Page 501, lines 17 through 22 and Page 502 entirely and Page 503, lines 1 through 4:
This supports 'quality assurance' and the provision speaks for itself. There is no secret agendas, this provision supports research in seeking better quality to consumers.
TITLE IV—QUALITY
Subtitle A—Comparative Effectiveness Research
SEC. 1401. COMPARATIVE EFFECTIVENESS RESEARCH
(a) IN GENERAL.—title XI of the Social Security Act is amended by adding at the end the following new part:
‘‘PART D—COMPARATIVE EFFECTIVENESS RESEARCH
‘‘COMPARATIVE EFFECTIVENESS RESEARCH
‘‘SEC. 1181. (a) CENTER FOR COMPARATIVE EFFECTIVENESS RESEARCH ESTABLISHED.—
‘‘(1) IN GENERAL.—The Secretary shall establish within the Agency for Healthcare Research and Quality a Center for Comparative Effectiveness Research (in this section referred to as the ‘Center’) to conduct, support, and synthesize research (including research conducted or supported under section 1013 of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003) with respect to the outcomes, effectiveness, and appropriateness of
health care services and procedures in order to identify the manner in which diseases, disorders, and other health conditions can most effectively and appropriately be prevented, diagnosed, treated, and managed clinically.
‘‘(2) DUTIES.—The Center shall—
‘‘(A) conduct, support, and synthesize research relevant to the comparative effectiveness of the full spectrum of health care items, services and systems, including pharmaceuticals, medical devices, medical and surgical procedures, and other medical interventions;
This provision is to receive oversight with its own commission. It requires an independant commission because the topic is different requiring different qualification for its members.
Page 505, lines 5 through 14 and Page 506, lines 19 through 24, Page 508, lines 6 through 25 and Page 509 entirely. This is all self explanatory and placed here as reassurance of content.
‘‘(b) OVERSIGHT BY COMPARATIVE EFFECTIVENESS RESEARCH COMMISSION.—
‘‘(1) IN GENERAL.—The Secretary shall establish an independent Comparative Effectiveness Research Commission (in this section referred to as the ‘Commission’) to oversee and evaluate the activities carried out by the Center under subsection (a), subject to the authority of the Secretary, to ensure such activities result in highly credible research and infor14
mation resulting from such research....
...‘‘(G) make recommendations for policies that would allow for public access of data pro21
duced under this section, in accordance with appropriate privacy and proprietary practices,
while ensuring that the information produced through such data is timely and credible;...
‘‘(3) COMPOSITION OF COMMISSION.—
‘‘(A) IN GENERAL.—The members of the Commission shall consist of—
‘‘(i) the Director of the Agency for Healthcare Research and Quality;
‘‘(ii) the Chief Medical Officer of the Centers for Medicare & Medicaid Services;
and ‘‘(iii) 15 additional members who shall represent broad constituencies of stake16
holders including clinicians, patients, researchers, third-party payers, consumers of Federal and State beneficiary programs. Of such members, at least 9 shall be practicing physicians, health care practitioners, consumers, or patients.
‘‘(B) QUALIFICATIONS.—
‘‘(i) DIVERSE REPRESENTATION OF PERSPECTIVES.—The members of the Commission shall represent a broad range of perspectives and shall collectively have experience in the following areas: ‘‘(I) Epidemiology. ‘‘(II) Health services research. ‘‘(III) Bioethics. ‘‘(IV) Decision sciences. ‘‘(V) Health disparities. ‘‘(VI) Economics.
‘‘(ii) DIVERSE REPRESENTATION OF HEALTH CARE COMMUNITY.—At least one member shall represent each of the following health care communities: ‘‘(I) Patients. ‘‘(II) Health care consumers. ‘‘(III) Practicing Physicians, including surgeons. ‘‘(IV) Other health care practitioners engaged in clinical care. ‘‘(V) Employers. ‘‘(VI) Public payers. ‘‘(VII) Insurance plans. ‘‘(VIII) Clinical researchers who conduct research on behalf of pharmaceutical or device manufacturers.
