PHYSICIAN PAYMENT, EFFICIENCY, AND QUALITY IMPROVEMENTS.

SEC. 131. PHYSICIAN PAYMENT, EFFICIENCY, AND QUALITY IMPROVEMENTS.(a) In General.—(1) Increase in update for the second half of 2008 and for 2009.—(A) For the second half of 2008.—Section 1848(d)(8) of the Social Security Act (42 U.S.C. 1395w–4(d)(8)), as added by section 101 of the Medicare, Medicaid, and SCHIP Extension Act of 2007 (Public Law 110–173), is amended—(i) in the heading, by striking “a portion of”;(ii) in subparagraph (A), by striking “for the period beginning on January 1, 2008, and ending on June 30, 2008,”; and(iii) in subparagraph (B)—(I) in the heading, by striking “the remaining portion of 2008 and”; and(II) by striking “for the period beginning on July 1, 2008, and ending on December 31, 2008, and”.(B) For 2009.—Section 1848(d) of the Social Security Act (42 U.S.C. 1395w–4(d)), as amended by section 101 of the Medicare, Medicaid, and SCHIP Extension Act of 2007 (Public Law 110–173), is amended by adding at the end the following new paragraph:“(9) Update for 2009.—“(A) In general.—Subject to paragraphs (7)(B) and (8)(B), in lieu of the update to the single conversion factor established in paragraph (1)(C) that would otherwise apply for 2009, the update to the single conversion factor shall be 1.1 percent.“(B) No effect on computation of conversion factor for 2010 and subsequent years.—The conversion factor under this subsection shall be computed under paragraph (1)(A) for 2010 and subsequent years as if subparagraph (A) had never applied.”.(3) Revision of the physician assistance and quality initiative fund.—122 STAT. 2521(A) In general.—Subject to subparagraph (B), section 1848(l)(2) of the Social Security Act (42 U.S.C. 1395w–4(l)(2)), as amended by section 101(a)(2) of the Medicare, Medicaid, and SCHIP Extension Act of 2007 (Public Law 110–173), is amended—(i) in subparagraph (A)—(I) by striking clause (i)(III); and(II) by striking clause (ii)(III); and(ii) in subparagraph (B)—(I) in clause (i), by adding “and” at the end;(II) in clause (ii), by striking “; and” and inserting a period; and(III) by striking clause (iii).(B) Contingency.—If there is enacted, before, on, or after the date of the enactment of this Act, a Supplemental Appropriations Act, 2008 that includes a provision amending section 1848(l) of the Social Security Act, the alternative amendment described in subparagraph (C)—(i) shall apply instead of the amendments made by subparagraph (A); and(ii) shall be executed after such provision in such Supplemental Appropriations Act.(C) Alternative amendment described.—The alternative amendment described in this subparagraph is as follows: Section 1848(l)(2) of the Social Security Act (42 U.S.C. 1395w–4(l)(2)), as amended by section 101(a)(2) of the Medicare, Medicaid, and SCHIP Extension Act of 2007 (Public Law 110–173) and by the Supplemental Appropriations Act, 2008, is amended—(i) in subparagraph (A)—(I) by striking subclauses (III) and (IV) of clause (i); and(II) by striking subclauses (III) and (IV) of clause (ii); and(ii) in subparagraph (B)—(I) in clause (i), by adding “and” at the end;(II) in clause (ii), by striking the semicolon at the end and inserting a period; and(III) by striking clauses (iii) and (iv).(b) Extension and Improvement of the Quality Reporting System.—(1) System.—Section 1848(k)(2) of the Social Security Act (42 U.S.C. 1395w–4(k)(2)), as amended by section 101(b)(1) of the Medicare, Medicaid, and SCHIP Extension Act of 2007 (Public Law 110–173), is amended by adding at the end the following new subparagraphs:“(C) For 2010 and subsequent years.—“(i) In general.—Subject to clause (ii), for purposes of reporting data on quality measures for covered professional services furnished during 2010 and each subsequent year, subject to subsection (m)(3)(C), the quality measures (including electronic prescribing quality measures) specified under this paragraph shall be such measures selected by the Secretary from measures that have been endorsed by the entity with a contract with the Secretary under section 1890(a).122 STAT. 2522“(ii) Exception.—In the case of a specified area or medical topic determined appropriate by the Secretary for which a feasible and practical measure has not been endorsed by the entity with a contract under section 1890(a), the Secretary may specify a measure that is not so endorsed as long as due consideration is given to measures that have been endorsed or adopted by a consensus organization identified by the Secretary, such as the AQA alliance.“(D) Opportunity to provide input on measures for 2009 and subsequent years.