Wired for Health Care Quality Act

Floor Speech

WIRED FOR HEALTH CARE QUALITY ACT -- (Senate - August 03, 2007)

Mr. GRASSLEY. Mr. President, I want to take a few minutes to explain the action I am taking related to S. 1693, the Wired for Health Care Quality Act. Today, with great reluctance, I have asked Republican Leader McConnell to consult with us prior to any action regarding the consideration of this bill, which the Health, Education, Labor, and Pensions Committee reported on August 1, 2007.

The Wired for Health Care Quality Act would encourage the development of interoperable standards for health information technology, IT, offer incentives for providers to acquire qualified health IT systems to improve the quality and efficiency of health care, and facilitate the secure exchange of electronic health information. The bill also includes provisions to require all federal agencies to comply with standards and specifications adopted by the Federal Government for purposes determined appropriate by the Secretary of Health and Human Services, HHS, and to ensure quality measurement and reporting of provider performance under the Public Health Service Act.

I fully support fostering the adoption of health information technology to assist providers in making quality improvements in our health care system. In 2005, Senator Baucus and I introduced the Medicare Value Purchasing Act, S. 1356, in conjunction with Senators ENZI and KENNEDY's legislation known as the Better Healthcare Through Information Technology Act, S. 1355. Although the Medicare Value Purchasing Act did not pass in its entirety, provisions based on our bill have been enacted in other legislation.

Medicare is the single largest purchaser of health care in the Nation, so adopting quality payments in Medicare influences the level of quality in all of health care. We have seen time and time again how when Medicare leads, the other public and private purchasers follow. Medicare can drive quality improvement through payment incentives. The adoption of information technology is also desirable, both to facilitate the reporting of quality measures and to increase the efficiency and quality of our health care system. These two concepts should work together.

A number of legislative initiatives have been enacted in Medicare in recent years to promote the development and reporting of quality measures. The Medicare Prescription Drug, Improvement, and Modernization Act of 2003, MMA, included provisions that required the reporting of quality measures for inpatient hospitals. The Deficit Reduction Act of 2005 expanded the reporting of quality measures for inpatient hospital services and extended quality measures to home health settings.

Last year, the Tax Relief and Health Care Act of 2006, TRHCA, extended quality measure reporting to hospital outpatient services and ambulatory service centers. TRHCA also authorized the 2007 Physician Quality Reporting Initiative, PQRI, a voluntary quality reporting system in Medicare for physicians and other eligible health care professionals. Beginning July 1, 2007, the new PQRI program provides Medicare incentive payments for the successful reporting of quality measures that have been adopted or endorsed by a consensus organization. The Centers for Medicare and Medicaid Services, CMS, has worked diligently with the American Medical Association Physician Consortium for Performance Improvement, the Ambulatory Quality Alliance, and the National Quality Forum in the development, adoption, endorsement, and selection of quality measures for this program.

Considerable time and effort have been devoted to the development and reporting of quality measures for various providers in Medicare under the Social Security Act. Many of these programs have now been up and running for some time. This is why I am greatly troubled that, as currently drafted, the Wired for Health Care Quality Act would require the development and reporting of quality measures under the Public Health Service Act.

It is hard to comprehend how the quality measurement system created by S. 1693 would interact with the various quality measurement programs that have already been enacted by Congress under the Social Security Act and implemented by CMS. Creating two different quality measurement systems would have the potential to create differing or even duplicative quality measurement systems which could drastically interfere with our common goal of improving the quality of health care in this country.

Under the bill, the Secretary also would establish Federal standards and implementation specifications for data collection. Within three years of their adoption, all Federal agencies would have to implement these standards according to the specifications. While this sounds appealing, I am concerned about the reality of implementing such standards--across the myriad programs at the Departments of Health and Human Services, Veterans Affairs, Defense, and all the other Federal agencies that may have health care data. It would be an enormous challenge. Agencies collect data for many different purposes, using many different data systems. Six years ago, when Secretary Thompson first arrived at the Department of Health and Human Services, the department had eight different computer systems. Presumably other agencies similarly have multiple systems. All will be expensive and difficult to retrofit to meet new federal standards.

The bill also would require the HHS Secretary to provide federal health data, including the Medicare claims databases, to at least three ``Quality Reporting Organizations'' that agreed to provide public reports based on the data.

The Quality Reporting Organizations would be required to release regular reports on quality performance that are provider- and supplier-specific. Any organization, including those with commercial interests, could request that the Quality Reporting Organizations compile specific reports based on the requester's methodology. So, for example, drug companies could request data on physician prescribing patterns to determine which physicians their salespeople should target.

In overseeing Medicare, Congress is working to bring more quality reporting into the program. As I mentioned before, just this past December Congress enacted the Tax Relief and Health Care Act of 2006, which implemented a physician pay-for-reporting program in Medicare. The Finance Committee has been working for some time now to phase-in the use of quality measures with various providers. Eventually, I hope that Medicare can compensate providers appropriately for providing high-quality care.

I am, however, concerned about public disclosure of provider-specific information without appropriate safeguards. If not used properly, the data could be misinterpreted. For example, hospitals that specialize in very difficult cases might seem to provide lower quality of care than those treating less severe cases. This would set up the wrong incentives for hospitals and other health care providers.

I agree that it would be helpful to standardize data reporting throughout the federal government, and to use that data appropriately to assess the quality of care provided by clinicians, hospitals, and other health care organizations. At the same time, I have serious concerns about how this bill is structured with respect to the disclosure and use of the data from federal health entitlement programs which are within the sole jurisdiction of the Finance Committee.

I welcome the opportunity to work with the sponsors of S. 1693, Senators KENNEDY, ENZI, CLINTON, and HATCH, along with members of the Health, Education, Labor, and Pensions Committee on this matter. I had hoped we could work out an agreement on legislative language that was acceptable to both the Finance Committee and the HELP Committee before the bill was on the floor. I appreciate the efforts that my colleagues, Senators ENZI and KENNEDY, have undertaken with us over the last month to resolve the concerns of the Finance Committee. However, I remain deeply troubled that, as currently drafted, the Wired for Health Care Quality Act could end up unintentionally delaying or frustrating the goal we all share of improving the quality of health care for all Americans.

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