A bill to require Medicare providers to disclose publicly staffing and performance in order to promote improved consumer information and choice, to protect employees of Medicare providers who report concerns about the safety and quality of services provid

14 Pages·1999·0.57 MB·English

by  United States. Congress. Senate

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Fjcltimora. Marylenri 21244
106thcongress S.966
1stSession
To requiremedicareproviders to disclosepubliclystaffingandperformance
inordertopromoteimprovedconsumerinformationandchoice,topro-
tect employees of medicare providers who report concerns about the
safety and quality of services pro\aded by medicare providers orwho
report violations of Federal or State law by those providers, and to
require review ofthe impact on public health and safetyofproposed
mergersandacquisitionsofmedicareproviders.
IN THE SENATE OF TliE UNITED STATES
May5,1999
Mr.Reidintroducedthefollowingbill;whichwasreadtwiceandreferredto
theCommitteeonFinance
A
BILL
To require medicare providers to disclose publicly staffing
andperformanceinordertopromoteimprovedconsumer
informationandchoice, toprotectemployeesofmedicare
providerswhoreport concernsaboutthe safetyandqual-
ity of services provided by medicare providers or who
report violations of Federal or State law by those pro-
viders, and to require review of the impact on public
health and safety of proposed mergers and acquisitions
ofmedicareproviders.
1 BeitenactedhytheSenateandHouseofRepresenta-
2 tivesoftheUnitedStatesofAmericainCongressassembled,
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2
1 SECTION1.SHORTTITLE.
2 TliisActmaybecitedasthe "PatientSafetyActof
3 1999".
4 SEC.2.FINDINGS.
5 Congressfindsthefollowing:
6 (1) Therehasbeenincreased andgrowingpub-
7 Heconcernexpressedregardingthequalityand safe-
8 ty of services provided by health care facilities, as
9 such facilities have instituted aggressive efforts to
10 reducelevelsofstaffwhoprovide directpatientcare
11 servicesasaprincipalmeansofdecreasingexpenses.
12 (2)Agrowingbodyofdatasuggests
13 (A) alinkagebetweenthenumberandmix
14 ofnursing staff and positive patient care out-
15 comes, includingthe avoidance ofpatient death
16 andinjury;and
17 (B) that certain adverse patient care indi-
18 cators, including medication errors, patient in-
19 jury, decubitus ulcers, nosocomial infections,
20 and nosocomial urinary tract infections, signal
21 a deterioration ofthe quahty ofcare that may
22 leadtopatientdeathandinjury.
23 (3) Many employees of health care facilities
24 haveexpressedfearfortheiremploymentiftheyre-
25 portunsafe conditions, includingviolations of State
26 orFederallaw.
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1 (4) Unprecedented consolidation among health
2 care facilities has led to increasing concern regard-
3 ingtheeffectofsuchactivityonthehealthandsafe-
4 ty ofcommunities served bythese facilities, yet the
5 Federal Government has little authorityto evaluate
6 such effect in deciding whether or not to approve
7 mergers and acquisitions among health care facUi-
8 ties.
9 SEC.3.DEFINmONS.
10 ForpurposesofthisAct:
11 (1) Licensedpractical nurse orlicensed
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12 vocational nurse. The term "licensed practical
13 nurse or licensed vocational nurse" means an indi-
14 vidualwho is entitled under Statelaworregulation
15 topracticeasalicensedpracticalnurseoralicensed
16 vocationalnurse.
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17 (2) Made publicly available. The term
18 "madepubliclyavailable" means,withrespectto in-
19 formation of a provider, information that is
20 provided
21 (A) to the Secretary and to any State
22 agency responsible for licensing or accrediting
23 theprovider;
24 (B) toanyStateagencywhichapprovesor
25 oversees health care services dehvered by the
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1 provider directly or tlirough an insuring entity
2 orcorporation; and
3 (C) to anymemberofthepublicwhich re-
4 quests such information directly from the pro-
5 vider.
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6 (3) Medicare program. Theterm"medicare
7 program" means the programs undertitleXVIII of
8 theSocialSecurityAct.