I can hear the complaints now, "Is all this necessary?"
Ahhhh, yep.
The USA is embarking on providing health insurance for everyone while tightening up the industry with provisions that will serve the best interest of the citizens of this country. Those best interests are a streamlined health care delivery system that is state of the art in quality. Health care is a complex issue, but, it can be made simple if there are experts developing the quality at every turn to be sure no dollars are squandered. Efficient health care delivery not only holds down costs it provides for better quality care. It is my guess each one of the commissions affiliated with the 'start up' of the Bill will dissipate over time and not be necessary.
This provision continues in the 'usual' manner of the Bill in that there are definitions and organizational structure, but, I found this interesting:
Page 520, lines 1 through 8:
‘‘(A) be designed, as appropriate, to take into account the potential for differences in the effectiveness of health care items and services used with various subpopulations such as racial and ethnic minorities, women, different age groups (including children, adolescents, adults,
and seniors), and individuals with different comorbidities; and—
This was also important. There is no direct link to reimbursement for services through the research provision, it is strictly fact finding to bring better quality to the citizens of the country while the Commission reviews any necessary changes to treatment modalities currently in place that research might prove prudent to change.
Page 524, lines 14 through 17:
‘‘(h) CONSTRUCTION.—Nothing in this section shall be construed to permit the Commission or the Center to mandate coverage, reimbursement, or other policies for any public or private payer.’’.
Page 525 begins a provision to increase transparency with Nursing Homes:
Subtitle B—Nursing Home
Transparency
PART 1—IMPROVING TRANSPARENCY OF INFORMATION ON SKILLED NURSING FACILITIES AND NURSING FACILITIES
SEC. 1411. REQUIRED DISCLOSURE OF OWNERSHIP AND ADDITIONAL DISCLOSABLE PARTIES INFORMATION.
(a) IN GENERAL.—Section 1124 of the Social Security Act (42 U.S.C. 1320a–3) is amended by adding at the end the following new subsection:
‘‘(c) REQUIRED DISCLOSURE OF OWNERSHIP AND ADDITIONAL DISCLOSABLE PARTIES INFORMATION.—
Page 527, lines 8 through 20:
‘‘(I) each member of the governing body of the facility, including the name, title, and period of service of each such member; ‘‘(II) each person or entity who is an officer, director, member, partner, trustee, or managing employee of the facility, including the name, title, and date of start of service of each such person or entity; and ‘‘(III) each person or entity who is an additional disclosable party of the facility.
It seems to me this would prevent double dipping by receiving payment through an establishment as an owner or physician while still billing in an individual capacity. Keeps everything honest. There is a provision to allow the Secretary to exempt such information where it is reported on IRS forms.
Just to example page 531, lines 21 through 25:
‘‘(i) a corporation, the officers, directors, and shareholders of the corporation who have an ownership interest in the corporation which is equal to or exceeds 25 percent;
There are directions to make such information available to the public. The transparency will make it easier to enforce the 'ethics' component to the Bill.
Page 536, lines 19 through 24 and Page 537, lines 1 through 7:
‘‘(iii) REQUIREMENTS FOR COMPLIANCE AND ETHICS PROGRAMS.—In this subparagraph, the term ‘compliance and ethics program’ means, with respect to a skilled nursing facility, a program of the operating organization that—‘‘(I) has been reasonably designed, implemented, and enforced so that it generally will be effective in preventing and detecting criminal, civil, and administrative violations under this Act and in promoting quality of care; andImagine that. Ethical standards no less. Well. This should be interesting. CEOs of health care industry factilities like to circumvent ethics while replacing it with 'customer care' rituals to distract from any adverse opinion of their institution. Soothing the public with 'customer service' in place of ethical standards allows for greater profits. Oh, yeah. Customer Service and Ethics are totally different dynamics. I mean there isn't strong ethical standards for the guy that changes the oil in your car, but, there certainly are high expectations of Customer Service.
