Text: S.246 — 111th Congress (2009-2010)All Information (Except Text)

There is one version of the bill.

Text available as:

Shown Here:
Introduced in Senate (01/14/2009)


111th CONGRESS
1st Session
S. 246


To amend title 38, United States Code, to improve the quality of care provided to veterans in Department of Veterans Affairs medical facilities, to encourage highly qualified doctors to serve in hard-to-fill positions in such medical facilities, and for other purposes.


IN THE SENATE OF THE UNITED STATES

January 14, 2009

Mr. Durbin introduced the following bill; which was read twice and referred to the Committee on Veterans' Affairs


A BILL

To amend title 38, United States Code, to improve the quality of care provided to veterans in Department of Veterans Affairs medical facilities, to encourage highly qualified doctors to serve in hard-to-fill positions in such medical facilities, 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 “Veterans Health Care Quality Improvement Act”.

SEC. 2. Standards for appointment and practice of physicians in Department of Veterans Affairs medical facilities.

(a) Standards.—

(1) IN GENERAL.—Subchapter I of chapter 74 of title 38, United States Code, is amended by inserting after section 7402 the following new section:

§ 7402A. Appointment and practice of physicians: standards

“(a) In general.—The Secretary shall, acting through the Under Secretary for Health, prescribe standards to be met by individuals in order to qualify for appointment in the Administration in the position of physician and to practice as a physician in medical facilities of the Administration. The standards shall incorporate the requirements of this section.

“(b) Disclosure of certain information before appointment.—Each individual seeking appointment in the Administration in the position of physician shall do the following:

“(1) Provide the Secretary a full and complete explanation of the following:

“(A) Each lawsuit, civil action, or other claim (whether open or closed) brought against the individual for medical malpractice or negligence (other than a lawsuit, action, or claim closed without any judgment against or payment by or on behalf of the individual).

“(B) Each payment made by or on behalf of the individual to settle any lawsuit, action, or claim covered by subparagraph (A).

“(C) Each investigation or disciplinary action taken against the individual relating to the individual's performance as a physician.

“(2) Submit a written request and authorization to the State licensing board of each State in which the individual holds or has held a license to practice medicine to disclose to the Secretary any information in the records of such State on the following:

“(A) Each lawsuit, civil action, or other claim brought against the individual for medical malpractice or negligence covered by paragraph (1)(A) that occurred in such State.

“(B) Each payment made by or on behalf of the individual to settle any lawsuit, action, or claim covered by subparagraph (A).

“(C) Each medical malpractice judgment against the individual by the courts or administrative agencies or bodies of such State.

“(D) Each disciplinary action taken or under consideration against the individual by an administrative agency or body of such State.

“(E) Any change in the status of the license to practice medicine issued the individual by such State, including any voluntary or nondisciplinary surrendering of such license by the individual.

“(F) Any open investigation of the individual by an administrative agency or body of such State, or any outstanding allegation against the individual before such an administrative agency or body.

“(G) Any written notification to the individual by such State of a potential termination of such license for cause or otherwise.

“(c) Disclosure of certain information following appointment.—(1) Each individual appointed in the Administration in the position of physician after the date of the enactment of the Veterans Health Care Quality Improvement Act shall, as a condition of service under the appointment, disclose to the Secretary, not later than 30 days after the occurrence of such event, the following:

“(A) A judgment against the individual for medical malpractice or negligence.

“(B) A payment made by or on behalf of the individual to settle any lawsuit, action, or claim disclosed under paragraph (1) or (2) of subsection (b).

“(C) Any disposition of or material change in a matter disclosed under paragraph (1) or (2) of subsection (b).

“(2) Each individual appointed in the Administration in the position of physician as of the date of the enactment of the Veterans Health Care Quality Improvement Act shall do the following:

“(A) Not later than the end of the 60-day period beginning on the date of the enactment of that Act and as a condition of service under the appointment after the end of that period, submit the request and authorization described in subsection (b)(2).

“(B) Agree, as a condition of service under the appointment, to disclose to the Secretary, not later than 30 days after the occurrence of such event, the following:

“(i) A judgment against the individual for medical malpractice or negligence.

“(ii) A payment made by or on behalf of the individual to settle any lawsuit, action, or claim disclosed pursuant to subparagraph (A) or under this subparagraph.

“(iii) Any disposition of or material change in a matter disclosed pursuant to subparagraph (A) or under this subparagraph.

“(3) Each individual appointed in the Administration in the position of physician shall, as part of the biennial review of the performance of the physician under the appointment, submit the request and authorization described in subsection (b)(2). The requirement of this paragraph is in addition to the requirements of paragraph (1) or (2), as applicable.