—For each quality measure (including an electronic prescribing quality measure) adopted by the Secretary under subparagraph (B) (with respect to 2009) or subparagraph (C), the Secretary shall ensure that eligible professionals have the opportunity to provide input during the development, endorsement, or selection of measures applicable to services they furnish.”.(2) Redesignation of reporting system.—Subsection (c) of section 101 of division B of the Tax Relief and Health Care Act of 2006 (42 U.S.C. 1395w–4 note), as amended by section 101(b)(2) of the Medicare, Medicaid, and SCHIP Extension Act of 2007 (Public Law 110–173), is redesignated as subsection (m) of section 1848 of the Social Security Act.(3) Incentive payments under reporting system.—Section 1848(m) of the Social Security Act, as redesignated by paragraph (2), is amended—(A) by amending the heading to read as follows: “Incentive Payments for Quality Reporting”;(B) by striking paragraph (1) and inserting the following:“(1) Incentive payments.—“(A) In general.—For 2007 through 2010, with respect to covered professional services furnished during a reporting period by an eligible professional, if—“(i) there are any quality measures that have been established under the physician reporting system that are applicable to any such services furnished by such professional for such reporting period; and“(ii) the eligible professional satisfactorily submits (as determined under this subsection) to the Secretary data on such quality measures in accordance with such reporting system for such reporting period,in addition to the amount otherwise paid under this part, there also shall be paid to the eligible professional (or to an employer or facility in the cases described in clause (A) of section 1842(b)(6)) or, in the case of a group practice under paragraph (3)(C), to the group practice, from the Federal Supplementary Medical Insurance Trust Fund established under section 1841 an amount equal to the applicable quality percent of the Secretary’s estimate (based on claims submitted not later than 2 months after the end of the reporting period) of the allowed charges under this part for all such covered professional services furnished by the eligible professional (or, in the case of a group practice under paragraph (3)(C), by the group practice) during the reporting period.122 STAT. 2523“(B) Applicable quality percent.—For purposes of subparagraph (A), the term ‘applicable quality percent’ means—“(i) for 2007 and 2008, 1.5 percent; and“(ii) for 2009 and 2010, 2.0 percent.”;(C) by striking paragraph (3) and redesignating paragraph (2) as paragraph (3);(D) in paragraph (3), as so redesignated—(i) in the matter preceding subparagraph (A), by striking “For purposes” and inserting the following:“(A) In general.—For purposes”;(ii) by redesignating subparagraphs (A) and (B) as clauses (i) and (ii), respectively, and moving the indentation of such clauses 2 ems to the right;(iii) in subparagraph (A), as added by clause (i), by adding at the end the following flush sentence:“For years after 2008, quality measures for purposes of this subparagraph shall not include electronic prescribing quality measures.”; and(iv) by adding at the end the following new subparagraphs:“(C) Satisfactory reporting measures for group practices.—“(i) In general.—By January 1, 2010, the Secretary shall establish and have in place a process under which eligible professionals in a group practice (as defined by the Secretary) shall be treated as satisfactorily submitting data on quality measures under subparagraph (A) and as meeting the requirement described in subparagraph (B)(ii) for covered professional services for a reporting period (or, for purposes of subsection (a)(5), for a reporting period for a year) if, in lieu of reporting measures under subsection (k)(2)(C), the group practice reports measures determined appropriate by the Secretary, such as measures that target high-cost chronic conditions and preventive care, in a form and manner, and at a time, specified by the Secretary.“(ii) Statistical sampling model.—The process under clause (i) shall provide for the use of a statistical sampling model to submit data on measures, such as the model used under the Physician Group Practice demonstration project under section 1866A.“(iii) No double payments.—Payments to a group practice under this subsection by reason of the process under clause (i) shall be in lieu of the payments that would otherwise be made under this subsection to eligible professionals in the group practice for satisfactorily submitting data on quality measures.“(D) Authority to revise satisfactorily reporting data.