,,ib  ,union ,cal5d> ,no4 #hjg  #aae?   
,,congress  #b;d ,session  ,h4 ,r4 #fjff
  ,report ,no4 #aae-ajcd  ,,9 ,,! ,,h\se
 ,,( ,,repres5tatives  ,june #h1 #bjah  
,mr4 ,w5/rup introduc$ ! foll[+ bill2   
:i* 0 ref]r$ to ! ,committee on         
,vet]ans' ,affairs  ,novemb] #af1 #bjah 
,report$ ) an am5dm5t1 committ$ to !    
,committee ( ! ,:ole ,h\se on ! ,/ate ( 
! ,union1 & ord]$ to be pr9t$ ,/rike out
 all aft] ! enact+ clause & ins]t ! "p  
pr9t$ 9 italic ,= text ( introduc$ bill1
 see copy ( bill z introduc$ on ,june   
#h1 #bjah  ,a ,,bill  ,to am5d title    
#ch1 ,unit$ ,/ates ,code1 to improve !  
productivity ( ! managem5t ( ,dep>tm5t (
 ,vet]ans ,affairs heal? c>e1 & = o!r   
purposes4  #a4 ,dep>tm5t ( ,vet]ans     
,affairs heal? c>e productivity         
improvem5t  7a7 ,9 g5]al ,sub*apt] ,i ( 
*apt] #ag ( title #ch1 ,unit$ ,/ates    
,code1 is am5d$ by ins]t+ aft] section  
#agje;,a ! foll[+ new section3          
#agje;,b4 ,managem5t ( heal? c>e3       
productivity  7a7 ,relative value unit  

track+ ,! ,secret>y %all track relative 
value units = all ,dep>tm5t provid]s4   
7b7 ,cl9ical proc$ure cod+ tra9+ ,if !  
cod+ accuracy ( a ,dep>tm5t provid] )9 a
 cl9ical area ( responsibility ( !      
provid] falls bel[ ! m9imum ?re%old set 
by ! ,secret>y1 ! ,secret>y %all require
 ! ,dep>tm5t provid] to att5d tra9+ on  
cl9ical proc$ure cod+4  7c7 ,p]=mance   
/&>ds  7#a7 ,! ,secret>y %all e/abli% = 
ea* ,dep>tm5t facility-- 7,a7 9         
accordance ) p>agraph 7#b71 /&>diz$     
p]=mance /&>ds bas$ on nationally       
recogniz$ relative value unit production
 /&>ds applicable to ea* specific       
pr(ession 9 ord] to evaluate cl9ical    
productivity at ! provid] & facility    
level2  7,b7 rem$iation plans to address
 l[ cl9ical productivity & cl9ical      
ineffici5cy2 &  7,c7 an ongo+ process to
 sy/ematically review ! cont5t1         
implem5tation1 & outcome ( ! plans      
develop$ "u subp>agraph 7,b74  7#b7 ,9  
e/abli%+ ! p]=mance /&>ds "u p>agraph   
7#a77;,a71 ! ,secret>y-- 7,a7 may       

incorporate values-bas$ productivity    
models & may incorporate o!r            
productivity measures & models det]m9$  
appropriate by ! ,secret>y2 &  7,b7 %all
 take into acc\nt non-cl9ical duties1   
includ+ ) respect to tra9+ & rese>*2    
7,c7 %all take into acc\nt factors t    
imp$e productivity & effici5cy &1 9     
develop+ rem$iation plans "u p>agraph   
7#a77;,b71 %all incorporate action plans
 to address su* factors4  7d7           
,def9itions ,9 ?is section3 7#a7 ,! t]m 
,dep>tm5t provid] means an employee ( ! 
,dep>tm5t :o has be5 appo9t$ to !       
,vet]ans ,heal? ,adm9i/ration z a       
physician1 a d5ti/1 an optometri/1 a    
podiatri/1 a *iropractor1 an advanc$    
practice regi/]$ nurse1 or a physician's
 assi/ant act+ z an indep5d5t provid]4  
7#b7 ,! t]m relative value unit means a 
unit = measur+ workload by det]m9+ ! "t1
 m5tal ef=t & judgm5t1 te*nical skill1  
physical ef=t1 & /ress involv$ 9 deliv]+
 a s]vice4  4  7b7 ,cl]ical am5dm5t ,!  
table ( sections at ! beg9n+ ( su* *apt]

 is am5d$ by ins]t+ aft] ! item relat+  
to section #agje;,a ! foll[+ new item3  
#agje;,b4 ,managem5t ( heal? c>e3       
productivity4  4  7c7 ,report ,n lat]   
?an "o ye> aft] ! date ( ! enactm5t (   
?is ,act1 ! ,secret>y ( ,vet]ans        
,affairs %all submit to ,congress a     
report on ! implem5tation ( section     
#agje;,b ( title #ch1 ,unit$ ,/ates     
,code1 z add$ by subsection 7a74 ,su*   
report %all include1 = ea* pr(essional  
category ( ,dep>tm5t ( ,vet]ans ,affairs
 provid]s1 ! relative value unit ( su*  
category ( provid]s at ! national1      
,vet]ans ,integrat$ ,s]vice ,network1 & 
facility levels4  7d7 ,compreh5sive     
/aff+ models ,n lat] ?an "o ye> aft] !  
date ( ! enactm5t ( ?is ,act1 !         
,secret>y ( ,vet]ans ,affairs %all      
develop compreh5sive /aff+ models = all 
,dep>tm5t ( ,vet]ans ,affairs m$ical    
c5t]s4  ,novemb] #af1 #bjah ,report$ )  
an am5dm5t1 committ$ to ! ,committee ( !
 ,:ole ,h\se on ! ,/ate ( ! ,union1 &   
ord]$ to be pr9t$