Quality of Care - Intro. to Comparison of Minority Healthcare Bills

Competing Minority Health Disparities Bills:
A Comparative Analysis of Sen. Frist’s (S.2091) and Sen. Lieberman’s (S.2594) Legislation

Introduction

Senators Joseph Lieberman (D-CT) and Bill Frist (R-TN) have introduced competing legislation to address the important problem of patient data collection and quality of care for racial and ethnic minorities. This piece is offered as a comparative analysis of the legislation. Below is a brief overview, followed by links to a more in depth discussion of the bills’ provisions and a chart for easy comparison of the bills..

More and more studies show that racial and ethnic minorities receive poorer quality care than the general population, even when they have health insurance. To reduce these disparities, researchers have worked to identify those conditions that tend to have a greater adverse impact on racial and ethnic minority groups. For instance, we know that blacks and people of lower socioeconomic status have higher death rates for all cancers combined, and that Hispanics and American Indians or Alaskan natives are less likely to have their cholesterol checked (National health care Disparities Report, 2003). Having this information allows health care providers to increase awareness and preventive care for specific conditions. The Frist and Lieberman bills are designed to provide an array of health disparities information useful in identifying health care issues of particular importance to racial and ethnic minorities.

Beyond data collection, each bill takes a different approach to improving quality: Sen. Lieberman’s FairCare Act (S. 2954 – Introduced 6/24/2004) centers on broader institutional changes, while Sen. Frist’s Closing the health care Gap Act of 2004 (S. 2091 – Introduced 2/12/2004) focuses on issues specific to minority health care.

The main provisions in Sen. Lieberman’s FairCare Act include:

Improved data collection on racial and ethnic minorities. Better information is needed to identify the sources of health disparities, implement effective solutions, and monitor improvement. With appropriate safeguards to protect privacy, the bill would require Medicare, Medicaid, SCHIP and Health Insurance Portability and Accountability Act (HIPAA) to collect and report data on race, ethnicity, education and primary language. Grants are available for demonstration projects.
Development of standardized quality measures. Standardized quality measures ensure that all patients receive the same quality of care. This bill would require quality measures for common treatment settings like hospitals and outpatient facilities. A new office of National health care Disparities and Quality would publish the National health care Disparities Report to include State and regional level data.
Payment for performance. Improved patient outcomes is not always incentive enough for facilities to adopt better quality care practices. This bill establishes a “FairCare” system for hospitals and community health centers, rewarding them with annual Medicare bonuses for adopting quality measures and reducing minority disparities. Doctors who spend at least 66% of their time in FairCare institutions would be able to receive a tax credit of up to 25% on malpractice insurance.
Community outreach. This bill would provide assistance for building new community health centers, expand Racial and Ethnic Approaches to Community Health (REACH) 2010 to support all states and territories and provide grants to design, implement and evaluate community-driven strategies to eliminate health disparities in 8 priority areas (cardiovascular disease, immunizations, breast and cervical cancer screening and management, diabetes, HIV/AIDS, infant mortality, asthma, obesity).

The main provisions in Sen. Frist’s Closing the health care Gap Act of 2004 include:

Improved data collection on racial and ethnic minorities. Better information is needed to identify the sources of health disparities, implement effective solutions, and monitor improvement. With appropriate safeguards to protect privacy, the bill would require Medicare, Medicaid and State Children’s Health Insurance Programs (SCHIP) providers to collect and report data on race, ethnicity, and primary language.
Development of standardized quality measures. Standardized measures of quality ensure that all patients receive the same quality of care. This bill would require the development of new quality measures for fifteen common health conditions that disproportionately affect minorities. These measures will assess quality improvement with regards to safety, timeliness, effectiveness, patient-centeredness and efficiency for all federal health programs.
Accountability and reporting. Standardized reporting and data sharing ensure the accurate and consistent analysis of minority data. The bill would require standardized public reporting requirements for clinicians, institutional providers, and health plans. Shared quality data would be compiled and analyzed in comparative quality reports.
Increased access to care. This bill provides grants to increase outreach and enrollment in Medicaid and SCHIP programs, as well as funding for programs to help minority patients better access and navigate the health care system.
Removing language barriers. Language barriers can lead to disparities through miscommunication and misunderstandings between patients and providers. This bill would create a support center for linguistic and cultural competence to carry out programs to provide bilingual or interpretive services and to improve access for those with limited or no English proficiency.
Workforce diversity and higher education. This program would extend existing programs that provide scholarships, grants and career opportunities to encourage minorities to enter into health care professions. Other provisions call for cultural competency curriculum development and internet clearinghouse so that eventually all health professionals will have the training and tools necessary to provide culturally appropriate care.

Click here for the in-depth discussion of the provisions of each bill.
Click here to view our bill comparison chart