I have had a gnawing concern that the Quality rubric of HR 3200 and now of HR 3962 is a wolf in sheep's closing for rationing in the Medicare Section of the Bill. Let me reiterate what the current Bills states, and it is worth comparing with what I said last July on the same matter.
The Bill states:
Subtitle C—Quality Measurements
SEC. 1441. ESTABLISHMENT OF NATIONAL PRIORITIES FOR QUALITY IMPROVEMENT. Title XI of the Social Security Act, as amended by section 1401(a), is further amended by adding at the end the following new part:
PART E—QUALITY IMPROVEMENT ESTABLISHMENT OF NATIONAL PRIORITIES FOR PERFORMANCE IMPROVEMENT
SEC. 1191. (a) ESTABLISHMENT OF NATIONAL PRIORITIES BY THE SECRETARY.—The Secretary shall establish and periodically update, not less frequently than triennially, national priorities for performance improvement.
(b) RECOMMENDATIONS FOR NATIONAL PRIORITIES.—In establishing and updating national priorities under subsection (a), the Secretary shall solicit and consider recommendations from multiple outside stake holders.
(c) CONSIDERATIONS IN SETTING NATIONAL PRIORITIES.—With respect to such priorities, the Secretary shall ensure that priority is given to areas in the delivery of health care services in the United States that—
(1) contribute to a large burden of disease, including those that address the health care provided to patients with prevalent, high-cost chronic dis eases;
(2) have the greatest potential to decrease morbidity and mortality in this country, including those that are designed to eliminate harm to patients;
(3) have the greatest potential for improving the performance, affordability, and patient centeredness of health care, including those due to variations in care;
(4) address health disparities across groups and areas; and
(5) have the potential for rapid improvement due to existing evidence, standards of care or other reasons.
(d) DEFINITIONS.—In this part:
(1) CONSENSUS-BASED ENTITY.—The term ‘consensus-based entity’ means an entity with a contract with the Secretary under section 1890.
(2) QUALITY MEASURE.—The term ‘quality measure’ means a national consensus standard for measuring the performance and improvement of population health, or of institutional providers of services, physicians, and other health care practitioners in the delivery of health care services.
Yet when one looks at who gets to opine on quality it is:
SEC. 1192. DEVELOPMENT OF NEW QUALITY MEASURES.
(a) AGREEMENTS WITH QUALIFIED ENTITIES.—
(1) IN GENERAL.—The Secretary shall enter into agreements with qualified entities to develop quality measures for the delivery of health care services in the United States.
(2) FORM OF AGREEMENTS.—The Secretary may carry out paragraph (1) by contract, grant, or otherwise.
(3) RECOMMENDATIONS OF CONSENSUS BASED ENTITY.—In carrying out this section, the Secretary shall—
(A) seek public input; and
(B) take into consideration recommendations of the consensus-based entity with a contract with the Secretary under section 1890(a).
(b) DETERMINATION OF AREAS WHERE QUALITY MEASURES ARE REQUIRED.—Consistent with the national priorities established under this part and with the programs administered by the Centers for Medicare & Medicaid Services and in consultation with other relevant Federal agencies, the Secretary shall determine areas in which quality measures for assessing health care services in the United States are needed.
and it continues:
(6) MULTI-STAKEHOLDER GROUPS.—For purposes of this subsection, the term ‘multi-stakeholder groups’ means, with respect to a quality measure, a voluntary collaborative of organizations representing persons interested in or affected by the use of such quality measure, such as the following:
(A) Hospitals and other institutional providers.
(B) Physicians.
(C) Health care quality alliances.
(D) Nurses and other health care practitioners.
(E) Health plans.
(F) Patient advocates and consumer groups.
(G) Employers.
(H) Public and private purchasers of health care items and services.
(I) Labor organizations.
(J) Relevant departments or agencies of the United States.
(K) Biopharmaceutical companies and manufacturers of medical devices.
(L) Licensing, credentialing, and accrediting bodies.