—For years after 2009, the Secretary, in consultation with stakeholders and experts, may revise the criteria under this subsection for satisfactorily submitting data on quality measures under subparagraph (A) and the criteria for submitting data on electronic prescribing quality measures under subparagraph (B)(ii).”;(E) in paragraph (5)—122 STAT. 2524(i) in subparagraph (C), by inserting “for 2007, 2008, and 2009,” after “provision of law,”;(ii) in subparagraph (D)—(I) in clause (i)—(aa) by inserting “for 2007 and 2008” after “under this subsection”; and(bb) by striking “paragraph (2)” and inserting “this subsection”;(II) in clause (ii), by striking “shall” and inserting “may establish procedures to”; and(III) in clause (iii)—(aa) by inserting “(or, in the case of a group practice under paragraph (3)(C), the group practice)” after “an eligible professional”;(bb) by striking “bonus incentive payment” and inserting “incentive payment under this subsection”; and(cc) by adding at the end the following new sentence: “If such payments for such period have already been made, the Secretary shall recoup such payments from the eligible professional (or the group practice).”;(iii) in subparagraph (E)—(I) by striking “(i) in general.—”;(II) by striking clause (ii);(III) by redesignating subclauses (I) through (IV) as clauses (i) through (iv), respectively, and moving the indentation of such clauses 2 ems to the left;(IV) in clause (ii), as so redesignated, by striking “paragraph (2)” and inserting “this subsection”; and(V) in clause (iv), as so redesignated—(aa) by striking “the bonus” and inserting “any”; and(bb) by inserting “and the payment adjustment under subsection (a)(5)(A)” before the period at the end;(iv) in subparagraph (F)—(I) by striking “2009, paragraph (3) shall not apply, and” and inserting “subsequent years,”; and(II) by striking “paragraph (2)” and inserting “this subsection”; and(v) by adding at the end the following new subparagraph:“(G) Posting on website.—The Secretary shall post on the Internet website of the Centers for Medicare & Medicaid Services, in an easily understandable format, a list of the names of the following:“(i) The eligible professionals (or, in the case of reporting under paragraph (3)(C), the group practices) who satisfactorily submitted data on quality measures under this subsection.“(ii) The eligible professionals (or, in the case of reporting under paragraph (3)(C), the group practices) who are successful electronic prescribers.”; and122 STAT. 2525(F) in paragraph (6), by striking subparagraph (C) and inserting the following:“(C) Reporting period.—“(i) In general.—Subject to clauses (ii) and (iii), the term ‘reporting period’ means—“(I) for 2007, the period beginning on July 1, 2007, and ending on December 31, 2007; and“(II) for 2008, 2009, 2010, and 2011, the entire year.“(ii) Authority to revise reporting period.—For years after 2009, the Secretary may revise the reporting period under clause (i) if the Secretary determines such revision is appropriate, produces valid results on measures reported, and is consistent with the goals of maximizing scientific validity and reducing administrative burden. If the Secretary revises such period pursuant to the preceding sentence, the term ‘reporting period’ shall mean such revised period.“(iii) Reference.—Any reference in this subsection to a reporting period with respect to the application of subsection (a)(5) shall be deemed a reference to the reporting period under subparagraph (D)(iii) of such subsection.”.(4) Inclusion of qualified audiologists as eligible professionals.—(A) In general.—Section 1848(k)(3)(B) of the Social Security Act (42 U.S.C. 1395w–4(k)(3)(B)), is amended by adding at the end the following new clause:“(iv) Beginning with 2009, a qualified audiologist (as defined in section 1861(ll)(3)(B)).”.(B) No change in billing.—Nothing in the amendment made by subparagraph (A) shall be construed to change the way in which billing for audiology services (as defined in section 1861(ll)(2) of the Social Security Act (42 U.S.C. 1395x(ll)(2))) occurs under title XVIII of such Act as of July 1, 2008.(5) Conforming amendments.—Section 1848(m) of the Social Security Act, as added and amended by paragraphs (2) and (3), is amended—(A) in paragraph (5)—(i) in subparagraph (A)—(I) by striking “section 1848(k) of the Social Security Act, as added by subsection (b),” and inserting “subsection (k)”; and(II) by striking “such section” and inserting “such subsection”;(ii) in subparagraph (B), by striking “of the Social Security Act (42 U.S.C. 1395l)”;(iii) in subparagraph (E), in the matter preceding clause (i), by striking “1869 or 1878 of the Social Security Act or otherwise” and inserting “1869, section 1878, or otherwise”; and(iv) in subparagraph (F)—(I) by striking “paragraph (2)(B) of section 1848(k) of the Social Security Act (42 U.S.C. 1395w–4(k))” and inserting “subsection (k)(2)(B)”; and122 STAT. 2526(II) by striking “paragraph (4) of such section” and inserting “subsection (k)(4)”;(B) in paragraph (6)—(i) in subparagraph (A), by striking “section 1848(k)(3) of the Social Security Act, as added by subsection (b)” and inserting “subsection (k)(3)”; and(ii) in subparagraph (B), by striking “section 1848(k) of the Social Security Act, as added by subsection (b)” and inserting “subsection (k)”; and(C) by striking paragraph (6)(D).