Graduate Medical Education Reform Act of 2012 - Amends title XVIII (Medicare) of the Social Security Act to direct the Secretary of Health and Human Services (HHS) to establish and implement procedures under which, beginning in FY2017, the amount of payments that a hospital would otherwise receive for indirect graduate medical education (GME) costs for discharges during a fiscal year is adjusted based on the hospital's performance on measures of patient care priorities.
Requires the Secretary to specify measures of patient care priorities, including the extent of training provided in: (1) the delivery of services categorized as evaluation and management codes by the Centers for Medicare and Medicaid Services, (2) a variety of settings and systems, (3) the coordination of patient care across settings, (4) the relevant cost and value of various diagnostic and treatment options, (5) interprofessionality and multidisciplinary care teams, (6) methods for identifying system errors and implementing system solutions, and (7) the use of health information technology.
Requires such measures of patient care to be: (1) adopted or endorsed by an accrediting organization, and (2) consensus-based. Allows such measures to include any submitted by teaching hospitals, medical schools, and other stakeholders.
Directs the Secretary to report to Congress and the National Health Care Workforce Commission on the GME payments hospitals receive under Medicare.
[Congressional Bills 112th Congress]
[From the U.S. Government Publishing Office]
[S. 3201 Introduced in Senate (IS)]
112th CONGRESS
2d Session
S. 3201
To reform graduate medical education payments, and for other purposes.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
May 17, 2012
Mr. Reed (for himself and Mr. Kyl) introduced the following bill; which
was read twice and referred to the Committee on Finance
_______________________________________________________________________
A BILL
To reform graduate medical education payments, and for other purposes.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Graduate Medical Education Reform
Act of 2012''.
SEC. 2. MEDICARE INDIRECT MEDICAL EDUCATION PERFORMANCE ADJUSTMENT.
Section 1886 of the Social Security Act (42 U.S.C. 1395ww) is
amended by adding at the end the following new subsection:
``(t) Indirect Medical Education Performance Adjustments.--
``(1) In general.--Subject to the succeeding provisions of
this subsection, the Secretary shall establish and implement
procedures under which the amount of payments that a hospital
(as defined in paragraph (11)(A)) would otherwise receive for
indirect medical education costs under subsection (d)(5)(B) for
discharges occurring during a fiscal year is adjusted based on
the reporting of measures and the performance of the hospital
on measures of patient care priorities specified by the
Secretary.
``(2) Adjustments to begin in fiscal year 2017.--The
adjustments shall apply to payments for discharges occurring--
``(A) with respect to the adjustments for reporting
under paragraph (8)(A), during fiscal year 2017; and
``(B) with respect to the adjustments for
performance under paragraph (8)(B), on or after October
1, 2017.
``(3) Measures.--The measures of patient care priorities
specified by the Secretary under this subsection shall include
the extent of training provided in--
``(A) the delivery of services categorized as
evaluation and management codes by the Centers for
Medicare & Medicaid Services;
``(B) a variety of settings and systems;
``(C) the coordination of patient care across
settings;
``(D) the relevant cost and value of various
diagnostic and treatment options;
``(E) interprofessional and multidisciplinary care
teams;
``(F) methods for identifying system errors and
implementing system solutions; and
``(G) the use of health information technology.
``(4) Measure development process.--
``(A) In general.--The measures of patient care
specified by the Secretary under this subsection--
``(i) shall--
``(I) be measures that have been
adopted or endorsed by an accrediting
organization (such as the Accreditation
Council for Graduate Medical Education
or the Commission on Osteopathic
College Accreditation); and
``(II) be measures that the
Secretary identifies as having used a
consensus-based process for developing
such measures; and
``(ii) may include measures that have been
submitted by teaching hospitals, medical
schools, and other stakeholders.
``(B) Proposed set of initial measures.--Not later
than July 1, 2014, the Secretary shall publish in the
Federal Register a proposed initial set of measures for
use under this subsection. The Secretary shall provide
for a period of public comment on such measures.
``(C) Final set of initial measures.--Not later
than January 1, 2015, the Secretary shall publish in
the Federal Register the set of initial measures to be
specified by the Secretary for use under this
subsection.
``(D) Update of measures.--The Secretary may,
through notice and comment rulemaking, periodically
update the measures specified under this subsection
pursuant to the requirements under subparagraph (A).