Health Care Industry CEOs learned some time ago, if one can make a nurse and unit secretary to perform like Disney personnel there will be more satisfaction with the facility even when the actual care given is poor. As a matter of fact, there are hospitals in the country that bring in Disney Trained Customer Service experts to train their staff, professional staff as well as housekeeping and dietary workers. It isn't just a matter of making health care palatable, providing 'comfort' allows distraction from the severity of the purpose to hospitalization. Absolutely. Higher degrees of creature comforts and distractions allow for lax standards that aren't under the control of the CEO, prevents lawsuits and brings higher approval ratings by patients and family.
Proven paradigm.
Absolutely.
Why would they do it?
TO BE NICE?
You've got to be joking.
Have a Latte on us for any inconvenience !
There is a hospital in Wilmington, North Carolina that actually stocks 'Customer Care' items in their supply rooms. Why? Because it allows the professional staff the 'ease' of finding a Gas Card or $5.00 voucher for the coffee shop or a $25 Gift Card to Target to present to any disgruntled 'customer' (not patient necessarily mind you) regardless of the reason. And I do mean regardless of the reason. Preceived malpractice? Having to wait in the hallway for an x-ray. They even have 'suggestions based on severity of unhappiness' as to what to give a patient or family. It is unbelieveable. Now I am not talking about the annual Teddy Bear drive for plush animals in the ER to assist with children and their fears. No, no. That isn't it. These are ADULTS in care on the floors and units and their families. Amazing. Along with the paraphernalia to be presented to adults including "Beanie Babies," there is a sheet any professional has to write on regarding the infraction, the item presented and the outcome. Talk about adding paperwork to any professional's work day. Not only that, but, those items are all part of the operating budget of the unit. Spare no expense. I have a feeling all that will change. The health care system run by Capitalists is an amazing institution.
Stop to realize the level of UNETHICAL standard that is. Stop and think about it. It borders on criminality. There are 'strategies' put in place in hospitals by CEOs and Directors of Nursing, etc. to distract anyone receiving services, from their complaints or grievances, regardless of the severity or legitmacy. It is designed to 'undermine' the 'will' of the patient and/or family to achieve a goal. All this is put in place to EFFECT 'certain' opinions. I guess patients and their families are mindless idiots that can be manipulated like marrionets on a string. Talk about insulting. That is American Health Care compliments of Capitalists.
Page 538, lines 5 through 13:
‘‘(III) The organization must have used due care not to delegate substantial discretionary authority to individuals whom the organization knew, or should have known through the exercise of due diligence, had a propensity to engage in criminal, civil, and administrative violations under this Act.
Page 543, lines 1 through 16:
‘‘(iii) REQUIREMENTS FOR COMPLIANCE AND ETHICS PROGRAMS.—In this subparagraph, the term ‘compliance and ethics program’ means, with respect to a nursing facility, a program of the operating organization that—
‘‘(I) has been reasonably designed, implemented, and enforced so that it generally will be effective in preventing and detecting criminal, civil, and administrative violations under this Act and in promoting quality of care; and ‘‘(II) includes at least the required components specified in clause (iv).
I'll end for today after this.
Page 551, lines 6 through 22:
(c) GAO STUDY ON NURSING FACILITY UNDER CAPITALIZATION.—
(1) IN GENERAL.—The Comptroller General of the United States shall conduct a study that examines the following:
(A) The extent to which corporations that own or operate large numbers of nursing facilities, taking into account ownership type (including private equity and control interests), are
undercapitalizing such facilities. (B) The effects of such undercapitalization on quality of care, including staffing and food costs, at such facilities. (C) Options to address such undercapitalization, such as requirements relating to surety bonds, liability insurance, or minimum capitalization.
...until later...
