Mr. President, for the sake of our security, economy and environment, America needs a comprehensive energy policy that is independent of foreign energy sources and weans America off of fossil fuels. Last year, I introduced comprehensive…
Mr. President, for the sake of our security, economy and environment, America needs a comprehensive energy policy that is independent of foreign energy sources and weans America off of fossil fuels.
Last year, I introduced comprehensive energy legislation that would address the many challenges across our economy to achieving sustainable energy independence. I am very hopeful that this Congress will soon take steps to bring forward a comprehensive energy bill that will address many of the areas I believe are essential to this effort. I have cosponsored many of the individual planks of this comprehensive effort, and today I want to address how we can ensure that this energy policy does not have an expiration date or fall short of its laudable goals.
Today I am introducing the Energy Independence Act.
The Energy Independence Act will deliver energy independence to Americans by providing an energy plan that has the capacity to change with innovation. My bill will ensure that our energy policy will increase the efficiency and decrease the environmental impact of America's energy policy, and encourage our energy policy to adapt to our needs and abilities.
My bill will set a congressional goal of achieving energy independence by 2017. ``Energy independence'' is defined as meeting all but 10 percent of our energy needs from domestic energy sources. The bill will also set a congressional goal of achieving independence from fossil fuels by 2037.
My bill will also create a Blue Ribbon Energy Commission, which will meet every two years starting in 2009, to evaluate our progress in efforts to become energy independent, and to recommend changes to be made in reports to Congress.
These are achievable goals.
Petroleum, mostly used for transportation, accounts for 84 percent of our imported energy. Transportation accounts for roughly 28 percent of our energy use. I support raising CAFE standards, and have cosponsored S. 357, legislation by Senator Feinstein which would raise these standards to 35 miles per gallon by 2019. Studies show that raising CAFE standards to 40 miles per gallon would save over 36 billion gallons of gas per year, and creating efficiency standards for replacement tires would save more than 7 billion barrels of oil over the next 50 years. Creating incentives for commuting by train or bus, and funding upgrades and new starts in public transit services, such as the purple line of the DC metro, will also make a difference--in an average year, the round trip to work uses over 250 gallons of gas and creates about 5,000 pounds of carbon dioxide emissions.
As part of a comprehensive energy bill we should also be mindful of the long-term effects of our energy policy on the environment, our landscape, and our health. I cosponsored S. 309, legislation by Senators Sanders and Boxer that provides for an economy-wide emissions cap and trade program. Enacting an economy-wide cap and trade program will ensure that our energy policy will be truly sustainable.
America currently gets only 6.3 percent of its energy from renewable energy sources. Current ideas for addressing this problem focus on trying to make the large up-front investment in infrastructure required to produce renewable energy less daunting, by creating a long-term market for renewable energy through increasing the Federal Government's use of renewables and creating a Federal renewable portfolio standard to make utilities offer renewable energy to American consumers, and by making incentives like the renewable production tax credit permanent. I support creating Federal renewable portfolio standard, and will cosponsor legislation to be offered by Senator Bingaman to do so. I have also cosponsored S. 590, Senator Smith's legislation that would extend solar tax incentives through 2016, while expanding these incentives to cover more of the up-front investment required to use solar energy.
In order to get to energy independence we must substantially increase our investment in energy research. I cosponsored S. 761, Senator Reid's America COMPETES Act, which will increase R&D funding for the Department of Energy, increase the DOE's emphasis on advanced energy research to overcome the long-term and high-risk technological barriers to the development of energy technologies, and implement recommendations made by the National Academies of Sciences report Rising Above a Gathering Storm.
I will be advocating other areas of energy policy reform, including increasing funding for weatherization, providing incentives for telecommuting, and providing additional energy efficiency standards for appliances.
We can do better, and the one overarching theme in the quest for a sustainable, long-term energy policy is the need to be able to be flexible and change our energy policy to suit our needs, capacity, research and development. My bill will give us the ability to provide long-term, bipartisan solutions that will address our energy policy going forward, and give us the flexibility, and the considered solutions of experts, to give the American people the energy policy they deserve.
Mr. President, I ask unanimous consent that the text of the bill be printed in the Record.
Mr. President, today I rise to introduce the Voluntary Medicare Quality Reporting Act of 2007. I thank my good friend, the gentleman from Pennsylvania, Mr. Specter, for joining me in this effort. This is an important bill for tens of millions of Medicare beneficiaries, for the physicians, nurse practitioners and allied health professionals who treat them, and for the future of the Medicare program.
At the end of this year, providers will again face the prospect of an across-the-board cut in their Medicare reimbursements. The scheduled cut for 2008 is the largest ever, 9.9 percent. These cuts are the result of a flawed reimbursement system created in 1997 that uses the Sustainable Growth Rate formula, or SGR, to determine an acceptable increase in the growth of provider expenditures.
Medicare reimbursements increase when the previous year's payments do not exceed a target level that is based on the growth of our economy. However, when the previous year's payments exceed that target level, reimbursements are cut. According to MedPAC, the SGR formula would reduce Medicare provider reimbursements by 40 percent over the next eight years if Congress does not act. MedPAC is also concerned that over the next several years these reductions ``would threaten beneficiary access to physician services over time, particularly those provided by primary care physicians.'' MedPAC recognizes the importance of provider participation in the Medicare program, particularly in our rural and underserved urban areas where the decision to not accept new Medicare patients can make all the difference in seniors' access to medical care.
