Statements on Introduced Bills and Joint Resolutions
Floor Speech
STATEMENTS ON INTRODUCED BILLS AND JOINT RESOLUTIONS -- (Senate - November 16, 2007)
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Mr. DURBIN. Mr. President, we are all aware of the current healthcare crisis in our nation. Health care spending continues to rise at an unsustainable rate, constituting 16 percent of the Federal budget. Health care costs have increased 78 percent since 2001, more than 4 times the pace of prices and wages.
One reason for the rise in costs and spending is the increase in chronic disease. Heart disease, cancer, and diabetes are the leading causes of death and disability in the U.S. They also account for 70 percent of all deaths in the U.S., or 1.7 million people each year. These diseases also make life harder for the 1 of 10 Americans who are living with them. The irony, of course, is that chronic diseases are both preventable and manageable.
The quality of our healthcare has not changed substantially despite the fact that we live in the wealthiest country in the world with the best researchers and medical doctors at our fingertips. At a time when both health care costs and chronic illnesses are on the rise, we need a better way to provide care.
Changing the delivery of care is a controversial topic, but it is a topic that has gained more traction in recent months. Last week, the New York Times published an article titled, ``A Model for Health Care That Pays for Quality.'' The article described a new model for healthcare, and I quote here, ``to identify the best primary care doctors and to steer patients their way. Those doctors, in turn, would be paid for more services than are currently reimbursed under typical health plan payments for office visits. The idea is to encourage doctors to meet with patients for more than a few minutes during an office visit and to also compensate them, or nurse coordinators, for communicating with patients by phone and e-mail outside office hours.'' This is an approach to delivering care that national physician groups and patient advocacy organizations call the medical home.
A medical home is something that those of us who have it take for granted. We see the same doctor, in the same setting, for extended periods of time. Our medical history is in one place, and even if we are seeing specialists or different doctors in the same practice, there is continuity in decisions about our health care. This is a medical home.
But many people do not have this luxury. Think about people who move from place to place, whose home lives are less than stable, who don't have health insurance, whose medical care is sporadic. For these members of our community, each visit to a clinic or an emergency room means starting over again.
So, everyone should have access to a medical home. A medical home is not only a place, but an approach to providing comprehensive primary care that respects, and responds to, individual patient preferences and needs and helps patients develop relationships with their providers.
It sounds easy, but it requires some changes and creative thinking and, perhaps most importantly, it requires a commitment by local providers to work together. The medical home model makes sense for improving health care for everyone. It is a model of care that makes sense for stretching our limited Federal health care dollars.
States like Illinois and North Carolina are already seeing progress with implementing the medical home model. Illinois Health Connect is a new program at the Illinois Department of Healthcare and Family Services that uses the medical home model to deliver primary and preventive care for children and adults covered through the All Kids program. This emphasis on coordinated and ongoing care is leading to better health outcomes, and it's saving money.
Community Care of North Carolina launched a medical home model in 1998, through nine physician-led networks. North Carolina started by creating medical homes for 250,000 Medicaid enrollees. Today, it is a State-wide program that has saved the state at least $60 million in Medicaid costs in 2003 and $120 million in 2004.
Cost savings is not the only benefit. Several studies show that the medical home approach improves quality of care. Early analyses are finding that having regular access to a particular physician through the medical home is associated with earlier and more accurate diagnoses, fewer emergency room visits, fewer hospitalizations, lower costs, better care, and increased patient satisfaction. Many studies conclude that having both health insurance and a medical home leads to improved overall health for the entire population, which brings down the cost of care and reduces health care disparities.
Today, I am proud to be joined by my colleague Senator RICHARD BURR of North Carolina to introduce the Medical Homes Act of 2007. This bill would make it easier for other states to implement a medical home model, much like Illinois and North Carolina have. Congress passed a medical home demonstration project for Medicare last year. The Medical Homes Act of 2007 would do this for Medicaid and SCHIP beneficiaries by making Federal funding available for a demonstration project in 8 States to provide care through patient-centered medical homes.
The approach we propose requires a per-member, per-month care management fee to help pay for participating doctors and provides initial start-up funding for participating States. The startup funds are used for the purchase of health information technology, primary care case managers, and other uses appropriate for the delivery of patient-centered care.
If patients, provider, payers, and the government work together to create a system that values the patient more than payments and the health outcome of the patient more than the number of patients seen, we can really change the way primary care is provided. I urge my colleagues to support the Medical Homes Act of 2007 and help stabilize healthcare delivery for low-income and elderly Americans.
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Mr. DURBIN. Mr. President, today I am introducing legislation along with Senator OBAMA that will address some serious deficiencies we have found in the Veterans Administration's health care quality assurance efforts. Over the past several months, we have learned of problems in the hiring practices and quality of care at the veterans hospital in Marion, IL. What we have learned suggests that there are flaws that could equally affect the hiring and quality assurance programs in other VA hospitals.