Thus again no direct involvement of patients. If all else fails please listen to your customer. They have every possible influencing group in this mix! Pork anyone?
The Bill states:
Subtitle C—Quality Measurements
SEC. 1441. ESTABLISHMENT OF NATIONAL PRIORITIES FOR QUALITY IMPROVEMENT. Title XI of the Social Security Act, as amended by section 1401(a), is further amended by adding at the end the following new part:
PART E—QUALITY IMPROVEMENT ESTABLISHMENT OF NATIONAL PRIORITIES FOR PERFORMANCE IMPROVEMENT
SEC. 1191. (a) ESTABLISHMENT OF NATIONAL PRIORITIES BY THE SECRETARY.—The Secretary shall establish and periodically update, not less frequently than triennially, national priorities for performance improvement.
(b) RECOMMENDATIONS FOR NATIONAL PRIORITIES.—In establishing and updating national priorities under subsection (a), the Secretary shall solicit and consider recommendations from multiple outside stake holders.
(c) CONSIDERATIONS IN SETTING NATIONAL PRIORITIES.—With respect to such priorities, the Secretary shall ensure that priority is given to areas in the delivery of health care services in the United States that—
(1) contribute to a large burden of disease, including those that address the health care provided to patients with prevalent, high-cost chronic dis eases;
(2) have the greatest potential to decrease morbidity and mortality in this country, including those that are designed to eliminate harm to patients;
(3) have the greatest potential for improving the performance, affordability, and patient centeredness of health care, including those due to variations in care;
(4) address health disparities across groups and areas; and
(5) have the potential for rapid improvement due to existing evidence, standards of care or other reasons.
(d) DEFINITIONS.—In this part:
(1) CONSENSUS-BASED ENTITY.—The term ‘consensus-based entity’ means an entity with a contract with the Secretary under section 1890.
(2) QUALITY MEASURE.—The term ‘quality measure’ means a national consensus standard for measuring the performance and improvement of population health, or of institutional providers of services, physicians, and other health care practitioners in the delivery of health care services.
Yet when one looks at who gets to opine on quality it is:
SEC. 1192. DEVELOPMENT OF NEW QUALITY MEASURES.
(a) AGREEMENTS WITH QUALIFIED ENTITIES.—
(1) IN GENERAL.—The Secretary shall enter into agreements with qualified entities to develop quality measures for the delivery of health care services in the United States.
(2) FORM OF AGREEMENTS.—The Secretary may carry out paragraph (1) by contract, grant, or otherwise.
(3) RECOMMENDATIONS OF CONSENSUS BASED ENTITY.—In carrying out this section, the Secretary shall—
(A) seek public input; and
(B) take into consideration recommendations of the consensus-based entity with a contract with the Secretary under section 1890(a).
(b) DETERMINATION OF AREAS WHERE QUALITY MEASURES ARE REQUIRED.—Consistent with the national priorities established under this part and with the programs administered by the Centers for Medicare & Medicaid Services and in consultation with other relevant Federal agencies, the Secretary shall determine areas in which quality measures for assessing health care services in the United States are needed.
and it continues:
(6) MULTI-STAKEHOLDER GROUPS.—For purposes of this subsection, the term ‘multi-stakeholder groups’ means, with respect to a quality measure, a voluntary collaborative of organizations representing persons interested in or affected by the use of such quality measure, such as the following:
(A) Hospitals and other institutional providers.
(B) Physicians.
(C) Health care quality alliances.
(D) Nurses and other health care practitioners.
(E) Health plans.
(F) Patient advocates and consumer groups.
(G) Employers.
(H) Public and private purchasers of health care items and services.
(I) Labor organizations.
(J) Relevant departments or agencies of the United States.
(K) Biopharmaceutical companies and manufacturers of medical devices.
(L) Licensing, credentialing, and accrediting bodies.
Thus again no direct involvement of patients. If all else fails please listen to your customer. They have every possible influencing group in this mix! Pork anyone?
Posts