``(5) Performance standards.--The Secretary shall establish
performance standards with respect to measures specified by the
Secretary under this subsection for a performance period for a
fiscal year (as established under paragraph (6)).
``(6) Performance period.--The Secretary shall establish
the performance period for a fiscal year. Such performance
period shall begin and end prior to the beginning of such
fiscal year.
``(7) Reporting of measures.--The procedures established
and implemented under paragraph (1) shall include a process
under which hospitals shall submit data on the measures
specified by the Secretary under this subsection to the
Secretary in a form and manner, and at a time, specified by the
Secretary for purposes of this subsection.
``(8) Adjustments.--
``(A) Reporting for fiscal year 2017.--For fiscal
year 2017, in the case of a hospital that does not
submit, to the Secretary in accordance with this
subsection, data required to be submitted under
paragraph (7) for a period (determined appropriate by
the Secretary) for such fiscal year, the total amount
that the hospital would otherwise receive under
subsection (d)(5)(B) for discharges in such fiscal year
shall be reduced by 0.5 percent.
``(B) Performance for fiscal year 2018 and
subsequent fiscal years.--
``(i) In general.--Subject to clause (ii),
based on the performance of each hospital with
respect to compliance with the measures for a
performance period for a fiscal year (beginning
with fiscal year 2018), the Secretary shall
determine the amount of any adjustment under
this subparagraph to payments to the hospital
under subsection (d)(5)(B) for discharges in
such fiscal year. Such adjustment may not
exceed an amount equal to 3 percent of the
total amount that the hospital would otherwise
receive under such subsection for discharges in
such fiscal year.
``(ii) Budget neutral.--In making
adjustments under this subparagraph, the
Secretary shall ensure that the total amount of
payments made to all hospitals under subsection
(d)(5)(B) for discharges in a fiscal year is
equal to the total amount of payments that
would have been made to such hospitals under
such subsection for discharges in such fiscal
year if this subsection had not been enacted.
``(9) No effect in subsequent fiscal years.--Any adjustment
under subparagraph (A) or (B) of paragraph (8) shall apply only
with respect to the fiscal year involved, and the Secretary
shall not take into account any such adjustment in making
payments to a hospital under this section in a subsequent
fiscal year.
``(10) Evaluation of submission of performance measures.--
Not later January 1, 2017, the Secretary shall submit to
Congress a report on the implementation of this subsection,
including--
``(A) the measure development procedures, including
any barriers to measure development;
``(B) the compliance with reporting on the
performance measures, including any barriers to such
compliance; and
``(C) recommendations to address any barriers
described in subparagraph (A) or (B).
``(11) Definition of hospital.--In this subsection, the
term `hospital' means a hospital the receives payments under
subsection (d)(5)(B).''.
SEC. 3. INCREASING GRADUATE MEDICAL EDUCATION TRANSPARENCY.
(a) In General.--Not later than 2 years after the date of the
enactment of this Act, and annually thereafter, the Secretary of Health
and Human Services shall submit to Congress and the National Health
Care Workforce Commission a report on the graduate medical education
payments that hospitals receive under the Medicare program. The report
shall include the following information with respect to each hospital
that receives such payments:
(1) The direct graduate medical education payments made to
the hospital under section 1886(h) of the Social Security Act
(42 U.S.C. 1395ww(h)).
(2) The total costs of direct graduate medical education to
the hospital as reported on the annual Medicare Cost Reports.
(3) The indirect medical education payments made to the
hospital under section 1886(d)(5)(B) of such Act (42 U.S.C.
1395ww(d)(1)(B)).
(4) The number of full-time-equivalent residents counted
for purposes of making the payments described in paragraph (1).
(5) The number of full-time-equivalent residents counted
for purposes of making the payments described in paragraph (3).
(6) The number of full-time-equivalent residents, if any,
that are not counted for purposes of making payments described
in paragraph (1).
(7) The number of full-time-equivalent residents, if any,
that are not counted for purposes of making payments described
in paragraph (3).
(8) The factors contributing to the higher costs of patient
care provided by the hospital, including--
(A) the costs of trauma, burn, other standby
services;
(B) translation services for disabled or non-
english speaking patients;
(C) the cost of uncompensated care;
(D) financial losses with respect to Medicaid
patients; and
(E) uncompensated costs of clinical research.
<all>
Introduced in Senate
Sponsor introductory remarks on measure. (CR S3286)
Read twice and referred to the Committee on Finance.
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