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9 (4)Provider. Theterm"provider"meansan
10 entitythatis
11 (A) apsychiatrichospital describedinsec-
12 tion1861(f) oftheSocialSecurityAct;
13 (B) aproviderofservicesdescribedinsec-
14 tion1861(u) ofsuchAct;
15 (C) a rural health clinic described in sec-
16 tion1861(aa)(2) ofsuchAct;
17 (D) an ambulatory surgical center de-
18 scribedin section 1832(a)(2)(F)(i) ofsuchAct;
19 or
20 (E) a renal dialysis facility described in
21 section1881(b)(1)(A)ofsuchAct.
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22 (5) Registered nurse. The term "reg-
23 istered nurse" means an individual v^^ho is entitled
24 under State law or regulation to practice as a reg-
25 isterednurse.
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1 (6) Secretaiiy. Theterm "Secretary" means
2 theSecretaryofHealthandHumanServices.
3 SEC.4.PUBLICDISCLOSUREOFSTAFFINGANDOUTCOMES
4 DATA.
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5 (a) Disclosure of Staffing and Outcomes.
6 Anyproviderunderthemedicareprogramshall,asacon-
7 dition ofcontinued participation in such program, make
8 pubhcly available information regarding nurse staffing
9 andpatientoutcomesas specifiedbythe Secretary. Such
10 informationshallincludeatleastthefollowing:
11 (1) The number ofregistered nurses providing
12 directcare. Thisinformationshallbeexpressedboth
13 in raw numbers, in terms oftotal hours ofnursing
14 care per patient (including adjustment for case mix
15 and acuity), and as a percentage of nursing staff,
16 andshallbebrokendownintermsofthetotalnurs-
17 ingstaff,eachunit, andeachshift.
18 (2) The number ofhcensed practical nurses or
19 hcensedvocationalnursesprovidingdirectcare. This
20 information shallbeexpressedbothinrawnumbers,
21 in terms oftotal hours ofnursing care per patient
22 (includingadjustmentforcasemix and acuity^, and
23 asapercentageofnursingstaff, andshallbebroken
24 downin terms ofthe total nursing staff, eachunit,
25 andeachshift.
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1 (3) Numbers ofunlicensedpersonnelutilizedto
2 providedirectpatientcare. Thisinformation shallbe
3 expressedbothinraw numbers and as apercentage
4 ofnursing staffand shall be broken down in terms
5 ofthetotal nursingstaff, eachunit, andeach shift.
6 (4) The average number of patients per reg-
7 istered nurse providing direct patient care. This in-
8 formation shallbebrokendownintermsofthetotal
9 nursingstaff,eachunit, andeachshift.
10 (5) Patient mortalityrate (in rawnumbers and
11 bydiagnosisordiagnostic-relatedgroup).
12 (6) Incidence ofadverse patient care incidents,
13 including as such incidents at least medication er-
14 rors, patient injury, decubitusulcers, nosocomial in-
15 fections, andnosocomialurinaiytractinfections.
16 • (7) Methodsusedfordeterminingandadjusting
17 staffing levels and patient care needs and the pro-
18 vider'scomplianceAviththesemethods.
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19 (b) Disclosure of Complaints. Data regarding
20 complaints filedwith the State agency, the Health Care
21 FinancingAdministration, oranaccreditingagency, com-
22 phancewiththestandards ofwhichhavebeen deemedto
23 demonstrate comphance with conditions of participation
24 under the medicare program, and data regarding inves-
25 tigationsandfindingsasaresultofthosecomplaintsand
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1 the findings ofscheduled inspectionvisits, shallbe made
2 publiclyavailable.
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3 (c)InformationonData. ^Alldatamadepublicly
4 available undertliis section shall indicate the source and
5 currencyofthedataprovided.
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6 (d)WaiverforSmallProviders. TheSecretary
7 maywaive or reduce reporting requirements under this
8 sectioninthecase ofasmallprovider (asdefinedbythe
9 Secretar\^) for whom the imposition ofthe requirements
10 wouldbeundulyburdensome.