“(d) Investigation of disclosed matters.—(1) The Director of the Veterans Integrated Services Network (VISN) in which an individual is seeking appointment in the Administration in the position of physician shall perform an investigation (in such manner as the standards required by this section shall specify) of each matter disclosed under subsection (b) with respect to the individual.

“(2) The Director of the Veterans Integrated Services Network in which an individual is appointed in the Administration in the position of physician shall perform an investigation (in a manner so specified) of each matter disclosed under subsection (c) with respect to the individual.

“(3) The results of each investigation performed under this subsection shall be fully documented.

“(e) Approval of appointments by Directors of VISNs.—(1) An individual may not be appointed in the Administration in the position of physician without the approval of the Director of the Veterans Integrated Services Network in which the individual will first serve under the appointment.

“(2) In approving the appointment under this subsection of an individual for whom any matters have been disclosed under subsection (b), a Director shall—

“(A) certify in writing the completion of the performance of the investigation under subsection (d)(1) of each such matter, including the results of such investigation; and

“(B) provide a written justification why any matters raised in the course of such investigation do not disqualify the individual from appointment.

“(3) A Director shall provide copies of the certification and the written justification with respect to an individual under paragraph (2) to the National Quality Assurance Officer and the Quality Assurance Officer of the Network in which the individual will first serve under the approved appointment.

“(f) Enrollment of physicians with practice privileges in Proactive Disclosure Service.—Each medical facility of the Department at which physicians are extended the privileges of practice shall enroll each physician extended such privileges in the Proactive Disclosure Service of the National Practitioners Data Bank

“(g) Encouragement of employment of physicians with board certification.—The Secretary shall include in each performance contract with a Director of a Veterans Integrated Services Network a provision that encourages the Director to hire in such Network physicians who are board certified in the specialty in which the physicians will practice. Each such provision shall include such elements as the Secretary considers appropriate.”.

(2) CLERICAL AMENDMENT.—The table of sections at the beginning of chapter 74 of such title is amended by inserting after the item relating to section 7402 the following new item:


“7402A. Appointment and practice of physicians: standards.”.

(b) Effective date and applicability.—

(1) EFFECTIVE DATE.—Except as provided in paragraph (2) and (3), the amendments made by subsection (a) shall take effect on the date of the enactment of this Act.

(2) ENROLLMENT IN PROACTIVE DISCLOSURE SERVICE OF PHYSICIANS PRACTICING ON EFFECTIVE DATE.—In the case of an individual appointed to the Veterans Health Administration in the position of physician as of the date of the enactment of this Act, the requirements of subsection (f) of section 7402A of title 38, United States Code, as added by subsection (a), shall take effect on the date that is 60 days after the date of the enactment of this Act.

(3) CONTRACT PROVISIONS ENCOURAGING EMPLOYMENT OF PHYSICIANS WITH BOARD CERTIFICATION.—The provisions of subsection (g) of such section 7402A, as so added, shall apply to any performance contract of a Director of a Veterans Integrated Services Network entered into during or after the first cycle of such performance contracts beginning on or after that date.

SEC. 3. Enhancement of quality assurance by the Veterans Health Administration.

(a) Enhancement of quality assurance through quality assurance officers.—

(1) IN GENERAL.—Subchapter II of chapter 73 of title 38, United States Code, is amended by inserting after section 7311 the following new section:

§ 7311A. Quality assurance officers

“(a) National quality assurance officer.—(1) The Under Secretary for Health shall designate an official of the Veterans Health Administration to act as the principal quality assurance officer for the quality-assurance program required by section 7311 of this title. The official so designated may be known as the ‘National Quality Assurance Officer of the Veterans Health Administration’ (in this section referred to as the ‘National Quality Assurance Officer’).

“(2) The National Quality Assurance Officer shall report directly to the Under Secretary for Health in the discharge of responsibilities and duties of the Officer under this section.

“(3) The National Quality Assurance Officer shall be the official within the Administration who is principally responsible for the quality-assurance program referred to in paragraph (1). In carrying out that responsibility, the Officer shall be responsible for—

“(A) establishing and enforcing the requirements of that program; and

“(B) carrying out such other responsibilities and duties relating to quality assurance in the Administration as the Under Secretary for Health shall specify.

“(4) The requirements under paragraph (3) shall include requirements regarding the following:

“(A) A confidential system for the submittal of reports by Administration personnel regarding quality assurance at Department facilities.

“(B) Mechanisms for the peer review of the actions of individuals appointed in the Administration in the position of physician.

“(C) Mechanisms for the accountability of the facility director and chief medical officer of each Administration medical facility for the actions of physicians in such facility.

“(b) Quality assurance officers for VISNs.—(1) The Director of each Veterans Integrated Services Network (VISN) shall appoint an official of the Network to act as the quality assurance officer of the Network.