(6) No affect on incentive payments for 2007 or 2008.—Nothing in the amendments made by this subsection or section 132 shall affect the operation of the provisions of section 1848(m) of the Social Security Act, as redesignated and amended by such subsection and section, with respect to 2007 or 2008.(c) Physician Feedback Program To Improve Efficiency and Control Costs.—(1) In general.—Section 1848 of the Social Security Act (42 U.S.C. 1395w–4), as amended by subsection (b), is amended by adding at the end the following new subsection:“(n) Physician Feedback Program.—“(1) Establishment.—“(A) In general.—The Secretary shall establish a Physician Feedback Program (in this subsection referred to as the ‘Program’) under which the Secretary shall use claims data under this title (and may use other data) to provide confidential reports to physicians (and, as determined appropriate by the Secretary, to groups of physicians) that measure the resources involved in furnishing care to individuals under this title. If determined appropriate by the Secretary, the Secretary may include information on the quality of care furnished to individuals under this title by the physician (or group of physicians) in such reports.“(B) Resource use.—The resources described in subparagraph (A) may be measured—“(i) on an episode basis;“(ii) on a per capita basis; or“(iii) on both an episode and a per capita basis.“(2) Implementation.—The Secretary shall implement the Program by not later than January 1, 2009.“(3) Data for reports.—To the extent practicable, reports under the Program shall be based on the most recent data available.“(4) Authority to focus application.—The Secretary may focus the application of the Program as appropriate, such as focusing the Program on—“(A) physician specialties that account for a certain percentage of all spending for physicians’ services under this title;“(B) physicians who treat conditions that have a high cost or a high volume, or both, under this title;“(C) physicians who use a high amount of resources compared to other physicians;“(D) physicians practicing in certain geographic areas; or122 STAT. 2527“(E) physicians who treat a minimum number of individuals under this title.“(5) Authority to exclude certain information if insufficient information.—The Secretary may exclude certain information regarding a service from a report under the Program with respect to a physician (or group of physicians) if the Secretary determines that there is insufficient information relating to that service to provide a valid report on that service.“(6) Adjustment of data.—To the extent practicable, the Secretary shall make appropriate adjustments to the data used in preparing reports under the Program, such as adjustments to take into account variations in health status and other patient characteristics.“(7) Education and outreach.—The Secretary shall provide for education and outreach activities to physicians on the operation of, and methodologies employed under, the Program.“(8) Disclosure exemption.—Reports under the Program shall be exempt from disclosure under section 552 of title 5, United States Code.”.(2) GAO study and report on the physician feedback program.—(A) Study.—The Comptroller General of the United States shall conduct a study of the Physician Feedback Program conducted under section 1848(n) of the Social Security Act, as added by paragraph (1), including the implementation of the Program.(B) Report.—Not later than March 1, 2011, the Comptroller General of the United States shall submit a report to Congress containing the results of the study conducted under subparagraph (A), together with recommendations for such legislation and administrative action as the Comptroller General determines appropriate.(d) Plan for Transition to Value-Based Purchasing Program for Physicians and Other Practitioners.—(1) In general.—The Secretary of Health and Human Services shall develop a plan to transition to a value-based purchasing program for payment under the Medicare program for covered professional services (as defined in section 1848(k)(3)(A) of the Social Security Act (42 U.S.C. 1395w–4(k)(3)(A))).(2) Report.—Not later than May 1, 2010, the Secretary of Health and Human Services shall submit a report to Congress containing the plan developed under paragraph (1), together with recommendations for such legislation and administrative action as the Secretary determines appropriate.