Index for HR3962: Affordable Health Care for America Act

To provide affordable, quality health care for all Americans and reduce the growth in health care spending, and for other purposes.

Mr. Dingell (for himself, Mr. Rangel, Mr. Waxman, Mr. George Miller of California, Mr. Stark, Mr. Pallone, and Mr. Andrews) introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, Education and Labor, Oversight and Government Reform, and the Budget, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned

Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled,

(a) In general.—Title IX of the Public Health Service Act (42 U.S.C. 299 et seq.) is amended—

(1) by redesignating part D as part E;

(2) by redesignating sections 931 through 938 as sections 941 through 948, respectively;

(3) in section 948(1), as redesignated, by striking “931” and inserting “941”; and

(4) by inserting after part C the following:

“(a) In general.—There is established the Center for Quality Improvement (referred to in this part as the ‘Center’), to be headed by the Director.

“(b) Prioritization.—

“(1) IN GENERAL.—The Director shall prioritize areas for the identification, development, evaluation, and implementation of best practices (including innovative methodologies and strategies) for quality improvement activities in the delivery of health care services (in this section referred to as ‘best practices’).

“(2) CONSIDERATIONS.—In prioritizing areas under paragraph (1), the Director shall consider—

“(A) the priorities established under section 1191 of the Social Security Act; and

“(B) the key health indicators identified by the Assistant Secretary for Health Information under section 1709.

“(3) LIMITATIONS.—In conducting its duties under this subsection, the Center for Quality Improvement shall not develop quality-adjusted life year measures or any other methodologies that can be used to deny benefits to a beneficiary against the beneficiary’s wishes on the basis of the beneficiary’s age, life expectancy, present or predicted disability, or expected quality of life.

“(c) Other responsibilities.—The Director, acting directly or by awarding a grant or contract to an eligible entity, shall—

“(1) identify existing best practices under subsection (e);

“(2) develop new best practices under subsection (f);

“(3) evaluate best practices under subsection (g);

“(4) implement best practices under subsection (h);

“(5) ensure that best practices are identified, developed, evaluated, and implemented under this section consistent with standards adopted by the Secretary under section 3004 for health information technology used in the collection and reporting of quality information (including for purposes of the demonstration of meaningful use of certified electronic health record (EHR) technology by physicians and hospitals under the Medicare program (under sections 1848(o)(2) and 1886(n)(3), respectively, of the Social Security Act)); and

“(6) provide for dissemination of information and reporting under subsections (i) and (j).

“(d) Eligibility.—To be eligible for a grant or contract under subsection (c), an entity shall—

“(1) be a nonprofit entity;

“(2) agree to work with a variety of institutional health care providers, physicians, nurses, and other health care practitioners; and

“(3) if the entity is not the organization holding a contract under section 1153 of the Social Security Act for the area to be served, agree to cooperate with and avoid duplication of the activities of such organization.

“(e) Identifying existing best practices.—The Director shall identify best practices that are—

“(1) currently utilized by health care providers (including hospitals, physician and other clinician practices, community cooperatives, and other health care entities) that deliver consistently high-quality, efficient health care services; and

“(2) easily adapted for use by other health care providers and for use across a variety of health care settings.

“(f) Developing new best practices.—The Director shall develop best practices that are—

“(1) based on a review of existing scientific evidence;

“(2) sufficiently detailed for implementation and incorporation into the workflow of health care providers; and

“(3) designed to be easily adapted for use by health care providers across a variety of health care settings.

“(g) Evaluation of best practices.—The Director shall evaluate best practices identified or developed under this section. Such evaluation—

“(1) shall include determinations of which best practices—

“(A) most reliably and effectively achieve significant progress in improving the quality of patient care; and

“(B) are easily adapted for use by health care providers across a variety of health care settings;

“(2) shall include regular review, updating, and improvement of such best practices; and

“(3) may include in-depth case studies or empirical assessments of health care providers (including hospitals, physician and other clinician practices, community cooperatives, and other health care entities) and simulations of such best practices for determinations under paragraph (1).

“(h) Implementation of best practices.—

“(1) IN GENERAL.—The Director shall enter into arrangements with entities in a State or region to implement best practices identified or developed under this section. Such implementation—

“(A) may include forming collaborative multi-institutional teams; and

“(B) shall include an evaluation of the best practices being implemented, including the measurement of patient outcomes before, during, and after implementation of such best practices.

“(2) PREFERENCES.—In carrying out this subsection, the Director shall give priority to health care providers implementing best practices that—

“(A) have the greatest impact on patient outcomes and satisfaction;

“(B) are the most easily adapted for use by health care providers across a variety of health care settings;

“(C) promote coordination of health care practitioners across the continuum of care; and

“(D) engage patients and their families in improving patient care and outcomes.

“(i) Public dissemination of information.—The Director shall provide for the public dissemination of information with respect to best practices and activities under this section. Such information shall be made available in appropriate formats and languages to reflect the varying needs of consumers and diverse levels of health literacy.

“(j) Report.—

“(1) IN GENERAL.—The Director shall submit an annual report to the Congress and the Secretary on activities under this section.

“(2) CONTENT.—Each report under paragraph (1) shall include—

“(A) information on activities conducted pursuant to grants and contracts awarded;

“(B) summary data on patient outcomes before, during, and after implementation of best practices; and

“(C) recommendations on the adaptability of best practices for use by health providers.”.

(b) Initial quality improvement activities and initiatives To be implemented.—Until the Director of the Agency for Healthcare Research and Quality has established initial priorities under section 931(b) of the Public Health Service Act, as added by subsection (a), the Director shall, for purposes of such section, prioritize the following:

(1) HEALTH CARE-ASSOCIATED INFECTIONS.—Reducing health care-associated infections, including infections in nursing homes and outpatient settings.

(2) SURGERY.—Increasing hospital and outpatient perioperative patient safety, including reducing surgical-site infections and surgical errors (such as wrong-site surgery and retained foreign bodies).

(3) EMERGENCY ROOM.—Improving care in hospital emergency rooms, including through the use of principles of efficiency of design and delivery to improve patient flow.

(4) OBSTETRICS.—Improving the provision of obstetrical and neonatal care, including the identification of interventions that are effective in reducing the risk of preterm and premature labor and the implementation of best practices for labor and delivery care.

(5) PEDIATRICS.—Improving the provision of preventive and developmental child health services, including interventions that can reduce child health disparities (as defined in section 3171 of the Public Health Service Act, as added by section 2301) and reduce the risk of developing chronic health-threatening conditions that affect an individual’s life course development.

(c) Report.—Not later than 18 months after the date of the enactment of this Act, the Director of the Agency for Healthcare Research and Quality shall submit a report to the Congress on the impact of the nurse-to-patient ratio on the quality of care and patient outcomes, including recommendations for further integration into quality measurement and quality improvement activities.