The problems at Marion first came to light in August after the VA became aware that there had been an abnormal spike in deaths at the hospital the previous winter. A doctor was practicing at Marion even though a year earlier he had agreed to stop practicing medicine in Massachusetts. This fact came to light only after he had resigned from Marion because he was being sued for malpractice involving a case at Marion. It turned out that he had been involved in at least nine other cases at Marion in which the patient died, and he had been the subject of at least two malpractice settlements and a disciplinary action in Massachusetts before moving to Illinois.
The VA initiated an investigation and has taken steps to protect the patients at Marion. All but the most simple outpatient surgeries have been suspended, one doctor has resigned, four others have had their privileges restricted, and four top staff members have been temporarily reassigned.
The VA's Inspector General is conducting a thorough investigation and I am looking forward to considering his conclusions. But we know enough to take action now. And we must take action now because what happened at Marion may not be an isolated case. The same problems may exist at other VA hospitals as well.
The legislation we are introducing has three main objectives. First, it would improve the process of vetting doctors applying to and working in the VA. Second, it would expand the quality control programs in the VA health care system. And third, it would create incentives to encourage high-quality doctors to practice at veterans hospitals.
The VA's standards for evaluating employment applicants must be strengthened. When the doctor whose problematic service brought this issue to light was hired by the VA, he had two malpractice payments on his record, but he had only disclosed one to the VA. He was also under investigation by the Massachusetts medical board for gross incompetence in several cases that led to the deaths of patients. This was not disclosed to the VA.
Our legislation will fix this problem. It will require all physician applicants to the VA, and all doctors practicing in the VA, to disclose any judgments, settlements, disciplinary actions, and open investigations involving them. In addition, each doctor would be required to make a written request to the State medical board of any State in which they have held a license, requesting that the board release this same information to the VA.
Now, as a lawyer, I understand the caution that must be used when dealing with investigations that are not complete and judgments that are not final. But doctors and hospitals understand and work with confidential information all the time. VA officials with hiring authority will keep this information confidential and will be able to differentiate between a frivolous lawsuit and a case that should raise real concern. Before we entrust our Nation's veterans to a doctor, the VA should know all the pertinent information about that individual. Before the VA hires a physician, it should be required to examine this kind of information to make sure the physician should not be disqualified from employment in the VA.
In addition, our bill requires doctors employed by the VA to be licensed in the state in which they practice.
The bill's second objective is to improve the VA's quality assurance program. Our legislation would establish a quality assure officer at each VA medical facility, in each Veterans Integrated Service Network, VISN, region, and at the VA national headquarters. These officers would establish and carry out a quality assurance program at each VA medical facility.
Over the year and a half that this doctor practiced at Marion, at least a few of the nurses had concerns about his skills and competence and raised those concerns with the hospital leadership. They were ignored. This is absolutely unacceptable.
Concerns about the quality of care in a VA facility should never go unexamined. If local hospital officials will not listen, another avenue should be available for raising these concerns. Our legislation would allow employees to raise quality of care concerns to the local quality assurance officer and the regional quality assurance officer, ensuring that there is a place employees can go and know that their concerns will be considered.
In addition, we would require that the quality assurance program at each hospital include a mechanism for the peer review of physicians in the hospital. At Marion, it appears that any kind of peer review program that might have been present was either dormant or ignored. As a result, early warning signs were missed that might have saved lives.
Our measure would require that the quality assurance officers be licensed physicians, so that they will be qualified to monitor the performance of other doctors and ensure a fair but thorough peer review process is in place.
Finally, our legislation includes provisions to encourage talented doctors to practice in the VA system. We would direct each VA hospital to seek to affiliate with a nearby medical school so that our hospitals will have the benefit of the fresh, young minds of medical students and the more experienced judgments Of medical school faculty. These affiliations would introduce young doctors to the work of the VA, which might lead them to consider a career there. We also would create loan forgiveness and tuition reimbursement programs to encourage doctors to commit to practice in VA hospitals.
We also recognize that many experienced doctors might be willing to practice part-time in a VA hospital but would be unwilling to totally leave private practice. Our bill would instruct the VA to develop programs to increase the recruitment of experienced, quality doctors who might be willing to practice part-time in the VA health care system. It would also offer access to the federal employees health insurance program to doctors who are willing to practice at least five days per month in a VA medical facility.
This bill addresses very real issues that directly affect the health of our veterans. The VA's investigation of what went wrong at Marion may lead us to additional legislative initiatives, but the steps we have outlined in this bill are steps that need to be taken now to protect veterans in VA hospitals throughout the country.
This legislation has been endorsed by Veterans for America. I urge my colleagues to join in moving forward with this legislation to ensure that our veterans receive the quality of care they deserve.
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