i) the preliminary data submission 
period under subparagraph (A) is com-
pleted; 
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‘‘(ii) the Secretary ensures that data 
have been made available to the public 
under subsection (e) for such period as the 
Secretary determines to be appropriate to 
provide adequate notice to the parties con-
cerned; and 
‘‘(iii) the requirements of paragraph 
(3) have been met. 
‘‘(7) ALIGNMENT
OF
INPATIENT
HOSPITAL 
QUALITY MEASURES WITH QUALITY MEASURES OF 
OTHER PROVIDERS AND SUPPLIERS.— 
‘‘(A) IN
GENERAL.—The Secretary shall 
ensure that the specified quality measures ap-
plicable to hospitals are coordinated with qual-
ity measures applicable to physicians under sec-
tion 1848(k) and with quality measures applica-
ble to other providers of services and suppliers 
under this title. 
‘‘(B) USE OF QUALITY MEASUREMENT DE-
VELOPMENT ORGANIZATIONS.—If the Secretary 
determines that there is evidence that a com-
plementary quality measure in a particular cir-
cumstance would improve the quality of patient 
care, the Secretary shall enter into arrange-
ments with quality measurement development 
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organizations for the development of com-
plementary quality measures for hospitals, phy-
sicians, and other providers of services and sup-
pliers. 
‘‘(C) CONDITION
FOR
SELECTION.—For 
purposes of paragraph (3), the Secretary may 
not accept the endorsement of a quality meas-
ure by the National Quality Forum or such 
other similar organization designated by the 
Secretary under paragraph (3)(A)(ii) unless the 
National Quality Forum or other organization 
has ensured the alignment of the quality meas-
ure for inpatient hospital services with one or 
more related quality measures for physicians’ 
services (if any). 
‘‘(c) DISCONTINUED USE OF MEASURES.— 
‘‘(1) AUTHORITY
TO
DISCONTINUE
USE
OF 
MEASURE.—The Secretary may terminate the use of 
a specified quality measure under this section if the 
Secretary determines that the continued use of the 
measure is inappropriate or unnecessary by reason 
of one or more of the following rationale: 
‘‘(A) A change in science, technology, or 
practice patterns. 
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‘‘(B) Subject to paragraph (2), a deter-
mination by the Secretary that hospitals have 
achieved uniformly high performance with re-
spect to that measure (commonly referred to as 
a ‘topped out measure’). 
‘‘(C) A determination by the Secretary 
that the measure has been subsequently shown 
not to represent the best clinical practice. 
‘‘(D) Such other considerations as the Sec-
retary determines to be appropriate. 
‘‘(2) PROVISIONS RELATING TO TOPPED OUT 
MEASURES.— 
‘‘(A) CONTINUED
REPORTING.—In the 
case of a specified quality measure referred to 
in paragraph (1)(B), the Secretary shall require 
the submission of data from hospitals on such 
a measure notwithstanding that such measures 
shall not be used for purposes of the perform-
ance-based payment program under subsection 
(f). 
‘‘(B) REVIEW
OF
HOSPITAL
PERFORM-
ANCE.—In the case of a specified quality meas-
ure referred to in paragraph (1)(B), the Sec-
retary shall monitor performance of hospitals 
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on such measure to ensure that hospitals main-
tain high levels of performance. 
‘‘(C) AUTHORITY TO REINSTATE.— 
‘‘(i) IN GENERAL.—Subject to clause 
(ii), for purposes of the performance-based 
payment program under subsection (f), the 
Secretary may reinstate the use of a speci-
fied quality measure referred to in para-
graph (1)(B) that has been terminated 
under paragraph (1) if the Secretary deter-
mines that a significant percentage of hos-
pitals fails to meet the performance thresh-
old for that quality measure. 
‘‘(ii) NOTICE.—The authority under 
clause (i) shall not apply before the conclu-
sion of a period, of not less than one year, 
of notice to the public indicating the intent 
of the Secretary to reinstate such specified 
quality measure. 
‘‘(3) REGULAR
REVIEW
OF
MEASURES.—The 
Secretary shall periodically reassess specified quality 
measures to determine whether the continued use of 
such measures is appropriate and necessary for pur-
poses of public reporting under subsection (e) and 
performance-based payment under subsection (f). 
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‘‘(d) DEVELOPMENT OF COMPOSITE MEASURES.— 
‘‘(1) IN GENERAL.—The Secretary shall com-
bine individual specified quality measures into com-
posite measures that assess the overall quality of 
care for a clinical condition or in a performance 
area. 
‘‘(2) CONSIDERATIONS.—In carrying out para-
graph (1), the Secretary shall— 
‘‘(A) evaluate the adequacy of individual 
specified quality measures in each significant 
clinical condition or performance area, including 
the validity of such measures for the creation of 
a composite measure; and 
‘‘(B) determine the best methodology to re-
port composite quality measures for those areas 
of clinical practice with a limited number of 
specified quality measures, including how to in-
corporate such composite measures in the per-
formance-based payment program under sub-
section (f). 
‘‘(e) PUBLIC REPORTING.— 
‘‘(1) CONTINUATION OF PUBLIC REPORTING RE-
QUIREMENTS.—Procedures established under sub-
clause (VII) of section 1886(b)(3)(B)(viii) for mak-
ing data submitted by a hospital under subclause (I) 
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of such section available to the public shall, as modi-
fied by the succeeding provisions of this subsection, 
apply to data required to be submitted under this 
section on all specified quality measures. 
‘‘(2) GENERAL REPORTING REQUIREMENTS.— 
The Secretary shall report quality measures of proc-
ess, structure, outcome, patient perspectives on care, 
efficiency, and costs of care that relate to services 
furnished in inpatient hospital settings on the Hos-
pital Compare Internet website maintained by the 
Department of Health and Human Services. 
‘‘(3) PROMPT DISSEMINATION OF INFORMATION 
ON QUALITY.—The Secretary shall review ways in 
which information on the quality of inpatient hos-
pital services can be used more effectively by hos-
pitals to increase the quality of patient care and to 
improve performance in the delivery of inpatient hos-
pital services. The Secretary shall provide for the 
dissemination of appropriate and timely quality in-
formation to such hospitals in a manner that most 
effectively contributes to continuous quality improve-
ment by the hospitals. 
‘‘(4) DISSEMINATION
ON
QUALITY
INFORMA-
TION TO PATIENTS.— 
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‘‘(A) IN
GENERAL.—The Secretary shall 
make available to the public information on the 
quality of inpatient hospital services provided 
by hospitals to patients in a manner that facili-
tates informed and balanced decisionmaking by 
patients and physicians. 
‘‘(B) REQUIREMENTS
FOR
COMPARATIVE 
INFORMATION.—Insofar as the Secretary makes 
information on the quality of inpatient hospital 
services provided by hospitals to patients avail-
able for purposes of comparison among hos-
pitals, the Secretary shall only present such in-
formation by specific clinical condition or per-
formance area and may not aggregate results 
across clinical conditions or performance areas 
or otherwise make available information indi-
cating an overall ranking of hospitals. 
‘‘(5) WEBSITE IMPROVEMENTS.— 
‘‘(A) TAILORED
STANDARD
REPORTS.— 
The Secretary shall develop a series of standard 
Internet website reports tailored to respond to 
the differing needs of hospitals, patients, re-
searchers, policymakers, and such other stake-
holders as the Secretary may identify. The Sec-
retary shall seek input from such stakeholders 
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