,,ii  #aacth ,,congress  #ast ,session  
,s4 #affb  ,,in ,,the ,,senate ,,of     
,,the ,,united ,,states  ,november #g1  
#bjac,mr4 ,mc,connell introduced the    
following bill2 which was read twice and
 referred to the ,committee on          
,veterans' ,affairs  ,a ,,bill  ,to     
provide for the introduction of         
pay-for-performance compensation        
mechanisms into contracts of the        
,department of ,veterans ,affairs with  
community-based outpatient clinics for  
the provision of health care services1  
and for other purposes4  #a4 ,short     
title ,this ,act may be cited as the    
,veterans ,health ,care ,improvement    
,act of #bjac4  #b4 ,findings ,congress 
makes the following findings3 7#a7      
,veterans of the ,armed ,forces have    
made tremendous sacrifices in the       
defense of freedom and liberty4  7#b7   
,congress recognizes these great        
sacrifices and reaffirms ,america's     
strong commitment to its veterans4  7#c7
 ,as part of the on-going congressional 

effort to recognize the sacrifices made 
by ,america's veterans1 ,congress has   
dramatically increased funding for the  
,department of ,veterans ,affairs for   
veterans health care in the years since 
,september #aa1 #bjja4  7#d7 ,part of   
the funding for the ,department of      
,veterans ,affairs for veterans health  
care is allocated toward community-based
 outpatient clinics 7,c,b,o,cs74  7#e7  
,a number of ,c,b,o,cs are administered 
by private contractors4  7#f7 ,c,b,o,cs 
administered by private contractors     
operate on a capitated basis4  7#g7     
,some current contracts for ,c,b,o,cs   
may create an incentive for contractors 
to enroll as many veterans as possible1 
without ensuring timely access to high  
quality health care for such veterans4  
7#h7 ,the top priorities for ,c,b,o,cs  
should be to provide quality health care
 and patient satisfaction for ,america's
 veterans4  7#i7 ,the ,department of    
,veterans ,affairs currently tracks the 
quality of patient care through its     

,computerized ,patient ,record ,system4 
,however1 fees paid to contractors are  
not currently adjusted automatically to 
reflect the quality of care provided to 
patients4  7#aj7 ,a pay-for-performance 
payment model offers a promising        
approach to health care delivery by     
aligning the payment of fees to         
contractors with the achievement of     
better health outcomes for patients4    
7#aa7 ,the ,department of ,veterans     
,affairs should begin to emphasize      
pay-for-performance in its contracts    
with ,c,b,o,cs4  #c4                    
,pay-for-performance under ,department  
of ,veterans ,affairs contracts with    
community-based outpatient health care  
clinics  7a7 ,plan required ,not later  
than one year after the date of the     
enactment of this ,act1 the ,secretary  
of ,veterans ,affairs shall submit to   
,congress a plan to introduce           
pay-for-performance measures into       
contracts which compensate contractors  
of the ,department of ,veterans ,affairs

 for the provision of health care       
services through community-based        
outpatient clinics 7,c,b,o,cs74  7b7    
,elements ,the plan required by         
subsection 7a7 shall include the        
following3 7#a7 ,measures to ensure that
 contracts of the ,department for the   
provision of health care services       
through ,c,b,o,cs begin to utilize      
pay-for-performance compensation        
mechanisms for compensating contractors 
for the provision of such services      
through such clinics1 including         
mechanisms as follows3 7,a7 ,to provide 
incentives for clinics that provide     
high-quality health care4  7,b7 ,to     
provide incentives to better assure     
patient satisfaction4  7,c7 ,to impose  
penalties 7including termination of     
contract7 for clinics that provide      
substandard care4  7#b7 ,mechanisms to  
collect and evaluate data on the        
outcomes of the services generally      
provided by ,c,b,o,cs in order to       
provide for an assessment of the quality

 of health care provided by such        
clinics4  7#c7 ,mechanisms to eliminate 
abuses in the provision of health care  
services by ,c,b,o,cs under contracts   
that continue to utilize capitated-basis
 compensation mechanisms for            
compensating contractors4  7#d7         
,mechanisms to ensure that veterans are 
not denied care or face undue delays in 
receiving care4  7c7 ,implementation    
,the ,secretary shall commence the      
implementation of the plan on the date  
that is #fj days after the date of the  
submittal of the plan4 ,in implementing 
the plan1 the ,secretary may initially  
carry out one or more pilot programs to 
assess the feasibility and advisability 
of mechanisms under the plan4  7d7      
,reports ,not later than #ahj days after
 the date of the enactment of this ,act 
and every #ahj days thereafter1 the     
,secretary shall submit to ,congress a  
report setting forth the recommendations
 of the ,secretary as to the feasibility
 and advisability of utilizing          

pay-for-performance compensation        
mechanisms in the provision of health   
care services by the ,department by     
means in addition to ,c,b,o,cs4