H.R. 3200/Division C/Title IV

TITLE IV — QUALITY AND SURVEILLANCE

Sec. 2401. Implementation of Best Practices in the Delivery of Health Care.

(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 938(1), by striking ``931´´ and inserting ``941´´; and

(4) by inserting after part C the following:

``PART D—Implementation of best practices in the delivery of health care

``SEC. 931. Center for Quality Improvement

.

``(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.

``(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 Secretary 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 Secretary 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 voluntary arrangements with health care providers (including hospitals and other health facilities and health practitioners) 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.

Sec. 2402. Assistant Secretary for Health Information.

(a) Establishment.—

Title XVII (42 U.S.C. 300u et seq.) is amended—

(1) by redesignating sections 1709 and 1710 as sections 1710 and 1711, respectively; and

(2) by inserting after section 1708 the following:

``SEC. 1709. Assistant Secretary for Health Information.

``(a) In general.—There is established within the Department an Assistant Secretary for Health Information (in this section referred to as the ‘Assistant Secretary’), to be appointed by the Secretary.

``(b) Responsibilities.—The Assistant Secretary shall—

``(1) ensure the collection, collation, reporting, and publishing of information (including full and complete statistics) on key health indicators regarding the Nation’s health and the performance of the Nation’s health care;

``(2) facilitate and coordinate the collection, collation, reporting, and publishing of information regarding the Nation’s health and the performance of the Nation’s health care (other than information described in paragraph (1));

``(3)(A) develop standards for the collection of data regarding the Nation’s health and the performance of the Nation’s health care; and

``(B) in carrying out subparagraph (A)—

``(i) ensure appropriate specificity and standardization for data collection at the national, regional, State, and local levels;

``(ii) include standards, as appropriate, for the collection of accurate data on health and health care by race, ethnicity, primary language, sex, sexual orientation, gender identity, disability, socioeconomic status, rural, urban, or other geographic setting, and any other population or subpopulation determined appropriate by the Secretary;

``(iii) ensure, with respect to data on race and ethnicity, consistency with the 1997 Office of Management and Budget Standards for Maintaining, Collecting and Presenting Federal Data on Race and Ethnicity (or any successor standards); and

``(iv) in consultation with the Director of the Office of Minority Health, and the Director of the Office of Civil Rights, of the Department, develop standards for the collection of data on health and health care with respect to data on primary language;

``(4) provide support to Federal departments and agencies whose programs have a significant impact upon health (as determined by the Secretary) for the collection and collation of information described in paragraphs (1) and (2);

``(5) ensure the sharing of information described in paragraphs (1) and (2) among the agencies of the Department;

``(6) facilitate the sharing of information described in paragraphs (1) and (2) by Federal departments and agencies whose programs have a significant impact upon health (as determined by the Secretary);

``(7) identify gaps in information described in paragraphs (1) and (2) and the appropriate agency or entity to address such gaps;

``(8) facilitate and coordinate identification and monitoring by the agencies of the Department of health disparities to inform program and policy efforts to reduce such disparities, including facilitating and funding analyses conducted in cooperation with the Social Security Administration, the Bureau of the Census, and other appropriate agencies and entities;

``(9) consistent with privacy, proprietary, and other appropriate safeguards, facilitate public accessibility of datasets (such as de-identified Medicare datasets or publicly available data on key health indicators) by means of the Internet; and

``(10) award grants or contracts for the collection and collation of information described in paragraphs (1) and (2) (including through statewide surveys that provide standardized information).

``(c) Key health indicators.—

``(1) In general.—In carrying out subsection (b)(1), the Assistant Secretary shall—

``(A) identify, and reassess at least once every 3 years, key health indicators described in such subsection;

``(B) publish statistics on such key health indicators for the public—

``(i) not less than annually; and

``(ii) on a supplemental basis whenever warranted by—

``(I) the rate of change for a key health indicator; or

``(II) the need to inform policy regarding the Nation’s health and the performance of the Nation’s health care; and

``(C) ensure consistency with the national strategy developed by the Secretary under section 3121 and consideration of the indicators specified in the reports under sections 308, 903(a)(6), and 913(b)(2).

``(2) Release of key health indicators.—The regulations, rules, processes, and procedures of the Office of Management and Budget governing the review, release, and dissemination of key health indicators shall be the same as the regulations, rules, processes, and procedures of the Office of Management and Budget governing the review, release, and dissemination of Principal Federal Economic Indicators (or equivalent statistical data) by the Bureau of Labor Statistics.

``(d) Coordination.—In carrying out this section, the Assistant Secretary shall coordinate with—

``(1) public and private entities that collect and disseminate information on health and health care, including foundations; and

``(2) the head of the Office of the National Coordinator for Health Information Technology to ensure optimal use of health information technology.

``(e) Request for information from other departments and agencies.—Consistent with applicable law, the Assistant Secretary may secure directly from any Federal department or agency information necessary to enable the Assistant Secretary to carry out this section.

``(f) Report.—

``(1) Submission.—The Assistant Secretary shall submit to the Secretary and the Congress an annual report containing—

``(A) a description of national, regional, or State changes in health or health care, as reflected by the key health indicators identified under subsection (c)(1);

``(B) a description of gaps in the collection, collation, reporting, and publishing of information regarding the Nation’s health and the performance of the Nation’s health care;

``(C) recommendations for addressing such gaps and identification of the appropriate agency within the Department or other entity to address such gaps;

``(D) a description of analyses of health disparities, including the results of completed analyses, the status of ongoing longitudinal studies, and proposed or planned research; and

``(E) a plan for actions to be taken by the Assistant Secretary to address gaps described in subparagraph (B).

``(2) Consideration.—In preparing a report under paragraph (1), the Assistant Secretary shall take into consideration the findings and conclusions in the reports under sections 308, 903(a)(6), and 913(b)(2).

``(g) Proprietary and privacy protections.—Nothing in this section shall be construed to affect applicable proprietary or privacy protections.

``(h) Consultation.—In carrying out this section, the Assistant Secretary shall consult with—

``(1) the heads of appropriate health agencies and offices in the Department, including the Office of the Surgeon General of the Public Health Service, the Office of Minority Health, and the Office on Women’s Health; and

``(2) as appropriate, the heads of other Federal departments and agencies whose programs have a significant impact upon health (as determined by the Secretary).

``(i) Definition.—In this section:

``(1) The terms ‘agency’ and ‘agencies’ include an epidemiology center established under section 214 of the Indian Health Care Improvement Act.

``(2) The term ‘Department’ means the Department of Health and Human Services.

``(3) The term ‘health disparities’ has the meaning given to such term in section 3171.´´.

(b) Other Coordination Responsibilities.—

Title III (42 U.S.C. 241 et seq.) is amended—

(1) in paragraphs (1) and (2) of section 304(c) (42 U.S.C. 242b(c)), by inserting ``, acting through the Assistant Secretary for Health Information,´´ after ``The Secretary´´ each place it appears; and

(2) in section 306(j) (42 U.S.C. 242k(j)), by inserting ``, acting through the Assistant Secretary for Health Information,´´ after ``of this section, the Secretary´´.

Sec. 2403. Authorization of Appropriations.

Section 799C, as added and amended, is further amended by adding at the end the following:

``(e) Quality and Surveillance.—For the purpose of carrying out part D of title IX and section 1709, in addition to any other amounts authorized to be appropriated for such purpose, there is authorized to be appropriated, out of any monies in the Public Health Investment Fund, $300,000,000 for each of fiscal years 2010 through 2014 and $330,000,000 for each of fiscal years 2015 through 2019.´´.