Congress recognizes this as well, and so we have intervened to prevent scheduled cuts resulting from SGR from taking effect. For all except the newest members of this body, this process of enacting a ``physician fix'' is a familiar scenario. For the past four years, Congress has acted to prevent these cuts to providers, usually through a last-minute provision added to a must-pass bill.
In the 109th Congress, I introduced bipartisan legislation implementing MedPAC's recommendations and calling for Congress to repeal the SGR formula and update provider reimbursements by the cost of care. Replacing SGR will require a thoughtful and protracted process involving the input of lawmakers and the provider community, and it is costly, but it is something that we must do.
The most recent ``fix'' was made to the 2006 Tax Relief and Health Care Act, Public Law 109-432. That law froze payment rates, staving off an across-the-board cut of 5.1 percent. Congress also added a quality reporting system called the Physician Quality Reporting Initiative program PQRI, which made providers eligible for a bonus payment of 1.5 percent of their total allowed Medicare charges if they report to HHS on certain quality measures starting in July 2007.
This new system is also known as ``pay-for-reporting,'' and it is based on the concept that physicians should receive an increase in Medicare reimbursement only once they have participated in extensive quality reporting. Across my State, I have heard serious concerns that this will lead to a mandatory reporting system in the near future, and that we will soon see an untested ``pay-for-performance'' system in place.
Now, I think all my colleagues would agree that our seniors deserve the highest quality care. But in our quest for improved quality, we must answer two questions here: should we proceed with an untested system of reporting requirements just for the sake of reporting, and will we actually achieve better care for our seniors via the PQRI.
I am very concerned about implementing reporting requirements that have not been tested. I believe that we must have the right process in place for defining a quality reporting system for services provided to Medicare beneficiaries by health care professionals. We should not be establishing reporting requirements for health professionals just for the sake of reporting, and we should not be moving forward with this system until we have adequate time to evaluate each stage of its development.
Current law does not provide sufficient time to assess the appropriateness and effectiveness of this new system. Nor do they take into account the fact that most physicians and other health professionals have no experience in quality reporting and do not have in place the necessary health information technology and administrative infrastructures to participate in a reporting system.
The bill I am introducing today will assure that health professionals will be at the center of the process for defining areas where quality measures are needed, as well as for defining the relevant measures themselves. Why is this important? Health professionals must be actively engaged in developing and implementing an effective reporting system because they are on the front lines of health care delivery, and they best understand the nexus between care delivery and quality measurement. The development process for quality measures must be transparent and consistent for all health professionals because they are the ones who will determine its successful implementation.
Additionally, quality measures should be tested across a variety of specialties and practice settings before they are included in a reporting system because measures must be clinically valid to be relevant for defining quality, and because physicians and health professionals practice in a variety of settings, for example: small vs. large practices, urban vs. suburban vs. rural locations, office-based vs. hospital-base practices.
Most importantly, we should not be using hastily devised quality measures to justify reimbursement cuts. There are some who advocate pay-for-performance as a way to slow the growth of physician spending. They think we can accomplish lower physician expenditures by setting arbitrary standards and then cutting payments to physicians who fail to meet them. But across America, there are practices that would face tremendous obstacles in meeting such standards: they lack of the information technology necessary to document and report standards in a timely manner; they see patients with economic and language barriers that will result in higher noncompliance rates; they treat a patient population for whom ethnic and racial differences require different clinical interventions than for other patients. Ignoring these considerations will not only fail to dramatically improve quality, it will significantly penalize providers who treat traditionally underserved populations.
This bill provides an opportunity to thoughtfully and carefully develop effective quality measures that reflect differences in practice patterns, to share our findings, and to determine and encourage the most cost-effective methods of providing the highest quality care.
Rather than moving forward precipitously in 2008 with a permanent Medicare quality reporting system after a transitional 6-month period this year, as current law requires, our bill, the Voluntary Medicare Quality Reporting Act of 2007, instead would establish a more realistic timeline for quality measure reporting by health professionals. It does so by:
Requiring the Secretary first to evaluate the 6-month transitional reporting system and reporting findings to the Congress by June 1, 2008;
Requiring the Secretary to undertake demonstrations for defining appropriate mechanisms whereby health professionals may provide data on quality measures to the Secretary through an appropriate medical registry;
Allowing physicians and other eligible professionals to continue reporting to the Secretary quality measures developed for 2007, in order for the Secretary to refine systems for reporting quality measures;
After completion of the evaluation, phasing in a permanent Voluntary Medicare Quality Reporting Program, with implementation beginning January 1, 2010, based on a consistent set of rules that define an orderly and transparent process of quality measure development;
Requiring that the Physician Consortium for Performance Improvement of the American Medical Association be the beginning point for the designation of clinical areas where quality measures are needed;
Having the Consortium, in collaboration with physician specialty organizations and other eligible professional organizations, develop and propose quality measures to a consensus organization such as the National Quality Forum for endorsement; and
Prohibiting the Secretary from using any measures that have not been recommended by the Consortium and endorsed by the consensus organization.
I am confident that with all of these measures we will achieve a successful and effective quality reporting system that will truly make a difference in the quality of care that our Medicare beneficiaries receive. At the end of this year, as Congress moves forward to address the physician reimbursement issue, I urge my colleagues to support this rational approach to promoting quality and guaranteeing access to care.