11 SEC.5.PROTECTIONOFCERTAINACTIVITIESBYEMPLOY-
12 EESOFMEDICAREPROVIDERS.
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13 (a) L\ General. No provider under the medicare
14 program shall terminate or take other adverse action
15 against any employee or groups ofemployees for actions
16 takenforthepurposeof
17 (1) notifying the provider of conditions which
18 the employee or group of employees identifies, in
19 communications with the provider, as dangerous or
20 potentiallydangerousorinjuriousto
21 (A) patientswho currentlyreceive services
22 fromtheprovider;
23 (B) individuals who are likely to receive
24 servicesfromtheprovider; or
25 (C)employeesoftheprovider;
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1 (2) notifying a Federal or State agency or an
2 accreditation agency, compliancewith the standards
3 ofwhich have been deemed to demonstrate compli-
4 ancewithconditionsofparticipationunderthemedi-
5 careprogram, ofsuchconditions asareidentifiedin
6 paragraph(1);
7 (3) notifying other individuals of conditions
8 which the employee or group of employees reason-
9 ablybelievetobesuchasaredescribedinparagraph
10 (1);
11 (4) discussing such conditions as are identified
12 in paragraph (1) with other employees for the pur-
13 posesofinitiatingactiondescribedinparagraph (1),
14 (2),or(3);or
15 (5) other related activities as specified inregu-
16 lationspromulgatedbytheSecretary.
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17 (b) Sanction. determination by the Secretary
18 thatapro\iderhastakensuchactionasdescribedinsub-
19 section (a) shall result in suspension from participation
20 inthemedicareprogramforaperiodoftimetobespeci-
21 fiedbythe Secretary, such period to be not less than 1
22 month.
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23 (c)Exception. Theprotectionsofthissectionshall
24 not apply to any employee who knowingly or recklessly
25 provides substantiallyfalse information to the Secretary.
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1 SEC.6.EVALUATIONOFHEALTHANDSAFETYOFCERTAIN
2 MERGERSANDACQUISITIONSBYORAMONG
3 MEDICAREPROVIDERS.
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4 (a) ImpactReport. ^Anyproviderunderthemedi-
5 care program that files with the Department of Justice
6 andtheFederalTradeCommissionnotificationofatrans-
7 actionwhichisrequiredtobereportedpursuanttosection
8 7AoftheClaytonAct(15U.S.C. 18a) shall, onthesame
9 date as such notification is submitted, provide the Sec-
10 retarywith awrittenreportthatincludesthe overallim-
11 pact ofsuch transaction on the health services available
12 andreadilyaccessibletothecommunityandthatincludes
13 the impact ofsuchtransaction on each ofthe following:
14 (1) On the availability and accessibihty ofpri-
15 mary,acutecare,andemergencyservices.
16 (2) Ontheavailabilityand accessibilityofserv-
17 icesformothersandchildren.
18 (3) Ontheavailabilityandaccessibilityofserv-
19 icestotheelderly.
20 (4) Ontheavailabilityandaccessibilityofserv-
21 icestootherspecificpopulations,includingthepoor,
22 the uninsured, ethnic minorities, women, the dis-
23 abled, andthelesbianandgaycommunities.
24 (5) On the availability and accessibility ofspe-
25 cialized services, including services for the preven-
26 tion, detection, and treatment of the human im-
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1 munodeficiency virus and related illnesses, mental
2 healthservices, andsubstanceabuseservices.
3 (6) On the safety and quality of health care
4 services to be provided, including anticipated
5 changes in numbers and mix of nursing and other
6 patientcarestaffandonotherfactorsrelatedtopa-
7 tientoutcomes.
8 (7) Ontheavailabilityandaccessibilityofsocial
9 servicesandotherserviceswithinthecommunity.
10 (8) On overall employment within the commu-
11 nity.
12 (9) Ontheprovider'sworkforce,including
13 (A) the status of existing collective bar-
14 gainingcontracts,ifany;and
15 (B) plans for retraining and redeplojnnent
16 of employees who are displaced as a result of
17 thecontemplatedtransaction.
18 (10) On the financial stabihty of the merged
19 entity,takinginto accountatleastprojectedacquisi-
20 tion costs, related expenses, and planned marketing
21 oradvertisingcampaignsforthenewentity.
22 (11) Onotherfactorstobe specifiedinregula-
23 tionstobepromulgatedbytheSecretary.
24 Suchreportshallbeinadditiontoanydocumentationre-
25 quiredbyanyotherFederalorStateagency.
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