“(2) Each official appointed as a quality assurance officer under this subsection shall be a board-certified physician.

“(3) The quality assurance officer for a Veterans Integrated Services Network shall report to the Director of the Veterans Integrated Services Network, and to the National Quality Assurance Officer, regarding the discharge of the responsibilities and duties of the officer under this section.

“(4) The quality assurance officer for a Veterans Integrated Services Network shall—

“(A) direct the quality assurance office in the Network; and

“(B) coordinate, monitor, and oversee the quality-assurance programs and activities of the Administration medical facilities in the Network in order to ensure the thorough and uniform discharge of quality assurance requirements under such programs and activities throughout such facilities.

“(c) Quality assurance officers for medical facilities.—(1) The director of each Administration medical facility shall appoint a quality assurance officer for that facility.

“(2) Each official appointed as a quality assurance officer under this subsection shall be a board-certified physician.

“(3) The official appointed as a quality assurance officer for a facility under this subsection shall be a practicing physician at the facility. If the official appointed as quality assurance officer for a facility has other clinical or administrative duties, the director of the facility shall ensure that those duties are sufficiently limited in scope so as to ensure that those duties do not prevent the officer from effectively discharging the responsibilities and duties of quality assurance officer at the facility.

“(4) The quality assurance officer for a facility shall report directly to the director of the facility, and to the quality assurance officer of the Veterans Integrated Services Network in which the facility is located, regarding the discharge of the responsibilities and duties of the quality assurance officer under this section.

“(5) The quality assurance officer for a facility shall be responsible for designing, disseminating, and implementing quality-assurance programs and activities for the facility that meet the requirements established by the National Quality Assurance Officer under subsection (a).”.

(2) CLERICAL AMENDMENT.—The table of sections at the beginning of chapter 73 of such title is amended by inserting after the item relating to section 7311 the following new item:


“7311A. Quality assurance officers.”.

(b) Reports on quality concerns under quality-assurance program.—Section 7311(b) of such title is amended by adding at the end the following new paragraph:

“(4) As part of the quality-assurance program, the Under Secretary for Health shall establish mechanisms through which employees of Administration facilities may submit reports, on a confidential basis, on matters relating to quality of care in Administration facilities to the quality assurance officers of such facilities under section 7311A(c) of this title and to the quality assurance officers of the Veterans Integrated Services Networks (VISNs) in which such facilities are located under section 7311A(b) of this title. The mechanisms shall provide for the prompt and thorough review of any reports so submitted by the receiving officials.”.

(c) Review of current health care quality safeguards.—

(1) IN GENERAL.—The Secretary of Veterans Affairs shall conduct a comprehensive review of all current policies and protocols of the Department of Veterans Affairs for maintaining health care quality and patient safety at Department of Veterans Affairs medical facilities. The review shall include a review and assessment of the National Surgical Quality Improvement Program (NSQIP), including an assessment of—

(A) the efficacy of the quality indicators under the program;

(B) the efficacy of the data collection methods under the program;

(C) the efficacy of the frequency with which regular data analyses are performed under the program; and

(D) the extent to which the resources allocated to the program are adequate to fulfill the stated function of the program.

(2) REPORT.—Not later than 60 days after the date of the enactment of this Act, the Secretary shall submit to Congress a report on the review conducted under paragraph (1), including the findings of the Secretary as a result of the review and such recommendations as the Secretary considers appropriate in light of the review.

SEC. 4. Incentives to encourage high-quality physicians to serve in the Veterans Health Administration.

(a) Incentives required.—

(1) IN GENERAL.—Subchapter III of chapter 74 of title 38, United States Code, is amended by inserting after section 7431 the following new section:

§ 7431A. Physicians: additional incentives for service in hard-to-fill positions

“(a) Loan repayment for physicians who serve in hard-To-fill positions.—(1) In order to recruit and retain physicians in the Administration in hard-to-fill positions (as designated by the Secretary for purposes of this subsection), the Secretary shall carry out a program under which the Secretary may repay, for each individual who agrees to serve as a physician for a period of not less than three years in an Administration facility in such a position and seeks such repayment, any loan of such individual as follows:

“(A) Any loan of the individual described in paragraphs (1) through (4) of section 16302(a) of title 10.

“(B) Any other loan of the individual designated by the Secretary for purposes of this subsection the proceeds of which were used by the individual to finance education leading to the medical degree of the individual.

“(2) Each individual seeking repayment of loans under paragraph (1) shall enter into an agreement with the Secretary regarding the repayment of loans. Under the agreement, the individual shall agree—

“(A) to perform satisfactory service in a physician position specified in the agreement in an Administration facility specified in the agreement for such period of years as the agreement shall specify; and

“(B) to possess and retain for the period of the agreement such professional qualifications as are necessary for the service specified under subparagraph (A).

“(3) Repayment of loans under this subsection shall be made on the basis of complete years of service under the agreement under this subsection. The amount to be repayed under an agreement under this subsection for a complete year of service specified in the agreement shall be such amount, not to exceed $30,000, for each complete year of service as the agreement shall specify.

“(4) An individual receiving loan repayment under paragraph (1) who does not satisfy the requirements of the agreement under paragraph (2) shall be subject to such repayment requirements as the Secretary shall specify in the agreement.

“(b) Tuition reimbursement for physician students who agree To serve in hard-To-fill positions.—(1) In order to recruit and retain physicians in the Administration in hard-to-fill positions (as designated by the Secretary for purposes of this subsection), the Secretary shall carry out a program under which the Secretary may reimburse individuals who are enrolled in a course of education leading toward board certification as a physician and seek such reimbursement for the tuition charged for pursuit of such course of education if such individuals agree to serve as a physician in an Administration facility in such a position.

“(2) Each individual seeking tuition reimbursement under paragraph (1) shall enter into an agreement with the Secretary regarding such tuition reimbursement. Under the agreement, the individuals shall agree—

“(A) to satisfactorily complete the course of education of the individual described in paragraph (1); and

“(B) upon completion of the course of education, to become board-certified as a physician; and

“(C) upon completion of the matters referred to in subparagraphs (A) and (B)—

“(i) to perform satisfactory service in a physician position specified in the agreement in an Administration facility specified in the agreement for such period of years as the agreement shall specify; and

“(ii) to possess and retain for the period of the agreement such professional qualifications as are necessary for the service specified under clause (i).

“(3) The amount of reimbursement payable to an individual under paragraph (1) for a year may not exceed $30,000.

“(4) Any individual receiving tuition reimbursement under paragraph (1) who does not satisfy the requirements of the agreement under paragraph (2) shall be subject to such repayment requirements as the Secretary shall specify in the agreement.

“(5) An individual receiving tuition reimbursement under paragraph (1) for pursuit of a course of education shall also be paid a stipend in the amount of $5,000 for each academic year of pursuit of such course of education after entry into an agreement under paragraph (2).

“(c) Participation in FEHBP of physicians who serve part-time in hard-To-fill positions.—(1) In order to recruit and retain physicians in the Administration in hard-to-fill positions (as designated by the Secretary for purposes of this subsection), an individual not otherwise eligible for health insurance under chapter 89 of title 5 who agrees to serve as a physician in an Administration facility in such a position for not less than five days per month (of which two days must occur in each 14-day period) shall be eligible for enrollment in the health benefit plans under chapter 89 of title 5 on a self only or self and family basis (as applicable).

“(2) The Secretary shall administer this subsection in consultation with the Director of the Office of Personnel Management.

“(d) Additional programs.—It is the sense of Congress that the Secretary should undertake active and on-going efforts to establish additional incentive programs to encourage individuals to serve in the position of physician in the Administration, or otherwise practice in the Administration, in hard-to-fill positions, including, in particular, incentive programs to encourage more experienced physicians to serve or practice in such positions.

“(e) Construction.—The incentives required under this section are in addition to any other special pays or benefits to which the individuals covered by this section are eligible or entitled under law.”.

(2) CLERICAL AMENDMENT.—The table of sections at the beginning of chapter 74 of such title is amended by inserting after the item relating to section 731 the following new item:


“7431A. Physicians: additional incentives for service in hard-to-fill positions.”.

(b) Affiliation of Department of Veterans Affairs medical facilities with medical schools.—The Secretary of Veterans Affairs shall, to the extent practicable, require each medical facility of the Department of Veterans Affairs to seek to establish an affiliation with a medical school within reasonable proximity of such medical facility.

SEC. 5. Reports to Congress.

(a) Report.—Not later than December 15, 2009, and each year thereafter through 2012, the Secretary of Veterans Affairs shall submit to the congressional veterans affairs committees a report on the implementation of this Act and the amendments made by this Act during the preceding fiscal year. Each report shall include, for the fiscal year covered by such report, the following:

(1) A comprehensive description of the implementation of this Act and the amendments made by this Act.

(2) Such recommendations as the Secretary considers appropriate for legislative or administrative action to improve the authorities and requirements in this Act and the amendments made by this Act or to otherwise improve the quality of health care and the quality of the physicians in the Veterans Health Administration.

(b) Congressional veterans affairs committees defined.—In this section, the term “congressional veterans affairs committees” means—

(1) the Committees on Veterans' Affairs and Appropriations of the Senate; and

(2) the Committees on Veterans' Affairs and Appropriations of the House of Representatives.